[Federal Register Volume 71, Number 89 (Tuesday, May 9, 2006)]
[Rules and Regulations]
[Pages 27040-27156]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 06-4202]



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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 412 and 424



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

  Federal Register / Vol. 71, No. 89 / Tuesday, May 9, 2006 / Rules and 
Regulations  

[[Page 27040]]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 412 and 424

[CMS-1306-F]
RIN 0938-AN82


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

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

ACTION: Final rule.

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

DATES: Effective Date: These regulations are effective on July 1, 2006.

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

SUPPLEMENTARY INFORMATION:

Table of Contents

    To assist readers in referencing sections contained in this 
document, we are providing the following table of contents.

I. Background
    A. General and Legislative History
    B. Overview of the Establishment of the IPF PPS
    C. Applicability of the IPF PPS
II. Overview for Updating the IPF PPS
    A. Requirements for Updating the IPF PPS
    B. Transition Period for Implementation of the IPF PPS
III. Provisions of the Proposed Regulation
IV. Analysis of and Responses to Public Comments
V. Updates to the IPF PPS for RY Beginning July 1, 2006
    A. Calculation of the Average Per Diem Cost
    B. Determining the Standardized Budget-Neutral Federal Per Diem 
Base Rate
    1. Standardization of the Federal Per Diem Base Rate
    2. Calculation of the Budget Neutrality Adjustment
    a. Outlier Adjustment
    b. Stop-Loss Provision Adjustment
    c. Behavioral Offset
    3. Revision of Standardization Factor
    C. Update of the Federal Per Diem Base Rate
    1. Market Basket for IPFs Reimbursed Under the IPF PPS
    a. Market Basket Index for IPF PPS
    b. Overview of the RPL Market Basket
    2. Methodology for Operating Portion of the RPL Market Basket
    3. Methodology for Capital Portion of the RPL Market Basket
    4. Labor-Related Share
VI. Update of the IPF PPS Adjustment Factors
    A. Overview of the IPF PPS Adjustment Factors
    B. Patient-Level Adjustments
    1. Adjustment for DRG Assignment
    2. Payment for Comorbid Conditions
    3. Patient Age Adjustments
    4. Variable Per Diem Adjustments
    C. Facility-Level Adjustments
    1. Wage Index Adjustment
    a. Revisions of IPF PPS Geographic Classifications
    b. Current IPF PPS Labor Market Areas Based on MSAs
    c. Core-Based Statistical Areas
    d. Revision of the IPF PPS Labor Market Areas
    i. New England MSAs
    ii. Metropolitan Divisions
    iii. Micropolitan Areas
    e. Implementation of the Revised Labor Market Areas Under the 
IPF PPS
    f. Wage Index Budget Neutrality
    2. Adjustment for Rural Location
    3. Teaching Adjustment
    4. Cost of Living Adjustment for IPFs Located in Alaska and 
Hawaii
    5. Adjustment for IPFs With a Qualifying Emergency Department 
(ED)
    a. New Source of Admission Code To Implement the ED Adjustment
    b. Applicability of the ED Adjustment to IPFs in Critical Access 
Hospitals
    D. Other Payment Adjustments and Policies
    1. Outlier Payments
    a. Update to the Outlier Fixed Dollar Loss Threshold Amount
    b. Statistical Accuracy of Cost-to-Charge Ratios
    2. Stop-Loss Provision
    3. Patients Who Receive Electroconvulsive Therapy (ECT)
    4. Physician Certification and Recertification Requirements
    5. Provision of Therapeutic Recreation in IPFs
    6. Same Day Transfers
VII. Miscellaneous Public Comments Within the Scope of the Proposed 
Rule
VIII. Provisions of the Final Rule
IX. Collection of Information Requirements
X. Regulatory Impact Analysis

Acronyms

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

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

I. Background

A. General and Legislative History

    The Congress directed implementation of a prospective payment 
system (PPS) for acute care hospitals with the enactment of Pub. L. 98-
21. Section 601 of the Social Security Amendments of 1983 (Pub. L. 98-
21) added a new section 1886(d) to the Social Security Act (the Act) 
that replaced the reasonable cost-based payment system for most 
hospital inpatient services with a PPS.
    Although most hospital inpatient services became subject to the 
PPS, certain hospitals, including IPFs, inpatient rehabilitation 
facilities (IRFs), long term care hospitals (LTCHs), and children's 
hospitals were excluded from the PPS for acute care hospitals. These 
hospitals and units were paid their reasonable costs for inpatient 
services,

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subject to a per discharge limitation or target amount under the 
authority of the Tax Equity and Fiscal Responsibility Act of 1982 
(TEFRA), Pub. L. 97-248. The regulations implementing the TEFRA 
(reasonable cost-based) payment provisions are located at 42 CFR part 
413. Cancer hospitals were added to the list of excluded hospitals by 
section 6004(a) of the Omnibus Budget Reconciliation Act of 1989, (Pub. 
L. 101-239).
    The Congress enacted various provisions in the Balanced Budget Act 
of 1997 (BBA) (Pub. L. 105-33), the Medicare, Medicaid, and SCHIP 
(State Children's Health Insurance Program) Balanced Budget Refinement 
Act of 1999 (BBRA) (Pub. L. 106-113), and the Medicare, Medicaid, and 
SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 
106-554) to replace the reasonable cost-based method of reimbursement 
with a PPS for IRFs, LTCHs, and IPFs. Section 124 of the BBRA required 
implementation of the IPF PPS.
    Section 124 of the BBRA mandated that the Secretary--(1) Develop a 
per diem PPS for inpatient hospital services furnished in psychiatric 
hospitals and psychiatric units; (2) include in the PPS an adequate 
patient classification system that reflects the differences in patient 
resource use and costs among psychiatric hospitals and psychiatric 
units; (3) maintain budget neutrality; (4) permit the Secretary to 
require psychiatric hospitals and psychiatric units to submit 
information necessary for the development of the PPS; and (5) submit a 
report to the Congress describing the development of the PPS. Section 
124 of the BBRA also required that the IPF PPS be implemented for cost 
reporting periods beginning on or after October 1, 2002.
    Section 405(g)(2) of the Medicare Prescription Drug, Improvement, 
and Modernization Act of 2003 (MMA) (Pub. L. 108-173) extended the IPF 
PPS to distinct part psychiatric units of critical access hospitals 
(CAHs).
    To implement these provisions, the following were published: a 
proposed rule in the Federal Register on November 28, 2003 (68 FR 
66920); a final rule on November 15, 2004 (69 FR 66922); and a 
correction notice to the final rule on April 1, 2005 (70 FR 16724). For 
more detail, see the program memorandum Web site, http://www.cms.hhs.gov/transmittals/01_overview.asp.

B. Overview of the Establishment of the IPF PPS

    The November 2004 IPF PPS final rule established regulations for 
the IPF PPS under 42 CFR 412, subpart N.
    The IPF PPS established the Federal per diem base rate for each 
patient day in an IPF derived from the national average daily routine 
operating, ancillary, and capital costs in IPFs in FY 2002. The average 
per diem cost was updated to the midpoint of the first year under the 
IPF PPS, standardized to account for the overall positive effects of 
the IPF PPS payment adjustments, and adjusted for budget neutrality. 
The Federal per diem payment under the IPF PPS is comprised of the 
Federal per diem base rate described above and certain patient and 
facility payment adjustments that were found in the regression analysis 
to be associated with statistically significant per diem cost 
differences (see 69 FR 66933 through 66936 for a description of the 
regression analysis). The patient-level adjustments include age, DRG 
assignment, comorbidities, and variable per diem adjustments to reflect 
the higher cost incurred in the early days of a psychiatric stay. 
Facility-level adjustments include adjustments for the IPF's wage 
index, rural location, teaching status, a cost of living adjustment for 
IPFs located in Alaska and Hawaii, and presence of a qualifying 
emergency department (ED). The IPF PPS provides additional payments for 
outlier cases, stop-loss protection which is applicable only during the 
IPF PPS transition period, includes special payment provisions for 
interrupted stays, and a per treatment adjustment for patients who 
undergo electroconvulsive therapy (ECT). We refer readers to the 
November 2004 IPF PPS final rule for a comprehensive discussion of the 
research and data that supported the establishment of the IPF PPS.
    We established a CMS Web site that contains useful information 
regarding the IPF PPS including the proposed rules, final rules, and 
the correction notices. The Web site URL is http://www.cms.hhs.gov/InpatientPsychFacilPPS/ and may be accessed to download or view 
publications and other information pertinent to the IPF PPS.

C. Applicability of the IPF PPS

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

II. Overview for Updating the IPF PPS

A. Requirements for Updating the IPF PPS

    Section 124 of the BBRA does not specify an update strategy for the 
IPF PPS and is broadly written to give the Secretary discretion in 
establishing an update methodology. Therefore, we reviewed the update 
approach used in other hospital PPSs (specifically, the IRF and LTCH 
PPS update methodologies). As a result of this analysis, we stated in 
the November 2004 IPF PPS final rule (69 FR 66966) that we would 
implement the IPF PPS using the following update strategy--(1) 
Calculate the final Federal per diem base rate to be budget neutral for 
the 18-month period (that is, January 1, 2005 through June 30, 2006); 
(2) use a July 1 through June 30 annual update cycle; and (3) allow the 
IPF PPS first update to be effective for discharges July 1, 2006 
through June 30, 2007.
    As explained in the November 2004 IPF PPS final rule, we believe it 
is important to delay updating the adjustment factors derived from the 
regression analysis until we have IPF PPS data that include as much 
information as possible regarding the patient-level characteristics of 
the population that each IPF serves. For this reason, we do not intend 
to update the regression analysis and recalculate the Federal per diem 
base rate until we analyze IPF PPS data (that is, no earlier than FY 
2008). Until that analysis is complete, we stated our intention to 
publish a notice in the Federal Register each spring to update the IPF 
PPS as specified in Sec.  412.428.

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    However, since the implementation of the IPF PPS, a new market 
basket index was announced in the August 2005 IPPS final rule. We 
believe that this new market basket should be implemented in the IPF 
PPS as well in order to update the system using the best data 
available. Therefore, rather than publish a notice to update the IPF 
PPS in 2006, we published a proposed rule in the Federal Register on 
January 23, 2006 (71 FR 3616) to allow interested parties an 
opportunity to comment on the proposed changes.
    Updates to the IPF PPS as specified in Sec.  412.428 include:
     A description of the methodology and data used to 
calculate the updated Federal per diem base payment amount.
     The rate of increase factor as described in Sec.  
412.424(a)(2)(iii), which is based on the excluded hospital with 
capital market basket under the update methodology of 1886(b)(3)(B)(ii) 
of the Act for each year.
     The best available hospital wage index and information 
regarding whether an adjustment to the Federal per diem base rate is 
needed to maintain budget neutrality.
     Updates to the fixed dollar loss amount in order to 
maintain the appropriate outlier percentage.
     Describe the ICD-9-CM coding and DRG classification 
changes discussed in the annual update to the hospital IPPS 
regulations.
     Update the ECT adjustment by a factor specified by CMS.

B. Transition Period for Implementation of the IPF PPS

    In the November 2004 IPF PPS final rule, we established Sec.  
412.426 to provide for a 3-year transition period from reasonable cost-
based reimbursement to full prospective payment for IPFs. New IPFs, as 
defined in Sec.  412.426(c), are paid 100 percent of the Federal per 
diem rate. However, for those IPFs that are transitioning to the new 
system, during the 3-year period as specified in the November 2004 IPF 
PPS final rule, payment is based on an increasing percentage of the PPS 
payment and a decreasing percentage of each IPF's facility-specific 
TEFRA reimbursement rate. The blend percentages are as follows:

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

    Changes to the blend percentages occur at the beginning of an IPF's 
cost reporting period. We note that we are currently in year two of the 
transition period. As a result, for discharges occurring during IPF 
cost reporting periods beginning in calendar year (CY) 2006, IPFs would 
receive a blended payment consisting of 50 percent of the facility-
specific TEFRA payment and 50 percent of the IPF PPS payment amount. 
However, regardless of when an IPF's cost reporting year begins, the 
payment update will be effective for discharges occurring on or after 
July 1, 2006 through June 30, 2007. We note that we are not making any 
changes to the transition approach established in the November 2004 IPF 
PPS final rule.

III. Provisions of the Proposed Regulation

    In January 2006, we published a proposed rule that appeared in the 
Federal Register at (71 FR 3616), and on February 24, 2006, a 
correction notice appeared in the Federal Register (71 FR 9505) to 
correct technical errors in the proposed rule and to extend the comment 
period for our policy concerning Electroconvulsive Therapy (ECT). The 
January 2006 proposed rule (hereinafter referred to as the Rate Year 
(RY) 2007 proposed rule) set forth the proposed annual update to the 
proposed prospective payment for IPFs for discharges occurring during 
the RY beginning July 1, 2006. As part of the update, we proposed to 
incorporate OMB's revised definitions for MSAs and its new definitions 
of Micropolitan Statistical Areas and Core-Based Statistical Areas 
(CBSAs). In addition, we proposed the following----
     Update payments for IPFs using a market basket reflecting 
the operating and capital cost structures of IRFs, IPFs, and LTCHs.
     Develop cost weights for benefits, contract labor, and 
blood and blood products using the FY 2002-based IPPS market basket.
     Provide weights and proxies for the FY 2002-based RPL 
market basket.
     Indicate the methodology for the capital portion of the FY 
2002-based RPL market basket.
     Update the outlier threshold amount to maintain total 
estimated outlier payments at 2 percent of total estimated payments.
     Use source code ``D'' to identify IPF patients who have 
been transferred to the IPF from the same hospital or CAH.
     Retain the 17 percent adjustment for IPFs located in rural 
areas, the 1.31 adjustment for IPFs with a qualifying ED, the 0.5150 
teaching adjustment to the Federal per diem base rate, and the DRG 
adjustment factors currently being paid to IPFs for discharges 
occurring during RY 2007.
     Update the payment rate for ECT.
     Update the DRG listing and comorbidity categories to 
reflect the ICD-9-CM revisions effective October 1, 2005.
    In addition to addressing these issues in the proposed rule for RY 
2007, we also proposed making the following specific revisions to the 
existing text of the regulations. We proposed to make conforming 
changes in 42 CFR parts 412 and 424, as discussed throughout this 
preamble.
    In Sec.  412.27, we proposed to revise paragraph (b) to remove the 
reference to recreational therapy.
    In Sec.  412.402, we proposed to revise the heading of ``Fixed 
dollar loss-threshold'' to ``Fixed dollar loss threshold amount'' and 
revise the definitions of ``Fixed dollar loss threshold amount'', 
``Qualifying emergency department'', ``Rural area'' and ``Urban area.'' 
For consistency, we proposed to make conforming changes to these 
terminologies wherever they appear in the regulations text.
    In Sec.  412.424, we proposed to add paragraph (d)(1)(iii)(E) to 
clarify that the teaching adjustment is made on a claim basis as an 
interim payment and the final payment in full is made during the final 
settlement of the cost report. For clarity, we also proposed to revise 
paragraph (d)(2) introductory text. The current language in (d)(2)(iii) 
would become the introductory text for paragraph (d)(2) and paragraph

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(d)(2)(iii) would be removed. In addition, we proposed to revise Sec.  
412.424(d)(3)(i)(A) to clarify that an outlier payment is made if an 
IPF's estimated total cost for a case exceeds a fixed dollar loss 
threshold amount plus the Federal payment amount for the case.
    In Sec.  412.426(a), we proposed to correct the cross reference to 
the Federal per diem payment amount. We incorrectly referenced the 
Federal per diem base rate as Sec.  412.424(c). The correct cross 
reference to the Federal per diem payment amount is Sec.  412.424(d).
    In Sec.  412.428, we proposed to revise paragraph (b) to specify 
that for discharges occurring on or after January 1, 2005 but before 
July 1, 2006 the rate of increase factor for the Federal portion of the 
payment is based on the FY 1997-based excluded hospital with capital 
market basket and for discharges occurring on or after July 1, 2006, 
the rate of increase factor for the Federal portion of the payment is 
based on the FY 2002-based Rehabilitation, Psychiatric, and Long-Term 
Care (RPL) market basket.
    In addition, we proposed to add a new paragraph (g) to state that 
we would update the national urban and rural cost to charge ratio 
medians and ceilings. Paragraph (1) through (3) would specify the types 
of IPFs in which to apply the national cost to charge ratio. 
Furthermore, we proposed to add a new paragraph (h) to update the cost 
of living adjustment factors, if appropriate.
    In Sec.  424.14, we proposed to revise the title to read, 
``Requirements for inpatient services of inpatient psychiatric 
facilities,'' to ensure consistency in compliance with the requirements 
among all IPFs. We also proposed to add a new paragraph (c)(3) to 
clarify for purposes of payment under the IPF PPS, that the physician 
would also recertify that the patient continues to need, on a daily 
basis, active inpatient psychiatric care (furnished directly by or 
requiring the supervision of inpatient psychiatric facility personnel) 
or other professional services that can only be provided on an 
inpatient basis.
    In addition, we proposed to revise paragraph (d)(2) to state that 
the first recertification is required as of the 12th day of 
hospitalization. Subsequent recertifications would be required at 
intervals established by the hospital's utilization review committee 
(on a case-by-case basis if it so chooses), but no less frequently than 
every 30 days.

IV. Analysis of and Responses to Public Comments

    We provided for a 60 day comment period on the RY 2007 proposed 
rule. The correction notice to correct technical errors that appeared 
in the RY 2007 proposed rule appeared in the Federal Register on 
February 24, 2006. The correction notice extended the public comment 
period on the ECT policy, to allow the public an opportunity to comment 
on the corrected policy.
    We received approximately 32 public comments from hospital 
associations, psychiatric hospitals and units, and acute care 
hospitals. In general, commenters expressed some concern about a few of 
our proposals and suggested that we wait to implement specific updates 
to the IPF PPS until we can analyze 2005 claims data. A few commenters 
requested that we provide the provider impact files that are comparable 
to the files prepared for the Inpatient Prospective Payment System 
(IPPS). In addition, several commenters requested that we retain the 
rural adjustment or provide a 3-year hold harmless provision for IPFs 
that would lose their rural adjustment if we adopted the proposed CBSA 
definitions. Several commenters supported the proposed changes to the 
IPF PPS.
    Summaries of the public comments received and our responses to 
those comments are provided in the appropriate sections in the preamble 
of this final rule.

V. Updates to the IPF PPS for RY Beginning July 1, 2006

    The IPF PPS is based on a standardized Federal per diem base rate 
calculated from IPF average per diem costs and adjusted for budget-
neutrality in the implementation year. The Federal per diem base rate 
is used as the standard payment per day under the IPF PPS and is 
adjusted by the applicable wage index factor and the patient-level and 
facility-level adjustments that are applicable to the IPF stay.
    The following is an explanation of how we calculated the Federal 
per diem base rate and the standardization and budget neutrality 
factors as described in the November 2004 IPF PPS final rule.

A. Calculation of the Average Per Diem Cost

    As indicated in the November 2004 IPF PPS final rule, to calculate 
the Federal per diem base rate, we estimated the average cost per day 
for-- (1) routine services from FY 2002 cost reports (supplemented with 
FY 2001 cost reports if the FY 2002 cost report was missing); and (2) 
ancillary services using data from the FY 2002 Medicare claims and 
corresponding data from facility cost reports.
    For routine services, the per diem operating and capital costs were 
used to develop the average per diem cost amount. The per diem routine 
costs were obtained from each facility's Medicare cost report. To 
estimate the costs for routine services included in the Federal per 
diem base rate calculation, we added the total routine costs (including 
costs for capital) submitted on the cost report for each provider and 
divided it by the total Medicare days.
    Some average routine costs per day were determined to be aberrant, 
that is, the costs were extraordinarily high or low and most likely 
contained data errors. We provided a detailed discussion in the 
November 2004 IPF PPS final rule (69 FR 66926 through 66927) of the 
method used to trim extraordinarily high or low cost values from the 
per diem rate development file in order to improve the accuracy of our 
results. For ancillary services, we calculated the costs by converting 
charges from the FY 2002 Medicare claims into costs using facility-
specific, cost-center specific cost-to-charge ratios obtained from each 
provider's applicable cost reports. We matched each provider's 
departmental cost-to-charge ratios from their Medicare cost report to 
each charge on their claims reported in the MedPAR file. Multiplying 
the total charges for each type of ancillary service by the 
corresponding cost-to-charge ratio provided an estimate of the costs 
for all ancillary services received by the patient during the stay. We 
determined the average ancillary amount per day by dividing the total 
ancillary costs for all stays by the total number of covered Medicare 
days.
    Adding the average ancillary costs per day and the average routine 
costs per day including capital costs provided the estimated average 
per diem cost for each patient day of inpatient psychiatric care in FY 
2002.

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

    Section 124(a)(1) of the BBRA requires that the implementing IPF 
PPS be budget neutral. In other words, the amount of total payments 
under the IPF PPS, including any payment adjustments, must be projected 
to be equal to the amount of total payments that would have been made 
if the IPF PPS were not implemented. Therefore, in the November 2004 
IPF PPS final

[[Page 27044]]

rule, we calculated the budget neutrality factor by setting the total 
estimated IPF PPS payments to be equal to the total estimated payments 
that would have been made under the TEFRA methodology had the IPF PPS 
not been implemented.
    The November 2004 IPF PPS final rule includes a step-by-step 
description of the methodology we used to estimate payments under the 
TEFRA payment system (69 FR 66930). For the IPF PPS methodology, we 
calculated the final Federal per diem base rate to be budget neutral 
during the implementation period under the IPF PPS using a July 1 
update cycle. Thus, the implementation period for the IPF PPS is the 
18-month period January 1, 2005 through June 30, 2006.
    We updated the average cost per day to the midpoint of the IPF PPS 
implementation period (that is, October 1, 2005). We used the most 
recent projection of the full percentage increase in the 1997-based 
excluded hospital with capital market basket index for FY 2003 and 
later in accordance with Sec.  413.40(c)(3)(viii). The updated average 
cost per day was used in the payment model to establish the budget 
neutrality adjustment.
    Public comments and our responses on changes for determining the 
standardized budget neutral federal per diem base rate are summarized 
below.
    Comment: We received several comments regarding the determination 
of the target amount and the temporary caps on the facility-specific 
TEFRA payments which expired in FY 2002. Specifically, the commenters 
stated that even though the temporary caps on the facility-specific 
(TEFRA) payments expired in FY 2002, the capped payment amounts which 
were used to establish the baseline for budget neutrality purposes, 
were inflated by the market basket rate for each year until the PPS 
began in 2005.
    The commenters believe that CMS should have used what would have 
been spent, absent the expired temporary caps inflated using the market 
basket rate, to establish the baseline rather than capped payments. The 
commenters stated that using the capped payments could have 
inappropriately reduced the allowed aggregate spending under the PPS 
each year.
    Response: We are aware that there have been concerns over the 
method we used for calculating the target amount for cost reporting 
periods beginning after FY 2002 for those hospitals and units that were 
subject to the ``payment caps'' in accordance with section 
1886(b)(3)(H) of the Act and regulations at Sec.  413.40(c)(4)(iii). We 
have addressed this issue several times, but most recently in the FY 
2006 IPPS final rule (70 FR 47278 and 70 FR 47464). Specifically, we 
addressed the issue of whether Sec.  413.40(c)(4)(iii) (specifically 
paragraph (c)(4)(iii)(A)) continues to apply beyond FY 2002. In that 
rule, we stated that Sec.  413.40(c)(4)(iii) applies only to cost 
reporting periods beginning on or after October 1, 1997 through 
September 30, 2002, for IPFs, IRFs, and LTCHs. In addition, we clarify 
that once the 75th percentile cap provision in paragraph (c)(4)(iii) of 
Sec.  413.40 expired, the target amount is then determined based on 
Sec.  413.40(c)(4)(ii) which states that, ``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 
paragraph (c)(5)(ii) of this section apply. Thus, under the 
requirements of Sec.  413.40 (c)(4)(ii), in this instance, the previous 
cost reporting period's target amount would be increased by the 
applicable update factor to arrive at the target amount for FY 2003. 
Similarly, for cost reporting periods beginning in years subsequent to 
FY 2003, we calculate a hospital's target amount by taking its previous 
year's target amount and updating it by the updated factor for the 
subject cost reporting period unless the provision of paragraph 
(c)(5)(ii) of this section apply. We followed the methodology in Sec.  
413.40(c)(4)(ii) and therefore our projections of what would have been 
spent under TEFRA and the budget neutrality adjustment are correct.
    Final Rule Action: To clarify, in order to calculate the target 
amounts for cost reporting periods beginning in FY 2003, our policy is 
that the target amounts for cost reporting periods beginning in FY 2002 
are updated as described in Sec.  413.40(c)(4)(ii). Similarly, for cost 
reporting periods beginning in years subsequent to FY 2003, we 
calculate target amounts by taking the previous year's target amount 
and updating it, consistent with Sec.  413.40(c)(4)(ii).
1. Standardization of the Federal Per Diem Base Rate
    In the November 2004 IPF PPS final rule, we standardized the IPF 
PPS Federal per diem base rate in order to account for the overall 
positive effects of the IPF PPS payment adjustment factors. To 
standardize the IPF PPS payments, we compared the IPF PPS payment 
amounts calculated from the FY 2002 MedPAR file to the projected TEFRA 
payments from the FY 2002 cost report file updated to the midpoint of 
the IPF PPS implementation period (that is, October 2005). The 
standardization factor was calculated by dividing total estimated 
payments under the TEFRA payment system by estimated payments under the 
IPF PPS. The standardization factor was calculated to be 0.8367. As a 
result, in the November 2004 IPF PPS final rule, the $724.43 average 
cost per day was reduced by 16.33 percent (100 percent minus 83.67 
percent).
2. Calculation of the Budget Neutrality Adjustment
    To compute the budget neutrality adjustment for the IPF PPS, we 
separately identified each component of the adjustment, that is, the 
outlier adjustment, stop-loss adjustment, and behavioral offset.
a. Outlier Adjustment
    Since the IPF PPS payment amount for each IPF includes applicable 
outlier amounts, we reduced the standardized Federal per diem base rate 
to account for aggregate IPF PPS payments estimated to be made as 
outlier payments. The appropriate outlier amount was determined by 
comparing the adjusted prospective payment for the entire stay to the 
computed cost per case. If costs were above the prospective payment 
plus the adjusted fixed dollar loss threshold amount, an outlier 
payment was computed using the applicable risk-sharing percentages (see 
section VI.D.1 of this final rule). The outlier amount was computed for 
all stays, and the total outlier amount was added to the final IPF PPS 
payment. The outlier adjustment was calculated to be 2 percent. As a 
result, the standardized Federal per diem base rate was reduced by 2 
percent to account for projected outlier payments.
b. Stop-Loss Provision Adjustment
    As explained in the November 2004 IPF PPS final rule, we provide a 
stop-loss payment to ensure that an IPF's total PPS payments are no 
less than a minimum percentage of their TEFRA payment, had the IPF PPS 
not been implemented. We reduced the standardized Federal per diem base 
rate by the percentage of aggregate IPF PPS payments estimated to be 
made for stop-loss payments.
    The stop-loss payment amount was determined by comparing aggregate 
prospective payments that the provider would receive under the IPF PPS 
to aggregate TEFRA payments that the provider would have otherwise 
received without implementation of the IPF PPS. If an IPF's aggregate 
IPF PPS payments are less than 70 percent of its aggregate

[[Page 27045]]

payments under TEFRA, a stop-loss payment was computed for that IPF. 
The stop-loss payment amounts were computed for those IPFs that were 
projected to receive the payments, and the total amount was added to 
the final IPF PPS payment amount. As a result, the standardized Federal 
per diem base rate was reduced by 0.39 percent to account for stop-loss 
payments.
c. Behavioral Offset
    As explained in the November 2004 IPF PPS final rule, 
implementation of the IPF PPS may result in certain changes in IPF 
practices especially with respect to coding for comorbid medical 
conditions. As a result, Medicare may incur higher payments than 
assumed in our calculations. Accounting for these effects through an 
adjustment is commonly known as a behavioral offset.
    Based on accepted actuarial practices and consistent with the 
assumptions made in other prospective payment systems, we assumed in 
determining the behavioral offset that IPFs would regain 15 percent of 
potential ``losses'' and augment payment increases by 5 percent. We 
applied this actuarial assumption, which is based on our historical 
experience with new payment systems, to the estimated ``losses'' and 
``gains'' among the IPFs. The behavioral offset for the IPF PPS was 
calculated to be 2.66 percent. As a result, we reduced the standardized 
Federal per diem base rate by 2.66 percent to account for behavioral 
changes.
    To summarize, the $724.43 updated average per diem cost was reduced 
by 16.33 percent to account for standardization to projected TEFRA 
payments for the implementation period, by 2 percent to account for 
outlier payments, by 0.39 percent to account for stop-loss payments, 
and by 2.66 percent reduction to account for the behavioral offset. The 
final standardized budget-neutral Federal per diem base rate for the 
IPF PPS implementation year was calculated to be $575.95. We discuss 
the Federal per diem base rate for RY 2007 below.
    Public comments and our responses on the behavioral offset are 
summarized below.
    Comment: Several commenters expressed concern that CMS continues to 
maintain the behavioral offset which is intended to account for changes 
in provider practice patterns as a result of movement to prospective 
payment which could result in higher Medicare payments. A few 
commenters stated that accurate coding is already a high priority in 
distinct part units and freestanding facilities. Therefore, coding 
practices in these facilities should not undergo major changes. The 
commenters suggested that because the PPS is being phased in, and only 
50 percent of the payment in the second year would be based on the IPF 
PPS, the incentive for behavior change is diminished.
    Several commenters recommended that CMS analyze the preliminary 
2005 claims data and adjust the calculations for the behavioral offset 
to maintain IPF spending at appropriate levels. A few commenters 
expressed concern that CMS did not indicate whether an analysis was 
conducted to determine if continuing the adjustment for behavioral 
offset is warranted. They believe the assumptions made for both the 
proposed RY and the implementation year of the IPF PPS overestimated 
the likely impact of changes in hospital behavior.
    Response: We explained in the November 2004 IPF PPS final rule and 
the RY 2007 proposed rule that we believe it is reasonable to expect 
changes in IPFs' practices especially with respect to coding for 
comorbid medical conditions and changes in length of stay (LOS), as a 
result of the implementation of the IPF PPS.
    In addition, based on accepted actuarial practices and consistent 
with the assumptions made in implementing other prospective payment 
systems, we assumed in determining the behavioral offset, that IPFs 
would regain 15 percent of potential ``losses'' and augment payment 
increases by 5 percent. We applied this actuarial assumption, which is 
based on our historical experience with new payment systems, to the 
estimated ``losses'' and ``gains'' among the IPFs.
    As indicated in the RY 2007 proposed rule, we do not plan to change 
adjustment factors or projections, including the behavioral offset, 
until we analyze IPF PPS data. At that time, we will re-assess the 
accuracy of the behavioral offset along with the other factors 
impacting budget neutrality. We anticipate analyzing 2005 IPF PPS 
claims and cost report data in the future.
    Comment: Several commenters inquired why CMS is continuing to 
include budget neutrality factors in the Federal per diem base rate 
(behavioral offset, stop-loss adjustment, and outlier adjustment), 
effectively lowering the base rate. Since the PPS is only budget 
neutral for the implementation year, the commenters believe the base 
rate should not reflect budget neutrality factors that effectively 
lower the amount.
    Response: We acknowledge that the PPS is only budget neutral for 
the implementation year. The standardization factor, behavioral offset, 
stop-loss adjustment, and outlier adjustment were included in the 2005 
Federal per diem base rate of $575.95. In implementing the RY 2007 
final rule, we adjust the standardization factor (see section V.B.3 of 
this final rule), and apply the market basket update and the wage index 
budget neutrality factor to the base rate. As indicated above, we do 
not plan to change any adjustment factors or projections, including the 
budget neutrality factors (behavioral offset, stop-loss adjustment, and 
outlier adjustment), until we analyze IPF PPS data. We will revisit all 
assumptions used to calculate the budget neutrality adjustment and make 
any necessary prospective changes to the Federal per diem base rate. In 
section VI.D.3 of this final rule, we address these comments with 
respect to the calculation of the ECT rate.
    Final Rule Action: In summary, for future RYs, we will reassess the 
appropriateness of the behavior offset along with the other factors 
impacting budget neutrality. For the RY 2007 IPF PPS, we will continue 
to adjust the standardization factor and apply the market basket 
updates and the wage index budget neutrality factors.
3. Revision of the Standardization Factor
    In reviewing the methodology used to simulate the IPF PPS payments 
used for the November 2004 IPF PPS final rule, we discovered that the 
computer code incorrectly assigned non-teaching status to most teaching 
facilities. As a result, total IPF PPS payments were underestimated by 
about 1.36 percent. The underestimated IPF PPS payment total was used 
in calculating the IPF PPS standardization factor. The standardization 
factor represents the amount by which the IPF PPS per diem payment rate 
and the ECT rate must be reduced in order to make total IPF PPS 
payments equal to estimated total TEFRA payments assuming IPFs 
continued to be paid solely under TEFRA for the first PPS payment year.
    The standardization factor is calculated as the ratio of estimated 
total TEFRA payments to estimated total IPF PPS payments assuming no 
reduction to the per diem and ECT payment rates. Since the IPF PPS 
payment total should have been larger than the estimated figure, the 
standardization factor should have been smaller (0.8254 vs. 0.8367). In 
turn, the Federal per diem base rate and the ECT rate should have been 
reduced by 0.8254 instead of 0.8367.
    To resolve this issue, we proposed to amend the Federal per diem 
base rate and the ECT payment rate prospectively. Using the 
standardization

[[Page 27046]]

factor of 0.8254, the base rate should have been $568.17 for the 
implementation year of the IPF PPS. It is this base rate that we 
proposed to update using the market basket rate of increase of 4.3 
percent and the budget-neutral wage index factor of 1.0042 (see section 
VI.C.1.f of this final rule). Applying these factors yields a proposed 
Federal per diem base rate of $595.09 for the RY beginning July 1, 2006 
through June 30, 2007.
    Public comments and our responses on the revision of the 
standardization factor are summarized below.
    Comment: One commenter asked whether the overall increase in the 
base rate is appropriately calculated and sufficient.
    Response: As explained above and in the RY 2007 proposed rule, the 
correction of the standardization factor reveals that last year's per 
diem rate should have been $568.17, and not $575.95. To correct this 
error prospectively, we apply the market basket increase of 4.3 percent 
to $568.17, and then apply the wage index budget neutrality factor to 
compute the Federal per diem base rate.
    Final Rule Action: In summary, we are finalizing our decision to 
revise the standardization factor prospectively, and the Federal per 
diem base rate for RY 2007 is $595.09.

C. Update of the Federal Per Diem Base Rate

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

[[Page 27047]]

days. Our goal is to measure cost shares that are reflective of case 
mix and practice patterns associated with providing services to 
Medicare beneficiaries.
    As proposed and for this final rule, we are using those cost 
reports for IRFs and LTCHs whose Medicare average LOS is within 15 
percent (that is, 15 percent higher or lower) of the total facility 
average LOS for the hospital. This is the same edit applied to the FY 
1992-based and FY 1997-based excluded hospital with capital market 
basket. We are using 15 percent because it includes those LTCHs and 
IRFs whose Medicare LOS is within approximately 5 days of the facility 
LOS.
    As proposed and for this final rule, we use a less stringent 
measure of Medicare LOS for IPFs whose average LOS is within 30 or 50 
percent (depending on the total facility average LOS) of the total 
facility average LOS. Using this less stringent edit allows us to 
increase our sample size by over 150 cost reports and produce a cost 
weight more consistent with the overall facility. The edit we applied 
to IPFs when developing the FY 1997-based excluded hospital with 
capital market basket was based on the best available data at the time.
    Public comments and our responses on the proposed changes for 
implementing the methodology for the operating portion of the RPL 
market basket are summarized below.
    Comment: One commenter disagreed with our proposed LOS methodology, 
which included those cost reports for IRFs and LTCHs whose Medicare 
average LOS is within 15 percent (that is, 15 percent higher or lower) 
of the total facility average LOS and those cost reports for IPFs whose 
average LOS is within 30 or 50 percent (depending on the total facility 
average LOS) of the total facility average LOS.
    A commenter stated that the LOS methodology appears to factor into 
the calculation a disproportionate share of psychiatric facilities with 
a longer LOS. In addition, the commenter indicated that the RY 2007 
proposed rule stated that costs decrease further into a patient's stay 
and that CMS assumes that IPFs have an incompatible cost per discharge 
when grouped with the lower LOS in the IRFs and LTCHs.
    Response: As stated previously, since the cost weights for the RPL 
market basket are based on facility costs, we limited our sample to 
hospitals with a Medicare average LOS within a comparable range of the 
total facility average LOS. We believe this provides a more accurate 
reflection of the structure of costs for Medicare treatments.
    We disagree with the commenter that the IPF LOS edit includes a 
disproportionate share of IPFs with a longer LOS. For clarity, we are 
providing below a table that compares the distribution of the Medicare 
and facility LOSs for IPFs using no edit and the proposed 30/50 edit.

                         Table 2.--IPFs FY 2002 Medicare and Facility LOS Distributions
----------------------------------------------------------------------------------------------------------------
                                                      Medicare length of stay         Facility length of stay
                                                 ---------------------------------------------------------------
                                                      No trim       30/50 trim        No trim       30/50 trim
----------------------------------------------------------------------------------------------------------------
100% Max........................................              93              70            5334              75
99%.............................................              86              54             822              63
95%.............................................              59              36             333              39
90%.............................................              49              23             227              26
75% Q3..........................................              28              15              57              15
50% Median......................................              13              11              13              10
25% Q1..........................................              10               9               8               8
10%.............................................               8               7               6               6
5%..............................................               7               7               6               5
1%..............................................               4               5               5               5
0% Min..........................................               1               3               1               3
----------------------------------------------------------------------------------------------------------------

    The Medicare and facility LOS distributions are consistent when the 
proposed edit is applied. However, not applying the edit would include 
in the market basket those IPFs whose facility LOS are dramatically 
different from their Medicare LOS. In addition, the Medicare LOS 
distribution with the 30/50 edit is similar to the Medicare LOS 
distribution with no edit. Therefore, we believe that the proposed edit 
does not include a disproportionate share of IPFs with a longer LOS in 
the market basket.
    Applying these LOS edits left us with a sample of hospitals whose 
average Medicare utilization was approximately 50 percent, while those 
excluded from the market basket had a Medicare utilization of 
approximately 10 percent. Given this, we firmly believe that these LOS 
edits help us meet our goal to measure cost shares that are reflective 
of case mix and practice patterns associated with providing services to 
Medicare beneficiaries.
    The detailed cost categories under the residual (that is, the 
remaining portion of the market basket after excluding wages and 
salaries, drugs, and professional liability cost weights) are derived 
from the FY 2002-based IPPS market basket and the 1997 Benchmark Input-
Output (I-O) Tables published by the Bureau of Economic Analysis, U.S. 
Department of Commerce. The FY 2002-based IPPS market basket was 
developed using FY 2002 Medicare hospital cost reports with the most 
recent and detailed cost data (see the August 12, 2005 IPPS final rule 
(70 FR 47388)). The 1997 Benchmark I-O is the most recent, 
comprehensive source of cost data for all hospitals. The RPL cost 
weights for benefits, contract labor, and blood and blood products were 
derived using the FY 2002-based IPPS market basket. For example, the 
ratio of the benefit cost weight to the wages and salaries cost weight 
in the FY 2002-based IPPS market basket was applied to the RPL wages 
and salaries cost weight to derive a benefit cost weight for the RPL 
market basket. As proposed and for this final rule, the remaining RPL 
operating cost categories were derived using the 1997 Benchmark I-O 
Tables, aged to 2002 using relative price changes. (The methodology we 
used to age the data involves applying the annual price changes from 
the price proxies to the appropriate cost categories. We repeated this 
practice for each year.) Therefore, using this methodology, roughly 59 
percent of the RPL market basket was accounted for by wages, drugs, and 
professional liability insurance data from FY 2002 Medicare cost report 
data for IRFs, LTCHs, and IPFs.
    Additional comments and our responses on the methodology for

[[Page 27048]]

operating portion of the RPL market basket are summarized below.
    Comment: Several commenters proposed that CMS regularly re-analyze 
the RPL cost report data, which are the basis of the RPL market basket. 
The commenters indicated that the methodology used for the RPL market 
basket includes data from the IPPS hospital market basket rather than 
relying solely on IPF, IRF, and LTCH data.
    The commenters recommended that CMS work with providers to improve 
the cost reports from rehabilitation, psychiatric, and LTCHs in order 
to ensure that the data used for the market basket represent only the 
types of excluded hospitals for which the RPL market basket was 
developed. The commenters believe that improving the data reported on 
the RPL cost reports would not only refine the RPL market basket but 
also improve the accuracy of the labor-related share to which the wage 
index is applied.
    Response: We rely on the IPPS cost report data to supplement the 
IRF, IPF, and LTCH Medicare cost report data for benefits, contract 
labor, and blood and blood products. For example, the ratio of the 
benefit cost weight to the wages and salaries cost weight in the FY 
2002-based IPPS market basket was applied to the RPL wages and salaries 
cost weight to derive a benefit cost weight for the RPL market basket. 
We did not use expenditure levels from the IPPS data directly but, as 
explained, we developed and used the ratios from IPPS data to determine 
these RPL cost weights.
    The wages and salaries cost weight was derived using the IRF, IPF, 
and LTCH Medicare cost reports and accounts for 50 percent of the RPL 
market basket. Due to data limitations, this was the best methodology 
for developing the latter cost weights.
    We agree with the commenters that improving the data reported on 
the RPL cost reports could improve the RPL market basket and labor-
related share. We have noticed this data improvement on other provider-
type cost reports and encourage IRF, IPF, and LTCH providers to fully 
complete their cost reports. We believe that this would help us develop 
the most complete and accurate market basket possible. We will analyze 
RPL cost report data on a regular basis and continue to consider the 
possibility of provider-specific market basket indices.
    Comment: One commenter requested that CMS explain how it computes 
cost category weights based on Medicare cost report data. The commenter 
stated that if they understood which data elements were used and how 
they were used, CMS could develop educational programs to improve their 
member hospitals' reporting.
    Response: The RPL market basket cost weights are based on 
freestanding Medicare cost report data for IRFs, IPFs, and LTCHs. We 
mainly rely on data from worksheets A through G to derive the cost 
weights. Worksheet S-3, part II is the only worksheet which allows for 
the reporting of benefits and contract labor data; however, it is not a 
required worksheet for IRFs, IPFs, and LTCHs. As stated previously, we 
relied on the IPPS Medicare cost report worksheet S-3, part II data to 
derive the relationships for benefits and contract labor to wages and 
salaries.
    Additionally, capital cost weights are derived using worksheet A-7. 
The estimates generated using this worksheet, as well as worksheet G, 
could be enhanced with higher reporting rates. Again, we encourage IRF, 
IPF, and LTCH providers to fully complete their cost reports to help us 
in developing the most complete and accurate market basket.
    Table 3 below sets forth the complete 2002-based RPL market basket 
including cost categories, weights, and price proxies. For comparison 
purposes, the corresponding FY 1997-based excluded hospital with 
capital market basket is listed as well.
    As proposed and for this final rule, wages and salaries are 52.895 
percent of total costs in the FY 2002-based RPL market basket compared 
to 47.335 percent for the FY 1997-based excluded hospital with capital 
market basket. Employee benefits are 12.982 percent in the FY 2002-
based RPL market basket compared to 10.244 percent for the FY 1997-
based excluded hospital with capital market basket. As a result, 
compensation costs (wages and salaries plus employee benefits) for the 
FY 2002-based RPL market basket are 65.877 percent of costs compared to 
57.579 percent for the FY 1997-based excluded hospital with capital 
market basket. Of the 8 percentage-point difference between the 
compensation shares, approximately 3 percentage points were due to the 
new base year (FY 2002 instead of FY 1997), 3 percentage points were 
due to the revised LOS edit, and the remaining 2 percentage points were 
due to the exclusion of other hospitals (that is, only including IPFs, 
IRFs, and LTCHs in the market basket).
    Following the table is a summary outlining the choice of the 
proxies we chose to use for the operating portion of the market basket. 
The price proxies for the capital portion are described in more detail 
in the capital methodology section (see section V.C.3 of this final 
rule).

   Table 3.--FY 2002-Based RPL Market Basket Cost Categories, Weights, and Proxies With FY 1997-Based Excluded
                             Hospital With Capital Market Basket Used for Comparison
----------------------------------------------------------------------------------------------------------------
                                            FY 1997-based
                                          excluded hospital  FY 2002-based RPL     FY 2002 market basket price
           Expense categories                with capital      market  basket                proxies
                                            market basket
----------------------------------------------------------------------------------------------------------------
Total...................................            100.000            100.000
Compensation............................             57.579             65.877
    Wages and Salaries *................             47.335             52.895  ECI--Wages and Salaries,
                                                                                 Civilian Hospital Workers.
    Employee Benefits *.................             10.244             12.982  ECI--Benefits, Civilian Hospital
                                                                                 Workers.
Professional Fees, Non-Medical..........              4.423              2.892  ECI--Compensation for
                                                                                 Professional, Specialty &
                                                                                 Technical Workers.
Utilities...............................              1.180              0.656
    Electricity.........................              0.726              0.351  PPI--Commercial Electric Power.
    Fuel Oil, Coal, etc.................              0.248              0.108  PPI--Commercial Natural Gas.
    Water and Sewage....................              0.206              0.197  CPI-U--Water & Sewage
                                                                                 Maintenance.
Professional Liability Insurance........              0.733              1.161  CMS Professional Liability
                                                                                 Premium Index.
All Other Products and Services.........             27.117             19.265
    All Other Products..................             17.914             13.323
        Pharmaceuticals.................              6.318              5.103  PPI Prescription Drugs.
        Food: Direct Purchase...........              1.122              0.873  PPI Processed Foods & Feeds.
        Food: Contract Service..........              1.043              0.620  CPI U Food Away From Home.

[[Page 27049]]

 
        Chemicals.......................              2.133              1.100  PPI Industrial Chemicals.
        Blood and Blood Products **.....              0.748
        Medical Instruments.............              1.795              1.014  PPI Medical Instruments &
                                                                                 Equipment.
        Photographic Supplies...........              0.167              0.096  PPI Photographic Supplies.
        Rubber and Plastics.............              1.366              1.052  PPI Rubber & Plastic Products.
        Paper Products..................              1.110              1.000  PPI Converted Paper & Paperboard
                                                                                 Products.
        Apparel.........................              0.478              0.207  PPI Apparel.
        Machinery and Equipment.........              0.852              0.297  PPI Machinery & Equipment.
        Miscellaneous Products..........              0.783              1.963  PPI Finished Goods less Food &
                                                                                 Energy.
    All Other Services..................              9.203              5.942
        Telephone.......................              0.348              0.240  CPI-U Telephone Services.
        Postage.........................              0.702              0.682  CPI-U Postage.
    All Other: Labor Intensive..........              4.453              2.219  ECI-Compensation for Private
                                                                                 Service Occupations.
    All Other: Non-labor Intensive......              3.700              2.800  CPI-U All Items.
Capital-Related Costs...................              8.968             10.149
    Depreciation........................              5.586              6.186
        Fixed Assets....................              3.503              4.250  Boeckh Institutional
                                                                                 Construction 23-year useful
                                                                                 life.
        Movable Equipment...............              2.083              1.937  WPI Machinery & Equipment 11-
                                                                                 year useful life.
    Interest Costs......................              2.682              2.775
        Nonprofit.......................              2.280              2.081  Average yield on domestic
                                                                                 municipal bonds (Bond Buyer 20
                                                                                 bonds) vintage-weighted (23
                                                                                 years).
        For Profit......................              0.402              0.694  Average yield on Moody's Aaa
                                                                                 bonds vintage weighted (23
                                                                                 years).
    Other Capital-Related Costs.........              0.699              1.187  CPI-U Residential Rent.
----------------------------------------------------------------------------------------------------------------
* Labor-related
** Blood and blood-related products is included in miscellaneous products
Note: Due to rounding, weights may not sum to total.

    Below we provide the proxies that we are using for the FY 2002-
based RPL market basket. With the exception of the Professional 
Liability proxy, all the price proxies for the operating portion of the 
RPL market basket are based on Bureau of Labor Statistics (BLS) data 
and are grouped into one of the following BLS categories:
     Producer Price Indexes--Producer Price Indexes (PPIs) 
measure price changes for goods sold in other than retail markets. PPIs 
are preferable price proxies for goods that hospitals purchase as 
inputs in producing their outputs because the PPIs would better reflect 
the prices faced by hospitals. For example, we use a special PPI for 
prescription drugs, rather than the Consumer Price Index (CPI) for 
prescription drugs because hospitals generally purchase drugs directly 
from the wholesaler. The PPIs that we use measure price change at the 
final stage of production.
     Consumer Price Indexes--Consumer Price Indexes (CPIs) 
measure change in the prices of final goods and services bought by the 
typical consumer. Because they may not represent the price faced by a 
producer, we use CPIs only if an appropriate PPI were not available, or 
if the expenditures were more similar to those of retail consumers in 
general rather than purchases at the wholesale level. For example, the 
CPI for food purchases away from home is used as a proxy for contracted 
food services.
     Employment Cost Indexes--Employment Cost Indexes (ECIs) 
measure the rate of change in employee wage rates and employer costs 
for employee benefits per hour worked. These indexes are fixed-weight 
indexes and strictly measure the change in wage rates and employee 
benefits per hour. Appropriately, they are not affected by shifts in 
employment mix.
    We evaluated the price proxies using the criteria of reliability, 
timeliness, availability, and relevance. Reliability indicates that the 
index is based on valid statistical methods and has low sampling 
variability. Timeliness implies that the proxy is published regularly, 
preferably at least once a quarter. Availability means that the proxy 
is publicly available. Finally, relevance means that the proxy is 
applicable and representative of the cost category weight to which it 
is applied. The CPIs, PPIs, and ECIs in this regulation meet these 
criteria.
    We note that the proxies are the same as those used for the FY 
1997-based excluded hospital with capital market basket. Because these 
proxies meet our criteria of reliability, timeliness, availability, and 
relevance, we believe they continue to be the best measure of price 
changes for the cost categories. For further discussion on the FY 1997-
based excluded hospital with capital market basket, see the August 1, 
2002 IPPS final rule (67 FR at 50042).
Wages and Salaries
    For measuring the price growth of wages in the FY 2002-based RPL 
market basket, we are using the ECI for wages and salaries for civilian 
hospital workers as the proxy for wages in the RPL market basket.
    The rehabilitation, psychiatric, and long-term care hospital (RPL) 
market basket uses the Bureau of Labor Statistics' Employment Cost 
Indexes (ECIs) as proxies for wages and salaries, and benefits for 
civilian industry workers classified in the Standard Industrial Code 
(SIC) 806, Hospitals. However, beginning April 28, 2006 with the 
publication of March 2006 data, the ECIs will be converted from the SIC 
system to the North American Industrial Classification System (NAICS). 
The NAICS-based ECI for hospitals (NAICS 622) is similar (at least 90 
percent identical) to the SIC-based ECI for hospitals. Therefore, when 
they are available, we will use the NAICS-based ECIs for hospitals as 
proxies to reflect the rate-of-price change for the wages

[[Page 27050]]

and salaries and employee benefits cost categories in the 2002-based 
RPL market basket.
    The RPL market basket and labor-related share in this final rule 
will use the most recent data available from the Bureau of Labor 
Statistics. We do not expect the RPL market basket and labor-related 
share to change significantly when the conversion from the SIC system 
to the NAICS system takes place.
Employee Benefits
    The FY 2002-based RPL market basket uses the ECI for employee 
benefits for civilian hospital workers.
Nonmedical Professional Fees
    The ECI for compensation for professional and technical workers in 
private industry is applied to this category since it includes 
occupations such as management and consulting, legal, accounting, and 
engineering services.
Fuel, Oil, and Gasoline
    The percentage change in the price of gas fuels as measured by the 
PPI (Commodity Code 0552) is applied to this component.
Electricity
    The percentage change in the price of commercial electric power as 
measured by the PPI (Commodity Code 0542) is applied to this 
component.
Water and Sewerage
    The percentage change in the price of water and sewage maintenance 
as measured by the Consumer Price Index (CPI) for all urban consumers 
(CPI Code CUUR0000SEHG01) is applied to this component.
Professional Liability Insurance
    The FY 2002-based RPL market basket uses the percentage change in 
hospital professional liability insurance (PLI) premiums as estimated 
by the CMS Hospital Professional Liability Index for the proxy of this 
category. In the FY 1997-based excluded hospital with capital market 
basket, the same proxy was used.
    We continue to research options for improving our proxy for 
professional liability insurance. This research includes exploring 
various options for expanding our current survey, including the 
identification of another entity that would be willing to work with us 
to collect more complete and comprehensive data. We are also exploring 
other options such as third party or industry data that might assist us 
in creating a more precise measure of PLI premiums. At this time we 
have not identified a preferred option, therefore no change is made for 
the proxy in this final rule.
Pharmaceuticals
    The percentage change in the price of prescription drugs as 
measured by the PPI (PPI Code PPI32541DRX) is used as a proxy 
for this cost category. This is a special index produced by BLS as a 
proxy in the 1997-based excluded hospital with capital market basket.
Food, Direct Purchases
    The percentage change in the price of processed foods and feeds as 
measured by the PPI (Commodity Code 02) is applied to this 
component.
Food, Contract Service
    The percentage change in the price of food purchased away from home 
as measured by the CPI for all urban consumers (CPI Code 
CUUR0000SEFV) is applied to this component.
Chemicals
    The percentage change in the price of industrial chemical products 
as measured by the PPI (Commodity Code 061) is applied to this 
component. While the chemicals hospitals purchase include industrial as 
well as other types of chemicals, the industrial chemicals component 
constitutes the largest proportion by far. Thus we believe that 
Commodity Code 061 is the appropriate proxy.
Medical Instruments
    The percentage change in the price of medical and surgical 
instruments as measured by the PPI (Commodity Code 1562) is 
applied to this component.
Photographic Supplies
    The percentage change in the price of photographic supplies as 
measured by the PPI Commodity Code 1542) is applied to this 
component.
Rubber and Plastics
    The percentage change in the price of rubber and plastic products 
as measured by the PPI (Commodity Code 07) is applied to this 
component.
Paper Products
    The percentage change in the price of converted paper and 
paperboard products as measured by the PPI (Commodity Code 
0915) is applied to this component.
Apparel
    The percentage change in the price of apparel as measured by the 
PPI (Commodity Code 381) is applied to this component.
Machinery and Equipment
    The percentage change in the price of machinery and equipment as 
measured by the PPI (Commodity Code 11) is applied to this 
component.
Miscellaneous Products
    The percentage change in the price of all finished goods less food 
and energy as measured by the PPI (Commodity Code SOP3500) is 
applied to this component. Using this index removes the double-counting 
of food and energy prices, which are captured elsewhere in the market 
basket. The weight for this cost category is higher, in part, than in 
the 1997-based index because the weight for blood and blood products 
(1.188) is added to it. In the 1997-based excluded hospital with 
capital market basket, we included a separate cost category for blood 
and blood products, using the BLS PPI for blood and derivatives as a 
price proxy. A review of recent trends in the PPI for blood and 
derivatives suggests that its movements may not be consistent with the 
trends in blood costs faced by hospitals. While this proxy did not 
match exactly with the product hospitals are buying, its trend over 
time appears to be reflective of the historical price changes of blood 
purchased by hospitals. However, an apparent divergence over recent 
years led us to reevaluate whether the PPI for blood and derivatives 
was an appropriate measure of the changing price of blood. We ran test 
market baskets classifying blood in three separate cost categories: 
Blood and blood products, contained within chemicals as was done for 
the 1992-based excluded hospital with capital market basket, and within 
miscellaneous products. These categories use as proxies the following 
PPIs: The PPI for blood and blood products, the PPI for chemicals, and 
the PPI for finished goods less food and energy, respectively. Of these 
three proxies, the PPI for finished goods less food and energy moved 
most like the recent blood cost and price trends. In addition, the 
impact on the overall market basket by using different proxies for 
blood was negligible, mostly due to the relatively small weight for 
blood in the market basket.
    Therefore, as proposed and for this final rule, we are using the 
PPI for finished goods less food and energy for the blood proxy because 
we believe it more appropriately proxies the price changes (not 
quantities or required tests) associated with blood purchased by 
hospitals. We will continue to evaluate this proxy for its 
appropriateness and will explore the development of

[[Page 27051]]

alternative price indexes to proxy the price changes associated with 
this cost.
Telephone
    The percentage change in the price of telephone services as 
measured by the CPI for all urban consumers (CPI Code 
CUUR0000SEED) is applied to this component.
Postage
    The percentage change in the price of postage as measured by the 
CPI for all urban consumers (CPI Code  CUUR0000SEEC01) is 
applied to this component.
All Other Services, Labor Intensive
    The percentage change in the ECI for compensation paid to service 
workers employed in private industry is applied to this component.
All Other Services, Nonlabor Intensive
    The percentage change in the all items component of the CPI for all 
urban consumers (CPI Code  CUUR0000SA0) is applied to this 
component.
3. Methodology for Capital Portion of the RPL Market Basket
    Unlike for the operating costs of the FY 2002-based RPL market 
basket, we did not have IRF, IPF, and LTCH FY 2002 Medicare cost report 
data for the capital cost weights, due to a change in the FY 2002 
reporting requirements. Rather, as proposed and for this final rule, we 
are using these hospitals' expenditure data for the capital cost 
categories of depreciation, interest, and other capital expenses for FY 
2001, and aged the data to a FY 2002 base year using relevant price 
proxies.
    We calculated weights for the RPL market basket capital costs using 
the same set of Medicare cost reports used to develop the operating 
share for IRFs, IPFS, and LTCHs. The resulting capital weight for the 
FY 2002 base year is 10.149 percent. This is based on FY 2001 Medicare 
cost report data for IRFs, IPFs, and LTCHs, aged to FY 2002 using 
relevant price proxies.
    Lease expenses are not a separate cost category in the market 
basket, but are distributed among the cost categories of depreciation, 
interest, and other, reflecting the assumption that the underlying cost 
structure of leases is similar to capital costs in general. We assumed 
10 percent of lease expenses were overhead and assigned them to the 
other capital expenses cost category as overhead. We base this 
assignment of 10 percent of lease expenses to overhead on the common 
assumption that overhead is 10 percent of costs. The remaining lease 
expenses were distributed to the three cost categories based on the 
weights of depreciation, interest, and other capital expenses not 
including lease expenses.
    Depreciation contains two subcategories: Building and fixed 
equipment and movable equipment. As proposed and for this final rule, 
the split between building and fixed equipment and movable equipment 
was determined using the FY 2001 Medicare cost reports for IRFs, IPFs, 
and LTCHs. This methodology was also used to compute the 1997-based 
index (67 FR at 50044).
    As proposed and for this final rule, the total interest expense 
cost category is split between the government/nonprofit and for-profit 
hospitals. The 1997-based excluded hospital with capital market basket 
allocated 85 percent of the total interest cost weight to the 
government nonprofit interest, proxies by average yield on domestic 
municipal bonds, and 15 percent to for-profit interest, proxies by 
average yield on Moody's Aaa bonds.
    We derived the split using the relative FY 2001 Medicare cost 
report data for PPS hospitals on interest expenses for the government/
nonprofit and for-profit hospitals. Due to insufficient Medicare cost 
report data for IPFs, IRFs, and LTCHs, as proposed and for this final 
rule, we use the same split used in the IPPS capital input price index. 
We believe it is important that this split reflect the latest relative 
cost structure of interest expenses for hospitals and, therefore, we 
have used a 75-25 split to allocate interest expenses to government/
nonprofit and for-profit (70 FR at 47408).
    Since capital is acquired and paid for over time, capital expenses 
in any given year are determined by both past and present purchases of 
physical and financial capital. The vintage-weighted capital index is 
intended to capture the long-term consumption of capital, using vintage 
weights for depreciation (physical capital) and interest (financial 
capital). These vintage weights reflect the purchase patterns of 
building and fixed equipment and movable equipment over time. 
Depreciation and interest expenses were determined by the amount of 
past and current capital purchases. Therefore, as proposed and for this 
final rule, we are using the vintage weights to compute vintage-
weighted price changes associated with depreciation and interest 
expense.
    Vintage weights are an integral part of the FY 2002-based RPL 
market basket. Capital costs are inherently complicated and are 
determined by complex capital purchasing decisions, over time, based on 
such factors as interest rates and debt financing. In addition, capital 
is depreciated over time instead of being consumed in the same period 
it is purchased. The capital portion of the FY 2002-based RPL market 
basket reflects the annual price changes associated with capital costs, 
and is a useful simplification of the actual capital investment 
process. By accounting for the vintage nature of capital, we have 
provided an accurate, stable annual measure of price changes. Annual 
non-vintage price changes for capital are unstable due to the 
volatility of interest rate changes and, therefore, do not reflect the 
actual annual price changes for Medicare capital-related costs. The 
capital component of the FY 2002-based RPL market basket reflects the 
underlying stability of the capital acquisition process and provides 
hospitals with the ability to plan for changes in capital payments.
    To calculate the vintage weights for depreciation and interest 
expenses, we needed a time series of capital purchases for building and 
fixed equipment and movable equipment. We found no single source that 
provides the best time series of capital purchases by hospitals for all 
of the above components of capital purchases. The early Medicare Cost 
Reports did not have sufficient capital data to meet this need. While 
the American Hospital Association (AHA) Panel Survey provided a 
consistent database back to 1963, it did not provide annual capital 
purchases. However, the AHA Panel Survey provided a time series of 
depreciation expenses through 1997 which could be used to infer capital 
purchases over time. From 1998 to 2001, hospital depreciation expenses 
were calculated by multiplying the AHA Annual Survey total hospital 
expenses by the ratio of depreciation to total hospital expenses from 
the Medicare cost reports. Beginning in 2001, the AHA Annual Survey 
began collecting depreciation expenses. We hope to be able to use these 
data in future rebasings.
    In order to estimate capital purchases from AHA data on 
depreciation and interest expenses, the expected life for each cost 
category (building and fixed equipment, movable equipment, and debt 
instruments) is needed. Due to insufficient Medicare cost report data 
for IPFs, IRFs, and LTCHs, as proposed and for this final rule, we are 
using FY 2001 Medicare Cost Reports for IPPS hospitals to determine the 
expected life of building and fixed equipment and movable equipment. We 
believe this data source reflects the latest relative cost structure of 
depreciation expenses for hospitals and is analogous to IPFs,

[[Page 27052]]

IRFs, and LTCHs. The expected life of any piece of equipment was 
determined by dividing the value of the asset (excluding fully 
depreciated assets) by its current year depreciation amount. This 
calculation yields the estimated useful life of an asset if 
depreciation were to continue at current year levels, assuming 
straight-line depreciation. From the FY 2001 Medicare cost reports for 
IPPS hospitals the expected life of building and fixed equipment was 
determined to be 23 years, and the expected life of movable equipment 
was determined to be 11 years.
    As proposed and for this final rule, we are also using the fixed 
and movable weights derived from FY 2001 Medicare cost reports for 
IPFs, IRFs, and LTCHs to separate the depreciation expenses into annual 
amounts of building and fixed equipment depreciation and movable 
equipment depreciation. By multiplying the annual depreciation amounts 
by the expected life calculations from the FY 2001 Medicare cost 
reports, year-end asset costs for building and fixed equipment and 
movable equipment were determined. We then calculated a time series 
back to 1963 of annual capital purchases by subtracting the previous 
year asset costs from the current year asset costs. From this capital 
purchase time series we were able to calculate the vintage weights for 
building and fixed equipment, movable equipment, and debt instruments. 
An explanation of each of these sets of vintage weights follows.
    As proposed and for this final rule, for building and fixed 
equipment vintage weights, the real annual capital purchase amounts for 
building and fixed equipment derived from the AHA Panel Survey were 
used. The real annual purchase amount was used to capture the actual 
amount of the physical acquisition, net of the effect of price 
inflation. This real annual purchase amount for building and fixed 
equipment was produced by deflating the nominal annual purchase amount 
by the building and fixed equipment price proxy, the Boeckh 
Institutional Construction Index. This is the same proxy used for the 
FY 1997-based excluded hospital with capital market basket. We believe 
this proxy continues to meet our criteria of reliability, timeliness, 
availability, and relevance. Since building and fixed equipment has an 
expected life of 23 years, the vintage weights for building and fixed 
equipment are deemed to represent the average purchase pattern of 
building and fixed equipment over 23-year periods. With real building 
and fixed equipment purchase estimates back to 1963, sixteen 23-year 
periods were averaged to determine the average vintage weights for 
building and fixed equipment that are representative of average 
building and fixed equipment purchase patterns over time. Vintage 
weights for each 23-year period were calculated by dividing the real 
building and fixed capital purchase amount in any given year by the 
total amount of purchases in the 23-year period. This calculation was 
done for each year in the 23-year period, and for each of the sixteen 
23-year periods. The average of each year across the sixteen 23-year 
periods was used to determine the 2002 average building and fixed 
equipment vintage weights.
    As proposed and for this final rule, for movable equipment vintage 
weights, the real annual capital purchase amounts for movable equipment 
derived from the AHA Panel Survey were used to capture the actual 
amount of the physical acquisition, net of price inflation. This real 
annual purchase amount for movable equipment was calculated by 
deflating the nominal annual purchase amount by the movable equipment 
price proxy, the PPI for Machinery and Equipment. This was the same 
proxy used for the FY 1997-based excluded hospital with capital market 
basket. We believe this proxy, which meets our criteria, is the best 
measure of price changes for this cost category. Since movable 
equipment has an expected life of 11 years, the vintage weights for 
movable equipment were deemed to represent the average purchase pattern 
of movable equipment over an 11-year period. With real movable 
equipment purchase estimates available back to 1963, twenty-eight 11-
year periods could be averaged to determine the average vintage weights 
for movable equipment that are representative of average movable 
equipment purchase patterns over time. Vintage weights for each 11-year 
period were calculated by dividing the real movable capital purchase 
amount for any given year by the total amount of purchases in the 11-
year period. This calculation was done for each year in the 11-year 
period, and for each of the twenty-eight 11-year periods. The average 
of the twenty-eight 11-year periods were used to determine the FY 2002 
average movable equipment vintage weights.
    As proposed and for this final rule, for interest vintage weights, 
the nominal annual capital purchase amounts for total equipment 
(building and fixed and movable) derived from the AHA Panel and Annual 
Surveys were used. Nominal annual purchase amounts were used to capture 
the value of the debt instrument. Since hospital debt instruments have 
an expected life of 23 years, the vintage weights for interest were 
deemed to represent the average purchase pattern of total equipment 
over 23-year periods. With nominal total equipment purchase estimates 
available back to 1963, sixteen 23-year periods were averaged to 
determine the average vintage weights for interest that are 
representative of average capital purchase patterns over time. Vintage 
weights for each 23-year period were calculated by dividing the nominal 
total capital purchase amount for any given year by the total amount of 
purchases in the 23-year period. This calculation was done for each 
year in the 23-year period and for each of the sixteen 23-year periods. 
The average of the sixteen 23-year periods were used to determine the 
FY 2002 average interest vintage weights. The vintage weights for the 
index are presented in Table 4 below.
    In addition to the price proxies for depreciation and interest 
costs described above in the vintage weighted capital section, as 
proposed and for this final rule, we used the CPI-U for Residential 
Rent as a price proxy for other capital-related costs. The price 
proxies for each of the capital cost categories are the same as those 
used for the IPPS final rule (67 FR at 50044) capital input price 
index.

                      Table 4.--CMS FY 2002-Based RPL market basket capital vintage weights
----------------------------------------------------------------------------------------------------------------
                                                                                             Interest:  capital-
                     Year                         Fixed assets (23     Movable assets (11     related (23 year
                                                    year weights)         year weights)           weights)
----------------------------------------------------------------------------------------------------------------
1.............................................                 0.021                 0.065                 0.010
2.............................................                 0.022                 0.071                 0.012
3.............................................                 0.025                 0.077                 0.014
4.............................................                 0.027                 0.082                 0.016

[[Page 27053]]

 
5.............................................                 0.029                 0.086                 0.019
6.............................................                 0.031                 0.091                 0.023
7.............................................                 0.033                 0.095                 0.026
8.............................................                 0.035                 0.100                 0.029
9.............................................                 0.038                 0.106                 0.033
10............................................                 0.040                 0.112                 0.036
11............................................                 0.042                 0.117                 0.039
12............................................                 0.045  ....................                 0.043
13............................................                 0.047  ....................                 0.048
14............................................                 0.049  ....................                 0.053
15............................................                 0.051  ....................                 0.056
16............................................                 0.053  ....................                 0.059
17............................................                 0.056  ....................                 0.062
18............................................                 0.057  ....................                 0.064
19............................................                 0.058  ....................                 0.066
20............................................                 0.060  ....................                 0.070
21............................................                 0.060  ....................                 0.071
22............................................                 0.061  ....................                 0.074
23............................................                 0.061  ....................                 0.076
                                               -----------------------------------------------------------------
    Total.....................................                 1.000                 1.000                 1.000
----------------------------------------------------------------------------------------------------------------

    The RY (that is, beginning July 1, 2006) update for the IPF PPS 
using the FY 2002-based RPL market basket and Global Insight's 1st 
quarter 2006 forecast is 4.3 percent. This includes increases in both 
the operating section and the capital section for the 18-month period 
(that is, January 1, 2005 through June 30, 2006). Global Insight, Inc. 
is a nationally recognized economic and financial forecasting firm that 
contracts with CMS to forecast the components of the market baskets. 
Using the current FY 1997-based excluded hospital with capital market 
basket (66 FR 41427), Global Insight's 1st quarter 2006 forecast for 
the RY beginning July 1, 2006 is 3.4 percent. Table 5 below compares 
the RY 2002-based RPL market basket and the FY 1997-based excluded 
hospital with capital market basket percent changes. For both the 
historical and forecasted periods between RY 2000 and RY 2008, the 
difference between the two market baskets is minor with the exception 
of RY 2002, where the FY-2002-based RPL market basket increased three 
tenths of a percentage point higher than the FY 1997-based excluded 
hospital with capital market basket. This is primarily due to the FY 
2002-based RPL having a larger compensation (that is, the sum of wages 
and salaries and benefits) cost weight than the FY 1997-based index and 
the price changes associated with compensation costs increasing much 
faster than the prices of other market basket components. Also 
contributing is the ``all other nonlabor intensive'' cost weight, which 
is smaller in the FY 2002-based RPL market basket than in the FY 1997-
based index, as well as the slower price changes associated with these 
costs.

  Table 5.--FY 2002-Based RPL market basket and FY 1997-Based excluded
          hospital with capital market basket, percent changes
------------------------------------------------------------------------
                                                         FY 1997-based
                                    FY 2002-based RPL  excluded hospital
          Rate year (RY)              market  basket     market basket
                                                          with capital
------------------------------------------------------------------------
Historical data:
    RY 2000.......................                2.8                2.7
    RY 2001.......................                3.8                3.9
    RY 2002.......................                4.1                3.8
    RY 2003.......................                3.8                3.7
    RY 2004.......................                3.6                3.6
    RY 2005.......................                3.8                4.0
    Average RY 2000-2005..........                3.7                3.5
Forecast:
    RY 2006.......................                3.6                3.8
    RY 2007.......................                3.4                3.4
    RY 2008.......................                3.2                3.1
    Average RY 2006-2008..........                3.4                3.4
------------------------------------------------------------------------
Source: Global Insight, Inc. 1stQtr 2006, @USMACRO/CONTROL0306 @CISSIM/
  CNTL08R3.SIM.
Note: The RY forecasts are based on the standard 12-month period of July
  1 to June 30. For this rule, we are moving from an 18-month period to
  a 12-month period.


[[Page 27054]]

4. Labor-Related Share
    As described below in this file rule, due to the variations in 
costs and geographic wage levels, we believe that payment rates under 
the IPF PPS should continue to be adjusted by a geographic wage index. 
This wage index applies to the labor-related portion of the proposed 
Federal per diem base rate, hereafter referred to as the labor-related 
share.
    The labor-related share is determined by identifying the national 
average proportion of operating costs that are related to, influenced 
by, or vary with the local labor market. Using our current definition 
of labor-related, the labor-related share is the sum of the relative 
importance of wages and salaries, fringe benefits, professional fees, 
labor-intensive services, and a portion of the capital share from an 
appropriate market basket. We used the FY 2002-based RPL market basket 
costs to determine the labor-related share for the IPF PPS. The labor-
related share for RY 2007 is the sum of the RY 2007 relative importance 
of each labor-related cost category, and reflects the different rates 
of price change for these cost categories between the base year (FY 
2002) and RY 2007. The sum of the relative importance for RY 2007 for 
operating costs (wages and salaries, employee benefits, professional 
fees, and labor-intensive services) is 71.586, as shown in Table 6 
below. The portion of capital that is influenced by the local labor 
market is estimated to be 46 percent, which is the same percentage used 
in the FY 1997-based IRF and IPF payment systems. Since the relative 
importance for capital is 8.867 percent of the FY 2002-based RPL market 
basket in RY 2007, we are taking 46 percent of 8.867 percent to 
determine the labor-related share of capital for RY 2007. The result is 
4.079 percent, which we added to 71.586 percent for the operating cost 
amount to determine the total labor-related share for RY 2007. Thus, 
the labor-related share that we are using for IPF PPS in RY 2007 is 
75.665 percent. This labor-related share is determined using the same 
methodology as employed in calculating all previous IPF labor-related 
shares (69 FR 66952).
    Comment: One commenter noted that the proposed labor-related share 
based on the RPL market basket would benefit hospitals with a wage 
index greater than or equal to 1.000. The commenter also recommended 
that CMS ensure that the labor-related share is calculated 
appropriately, based on recent and comprehensive data for the 
facilities in the market basket.
    Response: We recognize that the labor-related share would benefit 
hospitals with a wage index greater than 1.000. However, the wage index 
is estimated independently from the labor-related share. We do not take 
into consideration which hospitals would benefit from the revised and 
rebased labor-related share. We calculated the labor-related share 
using the same methodology used for the IPF implementation year and 
reflected the most recent and comprehensive data available. The labor-
related share represents the national average while the wage index 
reflects geographical cost differences.
    The proposed change in the labor-related share is primarily 
attributable to the exclusion of children's and cancer hospitals (which 
are less labor intensive than IRFs, IPFs, and LTCHs) and the update of 
the base year to reflect FY 2002 data. The FY 2002 data, the most 
recent and comprehensive data available, reflects that labor-related 
costs are increasing faster than aggregate non-labor-related costs. We 
will continue to analyze RPL cost report data on a regular basis to 
ensure it accurately reflects the cost structures facing IRFs, IPFs, 
and LTCHs serving Medicare beneficiaries.
    Table 6 below shows the RY 2007 relative importance of labor-
related shares using the FY 2002-based RPL market basket and the FY 
1997-based excluded hospital with capital market basket.

  Table 6.--Total Labor-Related Share--Relative Importance for RY 2007
------------------------------------------------------------------------
                                                       FY 1997 excluded
                                    FY 2002-based       hospital with
                                  RPL market basket     capital market
          Cost category                relative        basket relative
                                      importance          importance
                                  (percent) RY 2007   (percent) RY 2007
------------------------------------------------------------------------
Wages and salaries..............             52.506               48.021
Employee benefits...............             14.042               11.534
Professional fees...............              2.886                4.495
All other labor-intensive                     2.152                4.411
 services.......................
                                 ---------------------------------------
    Subtotal....................             71.586               68.461
Labor-related share of capital                4.079                3.222
 costs..........................
                                 ---------------------------------------
        Total...................             75.665               71.683
------------------------------------------------------------------------

IPFs Paid Based on a Blend of the Reasonable Cost-Based Payments
    Under the broad authority of sections 1886(b)(3)(A) and (b)(3)(B) 
of the Act and as stated in the FY 2006 IPPS final rule (70 FR 47399), 
for IPFs that are transitioning to the fully Federal prospective 
payment rate, we are now using the rebased and revised FY 2002-based 
excluded hospital market basket to update the reasonable cost-based 
portion of their payments. We rebase the market basket periodically so 
that the cost weights reflect changes in the mix of goods and services 
that hospitals purchase to furnish inpatient care between base periods. 
We chose FY 2002 as the base year for the excluded hospital market 
basket because we believe this is the most recent, complete year of 
Medicare cost report data.
    The reasonable cost-based payments, subject to TEFRA limits, are 
determined on a FY basis. The FY 2007 update factor for the portion of 
the IPF PPS transitional blend payment based on reasonable costs will 
be published in the FY 2007 IPPS proposed and final rules.

VI. Update of the IPF PPS Adjustment Factors

A. Overview of the IPF PPS Adjustment Factors

    In developing the IPF PPS, in order to ensure that the IPF PPS 
would be able to account adequately for each IPF's case-mix, we 
performed an extensive regression analysis of the relationship between 
the per diem costs and certain patient and facility characteristics to 
determine those characteristics associated with statistically 
significant cost differences on a per diem basis. For

[[Page 27055]]

characteristics with statistically significant cost differences, we 
used the regression coefficients of those variables to determine the 
size of the corresponding payment adjustments.
    The IPF PPS payment adjustments were derived from a regression 
analysis of 100 percent of the FY 2002 MedPAR data file which contained 
483,038 cases. We are using the same results of this regression 
analysis to implement the RY 2007 IPF PPS final rule (See 69 FR 66935 
through 66936 for a more detailed description of the data file used for 
the regression analysis.)
    We computed a per diem cost for each Medicare inpatient psychiatric 
stay, including routine operating, ancillary, and capital components 
using information from the FY 2002 MedPAR file and data from the FY 
2002 Medicare cost reports. To calculate the cost per day for each 
inpatient psychiatric stay, routine costs were estimated by multiplying 
the routine cost per day from the IPF's FY 2002 Medicare cost report by 
the number of Medicare covered days on the FY 2002 MedPAR stay record. 
Ancillary costs were estimated by multiplying each departmental cost-
to-charge ratio by the corresponding ancillary charges on the MedPAR 
stay record. The total cost per day was calculated by summing routine 
and ancillary costs for the stay and dividing it by the number of 
Medicare covered days for each day of the stay.
    The IPF PPS includes a payment adjustment for IPFs with qualifying 
Emergency Departments (EDs), and IPFs that are part of acute care 
hospitals and CAHs with qualifying EDs. As a result, ED costs were 
excluded from the dependent variable used in the cost regression in 
order to remove the effects of ED costs from other payment adjustment 
factors with which ED costs may be correlated and thus avoid overpaying 
ED costs.
    The log of per diem cost, like most health care cost measures, 
appeared to be normally distributed. Therefore, the natural logarithm 
of the per diem cost was the dependent variable in the regression 
analysis. We included variables in the regression to control for 
psychiatric hospitals that do not bill ancillary costs and for ECT 
costs that we pay separately. The per diem cost was adjusted for 
differences in labor cost across geographic areas using the FY 2005 
hospital wage index unadjusted for geographic reclassifications, in 
order to be consistent with our use of the market basket labor share in 
applying the wage index adjustment.
    As discussed in the November 2004 IPF PPS final rule (69 FR 66936), 
we computed a wage adjustment factor for each case by multiplying the 
Medicare 2005 hospital wage index based on MSA definitions defined by 
OMB in 1993 for each facility by the labor-related share and adding the 
non-labor share. We used the 1997-based excluded hospital with capital 
market basket to determine the labor-related share. The per diem cost 
for each case was divided by this factor before taking the natural 
logarithm. The payment adjustment for the wage index was computed 
consistently with the wage adjustment factor, which is equivalent to 
separating the per diem cost into a labor portion and a non-labor 
portion and adjusting the labor portion by the wage index.
    With the exception of the teaching adjustment, the independent 
variables were specified as one or more categorical variables. Once the 
regression model was finalized based on the log normal variables, the 
regression coefficients for these variables were converted to payment 
adjustment factors by treating each coefficient as an exponent of the 
base ``e'' for natural logarithms, which is approximately equal to 
2.718. The payment adjustment factors represent the proportional effect 
of each variable relative to a reference variable. As a result of the 
regression analysis, we established patient-level payment adjustments 
for age, DRG assignment based on patients' principal diagnoses, 
selected comorbidities, and a day of stay adjustment (the variable per 
diem adjustments) to reflect higher resource use in the early days of 
an IPF stay. We also established facility-level payment adjustments for 
wage area, rural location, teaching status, cost of living adjustment 
for IPFs located in Alaska and Hawaii, and an adjustment for IPFs with 
a qualifying ED. We do not plan to update the regression analysis until 
we analyze IPF PPS data (that is, no earlier than RY 2008). CMS plans 
to monitor claims and payment data independently from cost report data 
to assess issues, or whether changes in case-mix or payment shifts have 
occurred between free standing governmental, non-profit, and private 
psychiatric hospitals, and/or psychiatric units of general hospital, 
and other impact issues of importance to psychiatric facilities.

B. Patient-Level Adjustments

    In the November 2004 IPF PPS final rule, we provided payment 
adjustments for the following payment-level characteristics: DRG 
assignment of the patient's principal diagnosis, selected 
comorbidities, patient age, and the variable per diem adjustments.
1. Adjustment for DRG Assignment
    The IPF PPS includes payment adjustments for the psychiatric DRG 
assigned to the claim based on each patient's principal diagnosis. In 
the November 2004 IPF PPS final rule, we explained that the IPF PPS 
includes 15 diagnosis-related group (DRG) adjustment factors (69 FR 
66936). The adjustment factors were expressed relative to the most 
frequently reported DRG in FY 2002, that is, DRG 430. The coefficient 
values and adjustment factors were derived from the regression 
analysis.
    In accordance with Sec.  412.27, payment under the IPF PPS is made 
for claims with a principal diagnosis included in the Diagnostic and 
Statistical Manual of Mental Disorder--Fourth Edition--Text Revision 
(DSM-IV-TR) or Chapter Five of the International Classification of 
Diseases--9th Revision--Clinical Modifications (ICD-9-CM). The 
Standards for Electronic Transaction final rule published in the 
Federal Register on August 17, 2000 (65 FR 50312), adopted the ICD-9-CM 
as the designated code set for reporting diseases, injuries, 
impairments, other health related problems, their manifestations, and 
causes of injury, disease, impairment, or other health-related 
problems. As a result, the DSM-IV-TR, while essential for the diagnosis 
and treatment of mentally ill patients, may not be reported on Medicare 
claims. However, in order to recognize the importance of the DSM-IV-TR 
in mental health treatment, we updated the reference to the DSM in 
Sec.  412.27 from DSM-III-TR to DSM-IV-TR in the November 2004 IPF PPS 
final rule. As a result, under the revised Sec.  412.27, IPFs that are 
distinct part psychiatric units of acute care hospitals and CAHs may 
only admit patients who have a principal diagnosis in the DSM-IV-TR or 
Chapter Five of the ICD-9-CM although DSM codes may not be reported on 
medical claims.
    IPF claims with a principal diagnosis included in Chapter Five of 
the ICD-9-CM or the DSM-IV-TR will be paid the Federal per diem base 
rate under the IPF PPS. Psychiatric principal diagnoses that do not 
group to one of the 15 designated DRGs receive the Federal per diem 
base rate and all other applicable adjustments, but the payment would 
not include a DRG adjustment. Only those claims with diagnoses that 
group to one of these psychiatric DRGs would receive a DRG adjustment.
    We believe it is vital to maintain the same diagnostic coding and 
DRG classification for IPFs that is used under the IPPS for providing 
the same

[[Page 27056]]

psychiatric care. As we explained in the IPF PPS proposed rule (68 FR 
66924), all changes to the ICD-9-CM coding system that would impact the 
IPF PPS are addressed annually in the IPPS proposed and final rules 
published each year. The updated codes are effective October 1 of each 
year and must be used to report diagnostic or procedure information. 
The official version of the ICD-9-CM is available on CD-ROM from the 
U.S. Government Printing Office. The FY 2006 version can be ordered by 
contacting the Superintendent of Documents, U.S. Government Printing 
Office, Department 50, Washington, DC 20402-9329, telephone number 
(202) 512-1800. The stock number is 017-022-01544-7, and the price is 
$25.00. In addition, private vendors publish the ICD-9-CM. Questions 
concerning the ICD-9-CM should be directed to Patricia E. Brooks, Co-
Chairperson, ICD-9-CM Coordination and Maintenance Committee, CMS, 
Center for Medicare Management, Hospital and Ambulatory Policy Group, 
Division of Acute Care, Mailstop C4-08-06, 7500 Security Boulevard, 
Baltimore, Maryland 21244-1850. Questions and comments may be sent via 
e-mail to: [email protected].
    Further information concerning the Official Version of the ICD-9-CM 
can be found in the IPPS final regulation, ``Changes to the Hospital 
Inpatient Prospective Payment Systems and Fiscal Year 2006 Rates; Final 
Rule,'' in the August 12, 2005 Federal Register (70 FR 47278) and at 
http://www.cms.hhs.gov/QuarterlyProviderUpdates/downloads/cms1500f.pdf.
    The following two tables below list the FY 2006 new ICD diagnosis 
codes and FY 2006 revised diagnosis code titles, respectively. These 
tables are only a listing of FY 2006 changes and do not reflect all of 
the currently valid and applicable ICD codes classified in the DRGs. 
Table 7 below lists the new FY 2006 ICD diagnosis codes that are 
classified to one of the 15 DRGs that are provided a DRG adjustment in 
the IPF PPS. When coded as a principal code or diagnosis, these codes 
receive the correlating DRG adjustment.

                  Table 7.--FY 2006 New Diagnosis Codes
------------------------------------------------------------------------
        Diagnosis code               Description              DRG
------------------------------------------------------------------------
291.82........................  Alcohol induced sleep      521, 522, 523
                                 disorders.
292.85........................  Drug induced sleep         521, 522, 523
                                 disorders.
327.00........................  Organic insomnia,                    432
                                 unspecified.
327.01........................  Insomnia due to                      432
                                 medical condition
                                 classified elsewhere.
327.02........................  Insomnia due to                      432
                                 mental disorder.
327.09........................  Other organic                        432
                                 insomnia.
327.10........................  Organic hypersomnia,                 432
                                 unspecified.
327.11........................  Idiopathic                           432
                                 hypersomnia with
                                 long sleep time.
327.12........................  Idiopathic                           432
                                 hypersomnia without
                                 long sleep time.
327.13........................  Recurrent hypersomnia                432
327.14........................  Hypersomnia due to                   432
                                 medical condition
                                 classified elsewhere.
327.15........................  Hypersomnia due to                   432
                                 mental disorder.
327.19........................  Other organic                        432
                                 hypersomnia.
------------------------------------------------------------------------

    Table 8 below lists ICD diagnosis codes whose titles have been 
modified in FY 2006. Title changes do not impact the DRG adjustment. 
When used as a principal diagnosis, these codes still receive the 
correlating DRG adjustment.

                 Table 8.--Revised Diagnosis Code Titles
------------------------------------------------------------------------
        Diagnosis code               Description              DRG
------------------------------------------------------------------------
 307.45.......................  Circadian rhythm                     432
                                 sleep disorder of
                                 nonorganic origin.
 780.52.......................  Insomnia, unspecified                432
 780.54.......................  Hypersomnia,                         432
                                 unspecified.
 780.55.......................  Disruption of 24 hour                432
                                 sleep wake cycle,
                                 unspecified.
 780.58.......................  Sleep related                        432
                                 movement disorder,
                                 unspecified.
------------------------------------------------------------------------

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

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

    In order to maintain consistency with the IPPS, for discharges on 
or after October 1, 2005, ICD code 305.1, Tobacco Use Disorder, will 
not be a covered principal diagnosis under the IPF PPS.
    Although we are updating the IPF PPS to reflect ICD-9-CM coding 
changes and DRG classification changes discussed in the annual update 
to the IPPS, in the RY 2007 IPF PPS final rule, the DRG adjustment 
factors currently being paid to IPFs will remain the same (that is, for 
discharges occurring during the RY July

[[Page 27057]]

1, 2006 through June 30, 2007). As indicated in the November 2004 IPF 
PPS final rule, we do not plan to update the regression analysis until 
we analyze IPF PPS data.
    As a result, we are adopting the DRG adjustments factors, the ICD-
9-CM coding changes and the DRG classification changes that are 
currently being paid as indicated in Table 9 below.

              Table 9.--FY 2006 DRGs and Adjustment Factor
------------------------------------------------------------------------
                                                            Adjustment
              DRG                     DRG definition          factor
------------------------------------------------------------------------
DRG 424........................  O.R. Procedure with                1.22
                                  Principal Diagnosis of
                                  Mental Illness.
DRG 425........................  Acute Adjustment                   1.05
                                  Reaction &
                                  Psychosocial
                                  Dysfunction.
DRG 426........................  Depressive Neurosis....            0.99
DRG 427........................  Neurosis, Except                   1.02
                                  Depressive.
DRG 428........................  Disorders of                       1.02
                                  Personality & Impulse
                                  Control.
DRG 429........................  Organic Disturbances &             1.03
                                  Mental Retardation.
DRG 430........................  Psychoses..............            1.00
DRG 431........................  Childhood Mental                   0.99
                                  Disorders.
DRG 432........................  Other Mental Disorder              0.92
                                  Diagnoses.
DRG 433........................  Alcohol/Drug Abuse or              0.97
                                  Dependence, Leave
                                  Against Medical Advice
                                  (LAMA).
DRG 521........................  Alcohol/Drug Abuse or              1.02
                                  Dependence with CC.
DRG 522........................  Alcohol/Drug Abuse or              0.98
                                  Dependence with
                                  RehabilitationTherapy
                                  without CC.
DRG 523........................  Alcohol/Drug Abuse or              0.88
                                  Dependence without
                                  Rehabilitation Therapy
                                  without CC.
DRG 12.........................  Degenerative Nervous               1.05
                                  System Disorders.
DRG 23.........................  Non-traumatic Stupor &             1.07
                                  Coma.
------------------------------------------------------------------------

    Section 412.424(d) separately identifies both ``Diagnosis-related 
group assignment'' and ``Principal diagnosis'' as patient level 
adjustments. Since publication of the November 2004 IPF PPS final rule, 
we have received inquiries related to whether the IPF PPS includes two 
patient-level payment adjustments for principal diagnosis, an 
adjustment for the diagnosis-related group assignment, and a separate 
adjustment for providing a principal diagnosis in general. We intended 
that the IPF PPS provide one patient-level adjustment for principal 
diagnosis, which is ``Diagnosis-related group assignment.''
    In order to clarify our policy, we proposed to modify the language 
in section 412.424(d) by deleting sub-paragraph Sec.  
412.424(d)(2)(iii). We received no public comments on the proposed 
amendment. We are adopting this change in our final rule.
    Public comments and our responses on the proposed changes on the 
adjustment for DRG assignment are summarized below.
    Comment: We received several comments concerning the update to the 
DRG adjustment factors. Overall, the commenters supported our decision 
to delay updating the patient-level adjustment factors, stating that a 
delay in running the regression analysis would allow CMS to use more 
comprehensive and accurate patient-level coding data.
    However, one commenter recommended that CMS update the DRGs and 
adjustment factors on an on-going basis.
    Response: We do not plan to update the regression analysis until we 
analyze IPF PPS data. We believe that this will provide the best 
indication of current IPF practices. Therefore, the DRG adjustment 
factors currently being paid to IPFs will remain the same for the RY 
2007 (that is, for discharges occurring during the RY July 1, 2006 
through June 30, 2007).
    Comment: Several commenters requested clarification on the ``code 
first'' instructions, believing them to be contrary to regulations at 
Sec.  412.27. The commenters stated that Sec.  412.27 requires that 
psychiatric units only admit those patients who have a psychiatric 
principal diagnosis listed in the DSM or the Chapter Five of the ICD.
    Response: Section 412.27 and the ``code first'' instructions are 
not contrary to each other. As explained in the November 2004 final 
rule (69 FR 66922) and in three subsequent Change Requests (CR) (that 
is, CR 3541, published December 1, 2004; CR 3678, published January 21, 
2005; and CR 3752, published March 4, 2005), correct coding conventions 
should always be followed, including ``code first'' situations. 
According to the ICD-9-CM Official Guidelines for Coding and Reporting, 
when a primary diagnosis code has a code first notation, the provider 
follows the applicable ICD-9-CM coding convention which requires the 
underlying condition (etiology) to be sequenced first, followed by the 
manifestation due to the underlying condition. Therefore, we consider 
``code first'' diagnoses to be the primary diagnosis. The submitted 
claim goes through the IPF PPS claims processing system which 
identifies the primary diagnosis code as non-psychiatric and searches 
the secondary codes for a psychiatric code to assign the DRG in order 
to pay ``code first'' claims properly.
    For more coding guidance, please refer to the ICD-9-CM Official 
Guidelines for Coding and Reporting which can be located on the CMS Web 
site at http://new.cms.hhs.gov/ICD9ProviderDiagnosticCodes/.
    Comment: Commenters requested that CMS include the ICD-9-CM 
obstetrical series of codes 648.30 to 648.34 and 648.40 to 648.44, 
since they are subject to sequencing priority guidelines, in our code 
first logic.
    Response: At this point in time, we do not intend to update the 
regression analysis until we have analyzed one year of IPF PPS claims 
and cost report data. However, when we update the regression analysis, 
we will review the obstetric codes noted above and consider the 
appropriateness of including them in our code first logic. For RY 2007, 
no DRG Adjustment will be made to these codes.
    Final Rule Action: In summary, we received no public comments 
concerning the proposal to amend Sec.  412.424(d). In order to clarify 
our policy that the IPF PPS provides one patient level adjustment for 
principal diagnoses, we are modifying the language in section Sec.  
412.424(d) by deleting sub-paragraph Sec.  412.424(d)(2)(iii). In 
addition, we are adopting the DRG adjustment currently in effect and as 
shown in Table 9.

[[Page 27058]]

2. Payment for Comorbid Conditions
    In the November 2004 IPF PPS final rule, we established 17 
comorbidity categories and identified the ICD-9-CM diagnosis codes that 
generate a payment adjustment under the IPF PPS.
    Comorbidities are specific patient conditions that are secondary to 
the patient's primary diagnosis, and that require treatment during the 
stay. Diagnoses that relate to an earlier episode of care and have no 
bearing on the current hospital stay are excluded and not reported on 
IPF claims. Comorbid conditions must co-exist at the time of admission, 
develop subsequently, affect the treatment received, affect the length 
of stay or affect both treatment and LOS.
    The intent of the comorbidity adjustment was to recognize the 
increased cost associated with comorbid conditions by providing 
additional payments for certain concurrent medical or psychiatric 
conditions that are expensive to treat. For each claim, an IPF may 
receive only one comorbidity adjustment per comorbidity category, but 
it may receive an adjustment for more than one comorbidity category. 
Billing instructions require that IPFs must enter the full ICD-9-CM 
codes for up to 8 additional diagnoses if they co-exist at the time of 
admission or developed subsequently.
    The comorbidity adjustments were determined based on regression 
analysis using the diagnoses reported by hospitals in FY 2002. The 
principal diagnoses were used to establish the DRG adjustment and were 
not accounted for in establishing the comorbidity category adjustments, 
except where ICD-9-CM ``code first'' instructions apply. As we 
explained in the November 2004 IPF PPS final rule (69 FR 66922), the 
code first rule applies when a condition has both an underlying 
etiology and a manifestation due to the underlying etiology. For these 
conditions, the ICD-9-CM has a coding convention that requires the 
underlying conditions to be sequenced first followed by the 
manifestation. Whenever a combination exists, there is a ``use 
additional code'' note at the etiology code and a ``code first'' note 
at the manifestation code.
    Although we are updating the IPF PPS to reflect updates to the ICD-
9-CM codes, the comorbidity adjustment factors currently in effect will 
remain in effect for the RY beginning July 1, 2006. As we indicated in 
the November 2004 IPF PPS final rule, we do not plan to update the 
regression analysis until we analyze IPF PPS data. The comorbidity 
adjustments are shown in Table 12 below.
    As previously discussed in the DRG section, we believe it is 
essential to maintain the same diagnostic coding set for IPFs that is 
used under the IPPS for providing the same psychiatric care. Therefore, 
as proposed and in this final rule, we are using the most current FY 
2006 ICD codes. They are reflected in the FY 2006 GROUPER, version 23.0 
and are effective for discharges occurring on or after October 1, 2005.
    Table 10 lists the updated FY 2006 new ICD diagnosis codes that 
impact the comorbidity adjustment under the IPF PPS and Table 11 lists 
the invalid ICD codes no longer applicable for the comorbidity 
adjustment. Table 10 only lists the FY 2006 new codes and does not 
reflect all of the currently valid ICD codes applicable for the IPF PPS 
comorbidity adjustment.
    We note that ICD diagnosis code 585 Chronic Renal Failure was 
modified in two ways--(1) By expanding the level of specificity to 
include seven new codes; and (2) by changing the original code of 585 
to invalid, thereby leaving the remaining more specific codes 
reportable. Since diagnosis code 585 is no longer valid, we are 
eliminating this code from the comorbidity category ``Renal Failure, 
Chronic.''
    ICD diagnosis code 585 ``Chronic Renal Failure'' is defined in the 
ICD-9-CM as ``Progressive, persistent inadequate kidney function 
characterized by anuria, accumulation of urea and other nitrogenous 
bodies in the blood, nausea, vomiting, gastrointestinal bleeding, and 
yellowish-brown discoloration of the skin.'' This code included the 
various stages of chronic kidney disease, but it is no longer valid. 
The new codes listed below reflect the various stages of chronic kidney 
failure.
    In this final rule, we are adopting as proposed comorbidity 
adjustments for 585.3, ``Chronic kidney disease, Stage III 
(moderate),'' 585.4, ``Chronic kidney disease, Stage IV (severe),'' 
585.5, ``Chronic kidney disease, Stage V,'' 585.6, ``End Stage renal 
disease,'' and 585.9, ``Chronic kidney disease, unspecified.'' However, 
since the purpose of the comorbidity adjustment is to account for the 
higher resource costs associated with comorbid conditions that are 
expensive to treat on a per diem basis, we are not providing a 
comorbidity adjustment for 585.1, ``Chronic kidney disease, Stage I'' 
and 585.2, ``Chronic kidney disease, Stage II (mild).''
    We believe that these conditions (585.1 and 585.2) are less costly 
to treat on a per diem basis because patients with these conditions are 
either asymptomatic or may have only mild symptoms. These conditions 
represent a minimal to mild decrease in kidney function that is almost 
completely compensated such that the only finding is typically an 
abnormal laboratory test. Unlike patients with more significant kidney 
dysfunction, these patients do not usually require more costly patient 
care interventions such as additional laboratory tests to monitor renal 
function, special pharmacy attention to reduced dosages or kidney-
sparing medications, or fluid and electrolyte precautions with special 
diets, frequent weights, input/output balance, and fluid restriction. 
The resources and costs that these patients require for staff time, 
medications and supplies, and administrative services are expected to 
be similar to other patients without these conditions.

     Table 10.--FY 2006 New ICD Codes Applicable for the Comorbidity
                               Adjustment
------------------------------------------------------------------------
   Diagnosis
     code             Description          DRG      Comorbidity category
------------------------------------------------------------------------
585.3.........  Chronic kidney            315-316  Renal Failure,
                 disease, Stage III                 Chronic.
                 (moderate).
585.4.........  Chronic kidney            315-316  Renal Failure,
                 disease, Stage                     Chronic.
                 IV(severe).
585.5.........  Chronic kidney            315-316  Renal
                 disease, Stage V.                  Failure,Chronic.
585.6.........  End stage renal           315-316  Renal
                 disease.                           Failure,Chronic.
585.9.........  Chronic kidney            315-316  Renal Failure,
                 disease, unspecified.              Chronic.
V46.13........  Encounter for weaning         467  Chronic Obstructive
                 from respirator                    Pulmonary Disease.
                 [ventilator].
V46.14........  Mechanical                    467  Chronic Obstructive
                 complication of                    Pulmonary Disease.
                 respirator
                 [ventilator].
------------------------------------------------------------------------


[[Page 27059]]

    In Table 11 below, we list the FY 2006 invalid ICD diagnosis code 
585 that we will be removing from the comorbidity adjustment under the 
IPF PPS. This table does not reflect all of the currently valid ICD 
codes applicable for the IPF PPS comorbidity adjustment.

    Table 11.--FY 2006 Invalid ICD Codes No Longer Applicable for the
                         Comorbidity Adjustment
------------------------------------------------------------------------
   Diagnosis
     code             Description           DR      Comorbidity category
------------------------------------------------------------------------
585...........  Chronic renal failure.     315-36  Renal Failure,
                                                    Chronic.
------------------------------------------------------------------------

    The seventeen comorbidity categories for which we are providing an 
adjustment, their respective codes, including the new FY 2006 ICD 
codes, and their respective adjustment factors, are listed below in 
Table 12.

      Table 12.--FY 2006 Diagnosis Codes and Adjustment Factors for
                         Comorbidity Categories
------------------------------------------------------------------------
                                                              Adjustment
    Description of comorbidity            ICD-9CM code           factor
------------------------------------------------------------------------
Developmental Disabilities.......  317, 3180, 3181, 3182,           1.04
                                    and 319.
Coagulation Factor Deficits......  2860 through 2864........        1.13
Tracheostomy.....................  51900--through 51909 and         1.06
                                    V440.
Renal Failure, Acute.............  5845 through 5849, 63630,        1.11
                                    63631, 63632, 63730,
                                    63731, 63732, 6383,
                                    6393, 66932, 66934, 9585.
Renal Failure, Chronic...........  40301, 40311, 40391,             1.11
                                    40402, 40412, 40413,
                                    40492, 40493, 5853,
                                    5854, 5855, 5856, 5859,
                                    586, V451, V560, V561,
                                    and V562.
Oncology Treatment...............  1400 through 2390 with a         1.07
                                    radiation therapy code
                                    92.21-92.29 or
                                    chemotherapy code 99.25.
Uncontrolled Diabetes-Mellitus     25002, 25003, 25012,             1.05
 with or without complications.     25013, 25022, 25023,
                                    25032, 25033, 25042,
                                    25043, 25052, 25053,
                                    25062, 25063, 25072,
                                    25073, 25082, 25083,
                                    25092, and 25093.
Severe Protein Calorie             260 through 262..........        1.13
 Malnutrition.
Eating and Conduct Disorders.....  3071, 30750, 31203,              1.12
                                    31233, and 31234.
Infectious Disease...............  01000 through 04110, 042,        1.07
                                    04500 through 05319,
                                    05440 through 05449,
                                    0550 through 0770, 0782
                                    through 07889, and 07950
                                    through 07959.
Drug and/or Alcohol Induced        2910, 2920, 29212, 2922,         1.03
 Mental Disorders.                  30300, and 30400.
Cardiac Conditions...............  3910, 3911, 3912, 40201,         1.11
                                    40403, 4160, 4210, 4211,
                                    and 4219.
Gangrene.........................  44024 and 7854...........        1.10
Chronic Obstructive Pulmonary      49121, 4941, 5100, 51883,        1.12
 Disease.                           51884, V4611 and V4612,
                                    V4613 and V4614.
Artificial Openings--Digestive     56960 through 56969,             1.08
 and Urinary.                       9975, and V441 through
                                    V446.
Severe Musculoskeletal and         6960, 7100, 73000 through        1.09
 Connective Tissue Diseases.        73009, 73010 through
                                    73019, and 73020 through
                                    73029.
Poisoning........................  96500 through 96509,             1.11
                                    9654, 9670 through 9699,
                                    9770, 9800 through
                                    9809,9830 through 9839,
                                    986, 9890 through 9897.
------------------------------------------------------------------------

    We received several comments offering suggestions on how we could 
improve the comorbidity adjustment category list. The suggestions 
ranged from requests for the addition of a single ICD-9-CM code to a 
request for expanding the comorbidity categories to account for every 
ICD-9-CM code.
    Public comments and our responses to the proposed changes to 
payment for comorbid conditions are summarized below.
    Comment: We received a comment expressing concern that the 
comorbidity adjustment list does not include the more common conditions 
seen in psychiatric patients. This commenter indicated that most 
psychiatric patients are treated for multiple common conditions and 
illnesses (for example, heart conditions, and stroke), none of which 
would trigger a payment adjustment under the IPF PPS.
    Response: We explained in the November 2004 IPF PPS final rule (69 
FR 66922), that the data used in calculating the Federal per diem base 
rate included all the costs for comorbid diagnoses submitted in the FY 
2002 claims. Therefore, the cost for providing patient care (for 
example, medications, routine nursing care) required for common 
conditions seen in the psychiatric population, and recommended for 
comorbidity adjustment by commenters (that is, heart conditions or 
strokes) are already included in the Federal per diem base rate and a 
comorbidity adjustment for their presence was duplicative and 
unnecessary.
    Further, the design of the IPF PPS with its Federal per diem base 
rate, provides numerous adjustments for complex cases and the 
availability of outlier payments, and stop loss payments during the 3-
year transition.
    Comment: A few commenters stated that the range of diagnostic codes 
proposed for adjustment did not include all the ICD-9-CM codes within a 
diagnostic category. A particular commenter indicated that the list of 
codes under diabetes did not include all the diabetes codes. In 
addition, other commenters provided a list of ICD-9-CM codes and 
comorbidity adjustments that they believe should be included in the 
comorbidity adjustment category list.
    Response: The intent of the comorbidity adjustment is to provide

[[Page 27060]]

additional payments for concurrent medical or psychiatric conditions 
that are expensive to treat and require comparatively more costly 
treatment during an IPF stay than other comorbid conditions.
    Although we are updating the IPF PPS to reflect updates to the ICD-
9-CM codes, the comorbidity adjustment categories and factors currently 
in effect will remain in effect for the RY beginning July 1, 2006. As 
indicated in the November 2004 IPF PPS final rule, we do not plan to 
update the regression analysis until we analyze IPF PPS data.
    Comment: A commenter recommended that code 404.03 hypertensive 
heart and renal disease, malignant, with heart failure and renal 
failure continue to qualify for both Cardiac Conditions and Chronic 
Renal Failure comorbidity adjustments.
    Response: We are aware that ICD code 404.03, hypertensive heart and 
renal disease, malignant, with heart failure and renal failure, has 
caused confusion since this ICD code is currently used to code an 
adjustment in two separate IPF comorbidity categories, (that is, both 
``Renal Failure, Chronic'' and ``Cardiac Conditions''). We believe that 
it more appropriately corresponds to the ``Cardiac Conditions'' 
comorbidity than to the ``Renal Failure, Chronic'' comorbidity. 
Therefore, to be more clinically cohesive and to eliminate confusion, 
we are removing ICD code 404.03 from the comorbidity adjustment 
category ``Renal Failure, Chronic,'' but retaining it in the ``Cardiac 
Conditions'' comorbidity category. Since both comorbidity categories 
have the same adjustment factor of 1.11, we believe no negative payment 
consequence will result from this change.
    Final Rule Action: We are adopting the comorbidity adjustments 
currently in effect and as shown in Table 12 above for RY 2007 
beginning July 1, 2006.
3. Patient Age Adjustments
    As explained in the November 2004 IPF PPS final rule, we analyzed 
the impact of age on per diem cost by examining the age variable (that 
is, the range of ages) for payment adjustments.
    In general, we found that the cost per day increases with 
increasing age. The older age groups are more costly than the under 45 
years of age group; the differences in per diem cost increase for each 
successive age group, and the differences are statistically 
significant.
    Based on the results of the regression analysis, we established 8 
adjustment factors for age beginning with age groupings 45 and under 
50, 50 and under 55, 55 and under 60, 60 and under 65, 65 and under 70, 
70 and under 75, 75 and under 80, and 80 years of age and over. 
Patients under 45 years of age are assigned an age adjustment factor of 
1.00. As we indicated in the November 2004 IPF PPS final rule, we do 
not plan to update the regression analysis until we analyze IPF PPS 
data. As a result, we are adopting the patient age adjustments 
currently in effect and shown in Table 13 below.

             Table 13.--Age Groupings and Adjustment Factors
------------------------------------------------------------------------
                                                              Adjustment
                            Age                                 factor
------------------------------------------------------------------------
Under 45...................................................         1.00
45 and under 50............................................         1.01
50 and under 55............................................         1.02
55 and under 60............................................         1.04
60 and under 65............................................         1.07
65 and under 70............................................         1.10
70 and under 75............................................         1.13
75 and under 80............................................         1.15
80 and over................................................         1.17
------------------------------------------------------------------------

    Final Rule Action: In response to the RY 2007 proposed rule, we 
received no comments concerning the age adjustment. We are adopting the 
age adjustments currently in effect and as shown in Table 13 above, for 
RY 2007.
4. Variable Per Diem Adjustments
    We explained in the November 2004 IPF PPS final rule that cost 
regressions indicated that per diem cost declines as the LOS increases 
(69 FR 66947). The variable per diem adjustments to the Federal per 
diem base rate account for ancillary and administrative costs that 
occur disproportionately in the first days after admission to an IPF.
    We used regression analysis to estimate the average differences in 
per diem cost among stays of different length. Regression analysis 
simultaneously controls for cost differences associated with the other 
variables (for example, age, DRG, and presence of specific 
comorbidities). The regression coefficients measure the relative 
average cost per day for stays of differing lengths compared to a 
reference group's LOS. We analyzed through cost regression the relative 
cost per day for day 1 through day 30. We determined that the average 
per diem cost declined smoothly until the 22nd day. As a result of this 
analysis, we established variable per diem adjustments that begin on 
day 1 and decline gradually until day 21 of a patient's stay. For day 
22 and thereafter, the variable per diem adjustment remains the same 
each day for the remainder of the stay. However, the adjustment applied 
to day 1 depends upon whether the IPF has a qualifying emergency 
department (ED). If an IPF has a qualifying ED, it receives a 1.31 
adjustment for day 1 of each patient stay. If an IPF does not have a 
qualifying ED, it receives a 1.19 adjustment for day 1 of the stay. The 
ED adjustment is explained in more detail in section VI.C.5 of this 
final rule.
    As we indicated in the November 2004 IPF PPS final rule, we do not 
plan to make changes to the regression analysis until we analyze IPF 
PPS data. As a result, for the RY beginning July 1, 2006, we are 
adopting the variable per diem adjustment factors currently in effect. 
Table 14 below shows the variable per diem adjustments that we will be 
using for updating the IPF PPS.

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

    Final Rule Action: In response to the RY 2007 proposed rule, we 
received no comments concerning the proposed variable per diem 
adjustments. We are adopting the variable per diem adjustment factors 
currently in effect, and as shown in Table 14 above for RY 2007.

C. Facility-Level Adjustments

    The IPF PPS includes facility-level adjustments for the wage index, 
IPFs located in rural areas, teaching IPFs, cost of living adjustments 
for IPFs located in Alaska and Hawaii, and IPFs with a qualifying ED.

[[Page 27061]]

1. Wage Index Adjustment
a. Revisions of IPF PPS Geographic Classifications
    In the November 2004 IPF PPS final rule, we explained that in 
establishing an adjustment for area wage levels, the labor-related 
portion of an IPF's Federal prospective payment is adjusted by using an 
appropriate wage index. We also explained that an IPF's wage index is 
determined based on the location of the IPF in an urban or rural area 
as defined in Sec.  412.62(f)(1)(ii) and (f)(1)(iii), respectively.
    An urban area under the IPF PPS is defined at Sec.  
412.62(f)(1)(ii)(A) and (B). In general, an urban area is defined as a 
Metropolitan Statistical Area (MSA) or New England County Metropolitan 
Area (NECMA) as defined by the Office of Management and Budget (OMB). 
In addition, a few counties located outside of MSAs are considered 
urban as specified at Sec.  412.62(f)(1)(ii)(B). Under Sec.  
412.62(f)(1)(iii), a rural area is defined as any area outside of an 
urban area. The geographic classifications defined in Sec.  
412.62(f)(1)(ii) and (f)(1)(iii), were used under the IPPS from FYs 
1984 through 2004 (Sec.  412.62(f) and Sec.  412.63(b)), and have been 
used under the IPF PPS since it was implemented for cost reporting 
periods beginning on or after January 1, 2005.
    Under the IPPS, the wage index is calculated and assigned to 
hospitals on the basis of the labor market area in which the hospital 
is located or geographically reclassified to in accordance with 
sections 1886(d)(8) and (d)(10) of the Act. Under the IPF PPS, the wage 
index is calculated using IPPS wage index data (as discussed below in 
section VI.C.1.d of this preamble) on the basis of the labor market 
area in which the IPF is located, without taking into account 
geographic reclassification under sections 1886(d)(8) and (d)(10) of 
the Act and without applying the ``rural floor'' established under 
section 4410 of the BBA. (Section 4410 of the BBA provides that for the 
purposes of section 1886(d)(3)(E) of the Act, the area wage index 
applicable to hospitals located in an urban area of a State may not be 
less than the area wage index applicable to hospitals located in rural 
areas in the State. This provision is commonly referred to as the 
``rural floor'' under the IPPS.) However, when we established the IPF 
PPS, we did not apply the rural floor to IPFs. For this reason, the 
hospital wage index used for IPFs is commonly referred to as the ``pre-
floor'' hospital wage index indicating that the ``rural floor'' 
provision of the BBA is not applied. As a result, the applicable IPF 
wage index value is assigned to the IPF on the basis of the labor 
market area in which the IPF is geographically located.
    As noted above, the current IPF PPS labor market areas are defined 
based on the definitions of MSAs, Primary MSAs (PMSAs), and NECMAs 
issued by the OMB (commonly referred to collectively as ``MSAs''). The 
MSA definitions, which are discussed in greater detail below, are 
currently used under the IPF PPS and other PPSs (that is, the IRF PPS, 
the LTCH PPS, and the PPSs for home health agencies (HHA PPS) and 
skilled nursing facilities (SNF PPS)). In the FY 2005 IPPS final rule 
(69 FR 49026 through 49034), revised labor market area definitions were 
adopted under the IPPS (Sec.  412.64(b)), which were effective October 
1, 2004. These new standards, called Core-Based Statistical Areas 
(CBSAs), were announced by the OMB late in CY 2000 and are discussed in 
greater detail below.
b. Current IPF PPS Labor Market Areas Based on MSAs
    When we published the November 2004 IPF PPS final rule, we 
explained that we were not adopting the new statistical area 
definitions defined by OMB for the following reasons. First, the change 
in labor market areas under the IPPS had not changed at the time we 
published the IPF PPS proposed rule on November 28, 2003. As a result, 
IPFs and other interested parties were not afforded an opportunity to 
comment on the use of the new labor market area definitions under the 
IPF PPS. Second, we wanted to conduct a thorough analysis of the impact 
of the new labor market area definitions on payments under the IPF PPS. 
Finally, in the November 2004 IPF PPS final rule, we indicated our 
intent to publish in a proposed rule any changes we were considering 
for new labor market definitions.
    The analysis of the impact of the new labor market definitions has 
been completed. In the RY 2007 proposed rule, we proposed to adopt the 
new CBSA-based labor market area definitions. In this final rule, we 
are adopting these labor market area definitions for the IPF PPS. We 
believe it is helpful to provide a detailed description of the current 
IPF PPS labor market areas to help explain the changes to the IPF PPS 
labor market areas.
    As mentioned earlier, since the implementation of the IPF PPS, we 
have used labor market areas to further characterize urban and rural 
areas as determined under Sec.  412.62(f)(1)(ii) and (iii). To this 
end, we have defined labor market areas under the IPF PPS based on the 
definitions of MSAs, PMSAs, and NECMAs issued by the OMB in 1993, which 
is consistent with the IPPS approach prior to FY 2005. We note that OMB 
also defines Consolidated MSAs (CMSAs). A CMSA is a metropolitan area 
with a population of 1 million or more, comprising two or more PMSAs 
(identified by their separate economic and social character). However, 
for purposes of the wage index, we use the PMSAs rather than CMSAs 
because they allow a more precise breakdown of labor costs. If a 
metropolitan area is not designated as part of a PMSA, we use the 
applicable MSA.
    These different designations use counties as the building blocks 
upon which they are based. Therefore, under the IPF PPS, hospitals are 
assigned to either an MSA, PMSA, or NECMA based on whether the county 
in which the IPF is located is part of that area. All of the counties 
in a State outside a designated MSA, PMSA, or NECMA are designated as 
rural.
c. Core-Based Statistical Areas
    The OMB reviews its Metropolitan Area definitions preceding each 
decennial census. As discussed in the FY 2005 IPPS final rule (69 FR 
49026), in the fall of 1998, OMB chartered the Metropolitan Area 
Standards Review Committee to examine the Metropolitan Area standards 
and develop recommendations for possible changes to those standards. 
Three notices related to the review of the standards, providing an 
opportunity for public comment on the recommendations of the Committee, 
were published in the Federal Register on the following dates: December 
21, 1998 (63 FR 70526); October 20, 1999 (64 FR 56628); and August 22, 
2000 (65 FR 51060).
    In the December 27, 2000 Federal Register (65 FR 82228 through 
82238), OMB announced its new standards. In that notice, OMB defines a 
Core-Based Statistical Area (CBSA), beginning in 2003, as ``a 
geographic entity associated with at least one core of 10,000 or more 
population, plus adjacent territory that has a high degree of social 
and economic integration with the core as measured by commuting ties. 
The standards designate and define two categories of CBSAs: 
Metropolitan Statistical Areas and Micropolitan Statistical Areas.'' 
(65 FR 82236 through 82238).
    According to the OMB, MSAs are based on urbanized areas of 50,000 
or more population, and Micropolitan Statistical Areas (referred to in 
this discussion as Micropolitan Areas) are based on urban clusters of 
at least 10,000 population, but less than 50,000 population. Counties 
that do not fall

[[Page 27062]]

within CBSAs (either MSAs or Micropolitan Areas) are deemed ``Outside 
CBSAs.'' In the past, OMB defined MSAs around areas with a minimum core 
population of 50,000, and smaller areas were ``Outside MSAs.'' On June 
6, 2003, the OMB announced the new CBSAs, comprised of MSAs and the new 
Micropolitan Areas based on Census 2000 data. (A copy of the 
announcement may be obtained at the following Internet address: http://www.whitehouse.gov/omb/bulletins/fy04/b04-03.html.)
    The new CBSA designations recognize 49 new MSAs and 565 new 
Micropolitan Areas, and extensively revise the composition of many of 
the existing MSAs. There are 1,090 counties in MSAs under the new CBSA 
designations (previously, there were 848 counties in MSAs). Of these 
1,090 counties, 737 are in the same MSA as they were prior to the 
change in designations, 65 are in a different MSA, and 288 were not 
previously designated to any MSA. There are 674 counties in 
Micropolitan Areas. Of these, 41 were previously in an MSA, while 633 
were not previously designated to an MSA. There are five counties that 
previously were designated to an MSA but are no longer designated to 
either an MSA or a new Micropolitan Area: Carter County, KY; St. James 
Parish, LA; Kane County, UT; Culpepper County, VA; and King George 
County, VA. For a more detailed discussion of the conceptual basis of 
the new CBSAs, refer to the FY 2005 IPPS final rule (67 FR 49026 
through 49034).
d. Revision of the IPF PPS Labor Market Areas
    In its June 6, 2003 announcement, OMB cautioned that these new 
definitions ``should not be used to develop and implement Federal, 
State, and local nonstatistical programs and policies without full 
consideration of the effects of using these definitions for such 
purposes. These areas should not serve as a general-purpose geographic 
framework for nonstatistical activities, and they may or may not be 
suitable for use in program funding formulas.''
    We currently use MSAs to define labor market areas for purposes of 
Medicare wage indices in the IPF PPS since its implementation for cost 
reporting periods beginning on or after January 1, 2005. Until 
recently, MSAs were used to define labor market areas for purposes of 
the wage index for many of the other Medicare payment systems (for 
example, IRF PPS, SNF PPS, HHA PPS, and Outpatient PPS). While we 
recognize MSAs are not designed specifically to define labor market 
areas, we believe they represent a useful proxy for this purpose, 
because they are based upon characteristics we believe also generally 
reflect the characteristics of unified labor market areas. For example, 
CBSAs consist of a core population plus an adjacent territory that 
reflects a high degree of social and economic integration. This 
integration is measured by commuting ties, thus demonstrating that 
these areas may draw workers from the same general areas. In addition, 
the most recent CBSAs reflect the most up-to-date information. Our 
analysis and discussion here are focused on issues related to adopting 
the new CBSA designations to define labor market areas for the purposes 
of the IPF PPS.
    Historically, Medicare PPSs have utilized Metropolitan Area 
definitions developed by the OMB. As noted above, the labor market 
areas currently used under the IPF PPS are based on the Metropolitan 
Area definitions issued by the OMB and the OMB reviews its Metropolitan 
Area definitions preceding each decennial census to reflect more recent 
population changes. The CBSAs are OMB's latest Metropolitan Area 
definitions based on the Census 2000 data. Because we believe that the 
OMB's latest Metropolitan Area designations more accurately reflect the 
local economies and wage levels of the areas in which hospitals are 
currently located, we adopted the revised labor market area 
designations based on the OMB's CBSA designations under the IPPS 
effective October 1, 2004. When we implemented the wage index 
adjustment at Sec.  412.424(d)(1)(i) under the November 2004 IPF PPS 
final rule (69 FR 66952 through 66954), we explained that the IPF PPS 
wage index adjustment was intended to reflect the relative hospital 
wage levels in the geographic area of the hospital as compared to the 
national average hospital wage level. The OMB's CBSA designations based 
on Census 2000 data reflect the most recent available geographic 
classifications (Metropolitan Area definitions). Therefore, we are 
revising the labor market area definitions used under the IPF PPS based 
on the OMB's CBSA designations. This change ensures that the IPF PPS 
wage index adjustment most appropriately accounts for and reflects the 
relative hospital wage levels in the geographic area of the hospital as 
compared to the national average hospital wage level.
    Specifically, we are revising the IPF PPS labor market definitions 
based on the OMB's new CBSA designations (as discussed in greater 
detail below) effective for IPF PPS discharges occurring on or after 
July 1, 2006. Accordingly, we are revising Sec.  412.402, definitions 
for rural and urban areas. Effective for discharges occurring on or 
after July 1, 2006, ``rural'' and ``urban'' areas will be defined in 
Sec.  412.64(b)(1)(ii)(A) through (C). These definitions are the labor 
market definitions based on OMB's CBSA designations. For clarity, we 
are also revising the regulation text to include the urban and rural 
definitions applicable to discharges occurring during cost reporting 
periods beginning on or after January 1, 2005, but before July 1, 2006, 
under Sec.  412.62(f)(1)(ii) and Sec.  412.62(f)(1)(iii).
    We note that these are the same labor market area definitions 
(based on the OMB's new CBSA designations) implemented for acute care 
hospitals under the IPPS at Sec.  412.64(b), which were effective for 
those hospitals beginning October 1, 2004 as discussed in the FY 2005 
IPPS final rule (69 FR 49026-49034). The IPF PPS uses the acute care 
inpatient hospitals' wage data in calculating the IPF PPS wage index. 
However, unlike the IPPS, and similar to other Medicare payment systems 
(for example, SNF PPS and IRF PPS), the IPF PPS uses the pre-floor, 
pre-reclassified hospital wage index.
    Below, we discuss the composition of the RY 2007 IPF PPS labor 
market areas based on OMB's new CBSA designations. It should be noted 
that OMB's new CBSA designations are comprised of several county-based 
area definitions as explained above, which include Metropolitan Areas, 
Micropolitan Areas, and areas ``outside CBSAs.'' We implemented the IPF 
PPS using two types of labor market areas, that is, urban and rural. In 
this final rule, we are adopting the revised labor market areas based 
on OMB's new CBSA-based designations. As proposed in the RY 2007 
proposed rule, we will continue to have 2 types of labor market areas 
(urban and rural). In the discussion that follows, we explain how we 
are recognizing Metropolitan Areas, which include New England MSAs and 
Metropolitan Divisions, as urban. We also explain how we are 
recognizing Micropolitan Areas and areas ``outside CBSAs'' as rural. As 
discussed below in this final rule and as described in the RY 2007 
proposed rule, we describe the methodology for mapping OMB's CBSA-based 
designations into the IPF PPS (urban area or rural area) format.
i. New England MSAs
    As stated above, we currently use NECMAs to define labor market 
areas in New England, because these are county-based designations, 
rather than the 1990 MSA definitions for New England, which used minor 
civil divisions such

[[Page 27063]]

as cities and towns. Under the current MSA definitions, NECMAs provided 
more consistency in labor market definitions for New England compared 
with the rest of the country, where MSAs are county-based. Under the 
new CBSAs, the OMB has now defined the MSAs and Micropolitan Areas in 
New England on the basis of counties. The OMB also established New 
England City and Town Areas, which are similar to the previous New 
England MSAs.
    In order to create consistency across all IPF labor market areas, 
as proposed and in this final rule, we are using the county-based areas 
for all MSAs in the nation, including those in New England. The OMB has 
now defined the New England area based on counties, creating a city- 
and town-based system as an alternative. We believe that adopting 
county-based labor market areas for the entire country except those in 
New England will lead to inconsistencies in our designations. Adopting 
county-based labor market areas for the entire country provides 
consistency and stability in Medicare program payment because all of 
the labor market areas throughout the country, including New England, 
will be defined using the same system (that is, counties) rather than 
different systems in different areas of the county, and minimizes 
programmatic complexity.
    In addition, we have consistently employed a county-based system 
for New England for precisely that reason: To maintain consistency with 
the labor market definitions used throughout the country. Since we have 
never used cities and towns for defining IPF labor market areas, 
employing a county-based system in New England maintains that 
consistent practice. We note that this is consistent with the 
implementation of the CBSA-based designations under the IPPS for New 
England (69 FR 49028). Accordingly, for the IPF PPS, we are using the 
New England MSAs as determined under the new CBSA-based labor market 
area definitions in defining the revised IPF PPS labor market areas.
ii. Metropolitan Divisions
    Under OMB's new CBSA designations, a Metropolitan Division is a 
county or group of counties within a CBSA that contains a core 
population of at least 2.5 million, representing an employment center, 
plus adjacent counties associated with the main county or counties 
through commuting ties. A county qualifies as a main county if 65 
percent or more of its employed residents work within the county and 
the ratio of the number of jobs located in the county to the number of 
employed residents is at least 0.75. A county qualifies as a secondary 
county if 50 percent or more, but less than 65 percent, of its employed 
residents work within the county and the ratio of the number of jobs 
located in the county to the number of employed residents is at least 
0.75. After all the main and secondary counties are identified and 
grouped, each additional county that already has qualified for 
inclusion in the MSA falls within the Metropolitan Division associated 
with the main/secondary county or counties with which the county at 
issue has the highest employment interchange measure. Counties in a 
Metropolitan Division must be contiguous (65 FR 82236).
    The construct of relatively large MSAs being comprised of 
Metropolitan Divisions is similar to the current construct of CMSAs 
comprised of PMSAs. As noted above, in the past, the OMB designated 
CMSAs as Metropolitan Areas with a population of 1 million or more and 
comprised of two or more PMSAs. Under the IPF PPS, we currently use the 
PMSAs rather than CMSAs to define labor market areas because they 
comprise a smaller geographic area with potentially varying labor costs 
due to different local economies. We believe that CMSAs may be too 
large of an area with a relatively large number of hospitals, to 
accurately reflect the local labor costs of all of the individual 
hospitals included in that relatively ``large'' area. A large market 
area designation increases the likelihood of including many hospitals 
located in areas with very different labor market conditions within the 
same market area designation. This variation could increase the 
difficulty in calculating a single wage index that will be relevant for 
all hospitals within the market area designation. Similarly, we believe 
that MSAs with a population of 2.5 million or greater may be too large 
of an area to accurately reflect the local labor costs of all of the 
individual hospitals included in that relatively ``large'' area. 
Furthermore, as indicated above, Metropolitan Divisions represent the 
closest approximation to PMSAs, the building block of the current IPF 
PPS labor market area definitions, and therefore, will most accurately 
maintain our current structuring of the IPF PPS labor market areas. As 
implemented under the IPPS (69 FR 49029), we proposed and for this 
final rule, we are using the Metropolitan Divisions where applicable 
(as described below) under the new CBSA-based labor market area 
definitions.
    In addition to being comparable to the organization of the labor 
market areas under current MSA designations (that is, the use of PMSAs 
rather than CMSAs), we believe that using Metropolitan Divisions where 
applicable (as described below) under the IPF PPS will result in a more 
accurate adjustment for the variation in local labor market areas for 
IPFs. Specifically, if we recognize the relatively ``larger'' CBSA that 
comprises two or more Metropolitan Divisions as an independent labor 
market area for purposes of the wage index, it will be too large and 
include data from too many hospitals to compute a wage index that will 
accurately reflect the various local labor costs of all of the 
individual hospitals included in that relatively ``large'' CBSA. As 
mentioned earlier, a large market area designation increases the 
likelihood of including many hospitals located in areas with very 
different labor market conditions within the same market area 
designation. This variation could increase the difficulty in 
calculating a single wage index that will be relevant for all hospitals 
within the market area designation. Rather, by recognizing the 
Metropolitan Divisions where applicable (as described below) under the 
proposed new CBSA-based labor market area definitions under the IPF 
PPS, we believe that in addition to more accurately maintaining the 
current structuring of the IPF PPS labor market areas, the local labor 
costs will be more accurately reflected, thereby resulting in a wage 
index adjustment that better reflects the variation in the local labor 
costs of the local economies of the IPFs located in these relatively 
``smaller'' areas.
    Below we describe where Metropolitan Divisions will be applicable 
under the new CBSA-based labor market area definitions under the IPF 
PPS.
    Under OMB's new CBSA-based designations, there are 11 MSAs 
containing Metropolitan Divisions: Boston; Chicago; Dallas; Detroit; 
Los Angeles; Miami; New York; Philadelphia; San Francisco; Seattle; and 
Washington, D.C. Although these MSAs were also CMSAs under the prior 
definitions, in some cases these areas have been significantly altered. 
Under the current IPF PPS MSA designations, Boston is a single NECMA. 
Under the CBSA-based labor market area designations, it is comprised of 
four Metropolitan Divisions. Los Angeles will go from four PMSAs under 
the current IPF PPS MSA designations to two Metropolitan Divisions 
under the CBSA-based labor market area designations because two MSAs 
became separate MSAs. The New York CMSA will go from 15 PMSAs under the

[[Page 27064]]

current IPF PPS MSA designations to only four Metropolitan Divisions 
under the CBSA-based labor market area designations. The five PMSAs in 
Connecticut under the current IPF PPS MSA designations will become 
separate MSAs under the CBSA-based labor market area designations, and 
the number of PMSAs in New Jersey under the current IPF PPS MSA 
designations will go from five to two, with the consolidation of two 
New Jersey PMSAs (Bergen-Passaic and Jersey City) into the New York-
Wayne-White Plains, NY-NJ Division, under the CBSA-based labor market 
area designations. In San Francisco, under the CBSA-based labor market 
area designations, there are only two Metropolitan Divisions. 
Currently, there are six PMSAs, some of which are now separate MSAs 
under the current IPF PPS labor market area designations.
    Under the current IPF PPS labor market area designations, 
Cincinnati, Cleveland, Denver, Houston, Milwaukee, Portland, 
Sacramento, and San Juan are all designated as CMSAs, but will no 
longer be designated as CMSAs under the CBSA-based labor market area 
designations. As noted previously, the population threshold to be 
designated as a CMSA under the current IPF PPS labor market area 
designations is 1 million. In most of these cases, counties currently 
in a PMSA under the current IPF PPS labor market area designations will 
become separate, independent MSAs under the CBSA-based labor market 
area designations.
    We note that subsequent to the publication of the RY 2007 IPF PPS 
proposed rule, titles to certain CBSAs were changed based on OMB 
Bulletin No. 06-01 (December 2005). The title changes listed below are 
nomenclatures that do not result in substantive changes to the CBSA-
based designations. Thus, these changes are listed below and will be 
incorporated into the FY 2007 CBSA-based urban wage index tables.
     CBSA 26900: Indianapolis-Carmel, IN
     CBSA 42680: Sebastian-Vero Beach, FL
     CBSA 19780: Des Moines-West Des Moines, IA
     CBSA 47644: Warren-Troy-Farmington Hills, MI
     CBSA 31140: Louisville-Jefferson County, KY-IN
iii. Micropolitan Areas
    Under OMB's new CBSA-based designations, Micropolitan Areas are 
essentially a third area definition consisting primarily of currently 
rural areas, but also include some or all of areas that are currently 
designated as an urban MSA. As discussed in greater detail in the FY 
2005 IPPS final rule (69 FR 49029 through 49032), how these areas are 
treated will have significant impacts on the calculation and 
application of the wage index. Specifically, whether or not 
Micropolitan Areas are included as part of the respective statewide 
rural wage indices will impact the value of statewide rural wage index 
of any State that contains a Micropolitan Area because a hospital's 
classification as urban or rural affects which hospitals' wage data are 
included in the statewide rural wage index. We combine all of the 
counties in a State outside a designated urban area together to 
calculate the statewide rural wage index for each State.
    Including Micropolitan Areas as part of the statewide rural labor 
market area would result in an increase to the statewide rural wage 
index because hospitals located in those Micropolitan Areas typically 
have higher labor costs than other rural hospitals in the State. 
Alternatively, if Micropolitan Areas were to be recognized as 
independent labor market areas, because there would be so few hospitals 
in each labor market area, the wage indices for IPFs in those areas 
could become relatively unstable as they might change considerably from 
year to year.
    We currently use MSAs to define urban labor market areas and group 
all the hospitals in counties within each State that are not assigned 
to an MSA together into a statewide rural labor market area. We have 
used the terms ``urban'' and ``rural'' wage indexes in the past for 
ease of reference. However, the introduction of Micropolitan Areas by 
the OMB potentially complicates this terminology because these areas 
include many hospitals that are currently included in the statewide 
rural labor market areas.
    We proposed to treat Micropolitan Areas as rural labor market areas 
under the IPF PPS for the reasons outlined below. That is, counties 
that are assigned to a Micropolitan Area under the CBSA-based 
designations would be treated the same as other ``rural'' counties that 
are not assigned to either an MSA (Metropolitan Statistical Area) or a 
Micropolitan Area. Therefore, in determining an IPF's applicable wage 
index (based on IPPS hospital wage index data), an IPF in a 
Micropolitan Area under OMB's CBSA-based designations would be 
classified as ``rural'' and would be assigned the statewide rural wage 
index for the State in which it resides.
    In the FY 2005 IPPS final rule (69 FR 49029 through 49032), we 
discuss our evaluation of the impact of treating Micropolitan Areas as 
part of the statewide rural labor market area instead of treating 
Micropolitan Areas as independent labor market areas for hospitals paid 
under the IPPS. As discussed in that same final rule, one of the 
reasons Micropolitan Areas have such a dramatic impact on the wage 
index is because Micropolitan Areas encompass smaller populations than 
MSAs. In addition, they tend to include fewer hospitals per 
Micropolitan Area. Currently, there are only 25 MSAs with one hospital 
in the MSA. However, under the new CBSA-based definitions, there are 
373 Micropolitan Areas with one hospital, and 49 MSAs with only one 
hospital.
    Since Micropolitan Areas encompass smaller populations than MSAs, 
they tend to include fewer hospitals per Micropolitan Area, recognizing 
Micropolitan Areas as independent labor market areas will generally 
increase the potential for dramatic shifts in those areas' wage indices 
from 1 year to the next because a single hospital (or group of 
hospitals) could have a disproportionate effect on the wage index of 
the area. The large number of labor market areas with only one hospital 
and the increased potential for dramatic shifts in the wage indexes 
from 1 year to the next is a problem for several reasons. First, it 
creates instability in the wage index from year to year for a large 
number of hospitals. Second, it reduces the averaging effect (averaging 
effect allows for more data points to be used to calculate a 
representative standard of measured labor costs within a market area.) 
lessening some of the incentive for hospitals to operate efficiently. 
This incentive is inherent in a system based on the average hourly 
wages for a large number of hospitals, as hospitals could profit more 
by operating below that average. In labor market areas with a single 
hospital, high wage costs are passed directly into the wage index with 
no counterbalancing averaging with lower wages paid at nearby competing 
hospitals. Third, it creates an arguably inequitable system when so 
many hospitals have wage indexes based solely on their own wages, while 
other hospitals' wage indexes are based on an average hourly wage 
across many hospitals.
    For the reasons noted above, and consistent with the treatment of 
these areas under the IPPS, as proposed and consist with this final 
rule, we are not adopting Micropolitan Areas as independent labor 
market areas under the IPF PPS. Under the CBSA-based labor market area 
definitions,

[[Page 27065]]

Micropolitan Areas are considered a part of the statewide rural labor 
market area. Accordingly, we will determine an IPF PPS statewide rural 
wage index using the acute-care IPPS hospital wage data from hospitals 
located in non-MSA areas (for example, rural areas, including 
Micropolitan Areas) and that statewide rural wage index will be 
assigned to IPFs located in those non-MSA areas.
e. Implementation of the Revised Labor Market Areas Under the IPF PPS
    Section 124 of the BBRA is broadly written and gives the Secretary 
discretion in developing and making adjustments to the IPF PPS.
    When the revised labor market areas based on the OMB's new CBSA-
based designations were adopted under the acute care hospital IPPS 
beginning on October 1, 2004, a transition to the new labor market area 
designations was established due to the scope and substantial 
implications of these new boundaries and to buffer the subsequent 
significant impacts it may have on payments to numerous hospitals. As 
discussed in the FY 2005 IPPS final rule (69 FR 49032), during FY 2005, 
a blend of wage indexes is calculated for those acute care IPPS 
hospitals experiencing a drop in their wage indexes because of the 
adoption of the new labor market areas.
    While we recognize that, just like IPPS hospitals, some IPFs may 
experience decreases in their wage index as a result of the labor 
market area changes, our analysis shows that a majority of IPFs either 
expect no change in wage index or an increase in wage index based on 
CBSA definitions. In addition, a very small number of IPFs (fewer than 
3 percent) will experience a decline of 5 percent or more in the wage 
index based on CBSA designations. We also found that a very small 
number of IPFs (approximately 5 percent) will experience a change in 
either rural or urban designation under the CBSA-based definitions. 
Since a majority of IPFs will not be significantly impacted by the 
labor market areas, we believe it is not necessary for a transition to 
the new CBSA-based labor market area for the purposes of the IPF PPS 
wage index.
    We received several comments on our proposed changes for 
implementing the area wage adjustments. Public comments and our 
responses on the proposed changes for implementing the area wage 
adjustments are summarized below:
    Comment: Several commenters requested that CMS provide a transition 
period to phase in the CBSA-based labor market definitions. One 
commenter requested that IPFs should be allowed to choose whether or 
not they wanted a phase-in of the CBSA wage indices.
    Response: For cost reporting periods beginning in 2006, IPFs are 
paid based on a blend of 50 percent reasonable cost payments and 50 
percent PPS payments. The wage index adjustment is being phased in on 
the PPS portion of the payment. Since we are already in the middle of a 
transition to a full wage-index adjustment under the IPF PPS, we 
believe that the effects on the IPF PPS wage index from the changes to 
the IPF PPS labor market areas definitions will be mitigated. 
Specifically, most IPFs will be in their FY 2006 cost reporting period 
and therefore will be in the second year of the 3-year phase-in of the 
IPF PPS wage index adjustment when the revised labor market area 
designations will be applied. During the second year of the transition 
to the IPF PPS, the applicable wage index value is one-half (50 
percent) of the applicable full IPF PPS wage index adjustment. Since 
most IPFs will be in the second year of the 3-year phase-in of the wage 
index adjustment, for most IPFs, the labor-related portion of the 
Federal rate is only adjusted by 50 percent of the applicable full wage 
index (that is, one-half wage index value). As noted above, the IPF PPS 
wage index adjustment is made by multiplying the labor-related share of 
the IPF PPS Federal per diem base rate (75.66 percent) by the 
applicable wage index value.
    Consequently, for most IPFs, only approximately 38 percent of the 
Federal per diem base rate is affected by the wage index adjustment 
(75.665 percent x 0.50 = 37.8325 percent), and the revision to the 
labor market area definitions based on OMB's new CBSA-based 
designations will only have a minimal impact on IPF PPS payments.
    For the reasons discussed above, and also addressed in the RY 2007 
proposed rule (71 FR 3633), we are not providing a transition under the 
IPF PPS from the current MSA-based labor market areas designations to 
the new CBSA-based labor market area designations. Rather, we are 
adopting the current CBSA-based labor market area definitions beginning 
July 1, 2006 without a transition period.
    Comment: Several commenters do not believe that because the IPF PPS 
is in the second year of the transition blend, the effects of the wage 
index changes would be mitigated. The commenters stated that similar 
wage transitions have been applied in HHA and IRF, and therefore 
inconsistencies exist between payment systems.
    Response: We do not believe a need exists to implement a separate 
transition for the wage index changes. We acknowledge that similar wage 
transitions exist in other PPSs. However, unlike the IPF PPS, in those 
instances, the payment systems were not already in a transition period 
(as described above).
    Comment: Several commenters agreed with CMS's approach to wait 1 
full year until IPF PPS claims and cost report data could be analyzed 
before changing the wage index definitions. Other commenters indicated 
that if CMS were to implement this change now, it would be inconsistent 
with the approach to wait a year before analyzing IPF PPS data.
    The same commenters expressed concern that if CMS changes urban and 
rural classifications without any recourse (such as the Medicare 
Geographic Classification Review Board (MGCRB)) when CMS analyzes the 
PPS data and compares urban and rural IPFs, rural IPF data under MSA 
definitions would not be comparable to rural IPF data under CBSA 
definitions.
    Response: In the November 2004 IPF PPS rule, we stated that we 
would use the best available hospital wage index data, and that we 
would propose any changes to the wage index in a proposed rule. We note 
that all of the other PPSs have adopted, or begun to adopt, the CBSA 
definitions. Consistent with other Medicare PPSs, and in order to 
utilize the best available data, as we indicated we would do, the IPF 
PPS will adopt the CBSA definitions. We want to ensure that the IPF PPS 
wage index adjustment most appropriately accounts for and reflects the 
relative hospital wage levels in the geographic area of the hospital as 
compared to the national average hospital wage level, and we believe 
that OMB's CBSA designations based on Census 2000 data reflect the most 
recent available geographic classifications.
    With respect to the last comment, the meaning is not completely 
clear. If the commenters are concerned that changes to the area wage 
definitions will limit our ability to analyze the impact of the IPF 
PPS, CMS does not believe this is an issue. When we analyze the first 
year of IPF PPS claims and cost report data, the urban and rural 
designations will be under MSA definitions. We are now adopting the 
latest OMB definitions of urban and rural under CBSAs and we will view 
rural IPFs under these definitions. Finally, we want to note that, 
since the IPF PPS Provider Specific File is cumulative, CMS will have a 
record of which IPFs changed designations.
    Comment: One commenter expressed support for the proposed change to 
the CBSA-based labor market definitions. The commenter believes that 
the CBSAs

[[Page 27066]]

provide an accurate measure of the labor market areas in the United 
States.
    Response: We agree with the commenter that the CBSAs represent the 
best available wage data.
    Comment: The IPPS adopted a hold-harmless policy and an ``out-
commuting adjustment.'' Several commenters believe that since the 
majority of IPFs are distinct part units, there is an inconsistency 
when the acute care hospitals are paid the out-commuting or out-
migration adjustment and the IPFs are not paid the adjustment. The 
commenters stated that CMS should assume that IPF employees follow the 
same commuting patterns as those who work in the acute care hospital.
    In addition, the commenters indicated that distinct part units 
would be at a disadvantage in recruiting and retaining workers for the 
IPF unless CMS adopted an out-commuting or out-migration adjustment.
    Response: We are not providing a hold harmless policy or an ``out-
commuting'' adjustment under the IPF PPS from the current MSA-based 
labor market areas designations to the new CBSA-based labor market area 
designations. Nor do we believe that we are required to provide an out-
commuting adjustment. We note that section 505 of the MMA established 
new section 1886(d)(13) of the Act. Section 1886(d)(13) of the Act 
requires that the Secretary establish a process to make adjustments to 
the hospital wage index based on commuting patterns of hospital 
employees. We believe that this requirement for an ``out-commuting'' or 
``out-migration'' adjustment applies specifically to the IPPS and not 
to other PPS. Therefore, consistent with other PPS (for example, IRF 
and LTCH PPS), we did not propose out-commuting or out-migration 
adjustment under the IPF PPS, nor are we establishing such an 
adjustment under the IPF PPS in this final rule.
    We believe that our decisions not to adopt a transition or an out-
commuting adjustment are appropriate for IPFs because, despite some 
similarities between the IPF PPS and the IPPS, there are clear 
distinctions between the payment systems, particularly regarding wage 
index issues.
    For example, a wage index adjustment has been a stable feature of 
the acute care hospital IPPS since its 1983 implementation and the IPPS 
had utilized the prior MSA-based labor market area designation for over 
10 years. The IPF PPS has only been implemented since January 1, 2005.
    The most significant distinction between acute care hospitals under 
the IPPS and IPFs is that acute care hospitals have been paid using 
full wage index adjusted payments since 1983 and had used the previous 
IPPS MSA-based labor market area designations for over 10 years, 
whereas under the IPF PPS, a wage index adjustment is being phased-in 
over a 3-year period. As previously explained, the impact that the wage 
index can have on IPF PPS payments is limited at this point, since only 
a small percentage of the IPF PPS Federal per diem base rate is 
affected by the wage index (approximately 38 percent in most cases) 
because of the 3-year phase-in of the wage index adjustment.
    In contrast, a transition policy to the revised IPPS labor market 
area definitions under the IPPS was appropriate because there is no 
phase-in of a wage index adjustment under the IPPS and the full labor-
related share of the IPPS standardized amount (that is, Federal rate) 
is affected by the IPPS wage index adjustment, which resulted in a more 
significant projected impact for acute care hospitals under the IPPS.
    Comment: Several commenters indicated that IPFs that are distinct 
part units should be allowed to be reclassified to the same geographic 
area as the acute care hospital. The commenters also stated that wage 
issues between acute care hospitals and IPFs are similar, and that it 
is not logical for IPFs that are distinct part units to receive a 
different area wage index value than the acute care hospital. 
Commenters requested that CMS implement a rural floor like that of 
IPPS.
    Response: As stated above, the IPF PPS wage index is calculated 
using IPPS wage index data on the basis of the labor market area in 
which the IPF is located, without taking into account geographic 
reclassification under sections 1886(d)(8) and (d)(10) of the Act and 
without applying the ``rural floor'' established under section 4410 of 
the BBA. We believe that the actual location of an IPF (as opposed to 
the location of affiliated providers) is most appropriate for 
determining the wage adjustment because the prevailing wages in the 
area in which the IPF is located influence the cost of a case. In 
addition, we are using the latest OMB labor market area definitions 
based on 2000 Census data. Since these data are more recent than the 
data used for the wage index in the IPF PPS implementation year (2000 
versus 1993 data), we do not see a need for a reclassification policy. 
Finally, as discussed above, by recognizing the Metropolitan Divisions 
where applicable under the new CBSA-based labor market area definitions 
under the IPF PPS, we believe that the local labor costs will be more 
accurately reflected, thereby resulting in a wage index adjustment that 
better reflects the variation in the local labor costs of the local 
economies of the IPFs located in these relatively ``smaller'' areas 
when compared with CMSAs.
    Although some commenters request CMS to develop a ``rural floor'' 
like the IPPS, we believe the ``rural floor'' is required only for the 
acute care hospital payment system because, as stated in section 
VI.B.2, section 4410 of the Balanced Budget Act of 1997 (Pub. L. 105-
33) applies specifically to acute care hospitals and not excluded 
hospitals and excluded units. We believe that the ``pre-
reclassification and pre-floor'' wage data is the best proxy and most 
appropriate wage index for IPFs.
    Comment: Many commenters expressed concern regarding those IPFs who 
would lose the rural adjustment if they are redefined as urban under 
the CBSA-based labor market definitions. Specifically, the commenters 
stated that IPFs' reimbursement would decrease over the next several 
years due to the wage index changes. The commenters also indicated that 
the loss of the rural adjustment would increase the financial 
vulnerability of IPFs that are necessary to provide continued access to 
care in previously rural areas. As a result, the commenters requested 
that CMS provide a grandfathering provision to allow IPFs to continue 
to receive the rural adjustment or a hold harmless provision that would 
prevent payments from dropping below what the IPF would have received 
had they remained designated as a rural IPF.
    Response: We are finalizing our proposal to transition IPFs to 
CBSA-based labor market definitions. We recognize that IPFs that were 
previously considered rural will lose the 17 percent rural facility-
level adjustment when they are redesignated as urban. However, as 
discussed above, since we are currently in the middle of a transition 
period from reasonable-cost based payments to PPS payments, the effects 
of changing to CBSA-based definitions are mitigated, since currently 
the wage index affects approximately 38 percent of an IPF's payment, 
and the rural adjustment affects 50 percent of an IPF's payment.
    In addition, the IPF PPS has a stop-loss policy in place to protect 
IPFs that receive less than 70 percent of what they would have received 
under TEFRA. In general, the group of providers that stands to lose the 
rural adjustment did well under TERFA, and the purpose of the 
transition from TERFA to PPS is to allow IPFs to control and reduce 
their costs.

[[Page 27067]]

    As discussed in the August 11, 2004 IPPS final rule (69 FR 49032), 
during FY 2005, a hold harmless policy was implemented to minimize the 
overall impact of hospitals that were designated in FY 2004 as urban 
under the MSA designations, but would become rural under the CBSA 
designations. In the same final rule, hospitals were afforded a 3-year 
hold harmless policy because the IPPS determined that acute-care 
hospitals that changed designations from urban to rural would be 
substantially impacted by the significant change in wage index. 
Currently, under the IPF PPS, urban facilities that become rural would 
receive the rural facility adjustment (that is, 17 percent). As 
discussed in section VI.C.2 of this final rule, we are adopting the 17 
percent rural adjustment. The rural facility adjustment will be applied 
in the same way to urban facilities that will become rural under the 
CBSA-based definitions. Thus, we believe that the impact of the wage 
index changes on any urban facilities that become rural under the new 
definitions will be mitigated by the rural adjustment. Finally, as 
discussed above, the IPF PPS has a stop-loss policy in effect during 
the transition from TEFRA to PPS payments. Therefore, we do not believe 
it is appropriate or necessary to adopt a hold harmless policy for 
facilities that would experience a change in designation under the 
CBSA-based definitions.
    We note that for the CBSA designations, we identified some 
geographic areas where there were no hospitals, and thus no hospital 
wage index data on which to base the calculation of the RY 2007 IPF PPS 
wage index. In addressing this situation, we proposed approaches that 
we believe would serve as proxies for hospital wage data and provide an 
appropriate standard that accounts for geographic variation in labor 
costs.
    The first situation involves rural locations in Massachusetts and 
Puerto Rico. We have determined that there are no rural hospitals in 
those locations. Since there is no reasonable proxy for more recent 
rural data within those areas, we are using last year's wage index 
value for rural Massachusetts and rural Puerto Rico. This approach is 
consistent with other Medicare PPSs (for example, SNF PPS and IRF PPS).
    The second situation has to do with the urban area of Hinesville, 
GA (CBSA 25980). Under the new labor market areas there are no urban 
hospitals within this area. Therefore, we are using the urban areas 
within the State to serve as a reasonable proxy for the urban areas 
without specific hospital wage index data in determining the IPF PPS 
wage index. In this final rule, we are calculating the urban wage index 
value for purposes of the wage index for these areas without urban 
hospital data as the average wage index for all urban areas within the 
State. This approach is consistent with other Medicare PPSs (for 
example, SNF PPS and IRF PPS).
    We could not apply a similar averaging in rural areas because in 
the rural areas there are no State rural hospital wage data available 
for averaging on a State-wide basis. We did not receive comments on 
these approaches for calculating the wage index values for areas 
without hospitals for RY 2007 and subsequent years. We are adopting the 
proposed approach in this final rule.
    To facilitate an understanding of the policies related to the 
changes to the IPF PPS labor market areas discussed above, in the MSA/
CBSA Crosswalk included as Addendum B of this final rule, we are 
providing a listing of each Social Security Administration (SSA) State 
and county location code; State and county name; existing MSA-based 
labor market area designation; MSA-based wage index value; CBSA-based 
labor market area; and the new CBSA-based wage index value. We are also 
providing in Addenda C the wage index for urban and rural areas based 
on CBSA labor market areas.
    Final Rule Action: In summary, we are finalizing our proposal to 
adopt the CBSA labor market area definitions without a transition, 
without a hold-harmless policy, and without an out-commuting or out-
migration adjustment.
f. Wage Index Budget Neutrality
    Any adjustment or update to the IPF wage index will be made in a 
budget neutral manner that assures that the estimated aggregated 
payments under this subsection in the RY beginning July 1, 2006 are not 
greater or less than those that would have been made in the year 
without such an adjustment. Therefore, as proposed and in this final 
rule, we calculate a budget-neutral wage index adjustment factor using 
the following steps:
    Steps 1: Determine the total amount of the estimated IPF PPS 
payments for the implementation year using the labor-related share and 
wage indices from FY 2005 (based on MSAs).
    Step 2: Calculate the total amount of estimated IPF PPS payments 
for RY 2007 using the labor-related share and wage indices from FY 2006 
(based on CBSAs).
    Step 3: Divide the amount calculated in Step 1 by the amount 
calculated in Step 2 which yields a RY 2007 budget-neutral wage 
adjustment of 1.0042.
    This factor is applied in the update of the Federal per diem base 
rate for RY 2007.
2. Adjustment for Rural Location
    In the November 2004 IPF PPS final rule, we provided a 17 percent 
payment adjustment for IPFs located in a rural area. This adjustment 
was based on the regression analysis which indicated that the per diem 
cost of rural facilities was 17 percent higher than that of urban 
facilities after accounting for the influence of the other variables 
included in the regression. Many rural IPFs are small psychiatric units 
within small general acute care hospitals. We also stated in the 
November 2004 IPF PPS final rule that small-scale facilities are more 
costly on a per diem basis because there are minimum levels of fixed 
costs that cannot be avoided, and they do not have the economies of 
size advantage.
    Based on the results of our regression analysis, we provided a 
payment adjustment for IPFs located in rural areas of 17 percent. In 
this final rule, we are not changing this adjustment factor. In 
addition, we stated in the November 2004 IPF PPS final rule that we do 
not plan to conduct another regression analysis until we analyze IPF 
PPS data. At that time, we can compare rural and urban IPFs to 
determine how much more costly rural facilities are on a per diem basis 
under the IPF PPS. In the meantime, we are applying a 17 percent 
payment adjustment for IPFs located in a rural area as defined at Sec.  
412.64(b)(1)(ii)(C).
    Final Rule Action: In summary, we are adopting the 17 percent rural 
adjustment currently in effect for RY 2007.
3. Teaching Adjustment
    In the November 2004 IPF PPS final rule, we established a facility-
level adjustment for IPFs that are, or are part of, teaching 
institutions. The teaching status adjustment accounts for the higher 
indirect operating costs experienced by facilities that participate in 
graduate medical education (GME) programs. We have received numerous 
requests for clarification of the IPF PPS teaching adjustment, 
especially with regard to comparisons with the IPPS IME adjustment that 
were included in the November 2004 IPF PPS final rule. As a result, we 
are including an expanded explanation of the IPF PPS teaching status 
adjustment and are clarifying the changes to Sec.  412.424(d)(1)(iii) 
regarding the teaching adjustment.
    Medicare makes direct GME payments (for direct costs such as 
resident and teaching physician salaries, and other

[[Page 27068]]

direct teaching costs) to all teaching hospitals including those paid 
under the IPPS, and those that were once paid under the TEFRA rate-of-
increase limits but are now paid under other PPSs. These direct GME 
payments are made separately from payments for hospital operating costs 
and are not part of the PPSs. However, the direct GME payments do not 
address the higher indirect operating costs experienced by teaching 
hospitals. For teaching hospitals paid under the TEFRA rate-of-increase 
limits, Medicare did not make separate medical education payments 
because payments to these hospitals were based on the hospitals' 
reasonable costs. Since payments under TEFRA were based on hospitals' 
reasonable costs, the higher indirect costs that might be associated 
with teaching programs would automatically have been factored into the 
TEFRA payments.
    As previously mentioned, we conducted regression analysis of FY 
2002 IPF data as the basis for the payment adjustments included in the 
November 2004 IPF PPS final rule. In conducting the analysis, we used 
the resident counts reported on hospital cost reports (worksheet S-3, 
Part 1, line 12, column 7 for freestanding psychiatric hospitals and 
worksheet S-3, Part 1, line 14 (or line 14.01 for subprovider 2), 
column 7 for psychiatric units of acute care hospitals). That is, for 
the freestanding psychiatric hospitals, we used the number of residents 
and interns reported for the entire hospital. For the psychiatric units 
of acute care hospitals, we used the number of residents and interns 
reported for the psychiatric unit, which are reported separately on the 
cost report from the number reported for the rest of the hospital.
    The regression analysis (with the logarithm of costs as the 
dependent variable) showed that the indirect teaching cost variable is 
significant in explaining the higher costs of IPFs that have teaching 
programs. We calculated the teaching adjustment based on the IPF's 
``teaching variable,'' which is one plus the ratio of the number of 
full-time equivalent (FTE) residents training in the IPF (subject to 
limitations described below) to the IPF's average daily census (ADC).
    In the cost regressions conducted for the November 2004 IPF PPS 
final rule, the logarithm of the teaching variable had a coefficient 
value of 0.5150. We converted this cost effect to a teaching payment 
adjustment by treating the regression coefficient as an exponent and 
raising the teaching variable to a power equal to the coefficient 
value. In other words, the teaching adjustment is calculated by raising 
the teaching variable (1 + FTE residents/ADC) to the 0.5150 power. To 
compute the percentage increase in the IPF PPS payment attributable to 
the teaching adjustment (that is, the amount to be reconciled at cost 
report settlement), raise the teaching variable (1 + FTE residents/ADC) 
to the 0.5150 power. For example, for an IPF with a teaching variable 
of 0.10 and using a coefficient value of 0.5150, the per diem payment 
would increase by 5.03 percent; for an IPF with a teaching variable of 
0.05, the per diem payment would increase by 2.54 percent. We note that 
the coefficient value of 0.5150 was based on regression analysis 
holding all other components of the payment system constant.
    In addition, we established the teaching adjustment in a manner 
that limited the incentives for IPFs to add FTE residents for the 
purpose of increasing their teaching adjustment. We imposed a cap on 
the number of FTE residents that may be counted for purposes of 
calculating the teaching adjustment, similar to that established by 
sections 4621 (IME FTE cap for IPPS hospitals) and 4623 (direct GME FTE 
cap for all hospitals) of the BBA. We emphasize that the cap limits the 
number of FTE residents that teaching IPFs may count for the purposes 
of calculating the IPF PPS teaching adjustment, not the number of 
residents teaching institutions can hire or train.
    The FTE resident cap is applied the same way in freestanding 
teaching psychiatric hospitals and in distinct part psychiatric units 
with GME programs. Similar to the regulations for counting FTE 
residents under the IPPS as described in Sec.  412.105(f), we 
calculated the number of FTE residents that trained in the IPF during a 
``base year'' and use that FTE resident number as the cap. An IPF's FTE 
resident cap would ultimately be determined based on the final 
settlement of the IPF's most recent cost report filed before November 
15, 2004 (that is, the publication date of the IPF PPS final rule).
    Similar to teaching hospitals under the IPPS, IPFs that first begin 
training residents after November 15, 2004 initially receive an FTE cap 
of ``0''. The FTE caps for teaching IPFs (whether they are new or 
existing IPFs) that start training residents in a new GME program may 
be subsequently adjusted in accordance with the IPPS policies described 
in Sec.  412.105(f)(1)(vii) and GME policies described in Sec.  
413.79(e)(1)(i) and (ii). For purposes of the teaching status 
adjustment for IPFs, a new graduate medical education program means a 
medical education program that receives initial accreditation by the 
appropriate accrediting body or begins training residents on or after 
November 15, 2004. However, contrary to the policy for IME FTE resident 
caps under the IPPS, we do not allow IPFs to aggregate the FTE resident 
caps used to compute the IPF PPS teaching adjustment through 
affiliation agreements. We included these policies because we believe 
it is important to limit the total pool of resident FTE cap positions 
within the IPF community and avoid incentives for IPFs to add FTE 
residents in order to increase their payments.
    Residents with less than full-time status and residents rotating 
through the psychiatric hospital or unit for less than the entire cost 
reporting period are counted in proportion to the time they spend in 
their assignment with the IPF. For example, a 3-month rotation by a 
full-time resident to the IPF during a 12-month cost reporting period 
will be counted as 0.25 FTE for purposes of counting residents to 
calculate the ratio. No FTE resident time counted for purposes of the 
IPPS IME adjustment is permitted to be counted for purposes of the 
teaching status adjustment for the IPF PPS.
    As noted previously, the denominator used to calculate the teaching 
adjustment under the IPF PPS is the IPF's ADC from the current cost 
reporting period. We chose to use the ADC because it is closely related 
to the IPF's patient load, which affects the number of interns and 
residents the IPF can train. We also believe the ADC is a measure that 
can be defined precisely and is difficult to manipulate. Although the 
IPPS IME adjustment uses the hospital's number of beds as the 
denominator, the capital PPS (as specified at Sec.  412.322) and the 
IRF PPS (as specified at Sec.  412.624(e)(4) both use the ADC as the 
denominator for the indirect medical education and teaching 
adjustments, respectively.
    If a psychiatric hospital's or unit's FTE count of residents in a 
given year is higher than the FTE count in the base year (the base year 
being used to establish the cap), we base payments in that year on the 
lower number (the cap amount). This approach is consistent with the IME 
adjustment under the IPPS and the teaching adjustment under the IRF 
PPS. The IPF remains free to add FTE residents above the cap amount, 
but it cannot count the number of FTE residents above the cap for 
purposes of calculating the teaching adjustment. This means that the 
cap serves as an upper limit on the number of FTE residents that may be 
counted for purposes of calculating the teaching

[[Page 27069]]

status adjustment. IPFs can adjust their number of FTE residents 
counted for purposes of calculating the teaching adjustment as long as 
they remain under the cap. On the other hand, if a psychiatric hospital 
or unit were to have fewer FTE residents in a given year than in the 
base year (that is, fewer residents than its FTE resident cap), 
teaching adjustment payments in that year would be based on the lower 
number (that is, the current year's FTE count of resident).
    In response to inquiries about how the teaching adjustment is 
applied under the IPF PPS, we proposed to add a new paragraph Sec.  
412.424(d)(1)(iii)(E) to clarify that the teaching adjustment is made 
on a claim basis as an interim payment and the final payment for the 
claim would be made in full during the final settlement of the cost 
report. The difference between those interim payments and the actual 
teaching adjustment amount computed in the cost report would be 
adjusted through lump sum payments/recoupments when the cost report is 
filed and later settled.
    As noted in section VI.D.1.a of this final rule, in reviewing the 
methodology used to simulate the IPF PPS payments used for the November 
2004 IPF PPS final rule, we discovered that the computer code 
incorrectly assigned non-teaching status to most teaching facilities. 
As a result, total IPF PPS payments were underestimated by about 1.36 
percent. To resolve the issue, as discussed in section V.B.3 of this 
final rule, we are amending the Federal per diem base rate 
prospectively for all IPFs.
    As with other adjustment factors derived through the regression 
analysis, we do not plan to rerun the regression analysis until we 
analyze IPF PPS data. Until then, as proposed, we are retaining the 
0.5150 teaching adjustment to the Federal per diem base rate.
    Public comments and our responses on the proposed changes for 
implementing the teaching adjustment are summarized below:
    Comment: A commenter stated that the use of ``final settled'' cost 
reports may allow hospitals to report accurate counts during the audit 
process. However, the commenter indicated that if this is not correct, 
or if certain hospitals' 2004 cost reports have already gone through 
final settlement, CMS should take action to ensure that accurate 
resident counts for purposes of determining the IPF teaching adjustment 
resident cap.
    The commenter indicated that for the regression analysis, CMS used 
the resident count reported on Worksheet S-3, Part 1, lines 14 and 
14.01, column 7 for psychiatric units of acute care hospitals. The 
commenter expressed concern regarding the data used for the regression 
analysis due to the ambiguity of the cost reporting instructions. The 
commenter believes that this count may not accurately reflect the 
resident count in the hospital's psychiatric unit. Specifically, since 
the cost reporting instructions state that one should ``enter the 
number of interns and full time equivalents in an approved program 
determined in accordance with 42 CFR 412.105(g) for the indirect 
medical education adjustment.'' The commenter further stated that for 
cost reports before November 15, 2004, psychiatric unit resident counts 
were not eligible to be counted for purposes of the acute inpatient IME 
adjustment.
    Response: As explained in the November 2004 IPF PPS final rule and 
the RY 2007 proposed rule, similar to the regulations for counting FTE 
residents under the IPPS as described in Sec.  412.105(f), we calculate 
the number of FTE residents that trained in the IPF during a ``base 
year'' and use that FTE resident number as the cap. An IPF's FTE 
resident cap would ultimately be determined based on the final 
settlement of the IPF's most recent cost report filed before November 
15, 2004.
    Although we are concerned about the accuracy of the information 
reported in the cost report, including the number of FTE residents 
reported on Wkst. S-3, Part 1, Column 7, it is, foremost, the 
hospital's responsibility to report this data accurately. An official 
of the hospital certifies that the information on all the worksheets in 
the cost report is correct to the best of his or her knowledge and 
belief.
    Although the instructions for Column 7 of Wkst. S-3, Part I contain 
an outdated reference to Sec.  412.105(g) (that is, this reference was 
changed in the Code of Federal Regulations to Sec.  412.105(f) in 1997 
but the Wkst. S-3, Part I instructions were not updated accordingly), 
these instructions specify that the FTE resident count to be reported 
in Column 7 is determined in accordance with the policies for IME 
adjustment. We do not believe the redesignation of the relevant 
regulation should have caused confusion.
    If the hospitals believe that the FTE resident counts on the base 
year cost report are incorrect, they have an option of submitting an 
amended cost report or requesting a reopening.
    Comment: One commenter indicated a discrepancy between the 
reference to the regulation regarding the base period for determining 
the IPF's FTE resident in the RY 2007 IPF PPS proposed rule (71 FR 
3653) and the reference to that regulation in the current Code of 
Federal Regulations (CFR). The commenter stated that the RY 2007 IPF 
PPS proposed rule cited Sec.  412.424(d)(1)(iii)(C) as the relevant 
regulation, while the current CFR reference can be found at Sec.  
412.424(d)(1)(iii)(B)(1).
    Response: The existing regulation at Sec.  412.424(d)(1)(iii)(C) 
implements the FTE resident cap for purposes of the IPF teaching status 
adjustment. The FTE resident cap is established in the base period as 
specified in the November 2004 IPF PPS final rule (69 FR 66979), and 
codified in regulations at Sec.  412.424(d)(1)(iii)(B)(1). The 
reference in the RY 2007 IPF PPS proposed rule (71 FR 3653) reflects 
the proposal to redesignate portions of the reference to the teaching 
status adjustment. In this final rule, we will finalize the reference 
(and all other changes as proposed) to the base period to be Sec.  
412.424(d)(1)(iii)(C) and will replace Sec.  412.424(d)(1)(iii)(B)(1) 
currently in the CFR.
    Comment: One commenter requested clarification about application of 
the FTE resident cap for those IPFs that begin training residents after 
November 15, 2004.
    Response: As we indicated in the RY 2007 proposed rule, IPFs that 
did not train interns and residents during the time period of the IPF's 
most recent cost report filed before November 15, 2005 would receive an 
FTE cap of ``zero''. As a result, we would not apply a teaching 
adjustment to claims submitted by the IPF. However, if the IPF (whether 
it is new or existing) begins training residents in a new medical 
residency training program after that date, the IPF will begin to 
receive the teaching adjustment under the IPF PPS in the next cost 
reporting period based on the FTE intern and resident count in 
accordance with the policies applicable under the IPPS.
    In this case, the FTE resident cap would not be revised until the 
beginning of the fourth year of the new training program. The cap is 
set based on a review of the number of interns and residents in each of 
the first three program years. Before the completion of the third year 
of the new training program, the actual intern and resident count is 
reported on the cost report and used for the calculation of the 
teaching adjustment for the first three years of the new teaching 
program. After the third year of the new program, we revise the IPF's 
FTE resident cap to reflect the new training program. The revised cap 
is calculated by multiplying the highest number of interns and 
residents in any program year by the number of years in

[[Page 27070]]

which residents are expected to complete the program.
    For subsequent years, we compare the actual number of interns and 
residents trained in the IPF that year to the revised FTE resident cap 
and base the teaching adjustment on the lower number.
    Final Rule Action: In summary, we are retaining the coefficient 
value of 0.5150 for the teaching adjustment. In Sec.  412.402, we are 
providing a definition for ``new graduate medical education program'' 
to mean a medical education program that receives initial accreditation 
by the appropriate accrediting body or begins training residents on or 
after November 15, 2004.
    We are also clarifying at Sec.  412.424(d)(1)(iii)(E) that the 
teaching adjustment is made on a claim basis as an interim payment, and 
the final payment in full for the claim is made during the final 
settlement of the cost report.
4. Cost of Living Adjustment for IPFs Located in Alaska and Hawaii
    The IPF PPS includes a payment adjustment for IPFs located in 
Alaska and Hawaii based upon the county in which the IPF is located. As 
we explained in the November 2004 IPF PPS final rule, the FY 2002 data 
demonstrated that IPFs in Alaska and Hawaii had per diem costs that 
were disproportionately higher than other IPFs. Other Medicare PPSs 
(for example, IPPS and IRF PPS) have adopted a cost of living 
adjustment (COLA) to account for the cost differential of care 
furnished in Alaska and Hawaii. We analyzed the effect of applying a 
COLA to payments for IPFs located in Alaska and Hawaii. The results of 
our analysis demonstrated that a COLA for IPFs located in Alaska and 
Hawaii would improve payment equity for these facilities. As a result 
of this analysis, we provided a COLA adjustment in the November 2004 
IPF PPS final rule. We are also adopting the same COLA adjustment in 
this final rule.
    In general, the COLA accounts for the higher costs in the IPF and 
eliminates the projected loss that IPFs in Alaska and Hawaii would 
experience absent the COLA. A COLA factor for IPFs located in Alaska 
and Hawaii is made by multiplying the non-labor share of the Federal 
per diem base rate by the applicable COLA factor based on the county in 
which the IPF is located.
    Table 15 below lists the specific COLA for Alaska and Hawaii IPFs. 
The COLA factors were obtained from the U.S. Office of Personnel 
Management (OPM). The COLA factors are published on the U.S. Office of 
Personnel Management (OPM) Web site (http://www.opm.gov/oca/cola/rates.asp). As proposed and in this final rule, we are adopting the 
COLA adjustments obtained from OPM. We will update the COLA factors if 
OPM updates them and as updated by OPM. Any change in the COLA factors 
will be made in one of our IPF PPS RY update documents. We are also 
amending Sec.  412.428 to enable us to update the COLA factors if 
appropriate.

       Table 15.--Proposed COLA Factors for Alaska and Hawaii IPFs
------------------------------------------------------------------------
                                             Location            COLA
------------------------------------------------------------------------
Alaska..............................  All areas.............      1.25
Hawaii..............................  Honolulu County.......      1.25
                                      Hawaii County.........      1.165
                                      Kauai County..........      1.2325
                                      Maui County...........      1.2375
                                      Kalawao County........      1.2375
------------------------------------------------------------------------

    Final Rule Action: In summary, we did not receive any public 
comments on the proposed COLA for IPFs located in Alaska and Hawaii. We 
are adopting the COLA adjustments obtained from OPM currently in 
effect, and as shown in Table 15 above. We will update the COLA factors 
as updated by OPM. In addition, we are amending Sec.  412.428 to enable 
us to update the COLA factors, if appropriate.
5. Adjustment for IPFs With a Qualifying Emergency Department (ED)
    Currently, the IPF PPS includes a facility-level adjustment for 
IPFs with qualifying EDs. As explained in the November 2004 IPF PPS 
final rule, we provide an adjustment to the standardized Federal per 
diem base rate to account for the costs associated with maintaining a 
full-service ED. The adjustment is intended to account for ED costs 
allocated to the hospital's distinct part psychiatric unit for 
preadmission services otherwise payable under Medicare Part B furnished 
to a beneficiary during the day immediately preceding the date of 
admission to the IPF (see Sec.  413.40(c)) and the overhead cost of 
maintaining the ED. This payment is a facility-level adjustment that 
applies to all IPF admissions (with the one exception as described 
below), regardless of whether a particular patient receives 
preadmission services in the hospital's ED.
    The ED adjustment is incorporated into the variable per diem 
adjustment for the first day of each stay for IPFs with a qualifying 
ED. That is, IPFs with a qualifying ED receive a 31 percent adjustment 
as the variable per diem adjustment for day 1 of each stay. If an IPF 
does not have a qualifying ED, it receives a 19 percent adjustment as 
the variable per diem adjustment for day 1 of each patient stay.
    While any IPF with a qualifying ED receives the adjustment, the 
adjustment is paid most often to IPFs that are psychiatric units of 
acute care hospitals or critical access hospitals because these 
providers are more likely to have an ED that meets the definition of a 
qualified ED in Sec.  412.424(d)(1)(v). We defined a qualifying ED in 
order to avoid providing the ED adjustment to an intake unit that is 
not comparable to a full-service ED with respect to the array of 
emergency services available or cost. We defined a qualifying ED as one 
that is staffed and equipped to furnish a comprehensive array of 
emergency services and that meets the definition of a ``dedicated 
emergency department'' as specified in Sec.  489.24(b) and the 
definition of ``provider-based status'' as specified in Sec.  413.65. 
We intended that a qualifying ED provide a comprehensive array of 
medical and psychiatric services. In order to clarify that a 
comprehensive array of emergency services includes medical as well as 
psychiatric services, we proposed to amend Sec.  412.424(d)(1)(v)(A).
    As specified in Sec.  489.24, a dedicated ED means ``any department 
or facility of the hospital, regardless of whether it is located on or 
off the main hospital campus, that meets at least one of the following 
requirements:
     It is licensed by the State in which it is located under 
applicable State law as an emergency room or emergency department;
     It is held out to the public (by name, posted signs, 
advertising, or other means) as a place that provides care for 
emergency medical conditions on an urgent basis without requiring a 
previously scheduled appointment; or
     During the calendar year immediately preceding the 
calendar year in which a determination under this section is being 
made, based on a representative sample of patient visits that occurred 
during the calendar year, it provides at least one-third of all its 
outpatient visits for the treatment of emergency medical conditions on 
an urgent basis without requiring a previously scheduled appointment.''
    As specified in Sec.  413.65, provider-based status means ``the 
relationship between a main provider and a provider-based entity or a 
department of a provider, remote location of a hospital, or satellite 
facility that complies with the provisions.'' Including provider-based 
status in the definition of a qualifying ED reflects the common

[[Page 27071]]

ownership of the hospital and the distinct part psychiatric unit.
    As discussed in the November 2004 IPF PPS final rule, three steps 
were involved in the calculation of the ED adjustment factor.
    Step 1: We estimated the proportion by which the ED costs of a case 
would increase the cost of the first day of the stay. Using the IPFs 
with ED admissions in FY 2002, we divided their average ED cost per 
stay admitted through the ED ($198) by their average cost per day 
($715), which equals 0.28.
    Step 2: We adjusted the factor estimated in step 1 to account for 
the fact that we would pay the higher first day adjustment for all 
cases in the qualifying IPFs, not just the cases admitted through the 
ED. Since on average, 44 percent of the cases in IPFs with ED 
admissions are admitted through the ED, we multiplied 0.28 by 0.44, 
which equals 0.12.
    Step 3: We added the adjusted factor calculated in the previous 2 
steps to the variable per diem adjustment derived from the regression 
equation that we used to derive our other payment adjustment factors. 
The first day payment factor from this regression is 1.19. Adding the 
0.12, we obtained a first day variable per diem adjustment for IPFs 
with a qualifying ED equal to 1.31.
    The ED adjustment is made on every qualifying claim except as 
described below. As specified in Sec.  412.424(d)(1)(v)(B), the ED 
adjustment is not made where a patient is discharged from an acute care 
hospital or CAH and admitted to the same hospital's or CAH's 
psychiatric unit. An ED adjustment is not made in this case because the 
costs associated with ED services are reflected in the DRG payment to 
the acute care hospital or through the reasonable cost payment made to 
the CAH. As we explained in the November 2004 IPF PPS final rule, if we 
provided the ED adjustment in these cases, the hospital would be paid 
twice for the overhead costs of the ED (69 FR 66960).
    Therefore, when patients are discharged from an acute care hospital 
or CAH and admitted to the same hospital's or CAH's psychiatric unit, 
the IPF receives the 1.19 adjustment factor as the variable per diem 
adjustment for the first day of the patient's stay in the IPF. We do 
not intend to conduct a new regression analysis for this IPF PPS 
update. Rather, we plan to wait until we analyze IPF PPS data. 
Therefore, we are retaining the 1.31 adjustment factor for IPFs with 
qualifying EDs for the RY beginning July 1, 2006.
    As we indicated in the November 2004 IPF PPS final rule, in FY 
2002, one third of the IPFs admissions were through the ED. In the 
November 2003 IPF proposed rule (68 FR 66920) the percentage of 
admissions through the ED were understated. We plan to monitor claims 
data to determine the number of IPF admissions admitted through the ED.
    Public comments and our responses on the proposed adjustment for 
IPFs with qualifying EDs are summarized below:
    Comment: A few commenters questioned whether IPFs would have to 
reapply for the ED adjustment annually. Specifically, commenters asked 
whether it is necessary to re-submit verification of a qualifying ED 
each year.
    Other commenters asked for clarification as to whether the ED 
adjustment can still be applied based on the date the attestation 
letter is received or would the IPFs lose the adjustment for the entire 
cost reporting year.
    Response: We indicated in instructions ( Transmittal 384, CR 3541 
dated December 1, 2004 and Transmittal 444, CR 3678 dated January 21, 
2005) that IPFs should notify their FIs 30 days before the beginning of 
their cost reporting period regarding if they have a qualifying ED. FIs 
have the discretion as to how they wish to be notified and as to the 
type of documentation they require. Once the FI is satisfied that the 
IPF has a qualifying ED, the FI should enter the information in the 
provider-specific file within a reasonable timeframe so that the IPF 
can begin to receive the ED adjustment. This is a one-time 
verification. Application of the ED adjustment is prospective.
    FIs may also use the date the documentation was received from the 
IPF to implement the ED adjustment. The provider-specific file can be 
updated from the date of the attestation and claims processed from that 
date will receive the ED adjustment. We do not intend that IPFs would 
have to wait until the beginning of their next cost report period to 
receive the ED adjustment.
    However, if an IPF no longer meets the definition of a qualified 
ED, the IPF must notify their FI. The FI would immediately remove the 
flag from the provider-specific file and the provider will not receive 
the ED adjustment. If the provider should once again meet the 
definition of a qualified ED, they should contact their FI immediately 
in order to update their file.
    Comment: One commenter asked what criteria CMS would use to 
determine what constitutes a ``comprehensive'' array of medical as well 
as psychiatric services. In addition, the commenter asked if the 
criteria are appropriate and would ensure high-quality care for 
psychiatric patients.
    Response: In most cases, the FI would be familiar enough with the 
providers they service to know if the hospital has a qualifying ED. In 
those rare cases where the FI does not know whether the hospital's ED 
meets our definition of a qualifying ED (for example, new IPFs), the FI 
will establish that the IPF's ED is staffed and equipped to furnish a 
comprehensive array of emergency services. In response to the comment, 
we are clarifying in Sec.  412.424(d)(1)(v)(A) that a qualifying ED is 
staffed and equipped to furnish both medical as well as psychiatric 
emergency services.
    Final Rule Action: We are retaining the 1.31 percent adjustment 
factor for IPFs with qualifying EDs for the RY 2007.
a. New Source of Admission Code to Implement the ED Adjustment
    In order to ensure that the ED adjustment is not paid for patients 
who are discharged from an acute care hospital or CAH and admitted to 
the same hospital's or CAH's psychiatric unit, we directed IPFs to 
enter source of admission code ``4'' (transfers from hospital 
inpatient) on those claims. The source of admission code is a required 
field on Medicare claims and indicates the source of the patient 
admissions. However, as we implemented the IPF PPS, we realized that 
admission code ``4'' is too broad to distinguish these claims because 
it reflects transfers from any acute care hospital or CAH. Currently, 
where admission code ``4'' is entered on a claim, the ED adjustment is 
not paid, even if the patient is transferred from a different acute 
hospital or CAH.
    In order to pay these IPF claims appropriately, CMS requested a new 
source of admission code from the National Uniform Billing Committee to 
identify transfers from the same hospital or CAH. On June 07, 2005, the 
National Uniform Billing Committee granted our request to establish a 
new source of admission code to indicate transfers from the same 
hospital or CAH. The new source of admission code ``D'' is effective 
April 1, 2006. As proposed and in this final rule, the new code will be 
used by IPFs to identify IPF patients who have been transferred to the 
IPF from the same hospital or CAH. Claims with source of admission code 
``D'' will not receive the ED adjustment.
    Public comments and our response on the proposed new source of 
admission code to implement the ED adjustment are summarized below:

[[Page 27072]]

    Comment: Several commenters indicated that CMS should not penalize 
IPFs if they receive a transfer from the acute care medical-surgical 
units of the same hospital. A commenter stated that there may only be 
one hospital with a psychiatric emergency department in a particular 
area. The commenter believes that to penalize the transfers is unfair; 
each facility whether it is the ED, surgical unit, medical unit or 
psychiatric unit is doing their job and should be appropriately 
compensated.
    Response: As stated in the November 2004 final rule and the RY 2007 
proposed rule, in Sec.  412.424(d)(1)(v)(B) we specify that the ED 
adjustment is not made when a patient is discharged from an acute care 
hospital or CAH and admitted to the same hospital's or CAH's 
psychiatric unit. The ED adjustment is not made in this case because 
the costs associated with the ED services are already reflected in the 
DRG payment paid to the acute care hospital or through the reasonable 
cost payment made to the CAH. As explained in the November 2004 IPF PPS 
final rule and in the RY 2007 proposed rule, if we provided the ED 
adjustment in these cases, the hospital would be paid twice for 
overhead costs of the ED (see 69 FR 66960 and 71 FR 3641 respectively).
    We note that the ED adjustment is a facility-level adjustment, 
rather than a patient-level adjustment. This facility-level adjustment 
applies to psychiatric hospitals and acute care hospitals with distinct 
part units, and CAHs that maintain a qualifying ED. We are providing 
the adjustment to psychiatric units in acute care hospitals or CAHs, 
and psychiatric hospitals because the costs of the ED are allocated to 
all hospital departments, including the psychiatric units. Also, the 
adjustment is intended to account for ED costs allocated to the 
distinct part psychiatric unit for preadmission services otherwise 
payable under Medicare Part B furnished to a beneficiary during the day 
immediately preceding the date of admission to the IPF and the overhead 
cost of maintaining the ED.
    In order to ensure that Medicare does not pay twice for these types 
of transfers, we proposed that admission code ``D'' be used by IPFs to 
identify IPF patients who have been transferred to the IPF from the 
same hospital or CAH. Claims with source of admission code ``D'' will 
not receive the ED adjustment.
    Final Rule Action: We are finalizing our decision to adopt the new 
source of admission code ``D''. Claims with source of admission code 
``D'' will not receive the ED adjustment.
b. Applicability of the ED Adjustment to IPFs in Critical Access 
Hospitals
    The BBA created the CAH program, designed to represent a separate 
provider type to provide acute care services in rural areas. Generally, 
in order to qualify as a CAH, a hospital must--
     Be located in a rural area;
     Provide 24-hour emergency care services;
     Have an average LOS of 96 hours or less;
     Operate up to 25 beds for inpatient critical access care;
     Be located more than 35 miles from a hospital or another 
CAH or more than 15 miles in mountainous terrain or only secondary 
roads;
     Or be certified by the State as of December 31, 2005 as 
being a ``necessary provider'' of health care services to residents in 
the area.
    Section 405(g) of the MMA authorizes CAHs to establish distinct 
part psychiatric and rehabilitation units of up to 10 beds effective 
for cost reporting periods beginning on or after October 1, 2004. 
Services in these units are paid under the payment methodology that 
would apply if the services were provided in a distinct part 
psychiatric or rehabilitation unit of a hospital. As a result, IPFs 
that are distinct part units of CAHs are paid the same as if they were 
a distinct part unit of a hospital. Otherwise, the CAH is paid on a 
reasonable cost basis for inpatient critical access services.
    In the November 2004 IPF PPS final rule, we amended Sec.  413.70(e) 
to clarify that payments for services of distinct part psychiatric 
units in CAHs are made in accordance with the IPF PPS. In order to pay 
CAHs the same as other IPFs, CAHs would be subject to the 1-day 
preadmission services bundling provision specified in Sec.  
413.40(c)(2) for patients who are admitted to the CAH's IPF. As a 
result, the cost of preadmission services, including ED services 
furnished to CAH IPF patients would be allocated to the IPF.

D. Other Payment Adjustments and Policies

    The IPF PPS includes the following payment adjustments: (1) An 
outlier policy to promote access to IPF care for those patients who 
require expensive care and to limit the financial risk of IPFs treating 
unusually costly patients; (2) a stop-loss provision, applicable during 
the transition period, to reduce financial risk to IPFs projected to 
experience substantial reductions in Medicare payments under the IPF 
PPS; (3) an interrupted stay policy to avoid overpaying stays that 
include a brief absence from the IPF followed by readmission to the 
IPF; and (4) a payment for patients who receive ECT. As proposed, we 
are updating those policies in this final rule. We are also making 
clarifications to the physician certification and recertification 
requirements in order to ensure consistent practices across IPFs. In 
addition, we are clarifying coverage of recreation therapy.
1. Outlier Payments
    In the November 2004 IPF PPS final rule, we implemented regulations 
at Sec.  412.424(d)(3)(i) to provide a payment adjustment for IPF stays 
that have extraordinarily high costs. Providing additional payments for 
outlier cases to IPFs that are beyond the IPF's control strongly 
improves the accuracy of the IPF PPS in determining resource costs at 
the patient and facility level because facilities receive additional 
compensation over and above the adjusted Federal prospective payment 
amount for uniquely high-cost cases. These additional payments reduce 
the financial losses that would otherwise be caused by treating 
patients who require more costly care and, therefore, reduce the 
incentives to under-serve these patients.
    Under the IPF PPS, outlier payments are made on a per case basis 
rather than on a per diem basis because it is the overall financial 
``gain'' or ``loss'' of the case, and not of individual days, that 
determines an IPF's financial risk. In addition, because patient-level 
charges (from which costs are estimated) are typically aggregated for 
the entire IPF stay, they are not reported in a manner that would 
permit accurate accounting on a daily basis.
    Currently, we make outlier payments for discharges in which an 
IPF's estimated total cost for a case exceeds a fixed dollar loss 
threshold amount (multiplied by the IPF's facility-level adjustments) 
plus the Federal per diem payment amount for the case.
    In instances when the case qualifies for an outlier payment, we pay 
80 percent of the difference between the estimated cost for the case 
and the adjusted threshold amount for days 1 through 9 of the stay 
(consistent with the median length of stay for IPFs in FY 2002), and 60 
percent of the difference for day 10 and thereafter. We established the 
80 percent and 60 percent loss sharing ratios because we were concerned 
that a single ratio established at 80 percent (like other Medicare 
hospital PPSs) might provide an incentive under the IPF per diem 
payment system to increase length of

[[Page 27073]]

stay in order to receive additional payments. After establishing the 
loss sharing ratios, we determined the current fixed dollar loss 
threshold amount of $5,700 through payment simulations designed to 
compute a dollar loss beyond which payments are estimated to meet the 2 
percent outlier spending target.
a. Update to the Outlier Fixed Dollar Loss Threshold Amount
    As indicated in section II.A. of this final rule, in accordance 
with the update methodology described in Sec.  412.428(d), we are 
updating the fixed dollar loss threshold amount used under the IPF PPS 
outlier policy. Based on the regression analysis and payment 
simulations used to develop the IPF PPS, we established a 2 percent 
outlier policy to make an appropriate balance between protecting IPFs 
from extraordinarily costly cases while ensuring the adequacy of the 
Federal per diem base rate for all other cases that are not outlier 
cases.
    We continue to believe a 2 percent outlier policy is an appropriate 
target percentage and proposed to retain the 2 percent outlier policy. 
However, we believe it is necessary to update the fixed dollar loss 
threshold amount because analysis of the latest available data and rate 
increases indicates adjusting the fixed dollar loss amount is necessary 
in order to maintain an outlier percentage that equals 2 percent of 
total estimated IPF PPS payments. We intend to continue to analyze 
estimated outlier payments for subsequent years using the best 
available data in order to maintain estimated outlier payments at 2 
percent of total estimated IPF PPS payments.
    We have determined that in certain sections of the November 2004 
IPF PPS final rule, we used the phrase ``Fixed-dollar loss threshold'' 
and, in other sections, we used the phrase ``Fixed-dollar loss amount'' 
to describe the dollar amount by which the costs of a case exceed 
payment in order to qualify for an outlier payment. In order to avoid 
confusion regarding these phrases, we are using the term ``fixed-dollar 
loss threshold amount'' when we are referring to the dollar amount by 
which the costs of a case exceed payment in order to qualify for an 
outlier payment.
    As a result of this clarification, in Sec.  412.402, we are 
revising the term ``Fixed dollar loss threshold'' to ``Fixed dollar 
loss threshold amount.'' We are also making clarifying changes to Sec.  
412.424(d)(3)(i) and Sec.  412.424(d)(3)(i)(A) to state that we will 
provide an outlier payment if an IPF's estimated total cost for a case 
exceeds a ``fixed dollar loss threshold amount'' plus the total IPF 
adjusted payment amount for the stay, and that it is the fixed dollar 
loss threshold amount that is adjusted by the IPF's facility-level 
adjustments.
    Aside from updating the terminology ``fixed dollar loss threshold 
amount'' and making the conforming changes to the regulation text 
described above, we did not propose to make any other changes to the 
outlier policy. Therefore, we will continue to adjust the fixed dollar 
loss threshold amount by the applicable facility-level payment 
adjustments and add this amount to the IPF PPS payment amount in order 
to determine if a case qualifies for an outlier payment. For cases that 
meet the threshold amount, we will pay 80 percent for days 1 through 9 
and 60 percent for day 10 and thereafter.
    In the November 2004 IPF PPS final rule, we described the process 
by which we calculate the outlier fixed dollar loss threshold amount. 
We will continue to use this process in this final rule. We begin by 
simulating aggregate payments with and without an outlier policy, and 
applying an iterative process to a fixed dollar loss amount that will 
result in outlier payments being equal to 2 percent of total simulated 
payments under the simulation. Based on this process, we proposed a 
fixed dollar loss threshold amount of $6200 for RY 2007. In this final 
rule, we are finalizing this amount. For RY 2007, IPF PPS will use 
$6200 as the fixed dollar loss threshold amount in the outlier 
calculation in order to maintain the proposed 2 percent outlier policy.
    We note that the simulation analysis used to calculate the $6200 
fixed dollar loss threshold amount includes all of the changes to the 
IPF PPS discussed in this final rule.
    Public comments and our responses to changes to the outlier fixed 
dollar loss threshold amount are summarized below.
    Comment: Several commenters requested that CMS use FY 2005 claims 
data to ensure that the fixed dollar loss threshold amount is correctly 
set, and if that data are not available, the commenters recommended 
that CMS keep the threshold at its current level.
    Other commenters suggested that since CMS is not making any other 
changes to the major adjustments, changes should not be made to adjust 
the fixed dollar loss threshold amount. They felt that an increase in 
the threshold is unnecessary and might lead to a financial burden on 
IPFs. One commenter asked how CMS could accurately determine that 2 
percent is the best outlier percentage and that the threshold amounts 
are appropriate.
    Response: A complete set of FY 2005 claims data will not be 
available until later in the year, therefore we will not be able to 
analyze this data in time for publication of this final rule. It is 
necessary to update the fixed dollar loss threshold amount because we 
are increasing the Federal per diem base rate and the ECT payment rate. 
We are using the best available data to compute the updated fixed 
dollar loss threshold amount in our payment simulations. As stated 
above, we believe 2 percent is the optimal outlier percentage because 
it strikes an appropriate balance between protecting IPFs from 
extraordinarily costly cases while ensuring the adequacy of the Federal 
per diem base rate for all other cases that are not outlier cases. In 
the future, as IPF PPS data becomes available, we can analyze the 
accuracy of the fixed dollar loss threshold amount.
    Comment: Several commenters recommended that CMS provide a detailed 
description of the methodology used in calculating the fixed dollar 
loss threshold amount.
    Response: We estimate the cost of each case and inflate these costs 
to RY 2007 dollars in our simulations. We used FY 2002 claims and cost 
report data to estimate the cost per stay. We calculated these costs by 
taking routine per diem costs from the cost report (for the routine 
costs) and by taking departmental charges and cost-to-charge ratios 
(for the ancillary costs). These are the costs we then inflated to RY 
2007 dollars in our payment simulations. We then applied RY 2007 rates 
and policies in our payment simulations to compute the updated fixed 
dollar loss threshold amount.
    Comment: Several commenters requested that CMS use the same 
methodology as IPPS to calculate the threshold.
    Response: The cost-to-charge ratio applied to charges provides 
Medicare the most accurate measure of a provider's per-case cost for 
the purpose of paying for high-cost outlier cases at the point that we 
process the initial claim. The cost-to-charge ratio is based on the 
providers' own cost and charge information as reported by the 
providers. In this final rule, we have applied the cost-to-charge 
ratios to the reported charges to estimate the cost per case, and 
inflated the costs to current dollars. In the future, when more recent 
data is available, we will consider whether using the IPPS methodology 
of inflating the charges and applying the latest cost-to-charge ratios 
to estimate the cost per case is an even more accurate method of 
calculating the threshold amount.

[[Page 27074]]

    Comment: One commenter suggested that CMS investigate the 
possibility and legality of carrying over any unused outlier money from 
year to year.
    Response: We have responded to similar comments a number of times 
in the context of other PPS regulations, ((70 FR 24168), (70 FR 24196 
through 24197), (57 FR 39784), (58 FR 46347), (59 FR 45408), (60 FR 
45856), (61 FR 27496), (56 FR 43227), and (61 FR 46229 through 46230)). 
As we have explained before and as explained below, we do not make 
adjustments to PPS payment rates to account for differences between 
projected and actual outlier payments in a previous year.
    We implemented the IPF PPS outlier policy at Sec.  
412.424(d)(3)(i). We set outlier criteria so that outlier payments are 
projected to equal 2 percent of estimated total IPF PPS payments. In 
doing so, we use the best available data at the time to make our 
estimates.
    Outlier payments are ``funded'' through a prospective adjustment to 
the base rate. We do not set money aside into a discrete ``pool'' 
dedicated solely for outlier payments. Outlier payments are based on 
estimates. If outlier payments for a given year are greater than 
projected, we do not recoup money from IPFs; if outlier payments for a 
given year are lower than projected, we do not make an adjustment to 
account for the difference. If estimates turn out to be inaccurate, we 
believe the more appropriate action is to continue to examine the 
outlier policy and to try to refine the methodology for setting outlier 
thresholds. Thus, consistent with this approach, for this final rule we 
are finalizing our decision to update the outlier threshold amount to 
$6200 for RY 2007 to make estimated outlier payments equal to 2 percent 
of total estimated IRF PPS payments in RY 2007.
    Final Rule Action: In this final rule, we are adopting $6200 as the 
fixed dollar loss threshold amount for RY 2007.
b. Statistical Accuracy of Cost-to-Charge Ratios
    As stated previously, under the IPF PPS, an outlier payment is made 
if an IPF's cost for a stay exceeds a fixed dollar loss threshold 
amount. In order to establish an IPF's cost for a particular case, we 
multiply the IPF's reported charges on the discharge bill by their 
overall cost to charge ratio (CCR). This approach to determining a 
provider's cost is consistent with the approach used under the IPPS and 
other prospective payment systems. In FY 2004, we implemented changes 
to the IPPS outlier policy used to determine CCRs for acute care 
hospitals because we became aware that payment vulnerabilities resulted 
in inappropriate outlier payments. Under the IPPS, we established a 
statistical measure of accuracy for CCRs in order to ensure that 
aberrant CCR data did not result in inappropriate outlier payments. As 
we indicated in the November 2004 IPF PPS final rule, because we 
believe the IPF outlier policy is susceptible to the same payment 
vulnerabilities as the IPPS, we adopted an approach to ensure the 
statistical accuracy of CCRs under the IPF PPS. Therefore, we adopted 
the following in the November 2004 IPF PPS final rule:
     We calculated two national ceilings, one for IPFs located 
in rural areas and one for IPFs located in urban areas. We computed the 
ceilings by first calculating the national average and the standard 
deviation of the CCR for both urban and rural IPFs.
    To determine the rural and urban ceilings, we multiplied each of 
the standard deviations by 3 and added the result to the appropriate 
national CCR average (either rural or urban). The upper threshold CCR 
for IPFs in RY 2007 is 1.7447 for rural IPFs, and 1.7179 for urban 
IPFs, based upon CBSA-based geographic designations. If an IPF's CCR is 
above the applicable ceiling, the ratio is considered statistically 
inaccurate and we assign the appropriate national (either rural or 
urban) median CCR to the IPF.
    Additional information regarding the national median CCRs is 
included in the November 2004 IPF PPS final rule (69 FR 66961).
     We do not apply the applicable national median CCR when an 
IPF's CCR falls below a floor. We made this decision because using the 
national median CCR in place of the provider's actual CCR would 
overstate the IPF's costs. We are applying the national CCRs to the 
following situations:
    ++ New IPFs that have not yet submitted their first Medicare cost 
report.
    ++ IPFs whose operating or capital CCR is in excess of 3 standard 
deviations above the corresponding national geometric mean (that is, 
above the ceiling).
    ++ Other IPFs for whom the fiscal intermediary obtains inaccurate 
or incomplete data with which to calculate either an operating or 
capital CCR or both.
    For new facilities, we are using these national ratios until the 
facility's actual CCR can be computed using the first tentatively 
settled or final settled cost report, which will then be used for the 
subsequent cost report period.
    We are not making any changes to the procedures for ensuring the 
statistical accuracy of CCRs in RY 2007. However, we are updating the 
national urban and rural CCRs (ceilings and medians) for IPFs for RY 
2007 based on the full CY 2005 CCRs entered in the provider-specific 
file. In addition, we are updating the ceilings and national median 
CCRs will be based on CBSA-based geographic designations because the 
CBSAs are the geographic designations we are adopting for purposes of 
computing the proposed wage index adjustment to IPF payments beginning 
July 1, 2006. The national CCRs for RY 2007 were estimated to be 0.7100 
for rural IPFs and 0.5500 for urban IPFs and will be used in each of 
the three situations cited above. These estimates were based on the 
IPF's location (either urban or rural) using the CBSA-based geographic 
designations.
    In this final rule, we are finalizing our decision to update the 
national urban and rural CCRs (median and ceilings) based on the 
previous full CYs' provider-specific file. These CCRs will be announced 
in each year's annual notice of prospective payment rates published in 
the Federal Register. We are adding a new paragraph (g) to Sec.  
412.428 to clarify that we intend to update the national urban and 
rural ceilings and medians as part of the annual update of the IPF PPS 
and to specify when the national median urban and rural CCRs will be 
used.
    Comment: One commenter asked that a provision be added to the 
national median CCR policy that an exception to the computed CCR be 
allowed to be filed with the FI if using the national median CCR 
overstates the IPF's costs.
    Response: CMS believes that the actual CCR reported on the cost 
report should be used to calculate outlier payments. In the vast 
majority of cases, the IPF's CCR will be updated within a year, when 
the next cost report is filed. An interim cost report can be filed for 
special cases, in which case the updated CCR can be used. However, 
allowing IPFs to continually submit cost and charge data could create a 
burden for Fiscal Intermediaries. Finally, if the IPF is dissatisfied 
with the amount of payment, they can invoke existing appeal rights.
2. Stop-Loss Provision
    In the November 2004 IPF PPS final rule, we implemented a stop-loss 
policy to reduce financial risk for those facilities expected to 
experience substantial reductions in Medicare payments during the IPF 
PPS transition period. This stop-loss policy guarantees that each 
facility receives total IPF PPS

[[Page 27075]]

payments that are no less than 70 percent of its TEFRA payments, had 
the IPF PPS not been implemented.
    This policy is applied to the IPF PPS portion of Medicare payments 
during the 3-year transition. Hence, during year 1, when three-quarters 
of the payment were based on TEFRA and one-quarter on the IPF PPS; stop 
loss payments guarantee payments which are at least 70 percent of the 
TEFRA payments. The resulting 92.5 percent of TEFRA payments in year 1 
is the sum of 75 percent and 25 percent times 70 percent.
    In year 2, one-half of the payment will be based on TEFRA and one-
half on the IPF PPS. In year 3, one-quarter of the payment will be 
based on TEFRA and three-quarters on the IPF PPS. In year 4 of the IPF 
PPS, Medicare payments are based 100 percent on the IPF PPS.
    The combined effects of the transition and the stop-loss policies 
will be to ensure that the total estimated IPF PPS payments are no less 
than 92.5 percent in year 1, 85 percent in year 2, and 77.5 percent in 
year 3. We are not making any changes to the Stop-Loss provision.
3. Patients Who Receive Electroconvulsive Therapy (ECT)
    In developing the IPF PPS, we received numerous public comments 
recommending that we include a payment adjustment for patients who 
receive ECT treatments during their IPF stay because furnishing ECT 
treatment, either directly or under arrangements, adds significantly to 
the cost of these stays. When we analyzed the FY 2002 MedPAR data, we 
found that ECT cases comprised about 6 percent of all cases and that 
almost 95 percent of ECT cases were treated in IPFs that are 
psychiatric units of acute care hospitals. Even among psychiatric 
units, ECT cases are concentrated among a relatively small number of 
facilities. Overall, approximately 450 facilities had cases with ECT. 
Among these facilities, we estimated the mean number of ECT cases per 
facility to be approximately 25. In addition, approximately one-half of 
the IPFs providing ECT had no more than 15 cases in FY 2002.
    Our analysis confirmed that cases with ECT are substantially more 
costly than cases without ECT. We found that on a per case basis, ECT 
cases are approximately twice as expensive as non-ECT cases ($16,287 
compared to $7,684). Most of this difference is due to variation in LOS 
(20.5 days for ECT cases compared to 11.6 days for non-ECT cases). In 
addition, the ancillary costs per case for ECT cases are $2,740 higher 
than those for non-ECT cases.
    Although we are able to determine the cost of stays with ECT, we 
are unable to develop an ECT cost per treatment using the FY 2002 IPF 
claims data because the claims do not include the number of treatments. 
As a result, in the November 2004 IPF PPS final rule, we established 
the following methodology for calculating the IPF PPS ECT payment 
adjustment.
    We established an ECT base rate using the pre-scaled and pre-
adjusted median hospital cost for CPT procedure code 90870 used for 
payment under hospital outpatient PPS (OPPS), based on hospital claims 
data. The median cost for all OPPS services are posted after 
publication of the OPPS proposed rule at the following address: http://www.cms.hhs.gov/hospitaloutpatientPPS. We used unadjusted hospital 
claims data under the OPPS, that is, the pre-scaled and pre-adjusted 
median hospital cost per treatment, to establish the ECT base rate 
because we did not want the ECT payment under the IPF PPS to be 
affected by factors that are relevant to OPPS but not specifically 
applicable to IPFs. The median cost ($311.88) was then standardized and 
adjusted for budget neutrality, resulting in an ECT payment adjustment 
of $247.96 per treatment. The ECT base rate is adjusted for wage and 
COLA differences in the same manner that we adjust the Federal per diem 
base rate.
    In order to receive the payment adjustment, IPFs must indicate on 
their claims the revenue code for ECT (901), along with the total 
number of units (ECT treatments) provided to the patient during their 
IPF stay. In addition, IPFs must include the ICD-9-CM procedure code 
for ECT (94.27) and the date of the last ECT treatment the patient 
received.
    As we stated in the November 2004 IPF PPS final rule, although we 
established the ECT adjustment as a distinct payment under the IPF PPS, 
our preferred approach would be to include a patient level adjustment 
as a component of the model (for example, determined through the 
regression analyses) to account for the higher costs associated with 
ECT (69 FR 66951). We believe the approach will better control 
incentives towards over-utilization and be more consistent with the 
approach used for other patient level adjustments under the PPS. During 
the transition period we expect to collect more data on the number of 
ECT treatments per stay, and associated costs. We will utilize these 
data to evaluate alternative approaches for incorporating an adjustment 
for ECT in the payment system. To the extent that we change the payment 
methodology, we would propose the change first in a future rulemaking. 
Although our analysis will continue, we do not plan to redo the 
regression analysis until we analyze IPF PPS data.
    It is important to note that since ECT treatment is a specialized 
procedure, not all providers are equipped to provide the treatment. 
Therefore, many patients who need ECT treatment during their IPF stay 
must be referred to other providers to receive the ECT treatments, and 
then return to the IPF. In accordance with Sec.  412.404(d)(3), in 
these cases where the IPF is not able to furnish necessary treatment 
directly, the IPF would furnish ECT under arrangements with another 
provider. While a patient is an inpatient of the IPF, the IPF is 
responsible for all services furnished, including those furnished under 
arrangements by another provider. As a result, the IPF claim for these 
cases should reflect the services furnished under arrangements by other 
providers.
    Public comments and our responses on the proposed ECT payment 
policy are summarized below.
    Comment: Several commenters asked why CMS was continuing to adjust 
the ECT rate by the standardization factor, behavioral offset, stop-
loss adjustment, and outlier adjustment when the IPF PPS is no longer 
budget neutral after the implementation year.
    Response: We proposed to treat the ECT rate in a similar manner to 
the Federal per diem base rate. Specifically, we proposed to adjust the 
CY 2006 OPPS median rate for ECT by the standardization factor, 
behavioral offset, stop-loss adjustment, and outlier adjustment in 
addition to applying the wage index budget neutrality factor. This way, 
all of the adjustments that are incorporated into the Federal per diem 
base rate would be incorporated into the ECT rate. However, based on 
the comments we received, and in order to improve consistency and give 
more predictability in the ECT rate from year to year, we believe it is 
more appropriate to use the CY 2005 ECT rate as a base, and then update 
that amount by the market basket each rate year.
    This methodology, we believe, will be even more consistent with the 
methodology we use to update the Federal per diem base rate because we 
will use the RPL market basket increase to increase both rates. Exactly 
as the standardization factor, behavioral offset, stop-loss adjustment, 
and outlier adjustment are already built into the Federal per diem base 
rate before we apply the market basket and the wage index budget 
neutrality factor, the implementation year ECT rate of

[[Page 27076]]

$247.96 includes the standardization factor, behavioral offset, stop-
loss adjustment, and outlier adjustment. Then, just as we updated the 
federal per diem base rate, we will then apply the corrected 
standardization factor (please see section V.B for a discussion of how 
we adjust this factor on Federal per diem base rate), the market basket 
increase of 4.3 percent, and the wage index budget neutrality factor of 
1.0042 to compute a RY 2007 ECT rate of $256.20.
    We will monitor ECT payments and usage under the IPF PPS and the 
OPPS to ensure that the increased payments for ECT do not lead to 
changes in the frequency of utilization by reviewing the FY 2005 MedPAR 
claims data.
    Comment: One commenter stated that CMS should ensure that the ECT 
amount adequately reflects the cost of providing the treatment.
    Response: We believe using the CY 2005 median cost for ECT under 
the OPPS as a basis for our ECT payment rate is the best option at this 
time to ensure the most appropriate payment for ECT. We will continue 
to monitor ECT payments as new data become available, and will make 
changes, if warranted.
    Final Rule Action: In summary, we will finalize the update 
methodology for the ECT rate by using the CY 2005 ECT rate as a base 
and then updating that amount by the market basket increase each rate 
year. We will also continue to monitor ECT payments under the IPF PPS 
and the OPPS.
4. Physician Certification and Recertification Requirements
    Since the publication of the November 2004 IPF PPS final rule, we 
have received inquiries related to physician certification and 
recertification. It appears that some psychiatric units in acute care 
hospitals have been following the timeframes that are applicable to the 
acute care hospital of which they are a part (as specified in Sec.  
424.13) rather than those that apply to psychiatric hospitals (as 
specified in Sec.  424.14).
    To eliminate the confusion that we believe may be caused by the 
titles of Sec.  424.13 and Sec.  424.14 and to ensure consistency in 
compliance with the requirements among all IPFs, in the RY 2007 
proposed rule (71 FR 3616), we proposed to revise the title of Sec.  
424.14 from ``Requirements for inpatient services of psychiatric 
hospitals'' to ``Requirements for inpatient services of inpatient 
psychiatric facilities.'' In addition, we proposed that for the 
purposes of payment under the IPF PPS, all IPFs would follow the 
physician certification and recertification requirements as specified 
in Sec.  424.14.
    In the November 28, 2003 IPF PPS proposed rule (68 FR 66920), we 
proposed to--(1) amend Sec.  424.14 to state that in recertifying a 
patient's need for continued inpatient care in an IPF, a physician must 
indicate that the patient continues to need, on a daily basis, 
inpatient psychiatric care (furnished directly by or requiring the 
supervision of IPF personnel) or other professional services that, as a 
practical matter, can be provided only on an inpatient basis; and (2) 
revise Sec.  424.14(d) to require that a physician recertify a 
patient's continued need for inpatient psychiatric care on the 10th day 
following admission to the IPF rather than the 18th day following 
admission to the IPF (68 FR 66939).
    However, in the November 2004 IPF PPS final rule, we did not 
include the proposed physician recertification requirement changes 
because most of the public comments we received on this issue did not 
support the proposed changes and indicated that there are 
inconsistencies in the timeframes currently required for IPFs that 
warranted additional analysis. Instead, we stated that we would 
continue to require that a physician recertify a patient's continued 
need for inpatient psychiatric care on the 18th day following admission 
to the IPF.
    Since publication of the November 2004 IPF PPS final rule, we have 
received additional inquiries related to the physician certification 
and recertification timeframes that currently apply to IPFs. As noted 
above, it appears that some psychiatric units in acute care hospitals 
have continued to follow the timeframes that are applicable to the 
acute care hospital of which they are a part (as specified in Sec.  
424.13) rather than those that apply to psychiatric hospitals (as 
specified in Sec.  424.14). Section 424.13(d) requires the initial 
certification no later than as of the 12th day of hospitalization and 
the first recertification is required no later than as of the 18th day 
of hospitalization. Section Sec.  424.14(d) requires certification at 
the time of admission or as soon thereafter as is reasonable and 
practicable and the first recertification is required as of the 18th 
day of hospitalization.
    In order to clarify requirements and establish further consistency 
among provider types, for purposes of payment under the IPF PPS, we 
proposed that all IPFs (distinct part units of acute care hospitals and 
CAHs and psychiatric hospitals) meet the physician certification and 
recertification timeframes in Sec.  424.14.
    As proposed, we are revising Sec.  424.14(d) to provide that the 
initial physician certification will be required at the time of 
admission or as soon thereafter as is reasonable and practicable and 
the first recertification will be required as of the 12th day of 
hospitalization. Subsequent recertifications will be required at 
intervals established by the hospital's UR committee (on a case-by-case 
basis if desired), but no less frequently then every 30 days.
    We chose to propose the 12th day because it is more in line with 
the median LOS and it is current practice for certification in 
psychiatric units.
    In addition, we received inquiries from FIs requesting guidance on 
the content requirement of physician certifications at Sec.  424.14(c), 
relating to the medical necessity of continued inpatient psychiatric 
care. As a result, we are adding language to clarify that for purposes 
of payment under the IPF PPS, the physician will also recertify that 
the patient continues to need, on a daily basis, active treatment 
furnished directly by or requiring the supervision of inpatient 
psychiatric facility personnel.
    We received several comments related to the various changes we 
proposed making to the Certification and Plan of Treatment Requirements 
of Sec.  424.14.
    Commenters were silent with respect to our proposed title revision 
to Sec.  424.14 from ``Requirements for inpatient services of 
psychiatric hospitals'' to ``Requirements for inpatient services of 
inpatient psychiatric facilities.'' We are finalizing the title 
revision for Sec.  424.14 as ``Requirements for inpatient services of 
inpatient psychiatric facilities.''
    Overall, commenters supported making the physician certification 
requirements consistent among distinct part psychiatric units of acute 
care hospitals and CAHs and psychiatric hospitals. Therefore, for the 
purposes of payment under the IPF PPS, we are requiring that all IPFs 
(distinct part psychiatric units of acute care hospitals and CAHs and 
psychiatric hospitals) follow the physician certification and 
recertification requirements as specified in Sec.  424.14.
    We received mixed responses from commenters concerning our proposed 
physician certification and recertification timeframes.
    Specific comments and our responses on the proposed changes 
implementing physician certification and recertification requirements 
are summarized below.
    Comment: One hospital association expressed support for a 12-day 
recertification requirement, finding it

[[Page 27077]]

preferable to 18 days. Other commenters requested the current 
requirement of 18 days for the initial recertification remain in place, 
citing added administrative burden since most patients are discharged 
before the 18th day. A couple of the commenters recommended maintaining 
the 18-day recertification requirement since it is part of the original 
language for Sec.  424.14 and further believe it is the established 
practice in psychiatric hospitals.
    Response: When Sec.  424.14(d)(2) was developed in the 1980s, the 
average LOS for inpatient psychiatric hospitalization was much longer 
than the current median LOS of 9 days, thereby necessitating a parallel 
recertification requirement of 18 days, which was reflective of current 
treatment practice at that time. However, as inpatient psychiatric 
treatment has evolved with the development of new medications and 
therapies, so has the average length of inpatient care.
    According to the MedPar 2002 claims data, the median LOS for 
Medicare beneficiaries in IPFs is 9 days. Since the duration of 
inpatient psychiatric hospitalization stays have shortened, the 
certification and recertification timeframe and practices need to be 
updated in order to remain consistent with current practice. Thus, an 
earlier recertification timeframe is indicated by the shorter LOS for 
inpatient psychiatric hospitalization. Therefore, we continue to 
believe that an 18-day recertification requirement is outdated and not 
reflective of current inpatient psychiatric treatment.
    As a result, we are finalizing that for Sec.  424.14(d)(2), the 
first recertification is required as of the 12th day of 
hospitalization. Subsequent recertifications will be required at 
intervals established by the hospital's Utilization Review committee 
(on a case-by-case basis if desired), but no less frequently then every 
30 days.
    Comment: In general, commenters were silent concerning our proposal 
to modify the certification and recertification language of Sec.  
424.14(c), relating to the medical necessity of continued inpatient 
psychiatric care. However, a couple of commenters requested that the 
language required for certification and recertification remain 
consistent with Sec.  424.14(b) and Sec.  424.14(c). Another commenter 
requested clarification on the proposed language requiring ``the 
physician would recertify that the patient continues to need, on a 
daily basis* * *''. The commenter questioned whether physicians would 
need to chart daily in the patient's record that the patient continues 
to need active treatment.
    Response: We proposed only one modification to Sec.  424.14(c), 
``Content of recertification'', by adding language requiring that the 
physician would also recertify that the patient continues to need, on a 
daily basis, active treatment furnished directly by or requiring the 
supervision of inpatient psychiatric facility personnel. This means, 
the patient continues to need daily, active treatment that is furnished 
directly by or requiring the supervision of inpatient psychiatric 
facility personnel. To clarify, physician certification and 
recertification, under Sec.  424.14, are not the same as progress 
notes. A physician must certify the necessity of the services and, in 
some instances, recertify the continued need for those services to 
ensure that Medicare pays only for services of the type appropriate for 
Medicare coverage. Progress notes, under Sec.  412.27(c)(4), must also 
be recorded by the patient's physician, in addition to a nurse, social 
worker, and when appropriate, others significantly involved in active 
treatment modalities, but are used to document the progress of the 
patient's treatment, and are more frequent than the certification and 
recertification timelines. In addition to the purpose of clarifying the 
recertification content requirements, this modification is consistent 
with the medical necessity requirement for continued inpatient 
psychiatric care.
    As a result, for purposes of payment under the IPF PPS, the 
physician would also recertify that the patient continues to need, on a 
daily basis, active treatment furnished directly by or requiring the 
supervision of inpatient psychiatric facility personnel.
    Final Rule Action: In summary, we are changing the title for Sec.  
424.14 from ``Requirements for inpatient services of psychiatric 
hospitals'' to ``Requirements for inpatient services of inpatient 
psychiatric facilities.''
    In addition, for the purposes of payment under the IPF PPS, we are 
requiring that all IPFs (distinct part psychiatric units of acute care 
hospitals and CAHs and psychiatric hospitals) follow the physician 
certification and recertification requirements as specified in Sec.  
424.14.
    Furthermore, Sec.  424.14(d)(2) will require the first 
recertification as of the 12th day of hospitalization. Subsequent 
recertifications will be required at intervals established by the 
hospital's UR committee (on a case-by-case basis if desired), but no 
less frequently than every 30 days.
    We are also finalizing the content requirement of physician 
certifications at Sec.  424.14(c)(iii) by adding the following 
language, ``the physician will also recertify that the patient 
continues to need, on a daily basis, active treatment furnished 
directly by or requiring the supervision of inpatient psychiatric 
facility personnel.''
5. Provision of Therapeutic Recreation in IPFs
    Before the implementation of the IPPS payment methodology, Medicare 
coverage guidelines gave specific recognition to therapeutic recreation 
in inpatient psychiatric hospitals. The guidelines in Sec.  3102.1.A of 
the Medicare Intermediary Manual, Part 3 (MIM-3), and in Sec.  212.1 of 
the Medicare Hospital Manual (which now appear in the CMS Internet 
Online Manual at Pub. 100-02, Chapter 2, Sec.  20.1ff.) specifically 
identify therapeutic recreation as one of the services that can 
constitute ``active treatment'' in this setting when they are--
     Provided under an individualized treatment or diagnostic 
plan;
     Reasonably expected to improve the patient's condition or 
for the purpose of diagnosis; and
     Supervised and evaluated by a physician.
    However, these guidelines refer to therapeutic recreation in terms 
of being an ``adjunctive'' therapy, indicating that even in this 
setting, it will not independently serve as a patient's sole or primary 
form of therapeutic treatment, but rather, will be furnished in support 
of (but subordinate to) some other, primary form of therapy.
    When the IPPS was developed in 1983, to the extent that therapeutic 
recreation and other services had been furnished during the IPPS base 
period, the bundled IPPS payment for that setting would reflect these 
costs. However, during the IPPS rulemaking process, we received public 
comments concerned that, ``the cost-saving incentives of the PPS would 
lead hospitals paid under the system to stop providing recreational 
therapy services.'' In response, in the January 3, 1984 IPPS final rule 
(49 FR 242) we indicated that implementation of the IPPS would not, in 
fact, prohibit the provision of recreational therapy services, and that 
``these services will continue to be covered to the same extent they 
always have been under existing Medicare policies''.
    In implementing the IPPS regulations, we included criteria for 
identifying certain types of institutions (for example, psychiatric 
hospitals) that would be excluded from the IPPS and, thus, would 
continue to be paid under some other methodology. The

[[Page 27078]]

regulations also introduced criteria for identifying an IPPS-excluded 
inpatient psychiatric unit housed within a larger acute-care hospital 
that would itself be subject to the IPPS. One of these identifying 
criteria at 42 CFR 405.471(c)(4)(ii)(B) (later recodified at 42 CFR 
412.27(b)) was the provision, through the use of qualified personnel, 
of a number of specified types of services, including psychological 
services, social work services, psychiatric nursing, occupational 
therapy, and recreational therapy.
    As we explained in the IPPS interim final rule published on 
September 1, 1983 (48 FR 39758), the regulations designated these 
particular services because their provision ``is typical of units which 
treat patients whose characteristics are like those in psychiatric 
hospitals. Consequently, the provision of these services is an 
identifier of such a patient population''. We note that the designation 
of these particular services in this context did not serve to define 
the scope of their coverage under Medicare, nor to mandate their 
provision in this setting, but merely to identify them as being 
characteristic of the type of psychiatric unit that would qualify for 
exclusion from the IPPS.
    At the same time the IPPS was being developed, a parallel evolution 
was taking place in the certification requirements that facilities must 
meet in order to participate in the Medicare program: a shift from 
primarily ``process-oriented'' requirements to more ``outcome-
oriented'' requirements, which focus more on direct indicators of the 
quality of care actually being furnished to the facility's patients (as 
reflected in the presence of positive results and the absence of 
negative ones), and less on the specific ``process'' through which the 
facility achieves the desired outcome.
    In order to participate in the Medicare program, psychiatric 
hospitals not only had to meet the conditions of participation (COPs) 
that apply to general, acute-care hospitals, but additionally had to 
meet special conditions related to medical records and staffing. 
Consistent with the recognition of therapeutic recreation as 
constituting active treatment in this one particular setting (as 
discussed above), the original COPs for psychiatric hospitals at 42 CFR 
405.1038(g) mandated the presence of qualified therapists, assistants, 
or aides ``sufficient in number to provide comprehensive therapeutic 
activities, including at least occupational, recreational and physical 
therapy, as needed, to assure that appropriate treatment is rendered 
for each patient, and to establish and maintain a therapeutic milieu.'' 
Furthermore, 42 CFR 405.1038(g)(3) specified that ``recreational or 
activity therapy services are available under the direct supervision of 
a member of the staff who has demonstrated competence in therapeutic 
recreation programs,'' and Sec.  405.1038(g)(4) and Sec.  
405.1038(g)(5) went on to prescribe additional standards regarding 
therapy assistants or aides and overall staffing for recreational and 
activity therapy.
    However, when the special medical record and staffing COPs for 
psychiatric hospitals were subsequently recodified at Sec.  482.62(g), 
the specific references to recreation therapy were deleted and replaced 
with a more general requirement to provide a therapeutic activities 
program. In response to public comments that recommended us to restore 
the deleted requirements, we indicated that we believe that the deleted 
requirements concerning therapeutic activities were overly and 
unnecessarily prescriptive and that the hospital should have the 
flexibility to determine which activities are most appropriate to its 
patient population and to determine the criteria to be met by employees 
providing these services. (See the IPPS PPS rule published on June 17, 
1986 (51 FR 22032)).
    However, when the 1986 COP changes applicable to psychiatric 
hospitals were made, we inadvertently retained specific references to 
recreation therapy in Sec.  412.27. Since the intent of Sec.  412.27(b) 
is to identify services provided in psychiatric units that are 
characteristic of services furnished in psychiatric hospitals, we 
believe it is no longer appropriate to include references to specific 
therapies in Sec.  412.27. Therefore, in order to have consistent 
requirements among IPFs, in the RY 2007 IPF PPS proposed rule, we 
proposed removing recreational therapy from Sec.  412.27(b).
    We went on to further explain in the RY 2007 IPF PPS proposed rule 
that in addition to being consistent with current provisions, we 
believe the IPF PPS base rate which was developed using FY 2002 data, 
already reflects the provision of recreation therapy.
    We received a few public comments concerning our proposal to remove 
reference to recreational therapy in Sec.  412.27(b). Overall the 
commenters recommended that we not delete the reference to recreational 
therapy.
    Public comments and our responses on the proposed changes for 
removing the reference to recreational therapy are summarized below:
    Comment: An industry organization suggested that if CMS'; goal is 
to maintain consistency, CMS should adopt the language as specified in 
Sec.  482.62 from the COPs for Sec.  412.27(b).
    Response: We believe that this commenter raises a valid concern in 
terms of maintaining consistency. We also agree with the suggestion of 
applying the same language to both Sec.  482.62 and Sec.  412.27(b), 
thereby maintaining consistent requirements among IPFs. Since Sec.  
482.62 refers to ``therapeutic activities,'' we are revising Sec.  
412.27(b), to be consistent with Sec.  482.62, by replacing the 
reference to recreational and occupational therapy with the term 
``therapeutic activities.''
    Comment: Several commenters stated that the inclusion of 
recreational therapy in Sec.  412.27(b), is no more specific than the 
references included for social work or occupational therapy.
    Response: As we indicated in the RY 2007 IPF PPS proposed rule, 
since the intent of Sec.  412.27(b) is to identify services provided in 
psychiatric units that are characteristic of services furnished in 
psychiatric hospitals, we believe it is essential to maintain 
consistency among the provisions for Sec.  482.62 and Sec.  412.27(b). 
Therefore, we are removing the reference to both recreational and 
occupational therapy from Sec.  412.27(b) and replacing them with the 
more general reference to therapeutic activities which is currently 
used in Sec.  482.62.
    However, we believe it is important to maintain the reference to 
social work services in Sec.  412.27, since it is currently included in 
Sec.  482.62.
    Comment: One commenter requested that CMS continue to pay for 
recreational therapy. Other commenters were concerned that if the 
reference to recreational therapy is removed, people may not know that 
Medicare has traditionally recognized recreational therapy as an 
adjunctive therapy in psychiatric facilities.
    Response: As we discussed in the RY 2007 IPF PPS proposed rule, we 
believe the IPF PPS base rate, which was developed using FY 2002 data, 
reflects the provision of recreation and occupational therapy. Even 
though we are removing the specific reference to recreation and 
occupational therapy in Sec.  412.27(b), both recreational and 
occupational therapy services will continue to be covered to the same 
extent they always have been under existing Medicare policies.
    In addition, although we are removing the specific references to 
recreational and occupational therapy from Sec.  412.27(b), we want to 
emphasize that both therapies are, and continue to be,

[[Page 27079]]

valuable therapeutic interventions in psychiatric treatment.
    Final Rule Action: In summary, for consistency, we are adopting the 
language as specified in Sec.  482.62 from the COPs for Sec.  
412.27(b). Specifically, 412.27(b) will state--``Furnish, through the 
use of qualified personnel, psychological services, social work 
services, psychiatric nursing services and therapeutic activities.''
6. Same Day Transfers
    Currently, when a transfer, discharge, or death occurs on the same 
day as an admission to an IPF, the IPF PPS PRICER does not recognize 
any covered IPF days and the IPF claims are suspended. Based on review 
of a limited sample of the IPF and subsequent IPPS claims, it appears 
that many of these patients are first seen in a hospital's ED, are 
admitted to the hospital's psychiatric unit and, later the same day, 
determined to be too medically compromised to be managed in the 
psychiatric unit. This scenario may occur because the patient presents 
at the ED and is admitted to the psychiatric unit in the middle of the 
night, and when the patient's admission to the unit is reviewed by a 
psychiatrist the next morning, the physician determines that the 
patient should be discharged for acute care. In other cases, a patient 
may have been admitted to a freestanding psychiatric hospital based on 
the information furnished by an ED of an acute care hospital. However, 
after admission, the psychiatric hospital staff evaluates the patient 
and determines that the patient has medical needs that they are not 
staffed or equipped to meet.
    The Provider Reimbursement Manual addresses the same day transfer 
issue from the perspective of counting Medicare days for the purpose of 
Medicare cost reporting. Section 2205 indicates that only full patient 
days may be used to apportion inpatient routine care service costs and 
that a day begins at midnight and ends 24 hours later. However, section 
2205.1 explains how to count a day if the day of admission and the day 
of discharge are the same. Section 2205.1 indicates that when a patient 
is admitted and then transferred from one participating provider to 
another before midnight of the same day, a day (except for utilization 
purposes) is counted at both providers. A day of Medicare utilization 
is charged only for the admission to the second provider. This 
distinction is important for psychiatric admissions because IPF stays 
are subject to the 190-day lifetime limit on inpatient psychiatric 
care.
    Section 1812(b) of the Act and 42 CFR 409.62 indicate that payment 
is not available for inpatient psychiatric hospital services furnished 
beyond the 190-day lifetime limit. Thus, Medicare coverage of IPF 
services, specifically IPF services furnished in freestanding 
psychiatric hospitals is limited to 190 days. In consideration of the 
limit on coverage of IPF services, where there is a same day transfer 
between Medicare participating providers, we only count the second 
admission for utilization purposes. Therefore, the initial admission to 
the IPF does not count against a beneficiary's lifetime psychiatric 
services limit.
    We have some concerns regarding same day transfers from an IPF. 
Under TEFRA, a hospital receives its cost up to the hospital's TEFRA 
limit. The TEFRA limit is based on the hospital's average cost per 
discharge in a base period. When an admission and discharge occur on 
the same day, the hospital's cost is unlikely to exceed the TEFRA 
limit, so the hospital receives its cost for the day. These same day 
transfers also improve the hospital's payment under TEFRA by slightly 
reducing its cost per discharge. We are also concerned that when the 
transfer occurs in the same hospital, this practice circumvents 
bundling rules under the IPPS, in that it unbundles the ED charges from 
the IPPS claim and allocates the ED costs to the psychiatric unit even 
though the patient may have been inappropriately admitted to the unit.
    Based on the review of IPF PPS claims we conducted, it did not 
appear that the admissions to the IPF were medically reasonable and 
necessary. However, we believe it is important to base a decision 
regarding coverage of these days on a comprehensive review of the 
claims. Therefore, in the RY 2007 IPF PPS proposed rule, we did not 
propose a change in payment policy. However, we did consider several 
alternative methods for addressing same day transfers under the IPF PPS 
which are described below. Any change to treatment of same day 
transfers would be made prospectively.
    We could treat these days as covered days under the IPF PPS. 
However, under the IPF PPS, a 19 percent adjustment to the base rate is 
applied to day 1 of the stay to reflect the additional administrative 
and clinical costs associated with admission and the day 1 adjustment 
is increased to 31 percent when the IPF has a qualifying ED. The IPF 
may also receive, for example, a teaching adjustment or rural 
adjustment, for these partial days of care. Several of the claims in 
our analysis indicate a stay of 2 hours. We are concerned that this 
approach would overpay IPFs and encourage inappropriate admissions and 
transfers.
    Another option would be to make no PPS payment, but continue making 
TEFRA payments during the IPF PPS transition period. For example, for 
cost reporting periods beginning in 2006, IPFs would receive a blended 
payment consisting of 50 percent PPS and 50 percent TEFRA. Therefore, 
under this approach we would allow some payment for these days for cost 
reporting periods in 2006 and 2007, but once the IPF PPS transition 
period is over, the IPFs would receive no payment for these days. We 
think this approach would encourage changes in admission practices in 
order to avoid the need to transfer patients. However, once the IPF PPS 
transition is over, there would be no payment mechanism to pay IPFs for 
stays in which there is a circumstance, not reasonably foreseeable by 
the admitting IPF, for example, a serious change in health status on 
the day of admission.
    We could treat these same day transfer cases as covered days under 
the IPF PPS but limit payment to the Federal per diem base rate or some 
other payment amount, for example, half the Federal per diem base rate. 
This approach would limit payment to IPFs in order to provide an 
incentive for IPFs to make medical clearance determinations as early in 
the IPF stay as possible. However, we are concerned that this approach 
would not lead to changes in admission practices to avoid inappropriate 
admissions and the need for subsequent transfers.
    It is important to note that the cost for these days was included 
in the cost reports used to develop the IPF PPS, and, as a result, the 
average cost per day that was used to establish the Federal per diem 
base rate is higher than it would otherwise have been had those days 
not been included.
    We specifically request public comment from IPFs on this issue to 
help us to develop a payment policy that pays IPFs appropriately for 
these days and provides an incentive to avoid same day transfers 
wherever possible.
    Public comments and our responses on the proposed changes for 
implementing the same day transfers are summarized below.
    Comment: We received several comments concerning the issue of an 
appropriate payment for same day transfers. Many commenters indicated 
that CMS should conduct a thorough examination of the 2005 claims 
because they do not believe that same day transfers would be found to 
be prevalent occurrences. The same commenters also stated that if CMS 
decides to investigate

[[Page 27080]]

other options, the agency should convene the field through an open-door 
forum or other such venue to discuss the possibilities.
    In addition, several commenters requested that when sufficient data 
is available to fully evaluate same day transfers, CMS should request 
input from the field before making any changes to current policy. Other 
commenters also indicated that CMS should continue to reimburse same 
day transfers as 1-day stays unless it can demonstrate empirically that 
the cost of the former is sufficiently less than the cost of the latter 
to justify a partial payment.
    Another commenter requested that CMS release a version of the 
MedPar with relevant information to qualified researchers who would be 
pleased to conduct an empirical analysis for the agency.
    Many commenters supported CMS' instructions for its payment 
methodology for the suspended IPF PPS same day transfer claims from 
January 1, 2005. The instructions counted these days as covered for 
cost reporting purposes if the day of admission and the day of 
discharge are the same. Other commenters indicated that CMS should not 
penalize provider's evaluation and treatment efforts, stating that the 
work was done, therefore providers should be compensated.
    Furthermore, commenters support the way section 2205.1 of the 
Provider Reimbursement Manual instructs FIs to count a day if the day 
of admission and the day of discharge are the same. The majority of the 
commenters recommended paying the PPS per diem for these transfers.
    Response: We will take all comments into consideration as we 
develop a payment policy that not only pays appropriately for these 
days, but will also provide an incentive to avoid same day transfers 
wherever possible.
    Final Rule Action: In summary, we received multiple comments on the 
same day transfer. We will take all comments into consideration as we 
develop a payment policy for same day transfers. We will develop the 
policy for same day transfers in the future, after we analyze IPF PPS 
data.

VII. Miscellaneous Public Comments Within the Scope of the Proposed 
Rule

    Comment: A commenter requested an inner-city adjustment, indicating 
that the difficulties of inner-city IPFs are related to a high volume 
of non-payment in contrast to the more likely rural under use and low 
volume costs. The commenter suggested a 20 percent adjustment at least, 
for inner-city IPFs.
    Response: We did not include an explicit payment adjustment for 
inner city facilities in the November 2004 IPF PPS final rule nor did 
we propose an urban adjustment in the RY 2007 proposed rule. As 
indicated in the November 2004 IPF PPS final rule (69 FR 66954), we did 
not include an adjustment for urban IPFs because the regression 
analysis we conducted did not indicate that urban IPFs were more costly 
on a per diem basis.
    As previously stated, we do not plan to rerun the regression 
analysis until we analyze IPF PPS data (that is no earlier than FY 
2008). When we rerun the regression analysis, we will test for the need 
for an urban or inner city adjustment.
    Comment: A commenter objected to CMS not posting the proposed rule 
to the CMS Web site until January 18, 2006 while the rule actually went 
on public display January 13, 2006 and was not published in the Federal 
Register until January 23, 2006. The commenter stated that if CMS 
chooses to start the comment period based on the date of display, CMS 
must ensure that the display copy is promptly posted on the Web site to 
provide interested parties sufficient time to review the rule and draft 
comments before the comment period ends.
    Response: It is our general practice to post Federal Register 
documents on our website as soon as practicable after the documents are 
on public display at the Office of the Federal Register. When we chose 
to start the comment period from the day of public display, while we 
are not required to do so, it was our intent to post the proposed rule 
on CMS website immediately. However, due to circumstances out of our 
control, we were unable to immediately do so because our Web site at 
http://www.cms.hhs.gov was being redesigned. However, we did publish a 
press release on January 13, 2006, announcing the IPF PPS proposed rule 
went on public display at the Federal Register on January 13, 2006 and 
that it would be published in the Federal Register on January 23, 2006. 
In addition, we posted the rule as soon as was practicable for us to do 
so, on Wednesday, January 18, 2006.

VIII. Provisions of the Final Rule

    This final rule essentially incorporates the provisions of the 
proposed rule, in which we proposed to update the IPF PPS for RY 2007 
applicable to IPF discharges occurring during the RY beginning July 1, 
2006 through June 30, 2007. In addition, we proposed to adopt the new 
OMB labor market area definitions for our geographic classifications. 
The provisions of this final rule that differ from the proposed rule 
are as follows.

ECT policy Payment

    In the RY 2007 IPF PPS proposed rule, we proposed to update the ECT 
base rate using the pre-scaled pre-adjusted hospital median cost for 
ECT used for the CY 2006 update of the OPPS. The median cost would then 
be standardized, adjusted for budget neutrality, and adjusted for wage 
and COLA differences in the same manner that we adjust the per diem 
rate.
    However, based on the public comments, we are changing the 
methodology used for calculating the ECT policy payment rate. In order 
to improve consistency with our updates to the Federal per diem base 
rate and provide IPFs more predictability for the ECT rate from year to 
year, we will use the CY 2005 ECT rate as a base, and then update that 
amount by the market basket increase each rate year.

Section 412.402 Definition

    In Sec.  412.402, we are adding the definition of ``New GME 
education program'' to mean a medical education program that receives 
initial accreditation by the appropriate accrediting body or begins 
training residents on or after November 15, 2004.

Section 412.27 Excluded psychiatric units: Additional requirements.

    In Sec.  412.27, we are amending paragraph (b) to remove the 
specific reference to ``occupational therapy, and recreational 
therapy.'' We are adding in its place ``therapeutic activities'' in 
order to maintain consistency with current provisions and since the IPF 
PPS base rate already reflects the provision of recreational therapy.

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

    In Sec.  412.428, we are revising paragraph (b)(3) to reflect that 
the rate of increase factor is revised as of October 1 of each year.

Other Issues

    In the Inpatient Prospective Payment System proposed rule, 
published April 25, 2006 (71 FR 23996), we discussed in detail the 
Health Care Information Transparency Initiative and our efforts to 
promote effective use of health information technology (HIT) as a means 
to help improve health care quality and improve efficiency. 
Specifically, with regard to the transparency initiative, we discuss 
several potential options for making

[[Page 27081]]

pricing and quality information available to the public (71 FR 24120 
through 24121). We solicited comments on ways the Department can 
encourage transparency in health care quality and pricing whether 
through its leadership on voluntary initiatives or through regulatory 
requirements. We also are seeking comment on the Department's statutory 
authority to impose such requirements.
    In addition, we discussed the potential for HIT to facilitate 
improvements in the quality and efficiency of health care services (71 
FR 24100 through 24101). We solicited comments on our statutory 
authority to encourage the adoption and use of HIT. 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.'' We also are seeking 
comments on the appropriate role of HIT in potential value-based 
purchasing program, beyond the intrinsic incentives of a PPS 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 Medicare conditions of 
participation.
    We intend to consider both the health care information transparency 
initiative and the use of health information technology as we refine 
and update all Medicare payment systems. Therefore, while these 
initiatives are not included in this final rule, we are in the process 
of seeking input on these initiatives in various proposed Medicare 
payment rules being issued this year and may pursue these policies in 
future rulemaking for the IPF PPS.

IX. Collection of Information Requirement

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

X. Regulatory Impact Analysis

A. Overall Impact

    We have examined the impact of this final rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (UMRA) (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year).
    Based on the impact analysis, we estimate the expenditures from the 
IPF PPS implementation year to the 2007 IPF PPS RY will be increased by 
$160 million. The updates to the IPF labor-related share and wage 
indices are made in a budget neutral manner and thus have no effect on 
estimated costs to the Medicare program. Therefore, the estimated 
increased cost to the Medicare program is the result of a combination 
of the updated IPF market baskets, which is offset by the transition 
blend and the revision of the standardization factor. The IPF PPS was 
budget neutral in the implementation year, but it is not budget neutral 
in RY 2007. As discussed in section V.B.2 of this final rule, the 
standardization factor and budget neutrality factors (behavioral 
offset, stop-loss adjustment, and outlier adjustment) are built into 
the Federal per diem base rate and the ECT rate. We are increasing 
these rates by the market basket, resulting in a $160 million increase 
in payments from the implementation year to RY 2007.
    We note that aspects of the transition, including the stop-loss 
policy and the transition to the 50/50 percent blend in RY 2007 and the 
transition to the 75/25 percent blend in the 2008 IPF PPS RY, were 
included in the November 2004 IPF PPS final rule and thus are not 
incremental to this rule. Nevertheless, it is essential to analyze the 
impact of the transition blend in order to calculate the increase in 
cost to the Medicare program.
    The impact of the transition blend is an approximately 0.2 percent 
(about $10 million) decrease in overall payments in RY 2007 and the 
distribution of that impact is summarized in Table 15. Therefore, the 
impact attributable to the policy changes finalized in this rulemaking, 
primarily the market basket update and the standardization correction, 
is approximately $170 million in the IPF PPS RY 2007.
    Since costs to the Medicare program are estimated to be greater 
than $100 million, this final rule is considered a major economic rule, 
as defined in 5 U.S.C. 40(2).
    The RFA requires agencies to analyze options for regulatory relief 
of small businesses. For purposes of the RFA, small entities include 
small businesses, nonprofit organizations, and governmental 
jurisdictions. Most IPFs and most other providers and suppliers are 
considered small entities, either by nonprofit status or by having 
revenues of $6 million to $29 million in any 1 year. (For details, see 
the Small Business Administration's regulation that set forth size 
standards for health care industries at (65 FR 69432).)
    HHS considers that a substantial number of entities are affected if 
the rule impacts more than 5 percent of the total number of small 
entities as it does in this rule. We included all freestanding 
psychiatric hospitals (79 are non-profit hospitals) in the analysis 
since their total revenues do not exceed the $29 million threshold. We 
also included psychiatric units of small hospitals, that is, those 
hospitals with fewer than 100 beds. We did not include psychiatric 
units within larger hospitals in the analysis because we believe this 
final rule would not significantly impact total revenues of the entire 
hospital that supports the unit. We have provided the following RFA 
analysis in section V.B to emphasize that, although the final rule will 
impact a substantial number of IPFs that were identified as small 
entities, we do not believe it will have a significant economic impact. 
Based on the analysis of the 1063 psychiatric facilities that were 
classified as small entities as described above, we estimate the 
combined impact of the IPF PPS will be a 4.2 percent increase in 
payments in RY 2007 relative to their payments in the implementation 
year of the IPF PPS. Based on the information available, we believe 
that Medicare payments may constitute a small portion of governmental 
IPFs' revenue stream. We have prepared the impact analysis in section 
X.B.2 to describe the impact of the final rule in order to provide a 
factual basis for our conclusions regarding small business impact.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a final rule may have a significant 
impact on the operations of a substantial number of small rural 
hospitals. This analysis must conform to the provisions of section 604 
of the RFA. 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

[[Page 27082]]

Area (MSA) or New England County Metropolitan Area (NECMA). However, 
under the new labor market definitions, we will no longer employ NECMAs 
to define urban areas in New England. Therefore, for purposes of this 
analysis, we now define a small rural hospital as a hospital with fewer 
than 100 beds that is located outside of an MSA. We have determined 
that this final rule will have a substantial impact on hospitals 
classified as located in rural areas. As discussed earlier in this 
preamble, we will continue to provide a payment adjustment of 17 
percent for IPFs located in rural areas. In addition, we have 
established a 3-year transition to the new system to allow IPFs an 
opportunity to adjust to the new system. Therefore, the impacts shown 
in Table 15 below reflect the adjustments that are designed to minimize 
or eliminate any potentially significant negative impact that the IPF 
PPS may otherwise have on small rural IPFs.
    Section 202 of the Unfunded Mandates Reform Act of 1995 also 
requires that agencies assess anticipated costs and benefits before 
issuing any final 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 final 
rule will not mandate any requirements for State, local, or tribal 
governments, nor would it affect private sector costs.
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it promulgates a final rule that imposes 
substantial direct requirement costs on State and local governments, 
preempts State law, or otherwise has Federalism implications.
    We have reviewed this final rule under the criteria set forth in 
Executive Order 13132 and have determined that the final rule will not 
have any substantial impact on the rights, roles, and responsibilities 
of State, local, or tribal governments.

B. Anticipated Effects of the Final Rule

    We discuss below the impact of this final rule on the Federal 
Medicare budget and on IPFs.
1. Budgetary Impact
    As discussed in detail in the IPF PPS proposed rule and summarized 
in section V.B. of this final rule, we applied a budget neutrality 
factor to the Federal per diem and ECT base rates to ensure that total 
payments under the IPF PPS in the implementation period would equal the 
amount that would have been paid if the IPF PPS had not been 
implemented. The budget neutrality factor includes the following 
components: outlier adjustment, stop-loss adjustment, and the 
behavioral offset. We do not plan to change any of these adjustment 
factors or projections until we analyze IPF PPS data. In accordance 
with Sec.  412.424(c)(3)(ii), we will evaluate the accuracy of the 
budget neutrality adjustment within the first 5 years after 
implementation of the payment system. We may make a one-time 
prospective adjustment to the Federal per diem and ECT base rates to 
account for differences between the historical data on cost-based TEFRA 
payments (the basis of the budget neutrality adjustment) and estimates 
of TEFRA payments based on actual data from the first year of the IPF 
PPS. As part of that process, we will re-assess the accuracy of all of 
the factors impacting budget neutrality.
    In addition, as discussed in section VI.C.1 of this final rule, we 
are adopting the new CBSAs and labor market share in a budget neutral 
manner by applying a wage index budget neutrality factor to the Federal 
per diem and ECT base rates. Thus, the budgetary impact to the Medicare 
program by the update of the IPF PPS will be the combination of the 
market basket updates (see section V.C of this final rule), the 
revision of the standardization factor (see section V.B.3 of this final 
rule), and the planned update of the payment blend discussed below.
2. Impacts on Providers
    To understand the impact of the changes to the IPF PPS discussed in 
this final rule on providers, it is necessary to compare estimated 
payments under the IPF PPS rates and factors for the RY 2007 to 
estimated payments under the IPF PPS rates and factors for the IPF PPS 
implementation year. The estimated payments for the IPF implementation 
year are a blend of: 75 percent of the facility-specific TEFRA payment 
and 25 percent of the IPF PPS payment with stop loss payment. The 
estimated payments for the IPF PPS RY 2007 are a blend of: 50 percent 
of the facility-specific TEFRA payment and 50 percent of the IPF PPS 
payment with stop loss payment. We determined the percent change of 
estimated 2007 IPF PPS RY payments to estimated IPF PPS implementation 
year payments for each category of IPFs. In addition, for each category 
of IPFs, we have included the estimated percent change in payments 
resulting from the revision of the standardization factor (as discussed 
in section V.B.3 of this final rule, the ratio of estimated total TEFRA 
payments to estimated total PPS payments in the implementation year was 
overestimated and therefore needed to be reduced. We will apply the 
revised standardization factor prospectively to the Federal per diem 
base rate and ECT amount), the wage index changes for the IPF PPS RY 
2007, the market basket update to IPF PPS payments, and the transition 
blend for the IPF PPS RY 2007 payment and the facility-specific TEFRA 
payment.
    To illustrate the impacts of the final RY 2007 changes, our 
analysis begins with an implementation year baseline simulation model 
based on FY 2002 IPF payments inflated to 2005 with market baskets; the 
estimated outlier payments in 2005; the estimated stop-loss payments in 
2005; the MSA designations for IPFs based on OMB's MSA definitions 
before June 2003; the 2005 MSA wage index; the implementation year 
labor-market share; and the implementation year percentage amount of 
the rural adjustment. During the simulation, the outlier payment is 
maintained at the target of 2 percent of total PPS payments.
    Each of the following changes is added incrementally to this 
baseline model in order for us to isolate the effects of each change:
     IPF PPS payments adjusted by the revised standardization 
factor.
     The new CBSAs based on new geographic area definitions 
announced by OMB in June 2003 and the RY 2007 final budget-neutral 
labor-related share and wage index adjustment.
     A blended market basket update of 4.5 percent resulting in 
an update to the hospital-specific TEFRA target amount and an update to 
the IPF PPS base rates as discussed below.
    ++ In the IPPS final rule published August 12, 2005 (70 FR 47707), 
we established an update factor of 3.8 percent effective for cost 
reporting periods beginning on or after October 1, 2005 using the 2002-
based excluded hospital market basket. The 3.8 percent update is 
applied to the IPF's established TEFRA target amount for cost reporting 
periods beginning on or after October 1, 2005. However, since the 
midpoints of the RY 2007 and the IPF PPS implementation period are 15 
months apart, the TEFRA payment increase is projected to be 4.6 
percent.
    ++ An update to the Federal per diem base rate of 4.3 percent based 
on the 2002-based RPL market basket (see section V.C.1.b of this final 
rule). The market basket update is based on a 15-month time period 
(from the midpoint of the IPF PPS implementation period to the midpoint 
of the RY 2007).
     The transition to 50 percent IPF PPS payment and 50 
percent facility-specific TEFRA payment.

[[Page 27083]]

    Our final comparison illustrates the percent change in payments 
from the IPF PPS implementation year (that is, January 1, 2005 to June 
30, 2006) to RY 2007 (that is, July 1, 2006 to June 30, 2007).

                                          Table 15.--Projected Impacts
----------------------------------------------------------------------------------------------------------------
                                                               CBSA wage
                                Number of    Standardization   index and      Market     Transition     Total
     Facility by type (1)       facilities       factor       labor share     basket       blend      (percent)
                                   (2)         correction      (percent)    (percent)    (percent)       (7)
                                              (percent) (3)       (4)          (5)          (6)
----------------------------------------------------------------------------------------------------------------
All Facilities                       1,806            -0.3            0.0          4.5         -0.2          4.0
By Type of Ownership:
    Psychiatric Hospitals:
        Government                     178            -0.5            0.1          4.5         11.0         15.6
        Non-profit                      79            -0.4            0.1          4.5          1.6          6.0
        For-profit                     150            -0.4            0.1          4.5          4.3          8.7
        Psychiatric Units            1,399            -0.3            0.0          4.5         -1.8          2.3
Rural                                  385            -0.3            0.0          4.5         -0.9          3.2
Urban                                1,421            -0.3            0.0          4.5         -0.1          4.1
By Urban or Rural
 Classification:
    Urban by Facility Type:
    Psychiatric Hospitals:
        Government                     144            -0.5            0.1          4.5         10.9         15.4
        Non-profit                      73            -0.4            0.1          4.5          1.7          6.1
        For-profit                     143            -0.4            0.1          4.5          4.4          8.8
        Psychiatric Units            1,061            -0.3            0.0          4.5         -1.7          2.4
    Rural by Facility Type:
    Psychiatric Hospitals:
        Government                      34            -0.5           -0.1          4.5         12.0         16.3
        Non-profit                       6            -0.3            0.3          4.5         -0.7          3.9
        For-profit                       7            -0.2           -0.1          4.5         -1.8          2.4
        Psychiatric Units              338            -0.3            0.0          4.5         -2.0          2.1
By Teaching Status:
        Non-teaching                 1,537            -0.3            0.0          4.5         -0.4          3.8
        Less than 10% interns          148            -0.3            0.1          4.5          0.5          4.7
         and residents to
         beds
        10% to 30% interns              72            -0.3            0.0          4.5          0.4          4.6
         and residents to
         beds
        More than 30% interns           49            -0.4            0.1          4.5          0.0          4.3
         and residents to
         beds
By Region:
        New England                    126            -0.3            0.0          4.5         -0.4          3.8
        Mid-Atlantic                   306            -0.4            0.2          4.5          2.9          7.3
        South Atlantic                 238            -0.3           -0.2          4.5          0.1          4.0
        East North Central             325            -0.3           -0.1          4.5         -1.5          2.6
        East South Central             159            -0.4           -0.1          4.5         -0.3          3.7
        West North Central             169            -0.3           -0.2          4.5         -1.0          3.0
        West South Central             237            -0.3           -0.1          4.5         -2.7          1.4
        Mountain                        83            -0.3           -0.1          4.5         -0.4          3.7
        Pacific                        156            -0.3            0.3          4.5         -0.5          4.0
By Bed Size:

[[Page 27084]]

 
    Psychiatric Hospitals:
        Under 12 beds                   26            -0.2            0.1          4.5         -3.8          0.6
        12 to 25 beds                   46            -0.3           -0.2          4.5          0.2          4.3
        25 to 50 beds                   91            -0.4            0.1          4.5          4.2          8.6
        50 to 75 beds                   82            -0.4            0.1          4.5          3.8          8.3
        Over 75 beds                   162            -0.5            0.1          4.5          8.6         13.0
    Psychiatric Units:
        Under 12 beds                  600            -0.3           -0.1          4.5         -4.5         -0.5
        12 to 25 beds                  474            -0.3            0.0          4.5         -1.9          2.2
        25 to 50 beds                  228            -0.3            0.0          4.5         -0.6          3.5
        50 to 75 beds                   58            -0.3            0.0          4.5          0.1          4.3
        Over 75 beds                    39            -0.4            0.0          4.5          1.3          5.5
----------------------------------------------------------------------------------------------------------------

3. Results
    Table 15 above displays the results of our analysis. The table 
groups IPFs into the categories listed below based on characteristics 
provided in the Online Survey and Certification and Reporting (OSCAR) 
file and the FY 2002 cost report data from HCRIS:
     Facility Type
     Location
     Teaching Status Adjustment
     Census Region
     Size
    The top row of the table shows the overall impact on the 1,806 IPFs 
included in the analysis.
    In column 3, we present the effects of the revised standardization 
factor (see section V.B.3 of this final rule for a discussion of this 
revision). This is defined to be the comparison of the simulated 
implementation year payments under the revised standardization factor 
to the simulated implementation year payments under the original 
standardization factor. In aggregate, the revision is projected to 
result in a 0.3 percent decrease in overall payments to IPFs. There are 
small distributional effects among different categories of IPFs. For 
example, urban and rural government psychiatric hospitals and 
psychiatric hospitals with over 75 beds will receive the largest 
decrease of 0.5 percent, while rural for-profit psychiatric hospitals 
and psychiatric hospitals with fewer than 12 beds will receive the 
smallest decrease of 0.2 percent.
    In column 4, we present the effects of the budget-neutral update to 
the labor-related share and the wage index adjustment under the new 
CBSA geographic area definitions announced by OMB in June 2003. This is 
a comparison of the simulated implementation year payments under 
revised budget neutral factor and labor-related share and wage index 
under CBSA classification to the simulated implementation year payments 
under revised budget neutral factor and labor-related share and wage 
index under current MSA classifications. There is no projected change 
in aggregate payments to IPFs, as indicated in the first row of column 
4. There would, however, be small distributional effects among 
different categories of IPFs. For example, several categories of IPFs, 
such as IPFs located in the South Atlantic and West North Central 
regions, and psychiatric hospitals with between 12 and 25 beds, will 
experience a 0.2 percent decrease in payments. Rural non-profit 
hospitals and hospitals located in the Pacific region will receive the 
largest increase of 0.3 percent.
    In column 5, we present the effects of the market basket update to 
the IPF PPS payments by applying the TEFRA and PPS updates to payments 
under revised budget neutral factor and labor-related share and wage 
index under CBSA classification. In the aggregate this update is 
projected to be a 4.5 percent increase in overall payments to IPFs. 
This 4.5 percent reflects the current blend of the 4.6 percent update 
for IPF TEFRA payments and the 4.3 percent update for the IPF PPS 
payments.
    In column 6, we present the effects of the payment change in 
transition blend percentages to transition year 2 (TEFRA Rate 
Percentage = 50 percent, IPF PPS Federal Rate Percentage = 50 percent) 
from transition year 1 (TEFRA Rate Percentage = 75 percent, IPF PPS 
Federal Rate Percentage = 25 percent) of the IPF PPS under revised 
budget neutral factor, labor-related share and wage index under CBSA 
classification, and TEFRA and PPS updates to RY 2007. The overall 
aggregate effect, across all hospital groups, is projected to be a 0.2 
percent decrease in payments to IPFs. There are distributional effects 
of these changes among different categories of IPFs. The largest 
increases will be among government psychiatric hospitals, with rural 
government hospitals receiving a 12.0 percent increase and urban 
government hospitals receiving a 10.9 percent increase. Alternatively, 
psychiatric hospitals and units with fewer than 12 beds will receive 
the largest decreases of 3.8 percent and 4.5 percent, respectively.
    Column 7 compares our estimates of the changes reflected in this 
final rule for RY 2007, to our estimates of payments in the 
implementation year

[[Page 27085]]

(without these changes). This column reflects all RY 2007 changes 
relative to the implementation year (as shown in columns 3 through 6). 
The average increase for all IPFs is approximately 4.0 percent. This 
increase includes the effects of the market basket updates resulting in 
a 4.5 percent increase in total RY 2007 payments. It also includes a 
0.3 percent decrease in RY 2007 payments for the standardization factor 
revision and a 0.2 percent decrease in RY 2007 payments for the 
transition blend.
    Overall, the largest payment increase is projected to be among 
government IPFs. Urban government psychiatric hospitals will receive a 
15.4 percent increase and rural government psychiatric hospitals will 
receive a 16.3 percent increase. Psychiatric hospitals with fewer than 
12 beds will receive a 0.6 percent increase and psychiatric units with 
fewer than 12 beds will receive a 0.5 percent decrease.
4. Effect on the Medicare Program
    Based on actuarial projections resulting from our experience with 
other PPSs, we estimate that Medicare spending (total Medicare program 
payments) for IPF services over the next 5 years would be as follows:

                      Table 16.--Estimated Payments
------------------------------------------------------------------------
                                                            Dollars in
                        Rate year                            millions
------------------------------------------------------------------------
July 1, 2006 to June 30, 2007...........................          $4,299
July 1, 2007 to June 30, 2008...........................           4,427
July 1, 2008 to June 30, 2009...........................           4,613
July 1, 2009 to June 30, 2010...........................           4,813
July 1, 2010 to June 30, 2011...........................           5,033
------------------------------------------------------------------------

    These estimates are based on the current estimate of increases in 
the excluded hospital with capital market basket as follows:
     3.4 percent for RY 2007;
     3.1 percent for RY 2008;
     2.8 percent for RY 2009;
     2.3 percent for RY 2010; and
     2.7 percent for RY 2011.
    We estimate that there would be a change in fee-for-service 
Medicare beneficiary enrollment as follows:
     -0.3 percent in RY 2007;
     0.1 percent in RY 2008;
     0.2 percent in RY 2009;
     -0.3 percent in RY 2010; and
     -0.2 percent in RY 2011.
    In the implementation year we estimated aggregate payments under 
the IPF PPS to equal the estimated aggregate payments that would be 
made if the IPF PPS were not implemented. Our methodology for 
estimating payments for purposes of the budget-neutrality calculations 
uses the best available data.
    We will evaluate the accuracy of the assumptions used to compute 
the budget-neutrality calculation in the implementation year. We intend 
to analyze claims and cost report data from the implementation year of 
the IPF PPS to determine whether the factors used to develop the 
Federal per diem base rate are not significantly different from the 
actual results experienced in that year. We plan to compare payments 
under the final IPF PPS (which relies on an estimate of cost-based 
TEFRA payments using historical data from a base year and assumptions 
that trend the data to the initial implementation period) to estimated 
cost-based TEFRA payments based on actual data from the first year of 
the IPF PPS. If we find that an adjustment is necessary, the percent 
difference (either positive or negative) would be applied prospectively 
to the established prospective payment rates to ensure the rates 
accurately reflect the payment levels intended by the statute.
    Section 124 of Pub. L. 106-113 provides the Secretary broad 
authority to make an adjustment. We intend to perform this analysis 
within the first 5 years of the implementation of the IPF PPS.
5. Effect on Beneficiaries
    Under the IPF PPS, IPFs will receive payment based on the average 
resources consumed by patients for each day. We do not expect changes 
in the quality of care or access to services for Medicare beneficiaries 
under the IPF PPS. In fact, we believe that access to IPF services will 
be enhanced due to the patient and facility level adjustment factors, 
all of which are intended to adequately reimburse IPFs for expensive 
cases. Finally, the stop-loss policy is intended to assist IPFs during 
the transition. In addition, we expect that setting payment rates 
prospectively for IPF services would enhance the efficiency of the 
Medicare program.
6. Computer Hardware and Software
    We do not anticipate that IPFs would incur additional systems 
operating costs in order to effectively participate in the IPF PPS. We 
believe that IPFs and CAHs possess the computer hardware capability to 
handle the billing requirements under the IPF PPS. Our belief is based 
on indications that approximately 99 percent of hospital inpatient 
claims are submitted electronically. In addition, we are not adopting 
significant changes in claims processing.

C. Accounting Statement

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

       Table 17.--Accounting Statement: Classification of Estimated
      Expenditures, From the 2006 IPF PPS RY to the 2007 IPF PPS RY
                              [In millions]
------------------------------------------------------------------------
                 Category                             Transfers
------------------------------------------------------------------------
Annualized Monetized Transfers............  $170.
From Whom To Whom?........................  Federal Government To IPFs
                                             Medicare Providers.
------------------------------------------------------------------------

D. Alternatives Considered

    We considered the following alternatives in developing the update 
to the IPF PPS:
    One option we considered was incorporating a transition from MSA-
based labor market definitions to CBSA-based labor market definitions 
for the purpose of applying the area wage index. As stated in section 
VI.C.1.e of this final rule, we are not adopting a transition policy 
here because IPFs are already in a transition from reasonable cost 
based reimbursement to IPF PPS payments. In addition, as evident in 
Table 15 above, the wage index change does not appear to have a large 
impact on IPFs.
    We also considered increasing our outlier percentage so that 
outlier payments would be projected to be 3 percent (or higher) of 
total PPS payments. However, this approach would not target the truly 
costly cases. Instead, implementing such a policy would have the effect 
of lowering the fixed dollar loss threshold amount, therefore spreading 
outlier payments across more IPFs. In addition, the Federal per diem 
base rate would have to be reduced by another percentage point.

[[Page 27086]]

    In this final rule, we used the best available complete data set 
(that is, FY 2002 claims and cost report data) to assess the impact of 
the various policy changes. As previously stated, we will not know the 
true impact of the wage index changes, the transition blend period, or 
the market basket increases until we analyze IPF PPS data.
    We considered alternative policies in order to reduce financial 
risk to facilities in the event that they experience substantial 
reductions in Medicare payments during the period of transition to the 
IPF PPS. The stop-loss adjustment is applied to the IPF PPS portion of 
Medicare payments during the transition. We estimate that about 10 
percent of IPFs would receive additional payments under the stop-loss 
policy.
    The 70 percent of TEFRA stop-loss policy required a reduction in 
the per diem rate to make the stop-loss policy budget neutral during 
the implementation year. As a result, in the November 2004 IPF PPS 
final rule, we made a reduction to the Federal per diem base rate of 
0.4 percent for budget neutrality.
    In developing this final rule, we again considered an 80 percent 
stop-loss policy for RY 2007. Adopting an 80 percent policy would 
require a reduction in the Federal per diem base rate of over 2.5 
percent, and we estimate that about 29 percent of IPFs would receive 
additional payments. We chose to stay with the 70 percent policy for 
the same reasons discussed in the November 2004 IPF PPS final rule. 
Specifically, the 70 percent stop-loss policy targets the IPFs that 
experience the greatest impact relative to current payments, and it 
limits the size of the reduction to the Federal per diem base rate.
    In accordance with the provisions of Executive Order 12866, this 
rule was previously reviewed by OMB.

List of Subjects

42 CFR Part 412

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

42 CFR Part 424

    Emergency medical services, Health facilities, Health professions, 
Medicare, Reporting and recordkeeping requirements.


0
For the reasons set forth in the preamble, the Centers for Medicare & 
Medicaid Services amends 42 CFR chapter IV as follows:

PART 412--PROSPECTIVE PAYMENT SYSTEMS FOR HOSPITAL SERVICES

0
1. The authority citation for part 412 is revised to read as follows:

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

0
2. Amend Sec.  412.27 by revising paragraph (b) to read as follows:


Sec.  412.27  Excluded psychiatric units: Additional requirements.

* * * * *
    (b) Furnish, through the use of qualified personnel, psychological 
services, social work services, psychiatric nursing, and therapeutic 
activities.
* * * * *

0
3. Section 412.402 is amended by--
0
A. Republishing the introductory text.
0
B. Removing the definition of ``Fixed dollar loss threshold.''
0
C. Adding the definitions of ``Fixed dollar loss threshold amount,'' 
and ``new graduate medical education program'' in alphabetical order.
0
D. Revising the definitions of ``Qualifying emergency department,'' 
``Rural area,'' and ``Urban area.''
    The revisions and additions read as follows:


Sec.  412.402  Definitions.

    As used in this subpart--
* * * * *
    Fixed dollar loss threshold amount means a dollar amount which, 
when added to the Federal payment amount for a case, the estimated 
costs of a case must exceed in order for the case to qualify for an 
outlier payment.
* * * * *
    New graduate medical education program means a medical education 
program that receives initial accreditation by the appropriate 
accrediting body or begins training residents on or after November 15, 
2004.
* * * * *
    Qualifying emergency department means an emergency department that 
is staffed and equipped to furnish a comprehensive array of emergency 
services and meeting the definitions of a dedicated emergency 
department as specified in Sec.  489.24(b) of this chapter and the 
definition of ``provider-based status'' as specified in Sec.  413.65 of 
this chapter.
    Rural area means for cost reporting periods beginning January 1, 
2005, with respect to discharges occurring during the period covered by 
such cost reports but before July 1, 2006, an area as defined in Sec.  
412.62(f)(1)(iii). For discharges occurring on or after July 1, 2006, 
rural area means an area as defined in Sec.  412.64(b)(1)(ii)(C).
    Urban area means for cost reporting periods beginning on or after 
January 1, 2005, with respect to discharges occurring during the period 
covered by such cost reports but before July 1, 2006, an area as 
defined in Sec.  412.62(f)(1)(ii). For discharges occurring on or after 
July 1, 2006, urban area means an area as defined in Sec.  
412.64(b)(1)(ii)(A) and Sec.  412.64(b)(1)(ii)(B).

0
4. Section 412.424 is amended by--
0
A. Revising paragraph (d)(l)(iii).
0
B. Republishing the heading of paragraph (d)(1)(v).
0
C. Revising paragraph (d)(1)(v)(A).
0
D. Adding paragraph (d)(2) introductory text.
0
E. Removing and reserving paragraph (d)(2)(iii).
0
F. Revising paragraphs (d)(3)(i) introductory text and (d)(3)(i)(A).
    The revisions and additions read as follows:


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

* * * * *
    (d) * * *
    (1) * * *
    (iii) Teaching adjustment. CMS adjusts the Federal per diem base 
rate by a factor to account for indirect teaching costs.
    (A) An inpatient psychiatric facility's teaching adjustment is 
based on the ratio of the number of full-time equivalent residents 
training in the inpatient psychiatric facility divided by the 
facility's average daily census.
    (B) Residents with less than full-time status and residents 
rotating through the inpatient psychiatric facility for less than a 
full year will be counted in proportion to the time they spend in the 
inpatient psychiatric facility.
    (C) Except as described in paragraph (d)(1)(iii)(D) of this 
section, the actual number of current year full-time equivalent 
residents used in calculating the teaching adjustment is limited to the 
number of full-time equivalent residents in the inpatient psychiatric 
facility's most recently filed cost report filed with its fiscal 
intermediary before November 15, 2004 (base year).
    (D) If the inpatient psychiatric facility first begins training 
residents in a new approved graduate medical education program after 
November 15, 2004, the number of full-time equivalent residents 
determined under paragraph (d)(1)(iii)(C) of this section may be 
adjusted using the method described in Sec.  413.79(e)(1)(i) and (ii) 
of this chapter.
    (E) The teaching adjustment is made on a claim basis as an interim 
payment,

[[Page 27087]]

and the final payment in full for the claim is made during the final 
settlement of the cost report.
* * * * *
    (v) Adjustment for IPF with qualifying emergency departments. (A) 
CMS adjusts the Federal per diem base rate to account for the costs 
associated with maintaining a qualifying emergency department. A 
qualifying emergency department is staffed and equipped to furnish a 
comprehensive array of emergency services (medical and psychiatric) and 
meets the requirements of Sec.  489.24(b) and Sec.  413.65 of this 
chapter.
* * * * *
    (2) Patient-level adjustments. The inpatient psychiatric facility 
must identify a principal psychiatric diagnosis as specified in Sec.  
412.27(a) for each patient. CMS adjusts the Federal per diem base rate 
by a factor to account for the diagnosis-related group assignment 
associated with the principal diagnosis, as specified by CMS.
* * * * *
    (3) Other adjustments. (i) Outlier payments. CMS provides an 
outlier payment if an inpatient psychiatric facility's estimated total 
cost for a case exceeds a fixed dollar loss threshold amount for an 
inpatient psychiatric facility as defined in Sec.  412.402 plus the 
Federal payment amount for the case.
    (A) The fixed dollar loss threshold amount is adjusted for the 
inpatient psychiatric facility's adjustments for wage area, teaching, 
rural locations, and cost of living adjustment for facilities located 
in Alaska and Hawaii.
* * * * *


Sec.  412.426  [Amended]

0
5. In Sec.  412.426, paragraph (a) introductory text is amended by 
removing the reference ``Sec.  412.424(c)'' and adding the reference 
``Sec.  412.424(d)'' in its place.

0
6. Section 412.428 is amended by--
0
A. Republishing the introductory text.
0
B. Revising paragraph (b) and (d).
0
C. Adding a new paragraph (g).
0
D. Adding a new paragraph (h).
    The revision and additions reads as follows:


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

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

PART 424--CONDITIONS FOR MEDICARE PAYMENT

0
7. 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).

0
8. Section 424.14 is amended by--
0
A. Revising the heading.
0
B. Adding a new paragraph (c)(3).
0
C. Revising paragraph (d)(2).
    The addition and revisions read as follows:


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

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

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

    Dated: April 19, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.

    Approved: April 28, 2006.
Michael O. Leavitt,
Secretary.

Addendum A--Rate and Adjustment Factors

                              Per Diem Rate
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Federal Per Diem Base Rate...................................    $595.09
Labor Share (0.75665)........................................     450.27
Non-Labor Share (0.24335)....................................     144.82
------------------------------------------------------------------------


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


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


                   Cost of Living Adjustments (COLAs)
------------------------------------------------------------------------
 
------------------------------------------------------------------------
Alaska.......................................................       1.25
Hawaii:

[[Page 27088]]

 
    Honolulu County..........................................       1.25
    Hawaii County............................................      1.165
    Kauai County.............................................     1.2325
    Maui County..............................................     1.2375
    Kalawao County...........................................     1.2375
------------------------------------------------------------------------


                           Patient Adjustments
------------------------------------------------------------------------
 
------------------------------------------------------------------------
ECT--Per Treatment...........................................    $256.20
------------------------------------------------------------------------


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


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


                             DRG Adjustments
------------------------------------------------------------------------
                                                              Adjustment
             DRG                      DRG definition            factor
------------------------------------------------------------------------
DRG 424......................  O.R. Procedure with                  1.22
                                Principal Diagnosis of
                                Mental Illness.
DRG 425......................  Acute Adjustment Reaction &          1.05
                                Psychosocial Dysfunction.
DRG 426......................  Depressive Neurosis.........         0.99
DRG 427......................  Neurosis, Except Depressive.         1.02
DRG 428......................  Disorders of Personality &           1.02
                                Impulse Control.
DRG 429......................  Organic Disturbances &               1.03
                                Mental Retardation.
DRG 430......................  Psychosis...................         1.00
DRG 431......................  Childhood Mental Disorders..         0.99
DRG 432......................  Other Mental Disorders               0.92
                                Diagnoses.
DRG 433......................  Alcohol/Drug Abuse or                0.97
                                Dependence Leave Against
                                Medical Advice (LAMA).
DRG 521......................  Alcohol/Drug Abuse or                1.02
                                Dependence with Comorbid
                                Conditions.
DRG 522......................  Alcohol/Drug Abuse or                0.98
                                Dependence with
                                Rehabilitation Therapy
                                without Comorbid Conditions.
DRG 523......................  Alcohol/Drug Abuse or                0.88
                                Dependence without
                                Rehabilitation Therapy.
DRG 12.......................  Degenerative Nervous System          1.05
                                Disorders without Comorbid
                                Conditions.
DRG 23.......................  Non-traumatic Stupor & Coma.         1.07
------------------------------------------------------------------------


                         Comorbidity Adjustments
------------------------------------------------------------------------
                                                              Adjustment
                        Comorbidity                             factor
------------------------------------------------------------------------
Developmental Disabilities.................................         1.04
Coagulation Factor Deficit.................................         1.13
Tracheostomy...............................................         1.06
Eating and Conduct Disorders...............................         1.12
Infectious Diseases........................................         1.07
Renal Failure, Acute.......................................         1.11
Renal Failure, Chronic.....................................         1.11
Oncology Treatment.........................................         1.07
Uncontrolled Diabetes Mellitus with or without                      1.05
 Complications.............................................
Severe Protein Calorie Malnutrition........................         1.13
Drug/Alcohol Induced Mental Disorders......................         1.03
Cardiac Conditions.........................................         1.11
Gangrene...................................................         1.10
Chronic Obstructive Pulmonary Disease......................         1.12
Artificial Openings - Digestive & Urinary..................         1.08
Severe Musculoskeletal & Connective Tissue Diseases........         1.09
Poisoning..................................................         1.11
------------------------------------------------------------------------

Addendum B--RY 2007 IPF PPS Wage Index Table

----------------------------------------------------------------------------------------------------------------
 SSA State/County                                    MSA urban/   2006 MSA-              CBSA urban/   2006 CBSA-
       Code            County name       MSA No.       rural       based WI   CBSA No.      rural       based WI
----------------------------------------------------------------------------------------------------------------
01000............  Autauga County,           5240  Urban             0.8618      33860  Urban             0.8618
                    Alabama.
01010............  Baldwin County,           5160  Urban             0.7861      99901  Rural             0.7446
                    Alabama.
01020............  Barbour County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01030............  Bibb County,                01  Rural             0.7432      13820  Urban             0.8959
                    Alabama.
01040............  Blount County,            1000  Urban             0.9000      13820  Urban             0.8959
                    Alabama.
01050............  Bullock County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01060............  Butler County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01070............  Calhoun County,           0450  Urban             0.7682      11500  Urban             0.7682
                    Alabama.

[[Page 27089]]

 
01080............  Chambers County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01090............  Cherokee County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01100............  Chilton County,             01  Rural             0.7432      13820  Urban             0.8959
                    Alabama.
01110............  Choctaw County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01120............  Clarke County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01130............  Clay County,                01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01140............  Cleburne County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01150............  Coffee County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01160............  Colbert County,           2650  Urban             0.8272      22520  Urban             0.8272
                    Alabama.
01170............  Conecuh County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01180............  Coosa County,               01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01190............  Covington County,           01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01200............  Crenshaw County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01210............  Cullman County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01220............  Dale County,              2180  Urban             0.7701      99901  Rural             0.7446
                    Alabama.
01230............  Dallas County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01240............  De Kalb County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01250............  Elmore County,            5240  Urban             0.8618      33860  Urban             0.8618
                    Alabama.
01260............  Escambia County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01270............  Etowah County,            2880  Urban             0.7938      23460  Urban             0.7938
                    Alabama.
01280............  Fayette County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01290............  Franklin County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01300............  Geneva County,              01  Rural             0.7432      20020  Urban             0.7721
                    Alabama.
01310............  Greene County,              01  Rural             0.7432      46220  Urban             0.8645
                    Alabama.
01320............  Hale County,                01  Rural             0.7432      46220  Urban             0.8645
                    Alabama.
01330............  Henry County,               01  Rural             0.7432      20020  Urban             0.7721
                    Alabama.
01340............  Houston County,           2180  Urban             0.7701      20020  Urban             0.7721
                    Alabama.
01350............  Jackson County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01360............  Jefferson County,         1000  Urban             0.9000      13820  Urban             0.8959
                    Alabama.
01370............  Lamar County,               01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01380............  Lauderdale County,        2650  Urban             0.8272      22520  Urban             0.8272
                    Alabama.
01390............  Lawrence County,          2030  Urban             0.8469      19460  Urban             0.8469
                    Alabama.
01400............  Lee County, Alabama       0580  Urban             0.8100      12220  Urban             0.8100
01410............  Limestone County,         3440  Urban             0.9146      26620  Urban             0.9146
                    Alabama.
01420............  Lowndes County,             01  Rural             0.7432      33860  Urban             0.8618
                    Alabama.
01430............  Macon County,               01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01440............  Madison County,           3440  Urban             0.9146      26620  Urban             0.9146
                    Alabama.
01450............  Marengo County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01460............  Marion County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01470............  Marshall County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01480............  Mobile County,            5160  Urban             0.7861      33660  Urban             0.7891
                    Alabama.
01490............  Monroe County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01500............  Montgomery County,        5240  Urban             0.8618      33860  Urban             0.8618
                    Alabama.
01510............  Morgan County,            2030  Urban             0.8469      19460  Urban             0.8469
                    Alabama.
01520............  Perry County,               01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01530............  Pickens County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01540............  Pike County,                01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01550............  Randolph County,            01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01560............  Russell County,           1800  Urban             0.8560      17980  Urban             0.8560
                    Alabama.
01570............  St Clair County,          1000  Urban             0.9000      13820  Urban             0.8959
                    Alabama.
01580............  Shelby County,            1000  Urban             0.9000      13820  Urban             0.8959
                    Alabama.
01590............  Sumter County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01600............  Talladega County,           01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01610............  Tallapoosa County,          01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01620............  Tuscaloosa County,        8600  Urban             0.8764      46220  Urban             0.8645
                    Alabama.
01630............  Walker County,              01  Rural             0.7432      13820  Urban             0.8959
                    Alabama.
01640............  Washington County,          01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01650............  Wilcox County,              01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
01660............  Winston County,             01  Rural             0.7432      99901  Rural             0.7446
                    Alabama.
02013............  Aleutians County            02  Rural             1.1888      99902  Rural             1.1977
                    East, Alaska.
02016............  Aleutians County            02  Rural             1.1888      99902  Rural             1.1977
                    West, Alaska.
02020............  Anchorage County,         0380  Urban             1.1784      11260  Urban             1.1895
                    Alaska.
02030............  Angoon County,              02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02040............  Barrow-North Slope          02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02050............  Bethel County,              02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02060............  Bristol Bay Borough         02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02068............  Denali County,              02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02070............  Bristol Bay County,         02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02080............  Cordova-Mc Carthy           02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02090............  Fairbanks County,           02  Rural             1.1888      21820  Urban             1.1408
                    Alaska.
02100............  Haines County,              02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02110............  Juneau County,              02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.

[[Page 27090]]

 
02120............  Kenai-Cook Inlet            02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02122............  Kenai Peninsula             02  Rural             1.1888      99902  Rural             1.1977
                    Borough, Alaska.
02130............  Ketchikan County,           02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02140............  Kobuk County,               02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02150............  Kodiak County,              02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02160............  Kuskokwin County,           02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02164............  Lake and Peninsula          02  Rural             1.1888      99902  Rural             1.1977
                    Borough, Alaska.
02170............  Matanuska County,           02  Rural             1.1888      11260  Urban             1.1895
                    Alaska.
02180............  Nome County, Alaska         02  Rural             1.1888      99902  Rural             1.1977
02185............  North Slope                 02  Rural             1.1888      99902  Rural             1.1977
                    Borough, Alaska.
02188............  Northwest Arctic            02  Rural             1.1888      99902  Rural             1.1977
                    Borough, Alaska.
02190............  Outer Ketchikan             02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02200............  Prince Of Wales             02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02201............  Prince of Wales-            02  Rural             1.1888      99902  Rural             1.1977
                    Outer Ketchikan
                    Census Area,
                    Alaska.
02210............  Seward County,              02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02220............  Sitka County,               02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02230............  Skagway-Yakutat             02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02231............  Skagway-Yakutat-            02  Rural             1.1888      99902  Rural             1.1977
                    Angoon Census
                    Area, Alaska.
02232............  Skagway-Hoonah-             02  Rural             1.1888      99902  Rural             1.1977
                    Angoon Census
                    Area, Alaska.
02240............  Southeast Fairbanks         02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02250............  Upper Yukon County,         02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02260............  Valdz-Chitna-               02  Rural             1.1888      99902  Rural             1.1977
                    Whitier County,
                    Alaska.
02261............  Valdex-Cordove              02  Rural             1.1888      99902  Rural             1.1977
                    Census Area,
                    Alaska.
02270............  Wade Hampton                02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02280............  Wrangell-Petersburg         02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
02282............  Yakutat Borough,            02  Rural             1.1888      99902  Rural             1.1977
                    Alaska.
02290............  Yukon-Koyukuk               02  Rural             1.1888      99902  Rural             1.1977
                    County, Alaska.
03000............  Apache County,              03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03010............  Cochise County,             03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03020............  Coconino County,          2620  Urban             1.1845      22380  Urban             1.2092
                    Arizona.
03030............  Gila County,                03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03040............  Graham County,              03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03050............  Greenlee County,            03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03055............  La Paz County,              03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03060............  Maricopa County,          6200  Urban             1.0127      38060  Urban             1.0127
                    Arizona.
03070............  Mohave County,            4120  Urban             1.1155      99903  Rural             0.8768
                    Arizona.
03080............  Navajo County,              03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03090............  Pima County,              8520  Urban             0.9007      46060  Urban             0.9007
                    Arizona.
03100............  Pinal County,             6200  Urban             1.0127      38060  Urban             1.0127
                    Arizona.
03110............  Santa Cruz County,          03  Rural             0.9045      99903  Rural             0.8768
                    Arizona.
03120............  Yavapai County,             03  Rural             0.9045      39140  Urban             0.9869
                    Arizona.
03130............  Yuma County,              9360  Urban             0.9126      49740  Urban             0.9126
                    Arizona.
04000............  Arkansas County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04010............  Ashley County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04020............  Baxter County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04030............  Benton County,            2580  Urban             0.8661      22220  Urban             0.8661
                    Arkansas.
04040............  Boone County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04050............  Bradley County,             04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04060............  Calhoun County,             04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04070............  Carroll County,             04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04080............  Chicot County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04090............  Clark County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04100............  Clay County,                04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04110............  Cleburne County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04120............  Cleveland County,           04  Rural             0.7744      38220  Urban             0.8680
                    Arkansas.
04130............  Columbia County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04140............  Conway County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04150............  Craighead County,         3700  Urban             0.7911      27860  Urban             0.7911
                    Arkansas.
04160............  Crawford County,          2720  Urban             0.8246      22900  Urban             0.8230
                    Arkansas.
04170............  Crittenden County,        4920  Urban             0.9416      32820  Urban             0.9397
                    Arkansas.
04180............  Cross County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04190............  Dallas County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04200............  Desha County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04210............  Drew County,                04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04220............  Faulkner County,          4400  Urban             0.8747      30780  Urban             0.8747
                    Arkansas.
04230............  Franklin County,            04  Rural             0.7744      22900  Urban             0.8230
                    Arkansas.
04240............  Fulton County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04250............  Garland County,             04  Rural             0.7744      26300  Urban             0.9005
                    Arkansas.
04260............  Grant County,               04  Rural             0.7744      30780  Urban             0.8747
                    Arkansas.
04270............  Greene County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04280............  Hempstead County,           04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04290............  Hot Spring County,          04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.

[[Page 27091]]

 
04300............  Howard County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04310............  Independence                04  Rural             0.7744      99904  Rural             0.7466
                    County, Arkansas.
04320............  Izard County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04330............  Jackson County,             04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04340............  Jefferson County,         6240  Urban             0.8680      38220  Urban             0.8680
                    Arkansas.
04350............  Johnson County,             04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04360............  Lafayette County,           04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04370............  Lawrence County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04380............  Lee County,                 04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04390............  Lincoln County,             04  Rural             0.7744      38220  Urban             0.8680
                    Arkansas.
04400............  Little River                04  Rural             0.7744      99904  Rural             0.7466
                    County, Arkansas.
04410............  Logan County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04420............  Lonoke County,            4400  Urban             0.8747      30780  Urban             0.8747
                    Arkansas.
04430............  Madison County,             04  Rural             0.7744      22220  Urban             0.8661
                    Arkansas.
04440............  Marion County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04450............  Miller County,            8360  Urban             0.8283      45500  Urban             0.8283
                    Arkansas.
04460............  Mississippi County,         04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04470............  Monroe County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04480............  Montgomery County,          04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04490............  Nevada County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04500............  Newton County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04510............  Ouachita County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04520............  Perry County,               04  Rural             0.7744      30780  Urban             0.8747
                    Arkansas.
04530............  Phillips County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04540............  Pike County,                04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04550............  Poinsett County,            04  Rural             0.7744      27860  Urban             0.7911
                    Arkansas.
04560............  Polk County,                04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04570............  Pope County,                04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04580............  Prairie County,             04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04590............  Pulaski County,           4400  Urban             0.8747      30780  Urban             0.8747
                    Arkansas.
04600............  Randolph County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04610............  St Francis County,          04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04620............  Saline County,            4400  Urban             0.8747      30780  Urban             0.8747
                    Arkansas.
04630............  Scott County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04640............  Searcy County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04650............  Sebastian County,         2720  Urban             0.8246      22900  Urban             0.8230
                    Arkansas.
04660............  Sevier County,              04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04670............  Sharp County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04680............  Stone County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04690............  Union County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04700............  Van Buren County,           04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04710............  Washington County,        2580  Urban             0.8661      22220  Urban             0.8661
                    Arkansas.
04720............  White County,               04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04730............  Woodruff County,            04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
04740............  Yell County,                04  Rural             0.7744      99904  Rural             0.7466
                    Arkansas.
05000............  Alameda County,           5775  Urban             1.5346      36084  Urban             1.5346
                    California.
05010............  Alpine County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05020............  Amador County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05030............  Butte County,             1620  Urban             1.0511      17020  Urban             1.0511
                    California.
05040............  Calaveras County,           05  Rural             1.0775      99905  Rural             1.1054
                    California.
05050............  Colusa County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05060............  Contra Costa              5775  Urban             1.5346      36084  Urban             1.5346
                    County, California.
05070............  Del Norte County,           05  Rural             1.0775      99905  Rural             1.1054
                    California.
05080............  Eldorado County,          6920  Urban             1.3143      40900  Urban             1.2969
                    California.
05090............  Fresno County,            2840  Urban             1.0428      23420  Urban             1.0538
                    California.
05100............  Glenn County,               05  Rural             1.0775      99905  Rural             1.1054
                    California.
05110............  Humboldt County,            05  Rural             1.0775      99905  Rural             1.1054
                    California.
05120............  Imperial County,            05  Rural             1.0775      20940  Urban             0.8906
                    California.
05130............  Inyo County,                05  Rural             1.0775      99905  Rural             1.1054
                    California.
05140............  Kern County,              0680  Urban             1.0470      12540  Urban             1.0470
                    California.
05150............  Kings County,               05  Rural             1.0775      25260  Urban             1.0036
                    California.
05160............  Lake County,                05  Rural             1.0775      99905  Rural             1.1054
                    California.
05170............  Lassen County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05200............  Los Angeles County,       4480  Urban             1.1783      31084  Urban             1.1783
                    California.
05210............  Los Angeles County,       4480  Urban             1.1783      31084  Urban             1.1783
                    California.
05300............  Madera County,            2840  Urban             1.0428      31460  Urban             0.8713
                    California.
05310............  Marin County,             7360  Urban             1.4994      41884  Urban             1.4994
                    California.
05320............  Mariposa County,            05  Rural             1.0775      99905  Rural             1.1054
                    California.
05330............  Mendocino County,           05  Rural             1.0775      99905  Rural             1.1054
                    California.
05340............  Merced County,            4940  Urban             1.1109      32900  Urban             1.1109
                    California.
05350............  Modoc County,               05  Rural             1.0775      99905  Rural             1.1054
                    California.
05360............  Mono County,                05  Rural             1.0775      99905  Rural             1.1054
                    California.

[[Page 27092]]

 
05370............  Monterey County,          7120  Urban             1.4128      41500  Urban             1.4128
                    California.
05380............  Napa County,              8720  Urban             1.3983      34900  Urban             1.2643
                    California.
05390............  Nevada County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05400............  Orange County,            5945  Urban             1.1559      42044  Urban             1.1559
                    California.
05410............  Placer County,            6920  Urban             1.3143      40900  Urban             1.2969
                    California.
05420............  Plumas County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05430............  Riverside County,         6780  Urban             1.1027      40140  Urban             1.1027
                    California.
05440............  Sacramento County,        6920  Urban             1.3143      40900  Urban             1.2969
                    California.
05450............  San Benito County,          05  Rural             1.0775      41940  Urban             1.5099
                    California.
05460............  San Bernardino            6780  Urban             1.1027      40140  Urban             1.1027
                    County, California.
05470............  San Diego County,         7320  Urban             1.1413      41740  Urban             1.1413
                    California.
05480............  San Francisco             7360  Urban             1.4994      41884  Urban             1.4994
                    County, California.
05490............  San Joaquin County,       8120  Urban             1.1307      44700  Urban             1.1307
                    California.
05500............  San Luis Obispo           7460  Urban             1.1349      42020  Urban             1.1349
                    County, California.
05510............  San Mateo County,         7360  Urban             1.4994      41884  Urban             1.4994
                    California.
05520............  Santa Barbara             7480  Urban             1.1694      42060  Urban             1.1694
                    County, California.
05530............  Santa Clara County,       7400  Urban             1.5118      41940  Urban             1.5099
                    California.
05540............  Santa Cruz County,        7485  Urban             1.5166      42100  Urban             1.5166
                    California.
05550............  Shasta County,            6690  Urban             1.2203      39820  Urban             1.2203
                    California.
05560............  Sierra County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05570............  Siskiyou County,            05  Rural             1.0775      99905  Rural             1.1054
                    California.
05580............  Solano County,            8720  Urban             1.3983      46700  Urban             1.4936
                    California.
05590............  Sonoma County,            7500  Urban             1.3493      42220  Urban             1.3493
                    California.
05600............  Stanislaus County,        5170  Urban             1.1885      33700  Urban             1.1885
                    California.
05610............  Sutter County,            9340  Urban             1.0921      49700  Urban             1.0921
                    California.
05620............  Tehama County,              05  Rural             1.0775      99905  Rural             1.1054
                    California.
05630............  Trinity County,             05  Rural             1.0775      99905  Rural             1.1054
                    California.
05640............  Tulare County,            8780  Urban             1.0123      47300  Urban             1.0123
                    California.
05650............  Tuolumne County,            05  Rural             1.0775      99905  Rural             1.1054
                    California.
05660............  Ventura County,           8735  Urban             1.1622      37100  Urban             1.1622
                    California.
05670............  Yolo County,              9270  Urban             0.9950      40900  Urban             1.2969
                    California.
05680............  Yuba County,              9340  Urban             1.0921      49700  Urban             1.0921
                    California.
06000............  Adams County,             2080  Urban             1.0723      19740  Urban             1.0723
                    Colorado.
06010............  Alamosa County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06020............  Arapahoe County,          2080  Urban             1.0723      19740  Urban             1.0723
                    Colorado.
06030............  Archuleta County,           06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06040............  Baca County,                06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06050............  Bent County,                06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06060............  Boulder County,           1125  Urban             0.9734      14500  Urban             0.9734
                    Colorado.
06070............  Chaffee County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06080............  Cheyenne County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06090............  Clear Creek County,         06  Rural             0.9380      19740  Urban             1.0723
                    Colorado.
06100............  Conejos County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06110............  Costilla County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06120............  Crowley County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06130............  Custer County,              06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06140............  Delta County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06150............  Denver County,            2080  Urban             1.0723      19740  Urban             1.0723
                    Colorado.
06160............  Dolores County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06170............  Douglas County,           2080  Urban             1.0723      19740  Urban             1.0723
                    Colorado.
06180............  Eagle County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06190............  Elbert County,              06  Rural             0.9380      19740  Urban             1.0723
                    Colorado.
06200............  El Paso County,           1720  Urban             0.9468      17820  Urban             0.9468
                    Colorado.
06210............  Fremont County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06220............  Garfield County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06230............  Gilpin County,              06  Rural             0.9380      19740  Urban             1.0723
                    Colorado.
06240............  Grand County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06250............  Gunnison County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06260............  Hinsdale County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06270............  Huerfano County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06280............  Jackson County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06290............  Jefferson County,         2080  Urban             1.0723      19740  Urban             1.0723
                    Colorado.
06300............  Kiowa County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06310............  Kit Carson County,          06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06320............  Lake County,                06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06330............  La Plata County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06340............  Larimer County,           2670  Urban             1.0122      22660  Urban             1.0122
                    Colorado.
06350............  Las Animas County,          06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06360............  Lincoln County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06370............  Logan County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06380............  Mesa County,              2995  Urban             0.9550      24300  Urban             0.9550
                    Colorado.
06390............  Mineral County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.

[[Page 27093]]

 
06400............  Moffat County,              06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06410............  Montezuma County,           06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06420............  Montrose County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06430............  Morgan County,              06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06440............  Otero County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06450............  Ouray County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06460............  Park County,                06  Rural             0.9380      19740  Urban             1.0723
                    Colorado.
06470............  Phillips County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06480............  Pitkin County,              06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06490............  Prowers County,             06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06500............  Pueblo County,            6560  Urban             0.8623      39380  Urban             0.8623
                    Colorado.
06510............  Rio Blanco County,          06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06520............  Rio Grande County,          06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06530............  Routt County,               06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06540............  Saguache County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06550............  San Juan County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06560............  San Miguel County,          06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06570............  Sedgwick County,            06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06580............  Summit County,              06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06590............  Teller County,              06  Rural             0.9380      17820  Urban             0.9468
                    Colorado.
06600............  Washington County,          06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06610............  Weld County,              3060  Urban             0.9570      24540  Urban             0.9570
                    Colorado.
06620............  Yuma County,                06  Rural             0.9380      99906  Rural             0.9380
                    Colorado.
06630............  Broomfield County,        2080  Urban             1.0723      19740  Urban             1.0723
                    Colorado.
07000............  Fairfield County,         5483  Urban             1.2196      14860  Urban             1.2592
                    Connecticut.
07010............  Hartford County,          3283  Urban             1.1073      25540  Urban             1.1073
                    Connecticut.
07020............  Litchfield County,        3283  Urban             1.1073      25540  Urban             1.1073
                    Connecticut.
07030............  Middlesex County,         3283  Urban             1.1073      25540  Urban             1.1073
                    Connecticut.
07040............  New Haven County,         5483  Urban             1.2196      35300  Urban             1.1887
                    Connecticut.
07050............  New London County,        5523  Urban             1.1345      35980  Urban             1.1345
                    Connecticut.
07060............  Tolland County,           3283  Urban             1.1073      25540  Urban             1.1073
                    Connecticut.
07070............  Windham County,             07  Rural             1.1730      99907  Rural             1.1730
                    Connecticut.
08000............  Kent County,              2190  Urban             0.9776      20100  Urban             0.9776
                    Delaware.
08010............  New Castle County,        9160  Urban             1.0527      48864  Urban             1.0471
                    Delaware.
08020............  Sussex County,              08  Rural             0.9579      99908  Rural             0.9579
                    Delaware.
09000............  Washington Dc             8840  Urban             1.0976      47894  Urban             1.0926
                    County, Dist Of
                    Col.
10000............  Alachua County,           2900  Urban             0.9388      23540  Urban             0.9388
                    Florida.
10010............  Baker County,               10  Rural             0.8677      27260  Urban             0.9290
                    Florida.
10020............  Bay County, Florida       6015  Urban             0.8005      37460  Urban             0.8005
10030............  Bradford County,            10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10040............  Brevard County,           4900  Urban             0.9839      37340  Urban             0.9839
                    Florida.
10050............  Broward County,           2680  Urban             1.0432      22744  Urban             1.0432
                    Florida.
10060............  Calhoun County,             10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10070............  Charlotte County,         6580  Urban             0.9255      39460  Urban             0.9255
                    Florida.
10080............  Citrus County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10090............  Clay County,              3600  Urban             0.9299      27260  Urban             0.9290
                    Florida.
10100............  Collier County,           5345  Urban             1.0139      34940  Urban             1.0139
                    Florida.
10110............  Columbia County,            10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10120............  Dade County,              5000  Urban             0.9750      33124  Urban             0.9750
                    Florida.
10130............  De Soto County,             10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10140............  Dixie County,               10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10150............  Duval County,             3600  Urban             0.9299      27260  Urban             0.9290
                    Florida.
10160............  Escambia County,          6080  Urban             0.8096      37860  Urban             0.8096
                    Florida.
10170............  Flagler County,           2020  Urban             0.9325      99910  Rural             0.8568
                    Florida.
10180............  Franklin County,            10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10190............  Gadsden County,           8240  Urban             0.8688      45220  Urban             0.8688
                    Florida.
10200............  Gilchrist County,           10  Rural             0.8677      23540  Urban             0.9388
                    Florida.
10210............  Glades County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10220............  Gulf County,                10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10230............  Hamilton County,            10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10240............  Hardee County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10250............  Hendry County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10260............  Hernando County,          8280  Urban             0.9233      45300  Urban             0.9233
                    Florida.
10270............  Highlands County,           10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10280............  Hillsborough              8280  Urban             0.9233      45300  Urban             0.9233
                    County, Florida.
10290............  Holmes County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10300............  Indian River                10  Rural             0.8677      42680  Urban             0.9434
                    County, Florida.
10310............  Jackson County,             10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10320............  Jefferson County,           10  Rural             0.8677      45220  Urban             0.8688
                    Florida.
10330............  Lafayette County,           10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10340............  Lake County,              5960  Urban             0.9464      36740  Urban             0.9464
                    Florida.
10350............  Lee County, Florida       2700  Urban             0.9356      15980  Urban             0.9356

[[Page 27094]]

 
10360............  Leon County,              8240  Urban             0.8688      45220  Urban             0.8688
                    Florida.
10370............  Levy County,                10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10380............  Liberty County,             10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10390............  Madison County,             10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10400............  Manatee County,           7510  Urban             0.9639      42260  Urban             0.9639
                    Florida.
10410............  Marion County,            5790  Urban             0.8925      36100  Urban             0.8925
                    Florida.
10420............  Martin County,            2710  Urban             1.0123      38940  Urban             1.0123
                    Florida.
10430............  Monroe County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10440............  Nassau County,            3600  Urban             0.9299      27260  Urban             0.9290
                    Florida.
10450............  Okaloosa County,          2750  Urban             0.8872      23020  Urban             0.8872
                    Florida.
10460............  Okeechobee County,          10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10470............  Orange County,            5960  Urban             0.9464      36740  Urban             0.9464
                    Florida.
10480............  Osceola County,           5960  Urban             0.9464      36740  Urban             0.9464
                    Florida.
10490............  Palm Beach County,        8960  Urban             1.0067      48424  Urban             1.0067
                    Florida.
10500............  Pasco County,             8280  Urban             0.9233      45300  Urban             0.9233
                    Florida.
10510............  Pinellas County,          8280  Urban             0.9233      45300  Urban             0.9233
                    Florida.
10520............  Polk County,              3980  Urban             0.8912      29460  Urban             0.8912
                    Florida.
10530............  Putnam County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10540............  Johns County,             3600  Urban             0.9299      27260  Urban             0.9290
                    Florida.
10550............  St Lucie County,          2710  Urban             1.0123      38940  Urban             1.0123
                    Florida.
10560............  Santa Rosa County,        6080  Urban             0.8096      37860  Urban             0.8096
                    Florida.
10570............  Sarasota County,          7510  Urban             0.9639      42260  Urban             0.9639
                    Florida.
10580............  Seminole County,          5960  Urban             0.9464      36740  Urban             0.9464
                    Florida.
10590............  Sumter County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10600............  Suwannee County,            10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10610............  Taylor County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10620............  Union County,               10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10630............  Volusia County,           2020  Urban             0.9325      19660  Urban             0.9299
                    Florida.
10640............  Wakulla County,             10  Rural             0.8677      45220  Urban             0.8688
                    Florida.
10650............  Walton County,              10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
10660............  Washington County,          10  Rural             0.8677      99910  Rural             0.8568
                    Florida.
11000............  Appling County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11010............  Atkinson County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11011............  Bacon County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11020............  Baker County,               11  Rural             0.8166      10500  Urban             0.8628
                    Georgia.
11030............  Baldwin County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11040............  Banks County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11050............  Barrow County,            0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11060............  Bartow County,            0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11070............  Ben Hill County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11080............  Berrien County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11090............  Bibb County,              4680  Urban             0.9277      31420  Urban             0.9443
                    Georgia.
11100............  Bleckley County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11110............  Brantley County,            11  Rural             0.8166      15260  Urban             0.9311
                    Georgia.
11120............  Brooks County,              11  Rural             0.8166      46660  Urban             0.8866
                    Georgia.
11130............  Bryan County,             7520  Urban             0.9461      42340  Urban             0.9461
                    Georgia.
11140............  Bulloch County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11150............  Burke County,               11  Rural             0.8166      12260  Urban             0.9748
                    Georgia.
11160............  Butts County,               11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11161............  Calhoun County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11170............  Camden County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11180............  Candler County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11190............  Carroll County,           0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11200............  Catoosa County,           1560  Urban             0.9088      16860  Urban             0.9088
                    Georgia.
11210............  Charlton County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11220............  Chatham County,           7520  Urban             0.9461      42340  Urban             0.9461
                    Georgia.
11230............  Chattahoochee             1800  Urban             0.8560      17980  Urban             0.8560
                    County, Georgia.
11240............  Chattooga County,           11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11250............  Cherokee County,          0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11260............  Clarke County,            0500  Urban             0.9855      12020  Urban             0.9855
                    Georgia.
11270............  Clay County,                11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11280............  Clayton County,           0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11281............  Clinch County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11290............  Cobb County,              0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11291............  Coffee County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11300............  Colquitt County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11310............  Columbia County,          0600  Urban             0.9808      12260  Urban             0.9748
                    Georgia.
11311............  Cook County,                11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11320............  Coweta County,            0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11330............  Crawford County,            11  Rural             0.8166      31420  Urban             0.9443
                    Georgia.
11340............  Crisp County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11341............  Dade County,              1560  Urban             0.9088      16860  Urban             0.9088
                    Georgia.

[[Page 27095]]

 
11350............  Dawson County,              11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11360............  Decatur County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11370............  De Kalb County,           0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11380............  Dodge County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11381............  Dooly County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11390............  Dougherty County,         0120  Urban             0.8628      10500  Urban             0.8628
                    Georgia.
11400............  Douglas County,           0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11410............  Early County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11420............  Echols County,              11  Rural             0.8166      46660  Urban             0.8866
                    Georgia.
11421............  Effingham County,         7520  Urban             0.9461      42340  Urban             0.9461
                    Georgia.
11430............  Elbert County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11440............  Emanuel County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11441............  Evans County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11450............  Fannin County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11451............  Fayette County,           0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11460............  Floyd County,               11  Rural             0.8166      40660  Urban             0.9414
                    Georgia.
11461............  Forsyth County,           0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11462............  Franklin County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11470............  Fulton County,            0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11471............  Gilmer County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11480............  Glascock County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11490............  Glynn County,               11  Rural             0.8166      15260  Urban             0.9311
                    Georgia.
11500............  Gordon County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11510............  Grady County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11520............  Greene County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11530............  Gwinnett County,          0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11540............  Habersham County,           11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11550............  Hall County,                11  Rural             0.8166      23580  Urban             0.8874
                    Georgia.
11560............  Hancock County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11570............  Haralson County,            11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11580............  Harris County,            1800  Urban             0.8560      17980  Urban             0.8560
                    Georgia.
11581............  Hart County,                11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11590............  Heard County,               11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11591............  Henry County,             0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11600............  Houston County,           4680  Urban             0.9277      47580  Urban             0.8645
                    Georgia.
11601............  Irwin County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11610............  Jackson County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11611............  Jasper County,              11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11612............  Jeff Davis County,          11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11620............  Jefferson County,           11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11630............  Jenkins County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11640............  Johnson County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11650............  Jones County,             4680  Urban             0.9277      31420  Urban             0.9443
                    Georgia.
11651............  Lamar County,               11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11652............  Lanier County,              11  Rural             0.8166      46660  Urban             0.8866
                    Georgia.
11660............  Laurens County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11670............  Lee County, Georgia       0120  Urban             0.8628      10500  Urban             0.8628
11680............  Liberty County,             11  Rural             0.8166      25980  Urban                \1\
                    Georgia.                                                                             0.91981
11690............  Lincoln County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11691............  Long County,                11  Rural             0.8166      25980  Urban                \1\
                    Georgia.                                                                             0.91981
11700............  Lowndes County,             11  Rural             0.8166      46660  Urban             0.8866
                    Georgia.
11701............  Lumpkin County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11702............  Mc Duffie County,         0600  Urban             0.9808      12260  Urban             0.9748
                    Georgia.
11703............  Mc Intosh County,           11  Rural             0.8166      15260  Urban             0.9311
                    Georgia.
11710............  Macon County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11720............  Madison County,           0500  Urban             0.9855      12020  Urban             0.9855
                    Georgia.
11730............  Marion County,              11  Rural             0.8166      17980  Urban             0.8560
                    Georgia.
11740............  Meriwether County,          11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11741............  Miller County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11750............  Mitchell County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11760............  Monroe County,              11  Rural             0.8166      31420  Urban             0.9443
                    Georgia.
11770............  Montgomery County,          11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11771............  Morgan County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11772............  Murray County,              11  Rural             0.8166      19140  Urban             0.9079
                    Georgia.
11780............  Muscogee County,          1800  Urban             0.8560      17980  Urban             0.8560
                    Georgia.
11790............  Newton County,            0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11800............  Oconee County,            0500  Urban             0.9855      12020  Urban             0.9855
                    Georgia.
11801............  Oglethorpe County,          11  Rural             0.8166      12020  Urban             0.9855
                    Georgia.
11810............  Paulding County,          0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11811............  Peach County,             4680  Urban             0.9277      99911  Rural             0.7662
                    Georgia.
11812............  Pickens County,           0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11820............  Pierce County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.

[[Page 27096]]

 
11821............  Pike County,                11  Rural             0.8166      12060  Urban             0.9793
                    Georgia.
11830............  Polk County,                11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11831............  Pulaski County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11832............  Putnam County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11833............  Quitman County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11834............  Rabun County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11835............  Randolph County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11840............  Richmond County,          0600  Urban             0.9808      12260  Urban             0.9748
                    Georgia.
11841............  Rockdale County,          0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11842............  Schley County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11850............  Screven County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11851............  Seminole County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11860............  Spalding County,          0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11861............  Stephens County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11862............  Stewart County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11870............  Sumter County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11880............  Talbot County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11881............  Taliaferro County,          11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11882............  Tattnall County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11883............  Taylor County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11884............  Telfair County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11885............  Terrell County,             11  Rural             0.8166      10500  Urban             0.8628
                    Georgia.
11890............  Thomas County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11900............  Tift County,                11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11901............  Toombs County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11902............  Towns County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11903............  Treutlen County,            11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11910............  Troup County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11911............  Turner County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11912............  Twiggs County,            4680  Urban             0.9277      31420  Urban             0.9443
                    Georgia.
11913............  Union County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11920............  Upson County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11921............  Walker County,            1560  Urban             0.9088      16860  Urban             0.9088
                    Georgia.
11930............  Walton County,            0520  Urban             0.9793      12060  Urban             0.9793
                    Georgia.
11940............  Ware County,                11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11941............  Warren County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11950............  Washington County,          11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11960............  Wayne County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11961............  Webster County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11962............  Wheeler County,             11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11963............  White County,               11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11970............  Whitfield County,           11  Rural             0.8166      19140  Urban             0.9079
                    Georgia.
11971............  Wilcox County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11972............  Wilkes County,              11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11973............  Wilkinson County,           11  Rural             0.8166      99911  Rural             0.7662
                    Georgia.
11980............  Worth County,               11  Rural             0.8166      10500  Urban             0.8628
                    Georgia.
12005............  Kalawao County,             12  Rural             1.0551      99912  Rural             1.0551
                    Hawaii.
12010............  Hawaii County,              12  Rural             1.0551      99912  Rural             1.0551
                    Hawaii.
12020............  Honolulu County,          3320  Urban             1.1214      26180  Urban             1.1214
                    Hawaii.
12040............  Kauai County,               12  Rural             1.0551      99912  Rural             1.0551
                    Hawaii.
12050............  Maui County, Hawaii         12  Rural             1.0551      99912  Rural             1.0551
13000............  Ada County, Idaho..       1080  Urban             0.9052      14260  Urban             0.9052
13010............  Adams County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13020............  Bannock County,           6340  Urban             0.9351      38540  Urban             0.9351
                    Idaho.
13030............  Bear Lake County,           13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13040............  Benewah County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13050............  Bingham County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13060............  Blaine County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13070............  Boise County, Idaho         13  Rural             0.9097      14260  Urban             0.9052
13080............  Bonner County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13090............  Bonneville County,          13  Rural             0.9097      26820  Urban             0.9420
                    Idaho.
13100............  Boundary County,            13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13110............  Butte County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13120............  Camas County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13130............  Canyon County,            1080  Urban             0.9052      14260  Urban             0.9052
                    Idaho.
13140............  Caribou County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13150............  Cassia County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13160............  Clark County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13170............  Clearwater County,          13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13180............  Custer County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13190............  Elmore County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13200............  Franklin County,            13  Rural             0.9097      30860  Urban             0.9164
                    Idaho.

[[Page 27097]]

 
13210............  Fremont County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13220............  Gem County, Idaho..         13  Rural             0.9097      14260  Urban             0.9052
13230............  Gooding County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13240............  Idaho County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13250............  Jefferson County,           13  Rural             0.9097      26820  Urban             0.9420
                    Idaho.
13260............  Jerome County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13270............  Kootenai County,            13  Rural             0.9097      17660  Urban             0.9647
                    Idaho.
13280............  Latah County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13290............  Lemhi County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13300............  Lewis County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13310............  Lincoln County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13320............  Madison County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13330............  Minidoka County,            13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13340............  Nez Perce County,           13  Rural             0.9097      30300  Urban             0.9886
                    Idaho.
13350............  Oneida County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13360............  Owyhee County,              13  Rural             0.9097      14260  Urban             0.9052
                    Idaho.
13370............  Payette County,             13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13380............  Power County, Idaho         13  Rural             0.9097      38540  Urban             0.9351
13390............  Shoshone County,            13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13400............  Teton County, Idaho         13  Rural             0.9097      99913  Rural             0.8037
13410............  Twin Falls County,          13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13420............  Valley County,              13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
13430............  Washington County,          13  Rural             0.9097      99913  Rural             0.8037
                    Idaho.
14000............  Adams County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14010............  Alexander County,           14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14020............  Bond County,                14  Rural             0.8301      41180  Urban             0.8954
                    Illinois.
14030............  Boone County,             6880  Urban             0.9984      40420  Urban             0.9984
                    Illinois.
14040............  Brown County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14050............  Bureau County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14060............  Calhoun County,             14  Rural             0.8301      41180  Urban             0.8954
                    Illinois.
14070............  Carroll County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14080............  Cass County,                14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14090............  Champaign County,         1400  Urban             0.9594      16580  Urban             0.9594
                    Illinois.
14100............  Christian County,           14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14110............  Clark County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14120............  Clay County,                14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14130............  Clinton County,           7040  Urban             0.8962      41180  Urban             0.8954
                    Illinois.
14140............  Coles County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14141............  Cook County,              1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14150............  Crawford County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14160............  Cumberland County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14170............  De Kalb County,           1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14180............  De Witt County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14190............  Douglas County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14250............  Du Page County,           1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14310............  Edgar County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14320............  Edwards County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14330............  Effingham County,           14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14340............  Fayette County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14350............  Ford County,                14  Rural             0.8301      16580  Urban             0.9594
                    Illinois.
14360............  Franklin County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14370............  Fulton County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14380............  Gallatin County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14390............  Greene County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14400............  Grundy County,            1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14410............  Hamilton County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14420............  Hancock County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14421............  Hardin County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14440............  Henderson County,           14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14450............  Henry County,             1960  Urban             0.8724      19340  Urban             0.8724
                    Illinois.
14460............  Iroquois County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14470............  Jackson County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14480............  Jasper County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14490............  Jefferson County,           14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14500............  Jersey County,            7040  Urban             0.8962      41180  Urban             0.8954
                    Illinois.
14510............  Jo Daviess County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14520............  Johnson County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14530............  Kane County,              1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14540............  Kankakee County,          3740  Urban             1.0721      28100  Urban             1.0721
                    Illinois.
14550............  Kendall County,           1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14560............  Knox County,                14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14570............  Lake County,              1600  Urban             1.0783      29404  Urban             1.0429
                    Illinois.

[[Page 27098]]

 
14580............  La Salle County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14590............  Lawrence County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14600............  Lee County,                 14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14610............  Livingston County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14620............  Logan County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14630............  Mc Donough County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14640............  Mc Henry County,          1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14650............  Mclean County,            1040  Urban             0.9075      14060  Urban             0.9075
                    Illinois.
14660............  Macon County,             2040  Urban             0.8067      19500  Urban             0.8067
                    Illinois.
14670............  Macoupin County,            14  Rural             0.8301      41180  Urban             0.8954
                    Illinois.
14680............  Madison County,           7040  Urban             0.8962      41180  Urban             0.8954
                    Illinois.
14690............  Marion County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14700............  Marshall County,            14  Rural             0.8301      37900  Urban             0.8870
                    Illinois.
14710............  Mason County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14720............  Massac County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14730............  Menard County,            7880  Urban             0.8792      44100  Urban             0.8792
                    Illinois.
14740............  Mercer County,              14  Rural             0.8301      19340  Urban             0.8724
                    Illinois.
14750............  Monroe County,            7040  Urban             0.8962      41180  Urban             0.8954
                    Illinois.
14760............  Montgomery County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14770............  Morgan County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14780............  Moultrie County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14790............  Ogle County,              6880  Urban             0.9984      99914  Rural             0.8271
                    Illinois.
14800............  Peoria County,            6120  Urban             0.8870      37900  Urban             0.8870
                    Illinois.
14810............  Perry County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14820............  Piatt County,               14  Rural             0.8301      16580  Urban             0.9594
                    Illinois.
14830............  Pike County,                14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14831............  Pope County,                14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14850............  Pulaski County,             14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14860............  Putnam County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14870............  Randolph County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14880............  Richland County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14890............  Rock Island County,       1960  Urban             0.8724      19340  Urban             0.8724
                    Illinois.
14900............  St Clair County,          7040  Urban             0.8962      41180  Urban             0.8954
                    Illinois.
14910............  Saline County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14920............  Sangamon County,          7880  Urban             0.8792      44100  Urban             0.8792
                    Illinois.
14921............  Schuyler County,            14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14940............  Scott County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14950............  Shelby County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14960............  Stark County,               14  Rural             0.8301      37900  Urban             0.8870
                    Illinois.
14970............  Stephenson County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14980............  Tazewell County,          6120  Urban             0.8870      37900  Urban             0.8870
                    Illinois.
14981............  Union County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14982............  Vermilion County,           14  Rural             0.8301      19180  Urban             0.9028
                    Illinois.
14983............  Wabash County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14984............  Warren County,              14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14985............  Washington County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14986............  Wayne County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14987............  White County,               14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14988............  Whiteside County,           14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14989............  Will County,              1600  Urban             1.0783      16974  Urban             1.0790
                    Illinois.
14990............  Williamson County,          14  Rural             0.8301      99914  Rural             0.8271
                    Illinois.
14991............  Winnebago County,         6880  Urban             0.9984      40420  Urban             0.9984
                    Illinois.
14992............  Woodford County,          6120  Urban             0.8870      37900  Urban             0.8870
                    Illinois.
15000............  Adams County,             2760  Urban             0.9706      99915  Rural             0.8624
                    Indiana.
15010............  Allen County,             2760  Urban             0.9706      23060  Urban             0.9793
                    Indiana.
15020............  Bartholomew County,         15  Rural             0.8739      18020  Urban             0.9588
                    Indiana.
15030............  Benton County,              15  Rural             0.8739      29140  Urban             0.8736
                    Indiana.
15040............  Blackford County,           15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15050............  Boone County,             3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15060............  Brown County,               15  Rural             0.8739      26900  Urban             0.9920
                    Indiana.
15070............  Carroll County,             15  Rural             0.8739      29140  Urban             0.8736
                    Indiana.
15080............  Cass County,                15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15090............  Clark County,             4520  Urban             0.9293      31140  Urban             0.9251
                    Indiana.
15100............  Clay County,              8320  Urban             0.8337      45460  Urban             0.8304
                    Indiana.
15110............  Clinton County,           3920  Urban             0.8736      99915  Rural             0.8624
                    Indiana.
15120............  Crawford County,            15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15130............  Daviess County,             15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15140............  Dearborn County,          1640  Urban             0.9734      17140  Urban             0.9615
                    Indiana.
15150............  Decatur County,             15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15160............  De Kalb County,           2760  Urban             0.9706      99915  Rural             0.8624
                    Indiana.
15170............  Delaware County,          5280  Urban             0.8930      34620  Urban             0.8930
                    Indiana.
15180............  Dubois County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.

[[Page 27099]]

 
15190............  Elkhart County,           2330  Urban             0.9627      21140  Urban             0.9627
                    Indiana.
15200............  Fayette County,             15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15210............  Floyd County,             4520  Urban             0.9293      31140  Urban             0.9251
                    Indiana.
15220............  Fountain County,            15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15230............  Franklin County,            15  Rural             0.8739      17140  Urban             0.9615
                    Indiana.
15240............  Fulton County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15250............  Gibson County,              15  Rural             0.8739      21780  Urban             0.8713
                    Indiana.
15260............  Grant County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15270............  Greene County,              15  Rural             0.8739      14020  Urban             0.8447
                    Indiana.
15280............  Hamilton County,          3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15290............  Hancock County,           3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15300............  Harrison County,          4520  Urban             0.9293      31140  Urban             0.9251
                    Indiana.
15310............  Hendricks County,         3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15320............  Henry County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15330............  Howard County,            3850  Urban             0.9508      29020  Urban             0.9508
                    Indiana.
15340............  Huntington County,        2760  Urban             0.9706      99915  Rural             0.8624
                    Indiana.
15350............  Jackson County,             15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15360............  Jasper County,              15  Rural             0.8739      23844  Urban             0.9395
                    Indiana.
15370............  Jay County, Indiana         15  Rural             0.8739      99915  Rural             0.8624
15380............  Jefferson County,           15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15390............  Jennings County,            15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15400............  Johnson County,           3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15410............  Knox County,                15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15420............  Kosciusko County,           15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15430............  Lagrange County,            15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15440............  Lake County,              2960  Urban             0.9395      23844  Urban             0.9395
                    Indiana.
15450............  La Porte County,            15  Rural             0.8739      33140  Urban             0.9399
                    Indiana.
15460............  Lawrence County,            15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15470............  Madison County,           3480  Urban             0.9865      11300  Urban             0.8586
                    Indiana.
15480............  Marion County,            3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15490............  Marshall County,            15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15500............  Martin County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15510............  Miami County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15520............  Monroe County,            1020  Urban             0.8447      14020  Urban             0.8447
                    Indiana.
15530............  Montgomery County,          15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15540............  Morgan County,            3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15550............  Newton County,              15  Rural             0.8739      23844  Urban             0.9395
                    Indiana.
15560............  Noble County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15570............  Ohio County,              1640  Urban             0.9734      17140  Urban             0.9615
                    Indiana.
15580............  Orange County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15590............  Owen County,                15  Rural             0.8739      14020  Urban             0.8447
                    Indiana.
15600............  Parke County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15610............  Perry County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15620............  Pike County,                15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15630............  Porter County,            2960  Urban             0.9395      23844  Urban             0.9395
                    Indiana.
15640............  Posey County,             2440  Urban             0.8713      21780  Urban             0.8713
                    Indiana.
15650............  Pulaski County,             15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15660............  Putnam County,              15  Rural             0.8739      26900  Urban             0.9920
                    Indiana.
15670............  Randolph County,            15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15680............  Ripley County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15690............  Rush County,                15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15700............  St Joseph County,         7800  Urban             0.9788      43780  Urban             0.9788
                    Indiana.
15710............  Scott County,             4520  Urban             0.9293      99915  Rural             0.8624
                    Indiana.
15720............  Shelby County,            3480  Urban             0.9865      26900  Urban             0.9920
                    Indiana.
15730............  Spencer County,             15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15740............  Starke County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15750............  Steuben County,             15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15760............  Sullivan County,            15  Rural             0.8739      45460  Urban             0.8304
                    Indiana.
15770............  Switzerland County,         15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15780............  Tippecanoe County,        3920  Urban             0.8736      29140  Urban             0.8736
                    Indiana.
15790............  Tipton County,            3850  Urban             0.9508      29020  Urban             0.9508
                    Indiana.
15800............  Union County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15810............  Vanderburgh County,       2440  Urban             0.8713      21780  Urban             0.8713
                    Indiana.
15820............  Vermillion County,        8320  Urban             0.8337      45460  Urban             0.8304
                    Indiana.
15830............  Vigo County,              8320  Urban             0.8337      45460  Urban             0.8304
                    Indiana.
15840............  Wabash County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15850............  Warren County,              15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15860............  Warrick County,           2440  Urban             0.8713      21780  Urban             0.8713
                    Indiana.
15870............  Washington County,          15  Rural             0.8739      31140  Urban             0.9251
                    Indiana.
15880............  Wayne County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.
15890............  Wells County,             2760  Urban             0.9706      23060  Urban             0.9793
                    Indiana.
15900............  White County,               15  Rural             0.8739      99915  Rural             0.8624
                    Indiana.

[[Page 27100]]

 
15910............  Whitley County,           2760  Urban             0.9706      23060  Urban             0.9793
                    Indiana.
16000............  Adair County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16010............  Adams County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16020............  Allamakee County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16030............  Appanoose County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16040............  Audubon County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16050............  Benton County, Iowa         16  Rural             0.8594      16300  Urban             0.8825
16060............  Black Hawk County,        8920  Urban             0.8557      47940  Urban             0.8557
                    Iowa.
16070............  Boone County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16080............  Bremer County, Iowa         16  Rural             0.8594      47940  Urban             0.8557
16090............  Buchanan County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16100............  Buena Vista County,         16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16110............  Butler County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16120............  Calhoun County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16130............  Carroll County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16140............  Cass County, Iowa..         16  Rural             0.8594      99916  Rural             0.8509
16150............  Cedar County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16160............  Cerro Gordo County,         16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16170............  Cherokee County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16180............  Chickasaw County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16190............  Clarke County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16200............  Clay County, Iowa..         16  Rural             0.8594      99916  Rural             0.8509
16210............  Clayton County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16220............  Clinton County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16230............  Crawford County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16240............  Dallas County, Iowa       2120  Urban             0.9669      19780  Urban             0.9669
16250............  Davis County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16260............  Decatur County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16270............  Delaware County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16280............  Des Moines County,          16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16290............  Dickinson County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16300............  Dubuque County,           2200  Urban             0.9024      20220  Urban             0.9024
                    Iowa.
16310............  Emmet County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16320............  Fayette County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16330............  Floyd County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16340............  Franklin County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16350............  Fremont County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16360............  Greene County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16370............  Grundy County, Iowa         16  Rural             0.8594      47940  Urban             0.8557
16380............  Guthrie County,             16  Rural             0.8594      19780  Urban             0.9669
                    Iowa.
16390............  Hamilton County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16400............  Hancock County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16410............  Hardin County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16420............  Harrison County,            16  Rural             0.8594      36540  Urban             0.9560
                    Iowa.
16430............  Henry County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16440............  Howard County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16450............  Humboldt County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16460............  Ida County, Iowa...         16  Rural             0.8594      99916  Rural             0.8509
16470............  Iowa County, Iowa..         16  Rural             0.8594      99916  Rural             0.8509
16480............  Jackson County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16490............  Jasper County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16500............  Jefferson County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16510............  Johnson County,           3500  Urban             0.9747      26980  Urban             0.9747
                    Iowa.
16520............  Jones County, Iowa.         16  Rural             0.8594      16300  Urban             0.8825
16530............  Keokuk County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16540............  Kossuth County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16550............  Lee County, Iowa...         16  Rural             0.8594      99916  Rural             0.8509
16560............  Linn County, Iowa..       1360  Urban             0.8825      16300  Urban             0.8825
16570............  Louisa County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16580............  Lucas County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16590............  Lyon County, Iowa..         16  Rural             0.8594      99916  Rural             0.8509
16600............  Madison County,             16  Rural             0.8594      19780  Urban             0.9669
                    Iowa.
16610............  Mahaska County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16620............  Marion County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16630............  Marshall County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16640............  Mills County, Iowa.         16  Rural             0.8594      36540  Urban             0.9560
16650............  Mitchell County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16660............  Monona County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16670............  Monroe County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16680............  Montgomery County,          16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16690............  Muscatine County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16700............  O Brien County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.

[[Page 27101]]

 
16710............  Osceola County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16720............  Page County, Iowa..         16  Rural             0.8594      99916  Rural             0.8509
16730............  Palo Alto County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16740............  Plymouth County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16750............  Pocahontas County,          16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16760............  Polk County, Iowa..       2120  Urban             0.9669      19780  Urban             0.9669
16770............  Pottawattamie             5920  Urban             0.9560      36540  Urban             0.9560
                    County, Iowa.
16780............  Poweshiek County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16790............  Ringgold County,            16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16800............  Sac County, Iowa...         16  Rural             0.8594      99916  Rural             0.8509
16810............  Scott County, Iowa.       1960  Urban             0.8724      19340  Urban             0.8724
16820............  Shelby County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16830............  Sioux County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16840............  Story County, Iowa.         16  Rural             0.8594      11180  Urban             0.9536
16850............  Tama County, Iowa..         16  Rural             0.8594      99916  Rural             0.8509
16860............  Taylor County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
16870............  Union County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16880............  Van Buren County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16890............  Wapello County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16900............  Warren County, Iowa       2120  Urban             0.9669      19780  Urban             0.9669
16910............  Washington County,          16  Rural             0.8594      26980  Urban             0.9747
                    Iowa.
16920............  Wayne County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16930............  Webster County,             16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16940............  Winnebago County,           16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16950............  Winneshiek County,          16  Rural             0.8594      99916  Rural             0.8509
                    Iowa.
16960............  Woodbury County,          7720  Urban             0.9416      43580  Urban             0.9381
                    Iowa.
16970............  Worth County, Iowa.         16  Rural             0.8594      99916  Rural             0.8509
16980............  Wright County, Iowa         16  Rural             0.8594      99916  Rural             0.8509
17000............  Allen County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17010............  Anderson County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17020............  Atchison County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17030............  Barber County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17040............  Barton County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17050............  Bourbon County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17060............  Brown County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17070............  Butler County,            9040  Urban             0.9175      48620  Urban             0.9153
                    Kansas.
17080............  Chase County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17090............  Chautauqua County,          17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17100............  Cherokee County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17110............  Cheyenne County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17120............  Clark County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17130............  Clay County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17140............  Cloud County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17150............  Coffey County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17160............  Comanche County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17170............  Cowley County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17180............  Crawford County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17190............  Decatur County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17200............  Dickinson County,           17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17210............  Doniphan County,            17  Rural             0.8040      41140  Urban             0.9519
                    Kansas.
17220............  Douglas County,           4150  Urban             0.8537      29940  Urban             0.8537
                    Kansas.
17230............  Edwards County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17240............  Elk County, Kansas.         17  Rural             0.8040      99917  Rural             0.8035
17250............  Ellis County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17260............  Ellsworth County,           17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17270............  Finney County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17280............  Ford County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17290............  Franklin County,            17  Rural             0.8040      28140  Urban             0.9476
                    Kansas.
17300............  Geary County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17310............  Gove County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17320............  Graham County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17330............  Grant County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17340............  Gray County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17350............  Greeley County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17360............  Greenwood County,           17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17370............  Hamilton County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17380............  Harper County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17390............  Harvey County,            9040  Urban             0.9175      48620  Urban             0.9153
                    Kansas.
17391............  Haskell County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17410............  Hodgeman County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17420............  Jackson County,             17  Rural             0.8040      45820  Urban             0.8920
                    Kansas.
17430............  Jefferson County,           17  Rural             0.8040      45820  Urban             0.8920
                    Kansas.

[[Page 27102]]

 
17440............  Jewell County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17450............  Johnson County,           3760  Urban             0.9490      28140  Urban             0.9476
                    Kansas.
17451............  Kearny County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17470............  Kingman County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17480............  Kiowa County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17490............  Labette County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17500............  Lane County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17510............  Leavenworth County,       3760  Urban             0.9490      28140  Urban             0.9476
                    Kansas.
17520............  Lincoln County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17530............  Linn County, Kansas         17  Rural             0.8040      28140  Urban             0.9476
17540............  Logan County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17550............  Lyon County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17560............  Mc Pherson County,          17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17570............  Marion County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17580............  Marshall County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17590............  Meade County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17600............  Miami County,             3760  Urban             0.9490      28140  Urban             0.9476
                    Kansas.
17610............  Mitchell County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17620............  Montgomery County,          17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17630............  Morris County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17640............  Morton County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17650............  Nemaha County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17660............  Neosho County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17670............  Ness County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17680............  Norton County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17690............  Osage County,               17  Rural             0.8040      45820  Urban             0.8920
                    Kansas.
17700............  Osborne County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17710............  Ottawa County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17720............  Pawnee County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17730............  Phillips County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17740............  Pottawatomie                17  Rural             0.8040      99917  Rural             0.8035
                    County, Kansas.
17750............  Pratt County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17760............  Rawlins County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17770............  Reno County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17780............  Republic County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17790............  Rice County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17800............  Riley County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17810............  Rooks County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17820............  Rush County, Kansas         17  Rural             0.8040      99917  Rural             0.8035
17830............  Russell County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17840............  Saline County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17841............  Scott County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17860............  Sedgwick County,          9040  Urban             0.9175      48620  Urban             0.9153
                    Kansas.
17870............  Seward County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17880............  Shawnee County,           8440  Urban             0.8920      45820  Urban             0.8920
                    Kansas.
17890............  Sheridan County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17900............  Sherman County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17910............  Smith County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17920............  Stafford County,            17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17921............  Stanton County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17940............  Stevens County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17950............  Sumner County,              17  Rural             0.8040      48620  Urban             0.9153
                    Kansas.
17960............  Thomas County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17970............  Trego County,               17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17980............  Wabaunsee County,           17  Rural             0.8040      45820  Urban             0.8920
                    Kansas.
17981............  Wallace County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17982............  Washington County,          17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17983............  Wichita County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17984............  Wilson County,              17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17985............  Woodson County,             17  Rural             0.8040      99917  Rural             0.8035
                    Kansas.
17986............  Wyandotte County,         3760  Urban             0.9490      28140  Urban             0.9476
                    Kansas.
18000............  Adair County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18010............  Allen County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18020............  Anderson County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18030............  Ballard County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18040............  Barren County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18050............  Bath County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18060............  Bell County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18070............  Boone County,             1640  Urban             0.9734      17140  Urban             0.9615
                    Kentucky.
18080............  Bourbon County,           4280  Urban             0.8988      30460  Urban             0.9075
                    Kentucky.
18090............  Boyd County,              3400  Urban             0.9477      26580  Urban             0.9477
                    Kentucky.
18100............  Boyle County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.

[[Page 27103]]

 
18110............  Bracken County,             18  Rural             0.7858      17140  Urban             0.9615
                    Kentucky.
18120............  Breathitt County,           18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18130............  Breckinridge                18  Rural             0.7858      99918  Rural             0.7766
                    County, Kentucky.
18140............  Bullitt County,           4520  Urban             0.9293      31140  Urban             0.9251
                    Kentucky.
18150............  Butler County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18160............  Caldwell County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18170............  Calloway County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18180............  Campbell County,          1640  Urban             0.9734      17140  Urban             0.9615
                    Kentucky.
18190............  Carlisle County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18191............  Carroll County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18210............  Carter County,            3400  Urban             0.9477      99918  Rural             0.7766
                    Kentucky.
18220............  Casey County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18230............  Christian County,         1660  Urban             0.8284      17300  Urban             0.8284
                    Kentucky.
18240............  Clark County,             4280  Urban             0.8988      30460  Urban             0.9075
                    Kentucky.
18250............  Clay County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18260............  Clinton County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18270............  Crittenden County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18271............  Cumberland County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18290............  Daviess County,           5990  Urban             0.8780      36980  Urban             0.8780
                    Kentucky.
18291............  Edmonson County,            18  Rural             0.7858      14540  Urban             0.8211
                    Kentucky.
18310............  Elliott County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18320............  Estill County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18330............  Fayette County,           4280  Urban             0.8988      30460  Urban             0.9075
                    Kentucky.
18340............  Fleming County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18350............  Floyd County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18360............  Franklin County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18361............  Fulton County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18362............  Gallatin County,          1640  Urban             0.9734      17140  Urban             0.9615
                    Kentucky.
18390............  Garrard County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18400............  Grant County,             1640  Urban             0.9734      17140  Urban             0.9615
                    Kentucky.
18410............  Graves County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18420............  Grayson County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18421............  Green County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18440............  Greenup County,           3400  Urban             0.9477      26580  Urban             0.9477
                    Kentucky.
18450............  Hancock County,             18  Rural             0.7858      36980  Urban             0.8780
                    Kentucky.
18460............  Hardin County,              18  Rural             0.7858      21060  Urban             0.8802
                    Kentucky.
18470............  Harlan County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18480............  Harrison County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18490............  Hart County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18500............  Henderson County,         2440  Urban             0.8713      21780  Urban             0.8713
                    Kentucky.
18510............  Henry County,               18  Rural             0.7858      31140  Urban             0.9251
                    Kentucky.
18511............  Hickman County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18530............  Hopkins County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18540............  Jackson County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18550............  Jefferson County,         4520  Urban             0.9293      31140  Urban             0.9251
                    Kentucky.
18560............  Jessamine County,         4280  Urban             0.8988      30460  Urban             0.9075
                    Kentucky.
18570............  Johnson County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18580............  Kenton County,            1640  Urban             0.9734      17140  Urban             0.9615
                    Kentucky.
18590............  Knott County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18600............  Knox County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18610............  Larue County,               18  Rural             0.7858      21060  Urban             0.8802
                    Kentucky.
18620............  Laurel County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18630............  Lawrence County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18640............  Lee County,                 18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18650............  Leslie County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18660............  Letcher County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18670............  Lewis County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18680............  Lincoln County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18690............  Livingston County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18700............  Logan County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18710............  Lyon County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18720............  Mc Cracken County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18730............  Mc Creary County,           18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18740............  Mc Lean County,             18  Rural             0.7858      36980  Urban             0.8780
                    Kentucky.
18750............  Madison County,           4280  Urban             0.8988      99918  Rural             0.7766
                    Kentucky.
18760............  Magoffin County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18770............  Marion County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18780............  Marshall County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18790............  Martin County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18800............  Mason County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18801............  Meade County,               18  Rural             0.7858      31140  Urban             0.9251
                    Kentucky.
18802............  Menifee County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.

[[Page 27104]]

 
18830............  Mercer County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18831............  Metcalfe County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18850............  Monroe County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18860............  Montgomery County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18861............  Morgan County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18880............  Muhlenberg County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18890............  Nelson County,              18  Rural             0.7858      31140  Urban             0.9251
                    Kentucky.
18900............  Nicholas County,            18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18910............  Ohio County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18920............  Oldham County,            4520  Urban             0.9293      31140  Urban             0.9251
                    Kentucky.
18930............  Owen County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18931............  Owsley County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18932............  Pendleton County,         1640  Urban             0.9734      17140  Urban             0.9615
                    Kentucky.
18960............  Perry County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18970............  Pike County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18971............  Powell County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18972............  Pulaski County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18973............  Robertson County,           18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18974............  Rockcastle County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18975............  Rowan County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18976............  Russell County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18977............  Scott County,             4280  Urban             0.8988      30460  Urban             0.9075
                    Kentucky.
18978............  Shelby County,              18  Rural             0.7858      31140  Urban             0.9251
                    Kentucky.
18979............  Simpson County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18980............  Spencer County,             18  Rural             0.7858      31140  Urban             0.9251
                    Kentucky.
18981............  Taylor County,              18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18982............  Todd County,                18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18983............  Trigg County,               18  Rural             0.7858      17300  Urban             0.8284
                    Kentucky.
18984............  Trimble County,             18  Rural             0.7858      31140  Urban             0.9251
                    Kentucky.
18985............  Union County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18986............  Warren County,              18  Rural             0.7858      14540  Urban             0.8211
                    Kentucky.
18987............  Washington County,          18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18988............  Wayne County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18989............  Webster County,             18  Rural             0.7858      21780  Urban             0.8713
                    Kentucky.
18990............  Whitley County,             18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18991............  Wolfe County,               18  Rural             0.7858      99918  Rural             0.7766
                    Kentucky.
18992............  Woodford County,          4280  Urban             0.8988      30460  Urban             0.9075
                    Kentucky.
19000............  Acadia County,            3880  Urban             0.8251      99919  Rural             0.7411
                    Louisiana.
19010............  Allen County,               19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19020............  Ascension County,         0760  Urban             0.8643      12940  Urban             0.8593
                    Louisiana.
19030............  Assumption County,          19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19040............  Avoyelles County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19050............  Beauregard County,          19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19060............  Bienville County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19070............  Bossier County,           7680  Urban             0.8737      43340  Urban             0.8760
                    Louisiana.
19080............  Caddo County,             7680  Urban             0.8737      43340  Urban             0.8760
                    Louisiana.
19090............  Calcasieu County,         3960  Urban             0.7858      29340  Urban             0.7833
                    Louisiana.
19100............  Caldwell County,            19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19110............  Cameron County,             19  Rural             0.7340      29340  Urban             0.7833
                    Louisiana.
19120............  Catahoula County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19130............  Claiborne County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19140............  Concordia County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19150............  De Soto County,             19  Rural             0.7340      43340  Urban             0.8760
                    Louisiana.
19160............  East Baton Rouge          0760  Urban             0.8643      12940  Urban             0.8593
                    County, Louisiana.
19170............  East Carroll                19  Rural             0.7340      99919  Rural             0.7411
                    County, Louisiana.
19180............  East Feliciana              19  Rural             0.7340      12940  Urban             0.8593
                    County, Louisiana.
19190............  Evangeline County,          19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19200............  Franklin County,            19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19210............  Grant County,               19  Rural             0.7340      10780  Urban             0.8033
                    Louisiana.
19220............  Iberia County,              19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19230............  Iberville County,           19  Rural             0.7340      12940  Urban             0.8593
                    Louisiana.
19240............  Jackson County,             19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19250............  Jefferson County,         5560  Urban             0.8995      35380  Urban             0.8995
                    Louisiana.
19260............  Jefferson Davis             19  Rural             0.7340      99919  Rural             0.7411
                    County, Louisiana.
19270............  Lafayette County,         3880  Urban             0.8251      29180  Urban             0.8428
                    Louisiana.
19280............  Lafourche County,         3350  Urban             0.7894      26380  Urban             0.7894
                    Louisiana.
19290............  La Salle County,            19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19300............  Lincoln County,             19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19310............  Livingston County,        0760  Urban             0.8643      12940  Urban             0.8593
                    Louisiana.
19320............  Madison County,             19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19330............  Morehouse County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19340............  Natchitoches                19  Rural             0.7340      99919  Rural             0.7411
                    County, Louisiana.

[[Page 27105]]

 
19350............  Orleans County,           5560  Urban             0.8995      35380  Urban             0.8995
                    Louisiana.
19360............  Ouachita County,          5200  Urban             0.8044      33740  Urban             0.8031
                    Louisiana.
19370............  Plaquemines County,       5560  Urban             0.8995      35380  Urban             0.8995
                    Louisiana.
19380............  Pointe Coupee               19  Rural             0.7340      12940  Urban             0.8593
                    County, Louisiana.
19390............  Rapides County,           0220  Urban             0.8033      10780  Urban             0.8033
                    Louisiana.
19400............  Red River County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19410............  Richland County,            19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19420............  Sabine County,              19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19430............  St Bernard County,        5560  Urban             0.8995      35380  Urban             0.8995
                    Louisiana.
19440............  St Charles County,        5560  Urban             0.8995      35380  Urban             0.8995
                    Louisiana.
19450............  St Helena County,           19  Rural             0.7340      12940  Urban             0.8593
                    Louisiana.
19460............  St James County,          5560  Urban             0.8995      99919  Rural             0.7411
                    Louisiana.
19470............  St John Baptist           5560  Urban             0.8995      35380  Urban             0.8995
                    County, Louisiana.
19480............  St Landry County,         3880  Urban             0.8251      99919  Rural             0.7411
                    Louisiana.
19490............  St Martin County,         3880  Urban             0.8251      29180  Urban             0.8428
                    Louisiana.
19500............  St Mary County,             19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19510............  St Tammany County,        5560  Urban             0.8995      35380  Urban             0.8995
                    Louisiana.
19520............  Tangipahoa County,          19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19530............  Tensas County,              19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19540............  Terrebonne County,        3350  Urban             0.7894      26380  Urban             0.7894
                    Louisiana.
19550............  Union County,               19  Rural             0.7340      33740  Urban             0.8031
                    Louisiana.
19560............  Vermilion County,           19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19570............  Vernon County,              19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19580............  Washington County,          19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
19590............  Webster County,           7680  Urban             0.8737      99919  Rural             0.7411
                    Louisiana.
19600............  West Baton Rouge          0760  Urban             0.8643      12940  Urban             0.8593
                    County, Louisiana.
19610............  West Carroll                19  Rural             0.7340      99919  Rural             0.7411
                    County, Louisiana.
19620............  West Feliciana              19  Rural             0.7340      12940  Urban             0.8593
                    County, Louisiana.
19630............  Winn County,                19  Rural             0.7340      99919  Rural             0.7411
                    Louisiana.
20000............  Androscoggin              4243  Urban             0.9331      30340  Urban             0.9331
                    County, Maine.
20010............  Aroostook County,           20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20020............  Cumberland County,        6403  Urban             1.0382      38860  Urban             1.0382
                    Maine.
20030............  Franklin County,            20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20040............  Hancock County,             20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20050............  Kennebec County,            20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20060............  Knox County, Maine.         20  Rural             0.8843      99920  Rural             0.8843
20070............  Lincoln County,             20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20080............  Oxford County,              20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20090............  Penobscot County,         0733  Urban             0.9993      12620  Urban             0.9993
                    Maine.
20100............  Piscataquis County,         20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20110............  Sagadahoc County,         6403  Urban             1.0382      38860  Urban             1.0382
                    Maine.
20120............  Somerset County,            20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20130............  Waldo County, Maine         20  Rural             0.8843      99920  Rural             0.8843
20140............  Washington County,          20  Rural             0.8843      99920  Rural             0.8843
                    Maine.
20150............  York County, Maine.       6403  Urban             1.0382      38860  Urban             1.0382
21000............  Allegany County,          1900  Urban             0.9317      19060  Urban             0.9317
                    Maryland.
21010............  Anne Arundel              0720  Urban             0.9897      12580  Urban             0.9897
                    County, Maryland.
21020............  Baltimore County,         0720  Urban             0.9897      12580  Urban             0.9897
                    Maryland.
21030............  Baltimore City            0720  Urban             0.9897      12580  Urban             0.9897
                    County, Maryland.
21040............  Calvert County,           8840  Urban             1.0976      47894  Urban             1.0926
                    Maryland.
21050............  Caroline County,            21  Rural             0.9230      99921  Rural             0.9353
                    Maryland.
21060............  Carroll County,           0720  Urban             0.9897      12580  Urban             0.9897
                    Maryland.
21070............  Cecil County,             9160  Urban             1.0527      48864  Urban             1.0471
                    Maryland.
21080............  Charles County,           8840  Urban             1.0976      47894  Urban             1.0926
                    Maryland.
21090............  Dorchester County,          21  Rural             0.9230      99921  Rural             0.9353
                    Maryland.
21100............  Frederick County,         8840  Urban             1.0976      13644  Urban             1.1483
                    Maryland.
21110............  Garrett County,             21  Rural             0.9230      99921  Rural             0.9353
                    Maryland.
21120............  Harford County,           0720  Urban             0.9897      12580  Urban             0.9897
                    Maryland.
21130............  Howard County,            0720  Urban             0.9897      12580  Urban             0.9897
                    Maryland.
21140............  Kent County,                21  Rural             0.9230      99921  Rural             0.9353
                    Maryland.
21150............  Montgomery County,        8840  Urban             1.0976      13644  Urban             1.1483
                    Maryland.
21160............  Prince Georges            8840  Urban             1.0976      47894  Urban             1.0926
                    County, Maryland.
21170............  Queen Annes County,       0720  Urban             0.9897      12580  Urban             0.9897
                    Maryland.
21180............  St Marys County,            21  Rural             0.9230      99921  Rural             0.9353
                    Maryland.
21190............  Somerset County,            21  Rural             0.9230      41540  Urban             0.9064
                    Maryland.
21200............  Talbot County,              21  Rural             0.9230      99921  Rural             0.9353
                    Maryland.
21210............  Washington County,        3180  Urban             0.9869      25180  Urban             0.9489
                    Maryland.
21220............  Wicomico County,            21  Rural             0.9230      41540  Urban             0.9064
                    Maryland.
21230............  Worcester County,           21  Rural             0.9230      99921  Rural             0.9353
                    Maryland.
22000............  Barnstable County,        0743  Urban             1.2600      12700  Urban             1.2600
                    Massachusetts.
22010............  Berkshire County,         6323  Urban             1.0181      38340  Urban             1.0181
                    Massachusetts.
22020............  Bristol County,           1123  Urban             1.1178      39300  Urban             1.0966
                    Massachusetts.

[[Page 27106]]

 
22030............  Dukes County,               22  Rural             1.0216      99922  Rural             1.0216
                    Massachusetts.
22040............  Essex County,             1123  Urban             1.1178      21604  Urban             1.0538
                    Massachusetts.
22060............  Franklin County,            22  Rural             1.0216      44140  Urban             1.0248
                    Massachusetts.
22070............  Hampden County,           8003  Urban             1.0263      44140  Urban             1.0248
                    Massachusetts.
22080............  Hampshire County,         8003  Urban             1.0263      44140  Urban             1.0248
                    Massachusetts.
22090............  Middlesex County,         1123  Urban             1.1178      15764  Urban             1.1172
                    Massachusetts.
22120............  Nantucket County,           22  Rural             1.0216      99922  Rural             1.0216
                    Massachusetts.
22130............  Norfolk County,           1123  Urban             1.1178      14484  Urban             1.1558
                    Massachusetts.
22150............  Plymouth County,          1123  Urban             1.1178      14484  Urban             1.1558
                    Massachusetts.
22160............  Suffolk County,           1123  Urban             1.1178      14484  Urban             1.1558
                    Massachusetts.
22170............  Worcester County,         1123  Urban             1.1178      49340  Urban             1.1028
                    Massachusetts.
23000............  Alcona County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23010............  Alger County,               23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23020............  Allegan County,           3000  Urban             0.9445      99923  Rural             0.8895
                    Michigan.
23030............  Alpena County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23040............  Antrim County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23050............  Arenac County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23060............  Baraga County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23070............  Barry County,               23  Rural             0.8824      24340  Urban             0.9390
                    Michigan.
23080............  Bay County,               6960  Urban             0.9241      13020  Urban             0.9343
                    Michigan.
23090............  Benzie County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23100............  Berrien County,           0870  Urban             0.8879      35660  Urban             0.8879
                    Michigan.
23110............  Branch County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23120............  Calhoun County,           3720  Urban             1.0143      12980  Urban             0.9508
                    Michigan.
23130............  Cass County,                23  Rural             0.8824      43780  Urban             0.9788
                    Michigan.
23140............  Charlevoix County,          23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23150............  Cheboygan County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23160............  Chippewa County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23170............  Clare County,               23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23180............  Clinton County,           4040  Urban             0.9794      29620  Urban             0.9794
                    Michigan.
23190............  Crawford County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23200............  Delta County,               23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23210............  Dickinson County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23220............  Eaton County,             4040  Urban             0.9794      29620  Urban             0.9794
                    Michigan.
23230............  Emmet County,               23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23240............  Genesee County,           2640  Urban             1.0655      22420  Urban             1.0655
                    Michigan.
23250............  Gladwin County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23260............  Gogebic County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23270............  Grand Traverse              23  Rural             0.8824      99923  Rural             0.8895
                    County, Michigan.
23280............  Gratiot County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23290............  Hillsdale County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23300............  Houghton County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23310............  Huron County,               23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23320............  Ingham County,            4040  Urban             0.9794      29620  Urban             0.9794
                    Michigan.
23330............  Ionia County,               23  Rural             0.8824      24340  Urban             0.9390
                    Michigan.
23340............  Iosco County,               23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23350............  Iron County,                23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23360............  Isabella County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23370............  Jackson County,           3520  Urban             0.9304      27100  Urban             0.9304
                    Michigan.
23380............  Kalamazoo County,         3720  Urban             1.0143      28020  Urban             1.0381
                    Michigan.
23390............  Kalkaska County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23400............  Kent County,              3000  Urban             0.9445      24340  Urban             0.9390
                    Michigan.
23410............  Keweenaw County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23420............  Lake County,                23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23430............  Lapeer County,            2160  Urban             1.0147      47644  Urban             0.9871
                    Michigan.
23440............  Leelanau County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23450............  Lenawee County,           0440  Urban             1.0707      99923  Rural             0.8895
                    Michigan.
23460............  Livingston County,        0440  Urban             1.0707      47644  Urban             0.9871
                    Michigan.
23470............  Luce County,                23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23480............  Mackinac County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23490............  Macomb County,            2160  Urban             1.0147      47644  Urban             0.9871
                    Michigan.
23500............  Manistee County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23510............  Marquette County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23520............  Mason County,               23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23530............  Mecosta County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23540............  Menominee County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23550............  Midland County,           6960  Urban             0.9241      99923  Rural             0.8895
                    Michigan.
23560............  Missaukee County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23570............  Monroe County,            2160  Urban             1.0147      33780  Urban             0.9468
                    Michigan.
23580............  Montcalm County,            23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23590............  Montmorency County,         23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23600............  Muskegon County,          3000  Urban             0.9445      34740  Urban             0.9664
                    Michigan.

[[Page 27107]]

 
23610............  Newaygo County,             23  Rural             0.8824      24340  Urban             0.9390
                    Michigan.
23620............  Oakland County,           2160  Urban             1.0147      47644  Urban             0.9871
                    Michigan.
23630............  Oceana County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23640............  Ogemaw County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23650............  Ontonagon County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23660............  Osceola County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23670............  Oscoda County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23680............  Otsego County,              23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23690............  Ottawa County,            3000  Urban             0.9445      26100  Urban             0.9055
                    Michigan.
23700............  Presque Isle                23  Rural             0.8824      99923  Rural             0.8895
                    County, Michigan.
23710............  Roscommon County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23720............  Saginaw County,           6960  Urban             0.9241      40980  Urban             0.9088
                    Michigan.
23730............  St Clair County,          2160  Urban             1.0147      47644  Urban             0.9871
                    Michigan.
23740............  St Joseph County,           23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23750............  Sanilac County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23760............  Schoolcraft County,         23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23770............  Shiawassee County,          23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23780............  Tuscola County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
23790............  Van Buren County,         3720  Urban             1.0143      28020  Urban             1.0381
                    Michigan.
23800............  Washtenaw County,         0440  Urban             1.0707      11460  Urban             1.0859
                    Michigan.
23810............  Wayne County,             2160  Urban             1.0147      19804  Urban             1.0424
                    Michigan.
23830............  Wexford County,             23  Rural             0.8824      99923  Rural             0.8895
                    Michigan.
24000............  Aitkin County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24010............  Anoka County,             5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24020............  Becker County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24030............  Beltrami County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24040............  Benton County,            6980  Urban             0.9965      41060  Urban             0.9965
                    Minnesota.
24050............  Big Stone County,           24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24060............  Blue Earth County,          24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24070............  Brown County,               24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24080............  Carlton County,             24  Rural             0.9132      20260  Urban             1.0213
                    Minnesota.
24090............  Carver County,            5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24100............  Cass County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24110............  Chippewa County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24120............  Chisago County,           5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24130............  Clay County,              2520  Urban             0.8486      22020  Urban             0.8486
                    Minnesota.
24140............  Clearwater County,          24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24150............  Cook County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24160............  Cottonwood County,          24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24170............  Crow Wing County,           24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24180............  Dakota County,            5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24190............  Dodge County,               24  Rural             0.9132      40340  Urban             1.1131
                    Minnesota.
24200............  Douglas County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24210............  Faribault County,           24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24220............  Fillmore County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24230............  Freeborn County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24240............  Goodhue County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24250............  Grant County,               24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24260............  Hennepin County,          5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24270............  Houston County,           3870  Urban             0.9564      29100  Urban             0.9564
                    Minnesota.
24280............  Hubbard County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24290............  Isanti County,            5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24300............  Itasca County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24310............  Jackson County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24320............  Kanabec County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24330............  Kandiyohi County,           24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24340............  Kittson County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24350............  Koochiching County,         24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24360............  Lac Qui Parle               24  Rural             0.9132      99924  Rural             0.9132
                    County, Minnesota.
24370............  Lake County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24380............  Lake Of Woods               24  Rural             0.9132      99924  Rural             0.9132
                    County, Minnesota.
24390............  Le Sueur County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24400............  Lincoln County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24410............  Lyon County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24420............  Mc Leod County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24430............  Mahnomen County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24440............  Marshall County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24450............  Martin County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24460............  Meeker County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24470............  Mille Lacs County,          24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24480............  Morrison County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24490............  Mower County,               24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.

[[Page 27108]]

 
24500............  Murray County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24510............  Nicollet County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24520............  Nobles County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24530............  Norman County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24540............  Olmsted County,           6820  Urban             1.1131      40340  Urban             1.1131
                    Minnesota.
24550............  Otter Tail County,          24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24560............  Pennington County,          24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24570............  Pine County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24580............  Pipestone County,           24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24590............  Polk County,              2985  Urban             0.7901      24220  Urban             0.7901
                    Minnesota.
24600............  Pope County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24610............  Ramsey County,            5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24620............  Red Lake County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24630............  Redwood County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24640............  Renville County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24650............  Rice County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24660............  Rock County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24670............  Roseau County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24680............  St Louis County,          2240  Urban             1.0213      20260  Urban             1.0213
                    Minnesota.
24690............  Scott County,             5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24700............  Sherburne County,         5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24710............  Sibley County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24720............  Stearns County,           6980  Urban             0.9965      41060  Urban             0.9965
                    Minnesota.
24730............  Steele County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24740............  Stevens County,             24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24750............  Swift County,               24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24760............  Todd County,                24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24770............  Traverse County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24780............  Wabasha County,             24  Rural             0.9132      40340  Urban             1.1131
                    Minnesota.
24790............  Wadena County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24800............  Waseca County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24810............  Washington County,        5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24820............  Watonwan County,            24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24830............  Wilkin County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24840............  Winona County,              24  Rural             0.9132      99924  Rural             0.9132
                    Minnesota.
24850............  Wright County,            5120  Urban             1.1075      33460  Urban             1.1075
                    Minnesota.
24860............  Yellow Medicine             24  Rural             0.9132      99924  Rural             0.9132
                    County, Minnesota.
25000............  Adams County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25010............  Alcorn County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25020............  Amite County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25030............  Attala County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25040............  Benton County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25050............  Bolivar County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25060............  Calhoun County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25070............  Carroll County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25080............  Chickasaw County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25090............  Choctaw County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25100............  Claiborne County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25110............  Clarke County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25120............  Clay County,                25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25130............  Coahoma County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25140............  Copiah County,              25  Rural             0.7634      27140  Urban             0.8311
                    Mississippi.
25150............  Covington County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25160............  Desoto County,            4920  Urban             0.9416      32820  Urban             0.9397
                    Mississippi.
25170............  Forrest County,           3285  Urban             0.7601      25620  Urban             0.7601
                    Mississippi.
25180............  Franklin County,            25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25190............  George County,              25  Rural             0.7634      37700  Urban             0.8156
                    Mississippi.
25200............  Greene County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25210............  Grenada County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25220............  Hancock County,           0920  Urban             0.8706      25060  Urban             0.8929
                    Mississippi.
25230............  Harrison County,          0920  Urban             0.8706      25060  Urban             0.8929
                    Mississippi.
25240............  Hinds County,             3560  Urban             0.8382      27140  Urban             0.8311
                    Mississippi.
25250............  Holmes County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25260............  Humphreys County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25270............  Issaquena County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25280............  Itawamba County,            25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25290............  Jackson County,           0920  Urban             0.8706      37700  Urban             0.8156
                    Mississippi.
25300............  Jasper County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25310............  Jefferson County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25320............  Jefferson Davis             25  Rural             0.7634      99925  Rural             0.7674
                    County,
                    Mississippi.
25330............  Jones County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25340............  Kemper County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.

[[Page 27109]]

 
25350............  Lafayette County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25360............  Lamar County,             3285  Urban             0.7601      25620  Urban             0.7601
                    Mississippi.
25370............  Lauderdale County,          25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25380............  Lawrence County,            25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25390............  Leake County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25400............  Lee County,                 25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25410............  Leflore County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25420............  Lincoln County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25430............  Lowndes County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25440............  Madison County,           3560  Urban             0.8382      27140  Urban             0.8311
                    Mississippi.
25450............  Marion County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25460............  Marshall County,            25  Rural             0.7634      32820  Urban             0.9397
                    Mississippi.
25470............  Monroe County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25480............  Montgomery County,          25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25490............  Neshoba County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25500............  Newton County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25510............  Noxubee County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25520............  Oktibbeha County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25530............  Panola County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25540............  Pearl River County,         25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25550............  Perry County,               25  Rural             0.7634      25620  Urban             0.7601
                    Mississippi.
25560............  Pike County,                25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25570............  Pontotoc County,            25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25580............  Prentiss County,            25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25590............  Quitman County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25600............  Rankin County,            3560  Urban             0.8382      27140  Urban             0.8311
                    Mississippi.
25610............  Scott County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25620............  Sharkey County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25630............  Simpson County,             25  Rural             0.7634      27140  Urban             0.8311
                    Mississippi.
25640............  Smith County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25650............  Stone County,               25  Rural             0.7634      25060  Urban             0.8929
                    Mississippi.
25660............  Sunflower County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25670............  Tallahatchie                25  Rural             0.7634      99925  Rural             0.7674
                    County,
                    Mississippi.
25680............  Tate County,                25  Rural             0.7634      32820  Urban             0.9397
                    Mississippi.
25690............  Tippah County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25700............  Tishomingo County,          25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25710............  Tunica County,              25  Rural             0.7634      32820  Urban             0.9397
                    Mississippi.
25720............  Union County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25730............  Walthall County,            25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25740............  Warren County,              25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25750............  Washington County,          25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25760............  Wayne County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25770............  Webster County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25780............  Wilkinson County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25790............  Winston County,             25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25800............  Yalobusha County,           25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
25810............  Yazoo County,               25  Rural             0.7634      99925  Rural             0.7674
                    Mississippi.
26000............  Adair County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26010............  Andrew County,            7000  Urban             0.9519      41140  Urban             0.9519
                    Missouri.
26020............  Atchison County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26030............  Audrain County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26040............  Barry County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26050............  Barton County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26060............  Bates County,               26  Rural             0.7959      28140  Urban             0.9476
                    Missouri.
26070............  Benton County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26080............  Bollinger County,           26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26090............  Boone County,             1740  Urban             0.8345      17860  Urban             0.8345
                    Missouri.
26100............  Buchanan County,          7000  Urban             0.9519      41140  Urban             0.9519
                    Missouri.
26110............  Butler County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26120............  Caldwell County,            26  Rural             0.7959      28140  Urban             0.9476
                    Missouri.
26130............  Callaway County,            26  Rural             0.7959      27620  Urban             0.8387
                    Missouri.
26140............  Camden County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26150............  Cape Girardeau              26  Rural             0.7959      99926  Rural             0.7900
                    County, Missouri.
26160............  Carroll County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26170............  Carter County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26180............  Cass County,              3760  Urban             0.9490      28140  Urban             0.9476
                    Missouri.
26190............  Cedar County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26200............  Chariton County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26210............  Christian County,         7920  Urban             0.8250      44180  Urban             0.8237
                    Missouri.
26220............  Clark County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26230............  Clay County,              3760  Urban             0.9490      28140  Urban             0.9476
                    Missouri.
26240............  Clinton County,           3760  Urban             0.9490      28140  Urban             0.9476
                    Missouri.

[[Page 27110]]

 
26250............  Cole County,                26  Rural             0.7959      27620  Urban             0.8387
                    Missouri.
26260............  Cooper County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26270............  Crawford County,            26  Rural             0.7959      41180  Urban             0.8954
                    Missouri.
26280............  Dade County,                26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26290............  Dallas County,              26  Rural             0.7959      44180  Urban             0.8237
                    Missouri.
26300............  Daviess County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26310............  De Kalb County,             26  Rural             0.7959      41140  Urban             0.9519
                    Missouri.
26320............  Dent County,                26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26330............  Douglas County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26340............  Dunklin County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26350............  Franklin County,          7040  Urban             0.8962      41180  Urban             0.8954
                    Missouri.
26360............  Gasconade County,           26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26370............  Gentry County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26380............  Greene County,            7920  Urban             0.8250      44180  Urban             0.8237
                    Missouri.
26390............  Grundy County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26400............  Harrison County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26410............  Henry County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26411............  Hickory County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26412............  Holt County,                26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26440............  Howard County,              26  Rural             0.7959      17860  Urban             0.8345
                    Missouri.
26450............  Howell County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26460............  Iron County,                26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26470............  Jackson County,           3760  Urban             0.9490      28140  Urban             0.9476
                    Missouri.
26480............  Jasper County,            3710  Urban             0.8582      27900  Urban             0.8582
                    Missouri.
26490............  Jefferson County,         7040  Urban             0.8962      41180  Urban             0.8954
                    Missouri.
26500............  Johnson County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26510............  Knox County,                26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26520............  Laclede County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26530............  Lafayette County,         3760  Urban             0.9490      28140  Urban             0.9476
                    Missouri.
26540............  Lawrence County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26541............  Lewis County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26560............  Lincoln County,           7040  Urban             0.8962      41180  Urban             0.8954
                    Missouri.
26570............  Linn County,                26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26580............  Livingston County,          26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26590............  Mc Donald County,           26  Rural             0.7959      22220  Urban             0.8661
                    Missouri.
26600............  Macon County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26601............  Madison County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26620............  Maries County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26630............  Marion County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26631............  Mercer County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26650............  Miller County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26660............  Mississippi County,         26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26670............  Moniteau County,            26  Rural             0.7959      27620  Urban             0.8387
                    Missouri.
26680............  Monroe County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26690............  Montgomery County,          26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26700............  Morgan County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26710............  New Madrid County,          26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26720............  Newton County,            3710  Urban             0.8582      27900  Urban             0.8582
                    Missouri.
26730............  Nodaway County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26740............  Oregon County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26750............  Osage County,               26  Rural             0.7959      27620  Urban             0.8387
                    Missouri.
26751............  Ozark County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26770............  Pemiscot County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26780............  Perry County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26790............  Pettis County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26800............  Phelps County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26810............  Pike County,                26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26820............  Platte County,            3760  Urban             0.9490      28140  Urban             0.9476
                    Missouri.
26821............  Polk County,                26  Rural             0.7959      44180  Urban             0.8237
                    Missouri.
26840............  Pulaski County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26850............  Putnam County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26860............  Ralls County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26870............  Randolph County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26880............  Ray County,               3760  Urban             0.9490      28140  Urban             0.9476
                    Missouri.
26881............  Reynolds County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26900............  Ripley County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26910............  St Charles County,        7040  Urban             0.8962      41180  Urban             0.8954
                    Missouri.
26911............  St Clair County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26930............  St Francois County,         26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26940............  St Louis County,          7040  Urban             0.8962      41180  Urban             0.8954
                    Missouri.
26950............  St Louis City             7040  Urban             0.8962      41180  Urban             0.8954
                    County, Missouri.
26960............  Ste Genevieve               26  Rural             0.7959      99926  Rural             0.7900
                    County, Missouri.

[[Page 27111]]

 
26970............  Saline County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26980............  Schuyler County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26981............  Scotland County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26982............  Scott County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26983............  Shannon County,             26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26984............  Shelby County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26985............  Stoddard County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26986............  Stone County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26987............  Sullivan County,            26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26988............  Taney County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26989............  Texas County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26990............  Vernon County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26991............  Warren County,            7040  Urban             0.8962      41180  Urban             0.8954
                    Missouri.
26992............  Washington County,          26  Rural             0.7959      41180  Urban             0.8954
                    Missouri.
26993............  Wayne County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26994............  Webster County,           7920  Urban             0.8250      44180  Urban             0.8237
                    Missouri.
26995............  Worth County,               26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
26996............  Wright County,              26  Rural             0.7959      99926  Rural             0.7900
                    Missouri.
27000............  Beaverhead County,          27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27010............  Big Horn County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27020............  Blaine County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27030............  Broadwater County,          27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27040............  Carbon County,              27  Rural             0.8762      13740  Urban             0.8834
                    Montana.
27050............  Carter County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27060............  Cascade County,           3040  Urban             0.9052      24500  Urban             0.9052
                    Montana.
27070............  Chouteau County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27080............  Custer County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27090............  Daniels County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27100............  Dawson County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27110............  Deer Lodge County,          27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27113............  Yellowstone                 27  Rural             0.8762      99927  Rural             0.8762
                    National Park,
                    Montana.
27120............  Fallon County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27130............  Fergus County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27140............  Flathead County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27150............  Gallatin County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27160............  Garfield County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27170............  Glacier County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27180............  Golden Valley               27  Rural             0.8762      99927  Rural             0.8762
                    County, Montana.
27190............  Granite County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27200............  Hill County,                27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27210............  Jefferson County,           27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27220............  Judith Basin                27  Rural             0.8762      99927  Rural             0.8762
                    County, Montana.
27230............  Lake County,                27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27240............  Lewis And Clark             27  Rural             0.8762      99927  Rural             0.8762
                    County, Montana.
27250............  Liberty County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27260............  Lincoln County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27270............  Mc Cone County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27280............  Madison County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27290............  Meagher County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27300............  Mineral County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27310............  Missoula County,          5140  Urban             0.9473      33540  Urban             0.9473
                    Montana.
27320............  Musselshell County,         27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27330............  Park County,                27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27340............  Petroleum County,           27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27350............  Phillips County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27360............  Pondera County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27370............  Powder River                27  Rural             0.8762      99927  Rural             0.8762
                    County, Montana.
27380............  Powell County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27390............  Prairie County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27400............  Ravalli County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27410............  Richland County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27420............  Roosevelt County,           27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27430............  Rosebud County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27440............  Sanders County,             27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27450............  Sheridan County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27460............  Silver Bow County,          27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27470............  Stillwater County,          27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27480............  Sweet Grass County,         27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27490............  Teton County,               27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27500............  Toole County,               27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27510............  Treasure County,            27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27520............  Valley County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.

[[Page 27112]]

 
27530............  Wheatland County,           27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27540............  Wibaux County,              27  Rural             0.8762      99927  Rural             0.8762
                    Montana.
27550............  Yellowstone County,       0880  Urban             0.8834      13740  Urban             0.8834
                    Montana.
28000............  Adams County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28010............  Antelope County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28020............  Arthur County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28030............  Banner County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28040............  Blaine County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28050............  Boone County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28060............  Box Butte County,           28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28070............  Boyd County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28080............  Brown County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28090............  Buffalo County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28100............  Burt County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28110............  Butler County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28120............  Cass County,              5920  Urban             0.9560      36540  Urban             0.9560
                    Nebraska.
28130............  Cedar County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28140............  Chase County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28150............  Cherry County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28160............  Cheyenne County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28170............  Clay County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28180............  Colfax County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28190............  Cuming County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28200............  Custer County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28210............  Dakota County,            7720  Urban             0.9416      43580  Urban             0.9381
                    Nebraska.
28220............  Dawes County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28230............  Dawson County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28240............  Deuel County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28250............  Dixon County,               28  Rural             0.8657      43580  Urban             0.9381
                    Nebraska.
28260............  Dodge County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28270............  Douglas County,           5920  Urban             0.9560      36540  Urban             0.9560
                    Nebraska.
28280............  Dundy County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28290............  Fillmore County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28300............  Franklin County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28310............  Frontier County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28320............  Furnas County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28330............  Gage County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28340............  Garden County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28350............  Garfield County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28360............  Gosper County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28370............  Grant County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28380............  Greeley County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28390............  Hall County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28400............  Hamilton County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28410............  Harlan County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28420............  Hayes County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28430............  Hitchcock County,           28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28440............  Holt County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28450............  Hooker County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28460............  Howard County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28470............  Jefferson County,           28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28480............  Johnson County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28490............  Kearney County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28500............  Keith County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28510............  Keya Paha County,           28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28520............  Kimball County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28530............  Knox County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28540............  Lancaster County,         4360  Urban             1.0214      30700  Urban             1.0214
                    Nebraska.
28550............  Lincoln County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28560............  Logan County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28570............  Loup County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28580............  Mc Pherson County,          28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28590............  Madison County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28600............  Merrick County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28610............  Morrill County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28620............  Nance County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28630............  Nemaha County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28640............  Nuckolls County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28650............  Otoe County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28660............  Pawnee County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28670............  Perkins County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28680............  Phelps County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.

[[Page 27113]]

 
28690............  Pierce County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28700............  Platte County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28710............  Polk County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28720............  Redwillow County,           28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28730............  Richardson County,          28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28740............  Rock County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28750............  Saline County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28760............  Sarpy County,             5920  Urban             0.9560      36540  Urban             0.9560
                    Nebraska.
28770............  Saunders County,            28  Rural             0.8657      36540  Urban             0.9560
                    Nebraska.
28780............  Scotts Bluff                28  Rural             0.8657      99928  Rural             0.8657
                    County, Nebraska.
28790............  Seward County,              28  Rural             0.8657      30700  Urban             1.0214
                    Nebraska.
28800............  Sheridan County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28810............  Sherman County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28820............  Sioux County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28830............  Stanton County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28840............  Thayer County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28850............  Thomas County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28860............  Thurston County,            28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28870............  Valley County,              28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28880............  Washington County,        5920  Urban             0.9560      36540  Urban             0.9560
                    Nebraska.
28890............  Wayne County,               28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28900............  Webster County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28910............  Wheeler County,             28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
28920............  York County,                28  Rural             0.8657      99928  Rural             0.8657
                    Nebraska.
29000............  Churchill County,           29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29010............  Clark County,             4120  Urban             1.1155      29820  Urban             1.1437
                    Nevada.
29020............  Douglas County,             29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29030............  Elko County, Nevada         29  Rural             0.9687      99929  Rural             0.9065
29040............  Esmeralda County,           29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29050............  Eureka County,              29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29060............  Humboldt County,            29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29070............  Lander County,              29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29080............  Lincoln County,             29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29090............  Lyon County, Nevada         29  Rural             0.9687      99929  Rural             0.9065
29100............  Mineral County,             29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29110............  Nye County, Nevada.       4120  Urban             1.1155      99929  Rural             0.9065
29120............  Carson City County,         29  Rural             0.9687      16180  Urban             1.0234
                    Nevada.
29130............  Pershing County,            29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
29140............  Storey County,              29  Rural             0.9687      39900  Urban             1.0982
                    Nevada.
29150............  Washoe County,            6720  Urban             1.0982      39900  Urban             1.0982
                    Nevada.
29160............  White Pine County,          29  Rural             0.9687      99929  Rural             0.9065
                    Nevada.
30000............  Belknap County, New         30  Rural             1.0817      99930  Rural             1.0817
                    Hampshire.
30010............  Carroll County, New         30  Rural             1.0817      99930  Rural             1.0817
                    Hampshire.
30020............  Cheshire County,            30  Rural             1.0817      99930  Rural             1.0817
                    New Hampshire.
30030............  Coos County, New            30  Rural             1.0817      99930  Rural             1.0817
                    Hampshire.
30040............  Grafton County, New         30  Rural             1.0817      99930  Rural             1.0817
                    Hampshire.
30050............  Hillsboro County,         1123  Urban             1.1178      31700  Urban             1.0354
                    New Hampshire.
30060............  Merrimack County,         1123  Urban             1.1178      31700  Urban             1.0354
                    New Hampshire.
30070............  Rockingham County,        1123  Urban             1.1178      40484  Urban             1.0374
                    New Hampshire.
30080............  Strafford County,         1123  Urban             1.1178      40484  Urban             1.0374
                    New Hampshire.
30090............  Sullivan County,            30  Rural             1.0817      99930  Rural             1.0817
                    New Hampshire.
31000............  Atlantic County,          0560  Urban             1.1496      12100  Urban             1.1615
                    New Jersey.
31100............  Bergen County, New        0875  Urban             1.1651      35644  Urban             1.3188
                    Jersey.
31150............  Burlington County,        6160  Urban             1.0922      15804  Urban             1.0517
                    New Jersey.
31160............  Camden County, New        6160  Urban             1.0922      15804  Urban             1.0517
                    Jersey.
31180............  Cape May County,          0560  Urban             1.1496      36140  Urban             1.1011
                    New Jersey.
31190............  Cumberland County,        8760  Urban             0.9827      47220  Urban             0.9827
                    New Jersey.
31200............  Essex County, New         5640  Urban             1.1834      35084  Urban             1.1883
                    Jersey.
31220............  Gloucester County,        6160  Urban             1.0922      15804  Urban             1.0517
                    New Jersey.
31230............  Hudson County, New        3640  Urban             1.1338      35644  Urban             1.3188
                    Jersey.
31250............  Hunterdon County,         5015  Urban             1.1167      35084  Urban             1.1883
                    New Jersey.
31260............  Mercer County, New        8480  Urban             1.0834      45940  Urban             1.0834
                    Jersey.
31270............  Middlesex County,         5015  Urban             1.1167      20764  Urban             1.1249
                    New Jersey.
31290............  Monmouth County,          5190  Urban             1.1260      20764  Urban             1.1249
                    New Jersey.
31300............  Morris County, New        5640  Urban             1.1834      35084  Urban             1.1883
                    Jersey.
31310............  Ocean County, New         5190  Urban             1.1260      20764  Urban             1.1249
                    Jersey.
31320............  Passaic County, New       0875  Urban             1.1651      35644  Urban             1.3188
                    Jersey.
31340............  Salem County, New         6160  Urban             1.0922      48864  Urban             1.0471
                    Jersey.
31350............  Somerset County,          5015  Urban             1.1167      20764  Urban             1.1249
                    New Jersey.
31360............  Sussex County, New        5640  Urban             1.1834      35084  Urban             1.1883
                    Jersey.
31370............  Union County, New         5640  Urban             1.1834      35084  Urban             1.1883
                    Jersey.
31390............  Warren County, New        5640  Urban             1.1834      10900  Urban             0.9818
                    Jersey.

[[Page 27114]]

 
32000............  Bernalillo County,        0200  Urban             0.9684      10740  Urban             0.9684
                    New Mexico.
32010............  Catron County, New          32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32020............  Chaves County, New          32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32025............  Cibola County, New          32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32030............  Colfax County, New          32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32040............  Curry County, New           32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32050............  De Baca County, New         32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32060............  Dona Ana County,          4100  Urban             0.8467      29740  Urban             0.8467
                    New Mexico.
32070............  Eddy County, New            32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32080............  Grant County, New           32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32090............  Guadalupe County,           32  Rural             0.8563      99932  Rural             0.8635
                    New Mexico.
32100............  Harding County, New         32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32110............  Hidalgo County, New         32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32120............  Lea County, New             32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32130............  Lincoln County, New         32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32131............  Los Alamos County,        7490  Urban             1.0748      99932  Rural             0.8635
                    New Mexico.
32140............  Luna County, New            32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32150............  Mc Kinley County,           32  Rural             0.8563      99932  Rural             0.8635
                    New Mexico.
32160............  Mora County, New            32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32170............  Otero County, New           32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32180............  Quay County, New            32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32190............  Rio Arriba County,          32  Rural             0.8563      99932  Rural             0.8635
                    New Mexico.
32200............  Roosevelt County,           32  Rural             0.8563      99932  Rural             0.8635
                    New Mexico.
32210............  Sandoval County,          0200  Urban             0.9684      10740  Urban             0.9684
                    New Mexico.
32220............  San Juan County,            32  Rural             0.8563      22140  Urban             0.8509
                    New Mexico.
32230............  San Miguel County,          32  Rural             0.8563      99932  Rural             0.8635
                    New Mexico.
32240............  Santa Fe County,          7490  Urban             1.0748      42140  Urban             1.0920
                    New Mexico.
32250............  Sierra County, New          32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32260............  Socorro County, New         32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32270............  Taos County, New            32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32280............  Torrance County,            32  Rural             0.8563      10740  Urban             0.9684
                    New Mexico.
32290............  Union County, New           32  Rural             0.8563      99932  Rural             0.8635
                    Mexico.
32300............  Valencia County,          0200  Urban             0.9684      10740  Urban             0.9684
                    New Mexico.
33000............  Albany County, New        0160  Urban             0.8559      10580  Urban             0.8589
                    York.
33010............  Allegany County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33020............  Bronx County, New         5600  Urban             1.3464      35644  Urban             1.3188
                    York.
33030............  Broome County, New        0960  Urban             0.8562      13780  Urban             0.8562
                    York.
33040............  Cattaraugus County,         33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33050............  Cayuga County, New        8160  Urban             0.9492      99933  Rural             0.8154
                    York.
33060............  Chautauqua County,        3610  Urban             0.7544      99933  Rural             0.8154
                    New York.
33070............  Chemung County, New       2335  Urban             0.8250      21300  Urban             0.8250
                    York.
33080............  Chenango County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33090............  Clinton County, New         33  Rural             0.8395      99933  Rural             0.8154
                    York.
33200............  Columbia County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33210............  Cortland County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33220............  Delaware County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33230............  Dutchess County,          2281  Urban             1.0475      39100  Urban             1.0891
                    New York.
33240............  Erie County, New          1280  Urban             0.9511      15380  Urban             0.9511
                    York.
33260............  Essex County, New           33  Rural             0.8395      99933  Rural             0.8154
                    York.
33270............  Franklin County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33280............  Fulton County, New          33  Rural             0.8395      99933  Rural             0.8154
                    York.
33290............  Genesee County, New       6840  Urban             0.9049      99933  Rural             0.8154
                    York.
33300............  Greene County, New          33  Rural             0.8395      99933  Rural             0.8154
                    York.
33310............  Hamilton County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33320............  Herkimer County,          8680  Urban             0.8358      46540  Urban             0.8358
                    New York.
33330............  Jefferson County,           33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33331............  Kings County, New         5600  Urban             1.3464      35644  Urban             1.3188
                    York.
33340............  Lewis County, New           33  Rural             0.8395      99933  Rural             0.8154
                    York.
33350............  Livingston County,        6840  Urban             0.9049      40380  Urban             0.9121
                    New York.
33360............  Madison County, New       8160  Urban             0.9492      45060  Urban             0.9574
                    York.
33370............  Monroe County, New        6840  Urban             0.9049      40380  Urban             0.9121
                    York.
33380............  Montgomery County,        0160  Urban             0.8559      99933  Rural             0.8154
                    New York.
33400............  Nassau County, New        5380  Urban             1.2719      35004  Urban             1.2719
                    York.
33420............  New York County,          5600  Urban             1.3464      35644  Urban             1.3188
                    New York.
33500............  Niagara County, New       1280  Urban             0.9511      15380  Urban             0.9511
                    York.
33510............  Oneida County, New        8680  Urban             0.8358      46540  Urban             0.8358
                    York.
33520............  Onondaga County,          8160  Urban             0.9492      45060  Urban             0.9574
                    New York.
33530............  Ontario County, New       6840  Urban             0.9049      40380  Urban             0.9121
                    York.
33540............  Orange County, New        5660  Urban             1.1207      39100  Urban             1.0891
                    York.
33550............  Orleans County, New       6840  Urban             0.9049      40380  Urban             0.9121
                    York.
33560............  Oswego County, New        8160  Urban             0.9492      45060  Urban             0.9574
                    York.
33570............  Otsego County, New          33  Rural             0.8395      99933  Rural             0.8154
                    York.

[[Page 27115]]

 
33580............  Putnam County, New        5600  Urban             1.3464      35644  Urban             1.3188
                    York.
33590............  Queens County, New        5600  Urban             1.3464      35644  Urban             1.3188
                    York.
33600............  Rensselaer County,        0160  Urban             0.8559      10580  Urban             0.8589
                    New York.
33610............  Richmond County,          5600  Urban             1.3464      35644  Urban             1.3188
                    New York.
33620............  Rockland County,          5600  Urban             1.3464      35644  Urban             1.3188
                    New York.
33630............  St Lawrence County,         33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33640............  Saratoga County,          0160  Urban             0.8559      10580  Urban             0.8589
                    New York.
33650............  Schenectady County,       0160  Urban             0.8559      10580  Urban             0.8589
                    New York.
33660............  Schoharie County,         0160  Urban             0.8559      10580  Urban             0.8589
                    New York.
33670............  Schuyler County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33680............  Seneca County, New          33  Rural             0.8395      99933  Rural             0.8154
                    York.
33690............  Steuben County, New         33  Rural             0.8395      99933  Rural             0.8154
                    York.
33700............  Suffolk County, New       5380  Urban             1.2719      35004  Urban             1.2719
                    York.
33710............  Sullivan County,            33  Rural             0.8395      99933  Rural             0.8154
                    New York.
33720............  Tioga County, New         0960  Urban             0.8562      13780  Urban             0.8562
                    York.
33730............  Tompkins County,            33  Rural             0.8395      27060  Urban             0.9793
                    New York.
33740............  Ulster County, New          33  Rural             0.8395      28740  Urban             0.9255
                    York.
33750............  Warren County, New        2975  Urban             0.8559      24020  Urban             0.8559
                    York.
33760............  Washington County,        2975  Urban             0.8559      24020  Urban             0.8559
                    New York.
33770............  Wayne County, New         6840  Urban             0.9049      40380  Urban             0.9121
                    York.
33800............  Westchester County,       5600  Urban             1.3464      35644  Urban             1.3188
                    New York.
33900............  Wyoming County, New         33  Rural             0.8395      99933  Rural             0.8154
                    York.
33910............  Yates County, New           33  Rural             0.8395      99933  Rural             0.8154
                    York.
34000............  Alamance County, N        3120  Urban             0.9018      15500  Urban             0.8905
                    Carolina.
34010............  Alexander County, N       3290  Urban             0.8921      25860  Urban             0.8921
                    Carolina.
34020............  Alleghany County, N         34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34030............  Anson County, N             34  Rural             0.8462      16740  Urban             0.9750
                    Carolina.
34040............  Ashe County, N              34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34050............  Avery County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34060............  Beaufort County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34070............  Bertie County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34080............  Bladen County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34090............  Brunswick County, N       9200  Urban             0.9582      48900  Urban             0.9582
                    Carolina.
34100............  Buncombe County, N        0480  Urban             0.9737      11700  Urban             0.9285
                    Carolina.
34110............  Burke County, N           3290  Urban             0.8921      25860  Urban             0.8921
                    Carolina.
34120............  Cabarrus County, N        1520  Urban             0.9715      16740  Urban             0.9750
                    Carolina.
34130............  Caldwell County, N        3290  Urban             0.8921      25860  Urban             0.8921
                    Carolina.
34140............  Camden County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34150............  Carteret County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34160............  Caswell County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34170............  Catawba County, N         3290  Urban             0.8921      25860  Urban             0.8921
                    Carolina.
34180............  Chatham County, N         6640  Urban             1.0034      20500  Urban             1.0244
                    Carolina.
34190............  Cherokee County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34200............  Chowan County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34210............  Clay County, N              34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34220............  Cleveland County, N         34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34230............  Columbus County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34240............  Craven County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34250............  Cumberland County,        2560  Urban             0.9416      22180  Urban             0.9416
                    N Carolina.
34251............  Currituck County, N       5720  Urban             0.8799      47260  Urban             0.8799
                    Carolina.
34270............  Dare County, N              34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34280............  Davidson County, N        3120  Urban             0.9018      99934  Rural             0.8540
                    Carolina.
34290............  Davie County, N           3120  Urban             0.9018      49180  Urban             0.8944
                    Carolina.
34300............  Duplin County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34310............  Durham County, N          6640  Urban             1.0034      20500  Urban             1.0244
                    Carolina.
34320............  Edgecombe County, N       6895  Urban             0.8915      40580  Urban             0.8915
                    Carolina.
34330............  Forsyth County, N         3120  Urban             0.9018      49180  Urban             0.8944
                    Carolina.
34340............  Franklin County, N        6640  Urban             1.0034      39580  Urban             0.9691
                    Carolina.
34350............  Gaston County, N          1520  Urban             0.9715      16740  Urban             0.9750
                    Carolina.
34360............  Gates County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34370............  Graham County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34380............  Granville County, N         34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34390............  Greene County, N            34  Rural             0.8462      24780  Urban             0.9425
                    Carolina.
34400............  Guilford County, N        3120  Urban             0.9018      24660  Urban             0.9104
                    Carolina.
34410............  Halifax County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34420............  Harnett County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34430............  Haywood County, N           34  Rural             0.8462      11700  Urban             0.9285
                    Carolina.
34440............  Henderson County, N         34  Rural             0.8462      11700  Urban             0.9285
                    Carolina.
34450............  Hertford County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34460............  Hoke County, N              34  Rural             0.8462      22180  Urban             0.9416
                    Carolina.
34470............  Hyde County, N              34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34480............  Iredell County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.

[[Page 27116]]

 
34490............  Jackson County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34500............  Johnston County, N        6640  Urban             1.0034      39580  Urban             0.9691
                    Carolina.
34510............  Jones County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34520............  Lee County, N               34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34530............  Lenoir County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34540............  Lincoln County, N         1520  Urban             0.9715      99934  Rural             0.8540
                    Carolina.
34550............  Mc Dowell County, N         34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34560............  Macon County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34570............  Madison County, N         0480  Urban             0.9737      11700  Urban             0.9285
                    Carolina.
34580............  Martin County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34590............  Mecklenburg County,       1520  Urban             0.9715      16740  Urban             0.9750
                    N Carolina.
34600............  Mitchell County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34610............  Montgomery County,          34  Rural             0.8462      99934  Rural             0.8540
                    N Carolina.
34620............  Moore County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34630............  Nash County, N            6895  Urban             0.8915      40580  Urban             0.8915
                    Carolina.
34640............  New Hanover County,       9200  Urban             0.9582      48900  Urban             0.9582
                    N Carolina.
34650............  Northampton County,         34  Rural             0.8462      99934  Rural             0.8540
                    N Carolina.
34660............  Onslow County, N          3605  Urban             0.8236      27340  Urban             0.8236
                    Carolina.
34670............  Orange County, N          6640  Urban             1.0034      20500  Urban             1.0244
                    Carolina.
34680............  Pamlico County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34690............  Pasquotank County,          34  Rural             0.8462      99934  Rural             0.8540
                    N Carolina.
34700............  Pender County, N            34  Rural             0.8462      48900  Urban             0.9582
                    Carolina.
34710............  Perquimans County,          34  Rural             0.8462      99934  Rural             0.8540
                    N Carolina.
34720............  Person County, N            34  Rural             0.8462      20500  Urban             1.0244
                    Carolina.
34730............  Pitt County, N            3150  Urban             0.9425      24780  Urban             0.9425
                    Carolina.
34740............  Polk County, N              34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34750............  Randolph County, N        3120  Urban             0.9018      24660  Urban             0.9104
                    Carolina.
34760............  Richmond County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34770............  Robeson County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34780............  Rockingham County,          34  Rural             0.8462      24660  Urban             0.9104
                    N Carolina.
34790............  Rowan County, N           1520  Urban             0.9715      99934  Rural             0.8540
                    Carolina.
34800............  Rutherford County,          34  Rural             0.8462      99934  Rural             0.8540
                    N Carolina.
34810............  Sampson County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34820............  Scotland County, N          34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34830............  Stanly County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34840............  Stokes County, N          3120  Urban             0.9018      49180  Urban             0.8944
                    Carolina.
34850............  Surry County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34860............  Swain County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34870............  Transylvania                34  Rural             0.8462      99934  Rural             0.8540
                    County, N Carolina.
34880............  Tyrrell County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34890............  Union County, N           1520  Urban             0.9715      16740  Urban             0.9750
                    Carolina.
34900............  Vance County, N             34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34910............  Wake County, N            6640  Urban             1.0034      39580  Urban             0.9691
                    Carolina.
34920............  Warren County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34930............  Washington County,          34  Rural             0.8462      99934  Rural             0.8540
                    N Carolina.
34940............  Watauga County, N           34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34950............  Wayne County, N           2980  Urban             0.8775      24140  Urban             0.8775
                    Carolina.
34960............  Wilkes County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34970............  Wilson County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
34980............  Yadkin County, N          3120  Urban             0.9018      49180  Urban             0.8944
                    Carolina.
34981............  Yancey County, N            34  Rural             0.8462      99934  Rural             0.8540
                    Carolina.
35000............  Adams County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35010............  Barnes County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35020............  Benson County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35030............  Billings County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35040............  Bottineau County, N         35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35050............  Bowman County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35060............  Burke County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35070............  Burleigh County, N        1010  Urban             0.7574      13900  Urban             0.7574
                    Dakota.
35080............  Cass County, N            2520  Urban             0.8486      22020  Urban             0.8486
                    Dakota.
35090............  Cavalier County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35100............  Dickey County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35110............  Divide County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35120............  Dunn County, N              35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35130............  Eddy County, N              35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35140............  Emmons County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35150............  Foster County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35160............  Golden Valley               35  Rural             0.7261      99935  Rural             0.7261
                    County, N Dakota.
35170............  Grand Forks County,       2985  Urban             0.7901      24220  Urban             0.7901
                    N Dakota.
35180............  Grant County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35190............  Griggs County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35200............  Hettinger County, N         35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.

[[Page 27117]]

 
35210............  Kidder County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35220............  La Moure County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35230............  Logan County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35240............  Mc Henry County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35250............  Mc Intosh County, N         35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35260............  Mc Kenzie County, N         35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35270............  Mc Lean County, N           35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35280............  Mercer County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35290............  Morton County, N          1010  Urban             0.7574      13900  Urban             0.7574
                    Dakota.
35300............  Mountrail County, N         35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35310............  Nelson County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35320............  Oliver County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35330............  Pembina County, N           35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35340............  Pierce County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35350............  Ramsey County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35360............  Ransom County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35370............  Renville County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35380............  Richland County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35390............  Rolette County, N           35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35400............  Sargent County, N           35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35410............  Sheridan County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35420............  Sioux County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35430............  Slope County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35440............  Stark County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35450............  Steele County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35460............  Stutsman County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35470............  Towner County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35480............  Traill County, N            35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35490............  Walsh County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35500............  Ward County, N              35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35510............  Wells County, N             35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
35520............  Williams County, N          35  Rural             0.7261      99935  Rural             0.7261
                    Dakota.
36000............  Adams County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36010............  Allen County, Ohio.       4320  Urban             0.9119      30620  Urban             0.9225
36020............  Ashland County,             36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36030............  Ashtabula County,         1680  Urban             0.9183      99936  Rural             0.8826
                    Ohio.
36040............  Athens County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36050............  Auglaize County,          4320  Urban             0.9119      99936  Rural             0.8826
                    Ohio.
36060............  Belmont County,           9000  Urban             0.7161      48540  Urban             0.7161
                    Ohio.
36070............  Brown County, Ohio.       1640  Urban             0.9734      17140  Urban             0.9615
36080............  Butler County, Ohio       3200  Urban             0.8951      17140  Urban             0.9615
36090............  Carroll County,           1320  Urban             0.8935      15940  Urban             0.8935
                    Ohio.
36100............  Champaign County,           36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36110............  Clark County, Ohio.       2000  Urban             0.8980      44220  Urban             0.8396
36120............  Clermont County,          1640  Urban             0.9734      17140  Urban             0.9615
                    Ohio.
36130............  Clinton County,             36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36140............  Columbiana County,        9320  Urban             0.8848      99936  Rural             0.8826
                    Ohio.
36150............  Coshocton County,           36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36160............  Crawford County,          4800  Urban             0.9891      99936  Rural             0.8826
                    Ohio.
36170............  Cuyahoga County,          1680  Urban             0.9183      17460  Urban             0.9213
                    Ohio.
36190............  Darke County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36200............  Defiance County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36210............  Delaware County,          1840  Urban             0.9874      18140  Urban             0.9860
                    Ohio.
36220............  Erie County, Ohio..         36  Rural             0.8921      41780  Urban             0.9019
36230............  Fairfield County,         1840  Urban             0.9874      18140  Urban             0.9860
                    Ohio.
36240............  Fayette County,             36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36250............  Franklin County,          1840  Urban             0.9874      18140  Urban             0.9860
                    Ohio.
36260............  Fulton County, Ohio       8400  Urban             0.9574      45780  Urban             0.9574
36270............  Gallia County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36280............  Geauga County, Ohio       1680  Urban             0.9183      17460  Urban             0.9213
36290............  Greene County, Ohio       2000  Urban             0.8980      19380  Urban             0.9064
36300............  Guernsey County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36310............  Hamilton County,          1640  Urban             0.9734      17140  Urban             0.9615
                    Ohio.
36330............  Hancock County,             36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36340............  Hardin County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36350............  Harrison County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36360............  Henry County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36370............  Highland County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36380............  Hocking County,             36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36390............  Holmes County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36400............  Huron County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36410............  Jackson County,             36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.

[[Page 27118]]

 
36420............  Jefferson County,         8080  Urban             0.7819      48260  Urban             0.7819
                    Ohio.
36430............  Knox County, Ohio..         36  Rural             0.8921      99936  Rural             0.8826
36440............  Lake County, Ohio..       1680  Urban             0.9183      17460  Urban             0.9213
36450............  Lawrence County,          3400  Urban             0.9477      26580  Urban             0.9477
                    Ohio.
36460............  Licking County,           1840  Urban             0.9874      18140  Urban             0.9860
                    Ohio.
36470............  Logan County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36480............  Lorain County, Ohio       1680  Urban             0.9183      17460  Urban             0.9213
36490............  Lucas County, Ohio.       8400  Urban             0.9574      45780  Urban             0.9574
36500............  Madison County,           1840  Urban             0.9874      18140  Urban             0.9860
                    Ohio.
36510............  Mahoning County,          9320  Urban             0.8848      49660  Urban             0.8603
                    Ohio.
36520............  Marion County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36530............  Medina County, Ohio       1680  Urban             0.9183      17460  Urban             0.9213
36540............  Meigs County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36550............  Mercer County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36560............  Miami County, Ohio.       2000  Urban             0.8980      19380  Urban             0.9064
36570............  Monroe County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36580............  Montgomery County,        2000  Urban             0.8980      19380  Urban             0.9064
                    Ohio.
36590............  Morgan County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36600............  Morrow County, Ohio         36  Rural             0.8921      18140  Urban             0.9860
36610............  Muskingum County,           36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36620............  Noble County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36630............  Ottawa County, Ohio         36  Rural             0.8921      45780  Urban             0.9574
36640............  Paulding County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36650............  Perry County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36660............  Pickaway County,          1840  Urban             0.9874      18140  Urban             0.9860
                    Ohio.
36670............  Pike County, Ohio..         36  Rural             0.8921      99936  Rural             0.8826
36680............  Portage County,           0080  Urban             0.8982      10420  Urban             0.8982
                    Ohio.
36690............  Preble County, Ohio         36  Rural             0.8921      19380  Urban             0.9064
36700............  Putnam County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36710............  Richland County,          4800  Urban             0.9891      31900  Urban             0.9891
                    Ohio.
36720............  Ross County, Ohio..         36  Rural             0.8921      99936  Rural             0.8826
36730............  Sandusky County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36740............  Scioto County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36750............  Seneca County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36760............  Shelby County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36770............  Stark County, Ohio.       1320  Urban             0.8935      15940  Urban             0.8935
36780............  Summit County, Ohio       0080  Urban             0.8982      10420  Urban             0.8982
36790............  Trumbull County,          9320  Urban             0.8848      49660  Urban             0.8603
                    Ohio.
36800............  Tuscarawas County,          36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36810............  Union County, Ohio.         36  Rural             0.8921      18140  Urban             0.9860
36820............  Van Wert County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36830............  Vinton County, Ohio         36  Rural             0.8921      99936  Rural             0.8826
36840............  Warren County, Ohio       1640  Urban             0.9734      17140  Urban             0.9615
36850............  Washington County,        6020  Urban             0.8270      37620  Urban             0.8270
                    Ohio.
36860............  Wayne County, Ohio.         36  Rural             0.8921      99936  Rural             0.8826
36870............  Williams County,            36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
36880............  Wood County, Ohio..       8400  Urban             0.9574      45780  Urban             0.9574
36890............  Wyandot County,             36  Rural             0.8921      99936  Rural             0.8826
                    Ohio.
37000............  Adair County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37010............  Alfalfa County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37020............  Atoka County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37030............  Beaver County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37040............  Beckham County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37050............  Blaine County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37060............  Bryan County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37070............  Caddo County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37080............  Canadian County,          5880  Urban             0.9025      36420  Urban             0.9031
                    Oklahoma.
37090............  Carter County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37100............  Cherokee County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37110............  Choctaw County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37120............  Cimarron County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37130............  Cleveland County,         5880  Urban             0.9025      36420  Urban             0.9031
                    Oklahoma.
37140............  Coal County,                37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37150............  Comanche County,          4200  Urban             0.7872      30020  Urban             0.7872
                    Oklahoma.
37160............  Cotton County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37170............  Craig County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37180............  Creek County,             8560  Urban             0.8587      46140  Urban             0.8543
                    Oklahoma.
37190............  Custer County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37200............  Delaware County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37210............  Dewey County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37220............  Ellis County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37230............  Garfield County,          2340  Urban             0.8666      99937  Rural             0.7581
                    Oklahoma.

[[Page 27119]]

 
37240............  Garvin County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37250............  Grady County,               37  Rural             0.7442      36420  Urban             0.9031
                    Oklahoma.
37260............  Grant County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37270............  Greer County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37280............  Harmon County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37290............  Harper County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37300............  Haskell County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37310............  Hughes County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37320............  Jackson County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37330............  Jefferson County,           37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37340............  Johnston County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37350............  Kay County,                 37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37360............  Kingfisher County,          37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37370............  Kiowa County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37380............  Latimer County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37390............  Le Flore County,            37  Rural             0.7442      22900  Urban             0.8230
                    Oklahoma.
37400............  Lincoln County,             37  Rural             0.7442      36420  Urban             0.9031
                    Oklahoma.
37410............  Logan County,             5880  Urban             0.9025      36420  Urban             0.9031
                    Oklahoma.
37420............  Love County,                37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37430............  Mc Clain County,          5880  Urban             0.9025      36420  Urban             0.9031
                    Oklahoma.
37440............  Mc Curtain County,          37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37450............  Mc Intosh County,           37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37460............  Major County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37470............  Marshall County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37480............  Mayes County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37490............  Murray County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37500............  Muskogee County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37510............  Noble County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37520............  Nowata County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37530............  Okfuskee County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37540............  Oklahoma County,          5880  Urban             0.9025      36420  Urban             0.9031
                    Oklahoma.
37550............  Okmulgee County,            37  Rural             0.7442      46140  Urban             0.8543
                    Oklahoma.
37560............  Osage County,             8560  Urban             0.8587      46140  Urban             0.8543
                    Oklahoma.
37570............  Ottawa County,              37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37580............  Pawnee County,              37  Rural             0.7442      46140  Urban             0.8543
                    Oklahoma.
37590............  Payne County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37600............  Pittsburg County,           37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37610............  Pontotoc County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37620............  Pottawatomie              5880  Urban             0.9025      99937  Rural             0.7581
                    County, Oklahoma.
37630............  Pushmataha County,          37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37640............  Roger Mills County,         37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37650............  Rogers County,            8560  Urban             0.8587      46140  Urban             0.8543
                    Oklahoma.
37660............  Seminole County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37670............  Sequoyah County,          2720  Urban             0.8246      22900  Urban             0.8230
                    Oklahoma.
37680............  Stephens County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37690............  Texas County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37700............  Tillman County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37710............  Tulsa County,             8560  Urban             0.8587      46140  Urban             0.8543
                    Oklahoma.
37720............  Wagoner County,           8560  Urban             0.8587      46140  Urban             0.8543
                    Oklahoma.
37730............  Washington County,          37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37740............  Washita County,             37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37750............  Woods County,               37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
37760............  Woodward County,            37  Rural             0.7442      99937  Rural             0.7581
                    Oklahoma.
38000............  Baker County,               38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38010............  Benton County,            1890  Urban             1.0729      18700  Urban             1.0729
                    Oregon.
38020............  Clackamas County,         6440  Urban             1.1266      38900  Urban             1.1266
                    Oregon.
38030............  Clatsop County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38040............  Columbia County,          6440  Urban             1.1266      38900  Urban             1.1266
                    Oregon.
38050............  Coos County, Oregon         38  Rural             1.0052      99938  Rural             0.9826
38060............  Crook County,               38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38070............  Curry County,               38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38080............  Deschutes County,           38  Rural             1.0052      13460  Urban             1.0786
                    Oregon.
38090............  Douglas County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38100............  Gilliam County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38110............  Grant County,               38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38120............  Harney County,              38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38130............  Hood River County,          38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38140............  Jackson County,           4890  Urban             1.0225      32780  Urban             1.0225
                    Oregon.
38150............  Jefferson County,           38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38160............  Josephine County,           38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38170............  Klamath County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38180............  Lake County, Oregon         38  Rural             1.0052      99938  Rural             0.9826

[[Page 27120]]

 
38190............  Lane County, Oregon       2400  Urban             1.0818      21660  Urban             1.0818
38200............  Lincoln County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38210............  Linn County, Oregon         38  Rural             1.0052      99938  Rural             0.9826
38220............  Malheur County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38230............  Marion County,            7080  Urban             1.0442      41420  Urban             1.0442
                    Oregon.
38240............  Morrow County,              38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38250............  Multnomah County,         6440  Urban             1.1266      38900  Urban             1.1266
                    Oregon.
38260............  Polk County, Oregon       7080  Urban             1.0442      41420  Urban             1.0442
38270............  Sherman County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38280............  Tillamook County,           38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38290............  Umatilla County,            38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38300............  Union County,               38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38310............  Wallowa County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38320............  Wasco County,               38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38330............  Washington County,        6440  Urban             1.1266      38900  Urban             1.1266
                    Oregon.
38340............  Wheeler County,             38  Rural             1.0052      99938  Rural             0.9826
                    Oregon.
38350............  Yamhill County,           6440  Urban             1.1266      38900  Urban             1.1266
                    Oregon.
39000............  Adams County,               39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39010............  Allegheny County,         6280  Urban             0.8860      38300  Urban             0.8845
                    Pennsylvania.
39070............  Armstrong County,           39  Rural             0.8319      38300  Urban             0.8845
                    Pennsylvania.
39080............  Beaver County,            6280  Urban             0.8860      38300  Urban             0.8845
                    Pennsylvania.
39100............  Bedford County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39110............  Berks County,             6680  Urban             0.9686      39740  Urban             0.9686
                    Pennsylvania.
39120............  Blair County,             0280  Urban             0.8944      11020  Urban             0.8944
                    Pennsylvania.
39130............  Bradford County,            39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39140............  Bucks County,             6160  Urban             1.0922      37964  Urban             1.1038
                    Pennsylvania.
39150............  Butler County,            6280  Urban             0.8860      38300  Urban             0.8845
                    Pennsylvania.
39160............  Cambria County,           3680  Urban             0.8086      27780  Urban             0.8354
                    Pennsylvania.
39180............  Cameron County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39190............  Carbon County,            0240  Urban             0.9845      10900  Urban             0.9818
                    Pennsylvania.
39200............  Centre County,            8050  Urban             0.8356      44300  Urban             0.8356
                    Pennsylvania.
39210............  Chester County,           6160  Urban             1.0922      37964  Urban             1.1038
                    Pennsylvania.
39220............  Clarion County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39230............  Clearfield County,          39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39240............  Clinton County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39250............  Columbia County,          7560  Urban             0.8524      99939  Rural             0.8291
                    Pennsylvania.
39260............  Crawford County,            39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39270............  Cumberland County,        3240  Urban             0.9233      25420  Urban             0.9313
                    Pennsylvania.
39280............  Dauphin County,           3240  Urban             0.9233      25420  Urban             0.9313
                    Pennsylvania.
39290............  Delaware County,          6160  Urban             1.0922      37964  Urban             1.1038
                    Pennsylvania.
39310............  Elk County,                 39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39320............  Erie County,              2360  Urban             0.8737      21500  Urban             0.8737
                    Pennsylvania.
39330............  Fayette County,           6280  Urban             0.8860      38300  Urban             0.8845
                    Pennsylvania.
39340............  Forest County,              39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39350............  Franklin County,            39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39360............  Fulton County,              39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39370............  Greene County,              39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39380............  Huntingdon County,          39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39390............  Indiana County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39400............  Jefferson County,           39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39410............  Juniata County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39420............  Lackawanna County,        7560  Urban             0.8524      42540  Urban             0.8540
                    Pennsylvania.
39440............  Lancaster County,         4000  Urban             0.9694      29540  Urban             0.9694
                    Pennsylvania.
39450............  Lawrence County,            39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39460............  Lebanon County,           3240  Urban             0.9233      30140  Urban             0.8459
                    Pennsylvania.
39470............  Lehigh County,            0240  Urban             0.9845      10900  Urban             0.9818
                    Pennsylvania.
39480............  Luzerne County,           7560  Urban             0.8524      42540  Urban             0.8540
                    Pennsylvania.
39510............  Lycoming County,          9140  Urban             0.8364      48700  Urban             0.8364
                    Pennsylvania.
39520............  Mc Kean County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39530............  Mercer County,            7610  Urban             0.7793      49660  Urban             0.8603
                    Pennsylvania.
39540............  Mifflin County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39550............  Monroe County,              39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39560............  Montgomery County,        6160  Urban             1.0922      37964  Urban             1.1038
                    Pennsylvania.
39580............  Montour County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39590............  Northampton County,       0240  Urban             0.9845      10900  Urban             0.9818
                    Pennsylvania.
39600............  Northumberland              39  Rural             0.8319      99939  Rural             0.8291
                    County,
                    Pennsylvania.
39610............  Perry County,             3240  Urban             0.9233      25420  Urban             0.9313
                    Pennsylvania.
39620............  Philadelphia              6160  Urban             1.0922      37964  Urban             1.1038
                    County,
                    Pennsylvania.
39630............  Pike County,              5660  Urban             1.1207      35084  Urban             1.1883
                    Pennsylvania.
39640............  Potter County,              39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39650............  Schuylkill County,          39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39670............  Snyder County,              39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.

[[Page 27121]]

 
39680............  Somerset County,          3680  Urban             0.8086      99939  Rural             0.8291
                    Pennsylvania.
39690............  Sullivan County,            39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39700............  Susquehanna County,         39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39710............  Tioga County,               39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39720............  Union County,               39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39730............  Venango County,             39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39740............  Warren County,              39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39750............  Washington County,        6280  Urban             0.8860      38300  Urban             0.8845
                    Pennsylvania.
39760............  Wayne County,               39  Rural             0.8319      99939  Rural             0.8291
                    Pennsylvania.
39770............  Westmoreland              6280  Urban             0.8860      38300  Urban             0.8845
                    County,
                    Pennsylvania.
39790............  Wyoming County,           7560  Urban             0.8524      42540  Urban             0.8540
                    Pennsylvania.
39800............  York County,              9280  Urban             0.9347      49620  Urban             0.9347
                    Pennsylvania.
40010............  Adjuntas County,            40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40020............  Aguada County,            0060  Urban             0.4876      10380  Urban             0.4738
                    Puerto Rico.
40030............  Aguadilla County,         0060  Urban             0.4876      10380  Urban             0.4738
                    Puerto Rico.
40040............  Aguas Buenas              7440  Urban             0.4752      41980  Urban             0.4621
                    County, Puerto
                    Rico.
40050............  Aibonito County,            40  Rural             0.3604      41980  Urban             0.4621
                    Puerto Rico.
40060............  Anasco County,            4840  Urban             0.4243      10380  Urban             0.4738
                    Puerto Rico.
40070............  Arecibo County,           0470  Urban             0.4112      41980  Urban             0.4621
                    Puerto Rico.
40080............  Arroyo County,              40  Rural             0.3604      25020  Urban             0.3181
                    Puerto Rico.
40090............  Barceloneta County,       7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40100............  Barranquitas                40  Rural             0.3604      41980  Urban             0.4621
                    County, Puerto
                    Rico.
40110............  Bayamon County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40120............  Cabo Rojo County,         4840  Urban             0.4243      41900  Urban             0.4650
                    Puerto Rico.
40130............  Caguas County,            1310  Urban             0.4120      41980  Urban             0.4621
                    Puerto Rico.
40140............  Camuy County,             0470  Urban             0.4112      41980  Urban             0.4621
                    Puerto Rico.
40145............  Canovanas County,         7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40150............  Carolina County,          7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40160............  Catano County,            7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40170............  Cayey County,             1310  Urban             0.4120      41980  Urban             0.4621
                    Puerto Rico.
40180............  Ceiba County,             7440  Urban             0.4752      21940  Urban             0.4153
                    Puerto Rico.
40190............  Ciales County,              40  Rural             0.3604      41980  Urban             0.4621
                    Puerto Rico.
40200............  Cidra County,             1310  Urban             0.4120      41980  Urban             0.4621
                    Puerto Rico.
40210............  Coamo County,               40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40220............  Comerio County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40230............  Corozal County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40240............  Culebra County,             40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40250............  Dorado County,            7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40260............  Fajardo County,           7440  Urban             0.4752      21940  Urban             0.4153
                    Puerto Rico.
40265............  Florida County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40270............  Guanica County,             40  Rural             0.3604      49500  Urban             0.4408
                    Puerto Rico.
40280............  Guayama County,             40  Rural             0.3604      25020  Urban             0.3181
                    Puerto Rico.
40290............  Guayanilla County,        6360  Urban             0.4881      49500  Urban             0.4408
                    Puerto Rico.
40300............  Guaynabo County,          7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40310............  Gurabo County,            1310  Urban             0.4120      41980  Urban             0.4621
                    Puerto Rico.
40320............  Hatillo County,           0470  Urban             0.4112      41980  Urban             0.4621
                    Puerto Rico.
40330............  Hormigueros County,       4840  Urban             0.4243      32420  Urban             0.4020
                    Puerto Rico.
40340............  Humacao County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40350............  Isabela County,             40  Rural             0.3604      10380  Urban             0.4738
                    Puerto Rico.
40360............  Jayuya County,              40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40370............  Juana Diaz County,        6360  Urban             0.4881      38660  Urban             0.4939
                    Puerto Rico.
40380............  Juncos County,            7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40390............  Lajas County,               40  Rural             0.3604      41900  Urban             0.4650
                    Puerto Rico.
40400............  Lares County,               40  Rural             0.3604      10380  Urban             0.4738
                    Puerto Rico.
40410............  Las Marias County,          40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40420............  Las Piedras County,       7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40430............  Loiza County,             7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40440............  Luquillo County,          7440  Urban             0.4752      21940  Urban             0.4153
                    Puerto Rico.
40450............  Manati County,            7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40460............  Maricao County,             40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40470............  Maunabo County,             40  Rural             0.3604      41980  Urban             0.4621
                    Puerto Rico.
40480............  Mayaguez County,          4840  Urban             0.4243      32420  Urban             0.4020
                    Puerto Rico.
40490............  Moca County, Puerto       0060  Urban             0.4876      10380  Urban             0.4738
                    Rico.
40500............  Morovis County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40510............  Naguabo County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40520............  Naranjito County,         7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40530............  Orocovis County,            40  Rural             0.3604      41980  Urban             0.4621
                    Puerto Rico.
40540............  Patillas County,            40  Rural             0.3604      25020  Urban             0.3181
                    Puerto Rico.
40550............  Penuelas County,          6360  Urban             0.4881      49500  Urban             0.4408
                    Puerto Rico.
40560............  Ponce County,             6360  Urban             0.4881      38660  Urban             0.4939
                    Puerto Rico.
40570............  Quebradillas                40  Rural             0.3604      41980  Urban             0.4621
                    County, Puerto
                    Rico.
40580............  Rincon County,              40  Rural             0.3604      10380  Urban             0.4738
                    Puerto Rico.

[[Page 27122]]

 
40590............  Rio Grande County,        7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40610............  Sabana Grande             4840  Urban             0.4243      41900  Urban             0.4650
                    County, Puerto
                    Rico.
40620............  Salinas County,             40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40630............  San German County,        4840  Urban             0.4243      41900  Urban             0.4650
                    Puerto Rico.
40640............  San Juan County,          7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40650............  San Lorenzo County,       1310  Urban             0.4120      41980  Urban             0.4621
                    Puerto Rico.
40660............  San Sebastian               40  Rural             0.3604      10380  Urban             0.4738
                    County, Puerto
                    Rico.
40670............  Santa Isabel                40  Rural             0.3604      99940  Rural             0.4047
                    County, Puerto
                    Rico.
40680............  Toa Alta County,          7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40690............  Toa Baja County,          7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40700............  Trujillo Alto             7440  Urban             0.4752      41980  Urban             0.4621
                    County, Puerto
                    Rico.
40710............  Utuado County,              40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40720............  Vega Alta County,         7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40730............  Vega Baja County,         7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40740............  Vieques County,             40  Rural             0.3604      99940  Rural             0.4047
                    Puerto Rico.
40750............  Villalba County,          6360  Urban             0.4881      38660  Urban             0.4939
                    Puerto Rico.
40760............  Yabucoa County,           7440  Urban             0.4752      41980  Urban             0.4621
                    Puerto Rico.
40770............  Yauco County,             6360  Urban             0.4881      49500  Urban             0.4408
                    Puerto Rico.
41000............  Bristol County,           6483  Urban             1.1058      39300  Urban             1.0966
                    Rhode Island.
41010............  Kent County, Rhode        6483  Urban             1.1058      39300  Urban             1.0966
                    Island.
41020............  Newport County,           6483  Urban             1.1058      39300  Urban             1.0966
                    Rhode Island.
41030............  Providence County,        6483  Urban             1.1058      39300  Urban             1.0966
                    Rhode Island.
41050............  Washington County,        6483  Urban             1.1058      39300  Urban             1.0966
                    Rhode Island.
42000............  Abbeville County, S         42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42010............  Aiken County, S           0600  Urban             0.9808      12260  Urban             0.9748
                    Carolina.
42020............  Allendale County, S         42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42030............  Anderson County, S        3160  Urban             0.9615      11340  Urban             0.8997
                    Carolina.
42040............  Bamberg County, S           42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42050............  Barnwell County, S          42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42060............  Beaufort County, S          42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42070............  Berkeley County, S        1440  Urban             0.9245      16700  Urban             0.9245
                    Carolina.
42080............  Calhoun County, S           42  Rural             0.8631      17900  Urban             0.9057
                    Carolina.
42090............  Charleston County,        1440  Urban             0.9245      16700  Urban             0.9245
                    S Carolina.
42100............  Cherokee County, S        3160  Urban             0.9615      99942  Rural             0.8638
                    Carolina.
42110............  Chester County, S           42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42120............  Chesterfield                42  Rural             0.8631      99942  Rural             0.8638
                    County, S Carolina.
42130............  Clarendon County, S         42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42140............  Colleton County, S          42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42150............  Darlington County,          42  Rural             0.8631      22500  Urban             0.8947
                    S Carolina.
42160............  Dillon County, S            42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42170............  Dorchester County,        1440  Urban             0.9245      16700  Urban             0.9245
                    S Carolina.
42180............  Edgefield County, S       0600  Urban             0.9808      12260  Urban             0.9748
                    Carolina.
42190............  Fairfield County, S         42  Rural             0.8631      17900  Urban             0.9057
                    Carolina.
42200............  Florence County, S        2655  Urban             0.9042      22500  Urban             0.8947
                    Carolina.
42210............  Georgetown County,          42  Rural             0.8631      99942  Rural             0.8638
                    S Carolina.
42220............  Greenville County,        3160  Urban             0.9615      24860  Urban             1.0027
                    S Carolina.
42230............  Greenwood County, S         42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42240............  Hampton County, S           42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42250............  Horry County, S           5330  Urban             0.8934      34820  Urban             0.8934
                    Carolina.
42260............  Jasper County, S            42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42270............  Kershaw County, S           42  Rural             0.8631      17900  Urban             0.9057
                    Carolina.
42280............  Lancaster County, S         42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42290............  Laurens County, S           42  Rural             0.8631      24860  Urban             1.0027
                    Carolina.
42300............  Lee County, S               42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42310............  Lexington County, S       1760  Urban             0.9082      17900  Urban             0.9057
                    Carolina.
42320............  Mc Cormick County,          42  Rural             0.8631      99942  Rural             0.8638
                    S Carolina.
42330............  Marion County, S            42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42340............  Marlboro County, S          42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42350............  Newberry County, S          42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42360............  Oconee County, S            42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42370............  Orangeburg County,          42  Rural             0.8631      99942  Rural             0.8638
                    S Carolina.
42380............  Pickens County, S         3160  Urban             0.9615      24860  Urban             1.0027
                    Carolina.
42390............  Richland County, S        1760  Urban             0.9082      17900  Urban             0.9057
                    Carolina.
42400............  Saluda County, S            42  Rural             0.8631      17900  Urban             0.9057
                    Carolina.
42410............  Spartanburg County,       3160  Urban             0.9615      43900  Urban             0.9172
                    S Carolina.
42420............  Sumter County, S          8140  Urban             0.8377      44940  Urban             0.8377
                    Carolina.
42430............  Union County, S             42  Rural             0.8631      99942  Rural             0.8638
                    Carolina.
42440............  Williamsburg                42  Rural             0.8631      99942  Rural             0.8638
                    County, S Carolina.
42450............  York County, S            1520  Urban             0.9715      16740  Urban             0.9750
                    Carolina.
43010............  Aurora County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43020............  Beadle County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43030............  Bennett County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.

[[Page 27123]]

 
43040............  Bon Homme County, S         43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43050............  Brookings County, S         43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43060............  Brown County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43070............  Brule County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43080............  Buffalo County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43090............  Butte County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43100............  Campbell County, S          43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43110............  Charles Mix County,         43  Rural             0.8551      99943  Rural             0.8560
                    S Dakota.
43120............  Clark County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43130............  Clay County, S              43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43140............  Codington County, S         43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43150............  Corson County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43160............  Custer County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43170............  Davison County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43180............  Day County, S               43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43190............  Deuel County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43200............  Dewey County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43210............  Douglas County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43220............  Edmunds County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43230............  Fall River County,          43  Rural             0.8551      99943  Rural             0.8560
                    S Dakota.
43240............  Faulk County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43250............  Grant County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43260............  Gregory County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43270............  Haakon County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43280............  Hamlin County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43290............  Hand County, S              43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43300............  Hanson County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43310............  Harding County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43320............  Hughes County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43330............  Hutchinson County,          43  Rural             0.8551      99943  Rural             0.8560
                    S Dakota.
43340............  Hyde County, S              43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43350............  Jackson County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43360............  Jerauld County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43370............  Jones County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43380............  Kingsbury County, S         43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43390............  Lake County, S              43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43400............  Lawrence County, S          43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43410............  Lincoln County, S         7760  Urban             0.9635      43620  Urban             0.9635
                    Dakota.
43420............  Lyman County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43430............  Mc Cook County, S           43  Rural             0.8551      43620  Urban             0.9635
                    Dakota.
43440............  Mc Pherson County,          43  Rural             0.8551      99943  Rural             0.8560
                    S Dakota.
43450............  Marshall County, S          43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43460............  Meade County, S             43  Rural             0.8551      39660  Urban             0.8987
                    Dakota.
43470............  Mellette County, S          43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43480............  Miner County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43490............  Minnehaha County, S       7760  Urban             0.9635      43620  Urban             0.9635
                    Dakota.
43500............  Moody County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43510............  Pennington County,        6660  Urban             0.8987      39660  Urban             0.8987
                    S Dakota.
43520............  Perkins County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43530............  Potter County, S            43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43540............  Roberts County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43550............  Sanborn County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43560............  Shannon County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43570............  Spink County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43580............  Stanley County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43590............  Sully County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43600............  Todd County, S              43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43610............  Tripp County, S             43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43620............  Turner County, S            43  Rural             0.8551      43620  Urban             0.9635
                    Dakota.
43630............  Union County, S             43  Rural             0.8551      43580  Urban             0.9381
                    Dakota.
43640............  Walworth County, S          43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43650............  Washabaugh County,          43  Rural             0.8551      99943  Rural             0.8560
                    S Dakota.
43670............  Yankton County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
43680............  Ziebach County, S           43  Rural             0.8551      99943  Rural             0.8560
                    Dakota.
44000............  Anderson County,          3840  Urban             0.8397      28940  Urban             0.8441
                    Tennessee.
44010............  Bedford County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44020............  Benton County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44030............  Bledsoe County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44040............  Blount County,            3840  Urban             0.8397      28940  Urban             0.8441
                    Tennessee.
44050............  Bradley County,             44  Rural             0.7935      17420  Urban             0.8139
                    Tennessee.
44060............  Campbell County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44070............  Cannon County,              44  Rural             0.7935      34980  Urban             0.9790
                    Tennessee.

[[Page 27124]]

 
44080............  Carroll County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44090............  Carter County,            3660  Urban             0.8007      27740  Urban             0.7937
                    Tennessee.
44100............  Cheatham County,          5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
44110............  Chester County,           3580  Urban             0.8964      27180  Urban             0.8964
                    Tennessee.
44120............  Claiborne County,           44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44130............  Clay County,                44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44140............  Cocke County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44150............  Coffee County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44160............  Crockett County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44170............  Cumberland County,          44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44180............  Davidson County,          5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
44190............  Decatur County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44200............  De Kalb County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44210............  Dickson County,           5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
44220............  Dyer County,                44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44230............  Fayette County,           4920  Urban             0.9416      32820  Urban             0.9397
                    Tennessee.
44240............  Fentress County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44250............  Franklin County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44260............  Gibson County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44270............  Giles County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44280............  Grainger County,            44  Rural             0.7935      34100  Urban             0.7961
                    Tennessee.
44290............  Greene County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44300............  Grundy County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44310............  Hamblen County,             44  Rural             0.7935      34100  Urban             0.7961
                    Tennessee.
44320............  Hamilton County,          1560  Urban             0.9088      16860  Urban             0.9088
                    Tennessee.
44330............  Hancock County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44340............  Hardeman County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44350............  Hardin County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44360............  Hawkins County,           3660  Urban             0.8007      28700  Urban             0.8054
                    Tennessee.
44370............  Haywood County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44380............  Henderson County,           44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44390............  Henry County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44400............  Hickman County,             44  Rural             0.7935      34980  Urban             0.9790
                    Tennessee.
44410............  Houston County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44420............  Humphreys County,           44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44430............  Jackson County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44440............  Jefferson County,           44  Rural             0.7935      34100  Urban             0.7961
                    Tennessee.
44450............  Johnson County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44460............  Knox County,              3840  Urban             0.8397      28940  Urban             0.8441
                    Tennessee.
44470............  Lake County,                44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44480............  Lauderdale County,          44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44490............  Lawrence County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44500............  Lewis County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44510............  Lincoln County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44520............  Loudon County,            3840  Urban             0.8397      28940  Urban             0.8441
                    Tennessee.
44530............  Mc Minn County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44540............  Mc Nairy County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44550............  Macon County,               44  Rural             0.7935      34980  Urban             0.9790
                    Tennessee.
44560............  Madison County,           3580  Urban             0.8964      27180  Urban             0.8964
                    Tennessee.
44570............  Marion County,            1560  Urban             0.9088      16860  Urban             0.9088
                    Tennessee.
44580............  Marshall County,            44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44590............  Maury County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44600............  Meigs County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44610............  Monroe County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44620............  Montgomery County,        1660  Urban             0.8284      17300  Urban             0.8284
                    Tennessee.
44630............  Moore County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44640............  Morgan County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44650............  Obion County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44660............  Overton County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44670............  Perry County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44680............  Pickett County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44690............  Polk County,                44  Rural             0.7935      17420  Urban             0.8139
                    Tennessee.
44700............  Putnam County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44710............  Rhea County,                44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44720............  Roane County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44730............  Robertson County,         5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
44740............  Rutherford County,        5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
44750............  Scott County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44760............  Sequatchie County,          44  Rural             0.7935      16860  Urban             0.9088
                    Tennessee.
44770............  Sevier County,            3840  Urban             0.8397      99944  Rural             0.7895
                    Tennessee.
44780............  Shelby County,            4920  Urban             0.9416      32820  Urban             0.9397
                    Tennessee.
44790............  Smith County,               44  Rural             0.7935      34980  Urban             0.9790
                    Tennessee.

[[Page 27125]]

 
44800............  Stewart County,             44  Rural             0.7935      17300  Urban             0.8284
                    Tennessee.
44810............  Sullivan County,          3660  Urban             0.8007      28700  Urban             0.8054
                    Tennessee.
44820............  Sumner County,            5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
44830............  Tipton County,            4920  Urban             0.9416      32820  Urban             0.9397
                    Tennessee.
44840............  Trousdale County,           44  Rural             0.7935      34980  Urban             0.9790
                    Tennessee.
44850............  Unicoi County,            3660  Urban             0.8007      27740  Urban             0.7937
                    Tennessee.
44860............  Union County,             3840  Urban             0.8397      28940  Urban             0.8441
                    Tennessee.
44870............  Van Buren County,           44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44880............  Warren County,              44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44890............  Washington County,        3660  Urban             0.8007      27740  Urban             0.7937
                    Tennessee.
44900............  Wayne County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44910............  Weakley County,             44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44920............  White County,               44  Rural             0.7935      99944  Rural             0.7895
                    Tennessee.
44930............  Williamson County,        5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
44940............  Wilson County,            5360  Urban             0.9808      34980  Urban             0.9790
                    Tennessee.
45000............  Anderson County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45010............  Andrews County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45020............  Angelina County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45030............  Aransas County,             45  Rural             0.7931      18580  Urban             0.8550
                    Texas.
45040............  Archer County,            9080  Urban             0.8365      48660  Urban             0.8285
                    Texas.
45050............  Armstrong County,           45  Rural             0.7931      11100  Urban             0.9156
                    Texas.
45060............  Atascosa County,            45  Rural             0.7931      41700  Urban             0.8980
                    Texas.
45070............  Austin County,              45  Rural             0.7931      26420  Urban             0.9996
                    Texas.
45080............  Bailey County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45090............  Bandera County,             45  Rural             0.7931      41700  Urban             0.8980
                    Texas.
45100............  Bastrop County,           0640  Urban             0.9437      12420  Urban             0.9437
                    Texas.
45110............  Baylor County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45113............  Bee County, Texas..         45  Rural             0.7931      99945  Rural             0.8003
45120............  Bell County, Texas.       3810  Urban             0.8526      28660  Urban             0.8526
45130............  Bexar County, Texas       7240  Urban             0.8984      41700  Urban             0.8980
45140............  Blanco County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45150............  Borden County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45160............  Bosque County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45170............  Bowie County, Texas       8360  Urban             0.8283      45500  Urban             0.8283
45180............  Brazoria County,          1145  Urban             0.8563      26420  Urban             0.9996
                    Texas.
45190............  Brazos County,            1260  Urban             0.8900      17780  Urban             0.8900
                    Texas.
45200............  Brewster County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45201............  qBriscoe County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45210............  Brooks County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45220............  Brown County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45221............  Burleson County,            45  Rural             0.7931      17780  Urban             0.8900
                    Texas.
45222............  Burnet County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45223............  Caldwell County,          0640  Urban             0.9437      12420  Urban             0.9437
                    Texas.
45224............  Calhoun County,             45  Rural             0.7931      47020  Urban             0.8160
                    Texas.
45230............  Callahan County,            45  Rural             0.7931      10180  Urban             0.7896
                    Texas.
45240............  Cameron County,           1240  Urban             0.9804      15180  Urban             0.9804
                    Texas.
45250............  Camp County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45251............  Carson County,              45  Rural             0.7931      11100  Urban             0.9156
                    Texas.
45260............  Cass County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45270............  Castro County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45280............  Chambers County,          3360  Urban             1.0091      26420  Urban             0.9996
                    Texas.
45281............  Cherokee County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45290............  Childress County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45291............  Clay County, Texas.         45  Rural             0.7931      48660  Urban             0.8285
45292............  Cochran County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45300............  Coke County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45301............  Coleman County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45310............  Collin County,            1920  Urban             1.0205      19124  Urban             1.0228
                    Texas.
45311............  Collingsworth               45  Rural             0.7931      99945  Rural             0.8003
                    County, Texas.
45312............  Colorado County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45320............  Comal County, Texas       7240  Urban             0.8984      41700  Urban             0.8980
45321............  Comanche County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45330............  Concho County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45340............  Cooke County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45341............  Coryell County,           3810  Urban             0.8526      28660  Urban             0.8526
                    Texas.
45350............  Cottle County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45360............  Crane County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45361............  Crockett County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45362............  Crosby County,              45  Rural             0.7931      31180  Urban             0.8783
                    Texas.
45370............  Culberson County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45380............  Dallam County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45390............  Dallas County,            1920  Urban             1.0205      19124  Urban             1.0228
                    Texas.

[[Page 27126]]

 
45391............  Dawson County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45392............  Deaf Smith County,          45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45400............  Delta County, Texas         45  Rural             0.7931      19124  Urban             1.0228
45410............  Denton County,            1920  Urban             1.0205      19124  Urban             1.0228
                    Texas.
45420............  De Witt County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45421............  Dickens County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45430............  Dimmit County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45431............  Donley County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45440............  Duval County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45450............  Eastland County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45451............  Ector County, Texas       5800  Urban             0.9741      36220  Urban             0.9884
45460............  Edwards County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45470............  Ellis County, Texas       1920  Urban             1.0205      19124  Urban             1.0228
45480............  El Paso County,           2320  Urban             0.8977      21340  Urban             0.8977
                    Texas.
45490............  Erath County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45500............  Falls County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45510............  Fannin County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45511............  Fayette County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45520............  Fisher County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45521............  Floyd County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45522............  Foard County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45530............  Fort Bend County,         3360  Urban             1.0091      26420  Urban             0.9996
                    Texas.
45531............  Franklin County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45540............  Freestone County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45541............  Frio County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45542............  Gaines County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45550............  Galveston County,         2920  Urban             0.9635      26420  Urban             0.9996
                    Texas.
45551............  Garza County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45552............  Gillespie County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45560............  Glasscock County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45561............  Goliad County,              45  Rural             0.7931      47020  Urban             0.8160
                    Texas.
45562............  Gonzales County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45563............  Gray County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45564............  Grayson County,           7640  Urban             0.9507      43300  Urban             0.9507
                    Texas.
45570............  Gregg County, Texas       4420  Urban             0.8888      30980  Urban             0.8730
45580............  Grimes County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45581............  Guadaloupe County,        7240  Urban             0.8984      41700  Urban             0.8980
                    Texas.
45582............  Hale County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45583............  Hall County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45590............  Hamilton County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45591............  Hansford County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45592............  Hardeman County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45600............  Hardin County,            0840  Urban             0.8412      13140  Urban             0.8412
                    Texas.
45610............  Harris County,            3360  Urban             1.0091      26420  Urban             0.9996
                    Texas.
45620............  Harrison County,          4420  Urban             0.8888      99945  Rural             0.8003
                    Texas.
45621............  Hartley County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45630............  Haskell County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45631............  Hays County, Texas.       0640  Urban             0.9437      12420  Urban             0.9437
45632............  Hemphill County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45640............  Henderson County,         1920  Urban             1.0205      99945  Rural             0.8003
                    Texas.
45650............  Hidalgo County,           4880  Urban             0.8934      32580  Urban             0.8934
                    Texas.
45651............  Hill County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45652............  Hockley County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45653............  Hood County, Texas.       2800  Urban             0.9522      99945  Rural             0.8003
45654............  Hopkins County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45660............  Houston County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45661............  Howard County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45662............  Hudspeth County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45670............  Hunt County, Texas.       1920  Urban             1.0205      19124  Urban             1.0228
45671............  Hutchinson County,          45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45672............  Irion County, Texas         45  Rural             0.7931      41660  Urban             0.8271
45680............  Jack County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45681............  Jackson County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45690............  Jasper County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45691............  Jeff Davis County,          45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45700............  Jefferson County,         0840  Urban             0.8412      13140  Urban             0.8412
                    Texas.
45710............  Jim Hogg County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45711............  Jim Wells County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45720............  Johnson County,           2800  Urban             0.9522      23104  Urban             0.9486
                    Texas.
45721............  Jones County, Texas         45  Rural             0.7931      10180  Urban             0.7896
45722............  Karnes County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45730............  Kaufman County,           1920  Urban             1.0205      19124  Urban             1.0228
                    Texas.

[[Page 27127]]

 
45731............  Kendall County,             45  Rural             0.7931      41700  Urban             0.8980
                    Texas.
45732............  Kenedy County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45733............  Kent County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45734............  Kerr County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45740............  Kimble County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45741............  King County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45742............  Kinney County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45743............  Kleberg County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45744............  Knox County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45750............  Lamar County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45751............  Lamb County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45752............  Lampasas County,            45  Rural             0.7931      28660  Urban             0.8526
                    Texas.
45753............  La Salle County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45754............  Lavaca County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45755............  Lee County, Texas..         45  Rural             0.7931      99945  Rural             0.8003
45756............  Leon County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45757............  Liberty County,           3360  Urban             1.0091      26420  Urban             0.9996
                    Texas.
45758............  Limestone County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45759............  Lipscomb County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45760............  Live Oak County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45761............  Llano County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45762............  Loving County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45770............  Lubbock County,           4600  Urban             0.8783      31180  Urban             0.8783
                    Texas.
45771............  Lynn County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45772............  Mc Culloch County,          45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45780............  Mc Lennan County,         8800  Urban             0.8518      47380  Urban             0.8518
                    Texas.
45781............  Mc Mullen County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45782............  Madison County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45783............  Marion County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45784............  Martin County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45785............  Mason County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45790............  Matagorda County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45791............  Maverick County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45792............  Medina County,              45  Rural             0.7931      41700  Urban             0.8980
                    Texas.
45793............  Menard County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45794............  Midland County,           5800  Urban             0.9741      33260  Urban             0.9514
                    Texas.
45795............  Milam County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45796............  Mills County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45797............  Mitchell County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45800............  Montague County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45801............  Montgomery County,        3360  Urban             1.0091      26420  Urban             0.9996
                    Texas.
45802............  Moore County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45803............  Morris County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45804............  Motley County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45810............  Nacogdoches County,         45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45820............  Navarro County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45821............  Newton County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45822............  Nolan County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45830............  Nueces County,            1880  Urban             0.8550      18580  Urban             0.8550
                    Texas.
45831............  Ochiltree County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45832............  Oldham County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45840............  Orange County,            0840  Urban             0.8412      13140  Urban             0.8412
                    Texas.
45841............  Palo Pinto County,          45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45842............  Panola County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45843............  Parker County,            2800  Urban             0.9522      23104  Urban             0.9486
                    Texas.
45844............  Parmer County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45845............  Pecos County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45850............  Polk County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45860............  Potter County,            0320  Urban             0.9156      11100  Urban             0.9156
                    Texas.
45861............  Presidio County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45870............  Rains County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45871............  Randall County,           0320  Urban             0.9156      11100  Urban             0.9156
                    Texas.
45872............  Reagan County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45873............  Real County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45874............  Red River County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45875............  Reeves County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45876............  Refugio County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45877............  Roberts County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45878............  Robertson County,           45  Rural             0.7931      17780  Urban             0.8900
                    Texas.
45879............  Rockwall County,          1920  Urban             1.0205      19124  Urban             1.0228
                    Texas.
45880............  Runnels County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45881............  Rusk County, Texas.         45  Rural             0.7931      30980  Urban             0.8730

[[Page 27128]]

 
45882............  Sabine County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45883............  San Augustine               45  Rural             0.7931      99945  Rural             0.8003
                    County, Texas.
45884............  San Jacinto County,         45  Rural             0.7931      26420  Urban             0.9996
                    Texas.
45885............  San Patricio              1880  Urban             0.8550      18580  Urban             0.8550
                    County, Texas.
45886............  San Saba County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45887............  Schleicher County,          45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45888............  Scurry County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45889............  Shackelford County,         45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45890............  Shelby County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45891............  Sherman County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45892............  Smith County, Texas       8640  Urban             0.9168      46340  Urban             0.9168
45893............  Somervell County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45900............  Starr County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45901............  Stephens County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45902............  Sterling County,            45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45903............  Stonewall County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45904............  Sutton County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45905............  Swisher County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45910............  Tarrant County,           2800  Urban             0.9522      23104  Urban             0.9486
                    Texas.
45911............  Taylor County,            0040  Urban             0.8054      10180  Urban             0.7896
                    Texas.
45912............  Terrell County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45913............  Terry County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45920............  Throckmorton                45  Rural             0.7931      99945  Rural             0.8003
                    County, Texas.
45921............  Titus County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45930............  Tom Green County,         7200  Urban             0.8271      41660  Urban             0.8271
                    Texas.
45940............  Travis County,            0640  Urban             0.9437      12420  Urban             0.9437
                    Texas.
45941............  Trinity County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45942............  Tyler County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45943............  Upshur County,            4420  Urban             0.8888      30980  Urban             0.8730
                    Texas.
45944............  Upton County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45945............  Uvalde County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45946............  Val Verde County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45947............  Van Zandt County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45948............  Victoria County,          8750  Urban             0.8160      47020  Urban             0.8160
                    Texas.
45949............  Walker County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45950............  Waller County,            3360  Urban             1.0091      26420  Urban             0.9996
                    Texas.
45951............  Ward County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45952............  Washington County,          45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45953............  Webb County, Texas.       4080  Urban             0.8068      29700  Urban             0.8068
45954............  Wharton County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45955............  Wheeler County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45960............  Wichita County,           9080  Urban             0.8365      48660  Urban             0.8285
                    Texas.
45961............  Wilbarger County,           45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45962............  Willacy County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45970............  Williamson County,        0640  Urban             0.9437      12420  Urban             0.9437
                    Texas.
45971............  Wilson County,            7240  Urban             0.8984      41700  Urban             0.8980
                    Texas.
45972............  Winkler County,             45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45973............  Wise County, Texas.         45  Rural             0.7931      23104  Urban             0.9486
45974............  Wood County, Texas.         45  Rural             0.7931      99945  Rural             0.8003
45980............  Yoakum County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45981............  Young County, Texas         45  Rural             0.7931      99945  Rural             0.8003
45982............  Zapata County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
45983............  Zavala County,              45  Rural             0.7931      99945  Rural             0.8003
                    Texas.
46000............  Beaver County, Utah         46  Rural             0.8762      99946  Rural             0.8118
46010............  Box Elder County,           46  Rural             0.8762      99946  Rural             0.8118
                    Utah.
46020............  Cache County, Utah.         46  Rural             0.8762      30860  Urban             0.9164
46030............  Carbon County, Utah         46  Rural             0.8762      99946  Rural             0.8118
46040............  Daggett County,             46  Rural             0.8762      99946  Rural             0.8118
                    Utah.
46050............  Davis County, Utah.       7160  Urban             0.9340      36260  Urban             0.9029
46060............  Duchesne County,            46  Rural             0.8762      99946  Rural             0.8118
                    Utah.
46070............  Emery County, Utah.         46  Rural             0.8762      99946  Rural             0.8118
46080............  Garfield County,            46  Rural             0.8762      99946  Rural             0.8118
                    Utah.
46090............  Grand County, Utah.         46  Rural             0.8762      99946  Rural             0.8118
46100............  Iron County, Utah..         46  Rural             0.8762      99946  Rural             0.8118
46110............  Juab County, Utah..         46  Rural             0.8762      39340  Urban             0.9500
46120............  Kane County, Utah..       2620  Urban             1.1845      99946  Rural             0.8118
46130............  Millard County,             46  Rural             0.8762      99946  Rural             0.8118
                    Utah.
46140............  Morgan County, Utah         46  Rural             0.8762      36260  Urban             0.9029
46150............  Piute County, Utah.         46  Rural             0.8762      99946  Rural             0.8118
46160............  Rich County, Utah..         46  Rural             0.8762      99946  Rural             0.8118
46170............  Salt Lake County,         7160  Urban             0.9340      41620  Urban             0.9421
                    Utah.
46180............  San Juan County,            46  Rural             0.8762      99946  Rural             0.8118
                    Utah.

[[Page 27129]]

 
46190............  Sanpete County,             46  Rural             0.8762      99946  Rural             0.8118
                    Utah.
46200............  Sevier County, Utah         46  Rural             0.8762      99946  Rural             0.8118
46210............  Summit County, Utah         46  Rural             0.8762      41620  Urban             0.9421
46220............  Tooele County, Utah         46  Rural             0.8762      41620  Urban             0.9421
46230............  Uintah County, Utah         46  Rural             0.8762      99946  Rural             0.8118
46240............  Utah County, Utah..       6520  Urban             0.9500      39340  Urban             0.9500
46250............  Wasatch County,             46  Rural             0.8762      99946  Rural             0.8118
                    Utah.
46260............  Washington County,          46  Rural             0.8762      41100  Urban             0.9392
                    Utah.
46270............  Wayne County, Utah.         46  Rural             0.8762      99946  Rural             0.8118
46280............  Weber County, Utah.       7160  Urban             0.9340      36260  Urban             0.9029
47000............  Addison County,             47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47010............  Bennington County,          47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47020............  Caledonia County,           47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47030............  Chittenden County,        1303  Urban             0.9410      15540  Urban             0.9410
                    Vermont.
47040............  Essex County,               47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47050............  Franklin County,          1303  Urban             0.9410      15540  Urban             0.9410
                    Vermont.
47060............  Grand Isle County,        1303  Urban             0.9410      15540  Urban             0.9410
                    Vermont.
47070............  Lamoille County,            47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47080............  Orange County,              47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47090............  Orleans County,             47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47100............  Rutland County,             47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47110............  Washington County,          47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47120............  Windham County,             47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
47130............  Windsor County,             47  Rural             0.9830      99947  Rural             0.9830
                    Vermont.
48010............  St Croix County,            48  Rural             0.7615      99948  Rural             0.7615
                    Virgin Islands.
48020............  St Thomas-John              48  Rural             0.7615      99948  Rural             0.7615
                    County, Virgin
                    Islands.
49000............  Accomack County,            49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49010............  Albemarle County,         1540  Urban             1.0187      16820  Urban             1.0187
                    Virginia.
49011............  Alexandria City           8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49020............  Alleghany County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49030............  Amelia County,              49  Rural             0.8417      40060  Urban             0.9328
                    Virginia.
49040............  Amherst County,           4640  Urban             0.8691      31340  Urban             0.8691
                    Virginia.
49050............  Appomattox County,          49  Rural             0.8417      31340  Urban             0.8691
                    Virginia.
49060............  Arlington County,         8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
49070............  Augusta County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49080............  Bath County,                49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49088............  Bedford City              4640  Urban             0.8691      31340  Urban             0.8691
                    County, Virginia.
49090............  Bedford County,           4640  Urban             0.8691      31340  Urban             0.8691
                    Virginia.
49100............  Bland County,               49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49110............  Botetourt County,         6800  Urban             0.8387      40220  Urban             0.8374
                    Virginia.
49111............  Bristol City              3660  Urban             0.8007      28700  Urban             0.8054
                    County, Virginia.
49120............  Brunswick County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49130............  Buchanan County,            49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49140............  Buckingham County,          49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49141............  Buena Vista City            49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49150............  Campbell County,          4640  Urban             0.8691      31340  Urban             0.8691
                    Virginia.
49160............  Caroline County,            49  Rural             0.8417      40060  Urban             0.9328
                    Virginia.
49170............  Carroll County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49180............  Charles City              6760  Urban             0.9328      40060  Urban             0.9328
                    County, Virginia.
49190............  Charlotte County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49191............  Charlottesville           1540  Urban             1.0187      16820  Urban             1.0187
                    City County,
                    Virginia.
49194............  Chesapeake County,        5720  Urban             0.8799      47260  Urban             0.8799
                    Virginia.
49200............  Chesterfield              6760  Urban             0.9328      40060  Urban             0.9328
                    County, Virginia.
49210............  Clarke County,            8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
49211............  Clifton Forge City          49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49212............  Colonial Heights          6760  Urban             0.9328      40060  Urban             0.9328
                    County, Virginia.
49213............  Covington City              49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49220............  Craig County,               49  Rural             0.8417      40220  Urban             0.8374
                    Virginia.
49230............  Culpeper County,          8840  Urban             1.0976      99949  Rural             0.8013
                    Virginia.
49240............  Cumberland County,          49  Rural             0.8417      40060  Urban             0.9328
                    Virginia.
49241............  Danville City             1950  Urban             0.8489      19260  Urban             0.8489
                    County, Virginia.
49250............  Dickenson County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49260............  Dinniddie County,         6760  Urban             0.9328      40060  Urban             0.9328
                    Virginia.
49270............  Emporia County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49280............  Essex County,               49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49288............  Fairfax City              8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49290............  Fairfax County,           8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
49291............  Falls Church City         8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49300............  Fauquier County,          8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
49310............  Floyd County,               49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49320............  Fluvanna County,          1540  Urban             1.0187      16820  Urban             1.0187
                    Virginia.
49328............  Franklin City               49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.

[[Page 27130]]

 
49330............  Franklin County,            49  Rural             0.8417      40220  Urban             0.8374
                    Virginia.
49340............  Frederick County,           49  Rural             0.8417      49020  Urban             1.0214
                    Virginia.
49342............  Fredericksburg City       8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49343............  Galax City County,          49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49350............  Giles County,               49  Rural             0.8417      13980  Urban             0.7954
                    Virginia.
49360............  Gloucester County,        5720  Urban             0.8799      47260  Urban             0.8799
                    Virginia.
49370............  Goochland County,         6760  Urban             0.9328      40060  Urban             0.9328
                    Virginia.
49380............  Grayson County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49390............  Greene County,            1540  Urban             1.0187      16820  Urban             1.0187
                    Virginia.
49400............  Greensville County,         49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49410............  Halifax County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49411............  Hampton City              5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49420............  Hanover County,           6760  Urban             0.9328      40060  Urban             0.9328
                    Virginia.
49421............  Harrisonburg City           49  Rural             0.8417      25500  Urban             0.9088
                    County, Virginia.
49430............  Henrico County,           6760  Urban             0.9328      40060  Urban             0.9328
                    Virginia.
49440............  Henry County,               49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49450............  Highland County,            49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49451............  Hopewell City             6760  Urban             0.9328      40060  Urban             0.9328
                    County, Virginia.
49460............  Isle Of Wight             5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49470............  James City Co             5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49480............  King And Queen              49  Rural             0.8417      40060  Urban             0.9328
                    County, Virginia.
49490............  King George County,       8840  Urban             1.0976      99949  Rural             0.8013
                    Virginia.
49500............  King William                49  Rural             0.8417      40060  Urban             0.9328
                    County, Virginia.
49510............  Lancaster County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49520............  Lee County,                 49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49522............  Lexington County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49530............  Loudoun County,           8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
49540............  Louisa County,              49  Rural             0.8417      40060  Urban             0.9328
                    Virginia.
49550............  Lunenburg County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49551............  Lynchburg City            4640  Urban             0.8691      31340  Urban             0.8691
                    County, Virginia.
49560............  Madison County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49561............  Martinsville City           49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49563............  Manassas City             8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49565............  Manassas Park City        8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49570............  Mathews County,           5720  Urban             0.8799      47260  Urban             0.8799
                    Virginia.
49580............  Mecklenburg County,         49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49590............  Middlesex County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49600............  Montgomery County,          49  Rural             0.8417      13980  Urban             0.7954
                    Virginia.
49610............  Nansemond County,           49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49620............  Nelson County,              49  Rural             0.8417      16820  Urban             1.0187
                    Virginia.
49621............  New Kent County,          6760  Urban             0.9328      40060  Urban             0.9328
                    Virginia.
49622............  Newport News City         5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49641............  Norfolk City              5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49650............  Northampton County,         49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49660............  Northumberland              49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49661............  Norton City County,         49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49670............  Nottoway County,            49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49680............  Orange County,              49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49690............  Page County,                49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49700............  Patrick County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49701............  Petersburg City           6760  Urban             0.9328      40060  Urban             0.9328
                    County, Virginia.
49710............  Pittsylvania              1950  Urban             0.8489      19260  Urban             0.8489
                    County, Virginia.
49711............  Portsmouth City           5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49712............  Poquoson City             5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49720............  Powhatan County,          6760  Urban             0.9328      40060  Urban             0.9328
                    Virginia.
49730............  Prince Edward               49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49740............  Prince George             6760  Urban             0.9328      40060  Urban             0.9328
                    County, Virginia.
49750............  Prince William            8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49770............  Pulaski County,             49  Rural             0.8417      13980  Urban             0.7954
                    Virginia.
49771............  Radford City                49  Rural             0.8417      13980  Urban             0.7954
                    County, Virginia.
49780............  Rappahannock                49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49790............  Richmond County,            49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49791............  Richmond City             6760  Urban             0.9328      40060  Urban             0.9328
                    County, Virginia.
49800............  Roanoke County,           6800  Urban             0.8387      40220  Urban             0.8374
                    Virginia.
49801............  Roanoke City              6800  Urban             0.8387      40220  Urban             0.8374
                    County, Virginia.
49810............  Rockbridge County,          49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49820............  Rockingham County,          49  Rural             0.8417      25500  Urban             0.9088
                    Virginia.
49830............  Russell County,             49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49838............  Salem County,             6800  Urban             0.8387      40220  Urban             0.8374
                    Virginia.
49840............  Scott County,             3660  Urban             0.8007      28700  Urban             0.8054
                    Virginia.
49850............  Shenandoah County,          49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49860............  Smyth County,               49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.

[[Page 27131]]

 
49867............  South Boston City           49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49870............  Southampton County,         49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49880............  Spotsylvania              8840  Urban             1.0976      47894  Urban             1.0926
                    County, Virginia.
49890............  Stafford County,          8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
49891............  Staunton City               49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49892............  Suffolk City              5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49900............  Surry County,               49  Rural             0.8417      47260  Urban             0.8799
                    Virginia.
49910............  Sussex County,              49  Rural             0.8417      40060  Urban             0.9328
                    Virginia.
49920............  Tazewell County,            49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49921............  Virginia Beach City       5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49930............  Warren County,            8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
49950............  Washington County,        3660  Urban             0.8007      28700  Urban             0.8054
                    Virginia.
49951............  Waynesboro City             49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49960............  Westmoreland                49  Rural             0.8417      99949  Rural             0.8013
                    County, Virginia.
49961............  Williamsburg City         5720  Urban             0.8799      47260  Urban             0.8799
                    County, Virginia.
49962............  Winchester City             49  Rural             0.8417      49020  Urban             1.0214
                    County, Virginia.
49970............  Wise County,                49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49980............  Wythe County,               49  Rural             0.8417      99949  Rural             0.8013
                    Virginia.
49981............  York County,              5720  Urban             0.8799      47260  Urban             0.8799
                    Virginia.
50000............  Adams County,               50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50010............  Asotin County,              50  Rural             1.0217      30300  Urban             0.9886
                    Washington.
50020............  Benton County,            6740  Urban             1.0619      28420  Urban             1.0619
                    Washington.
50030............  Chelan County,              50  Rural             1.0217      48300  Urban             1.0070
                    Washington.
50040............  Clallam County,             50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50050............  Clark County,             6440  Urban             1.1266      38900  Urban             1.1266
                    Washington.
50060............  Columbia County,            50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50070............  Cowlitz County,             50  Rural             1.0217      31020  Urban             0.9579
                    Washington.
50080............  Douglas County,             50  Rural             1.0217      48300  Urban             1.0070
                    Washington.
50090............  Ferry County,               50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50100............  Franklin County,          6740  Urban             1.0619      28420  Urban             1.0619
                    Washington.
50110............  Garfield County,            50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50120............  Grant County,               50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50130............  Grays Harbor                50  Rural             1.0217      99950  Rural             1.0510
                    County, Washington.
50140............  Island County,            7600  Urban             1.1567      99950  Rural             1.0510
                    Washington.
50150............  Jefferson County,           50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50160............  King County,              7600  Urban             1.1567      42644  Urban             1.1577
                    Washington.
50170............  Kitsap County,            1150  Urban             1.0675      14740  Urban             1.0675
                    Washington.
50180............  Kittitas County,            50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50190............  Klickitat County,           50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50200............  Lewis County,               50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50210............  Lincoln County,             50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50220............  Mason County,               50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50230............  Okanogan County,            50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50240............  Pacific County,             50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50250............  Pend Oreille                50  Rural             1.0217      99950  Rural             1.0510
                    County, Washington.
50260............  Pierce County,            8200  Urban             1.0742      45104  Urban             1.0742
                    Washington.
50270............  San Juan County,            50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50280............  Skagit County,              50  Rural             1.0217      34580  Urban             1.0454
                    Washington.
50290............  Skamania County,            50  Rural             1.0217      38900  Urban             1.1266
                    Washington.
50300............  Snohomish County,         7600  Urban             1.1567      42644  Urban             1.1577
                    Washington.
50310............  Spokane County,           7840  Urban             1.0905      44060  Urban             1.0905
                    Washington.
50320............  Stevens County,             50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50330............  Thurston County,          5910  Urban             1.0927      36500  Urban             1.0927
                    Washington.
50340............  Wahkiakum County,           50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50350............  Walla Walla County,         50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50360............  Whatcom County,           0860  Urban             1.1731      13380  Urban             1.1731
                    Washington.
50370............  Whitman County,             50  Rural             1.0217      99950  Rural             1.0510
                    Washington.
50380............  Yakima County,            9260  Urban             1.0155      49420  Urban             1.0155
                    Washington.
51000............  Barbour County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51010............  Berkeley County, W        8840  Urban             1.0976      25180  Urban             0.9489
                    Virginia.
51020............  Boone County, W             51  Rural             0.7900      16620  Urban             0.8445
                    Virginia.
51030............  Braxton County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51040............  Brooke County, W          8080  Urban             0.7819      48260  Urban             0.7819
                    Virginia.
51050............  Cabell County, W          3400  Urban             0.9477      26580  Urban             0.9477
                    Virginia.
51060............  Calhoun County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51070............  Clay County, W              51  Rural             0.7900      16620  Urban             0.8445
                    Virginia.
51080............  Doddridge County, W         51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51090............  Fayette County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51100............  Gilmer County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51110............  Grant County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51120............  Greenbrier County,          51  Rural             0.7900      99951  Rural             0.7717
                    W Virginia.
51130............  Hampshire County, W         51  Rural             0.7900      49020  Urban             1.0214
                    Virginia.

[[Page 27132]]

 
51140............  Hancock County, W         8080  Urban             0.7819      48260  Urban             0.7819
                    Virginia.
51150............  Hardy County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51160............  Harrison County, W          51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51170............  Jackson County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51180............  Jefferson County, W       8840  Urban             1.0976      47894  Urban             1.0926
                    Virginia.
51190............  Kanawha County, W         1480  Urban             0.8445      16620  Urban             0.8445
                    Virginia.
51200............  Lewis County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51210............  Lincoln County, W           51  Rural             0.7900      16620  Urban             0.8445
                    Virginia.
51220............  Logan County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51230............  Mc Dowell County, W         51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51240............  Marion County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51250............  Marshall County, W        9000  Urban             0.7161      48540  Urban             0.7161
                    Virginia.
51260............  Mason County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51270............  Mercer County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51280............  Mineral County, W         1900  Urban             0.9317      19060  Urban             0.9317
                    Virginia.
51290............  Mingo County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51300............  Monongalia County,          51  Rural             0.7900      34060  Urban             0.8420
                    W Virginia.
51310............  Monroe County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51320............  Morgan County, W            51  Rural             0.7900      25180  Urban             0.9489
                    Virginia.
51330............  Nicholas County, W          51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51340............  Ohio County, W            9000  Urban             0.7161      48540  Urban             0.7161
                    Virginia.
51350............  Pendleton County, W         51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51360............  Pleasants County, W         51  Rural             0.7900      37620  Urban             0.8270
                    Virginia.
51370............  Pocahontas County,          51  Rural             0.7900      99951  Rural             0.7717
                    W Virginia.
51380............  Preston County, W           51  Rural             0.7900      34060  Urban             0.8420
                    Virginia.
51390............  Putnam County, W          1480  Urban             0.8445      16620  Urban             0.8445
                    Virginia.
51400............  Raleigh County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51410............  Randolph County, W          51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51420............  Ritchie County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51430............  Roane County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51440............  Summers County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51450............  Taylor County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51460............  Tucker County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51470............  Tyler County, W             51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51480............  Upshur County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51490............  Wayne County, W           3400  Urban             0.9477      26580  Urban             0.9477
                    Virginia.
51500............  Webster County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51510............  Wetzel County, W            51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
51520............  Wirt County, W              51  Rural             0.7900      37620  Urban             0.8270
                    Virginia.
51530............  Wood County, W            6020  Urban             0.8270      37620  Urban             0.8270
                    Virginia.
51540............  Wyoming County, W           51  Rural             0.7900      99951  Rural             0.7717
                    Virginia.
52000............  Adams County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52010............  Ashland County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52020............  Barron County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52030............  Bayfield County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52040............  Brown County,             3080  Urban             0.9483      24580  Urban             0.9483
                    Wisconsin.
52050............  Buffalo County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52060............  Burnett County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52070............  Calumet County,           0460  Urban             0.9239      11540  Urban             0.9288
                    Wisconsin.
52080............  Chippewa County,          2290  Urban             0.9201      20740  Urban             0.9201
                    Wisconsin.
52090............  Clark County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52100............  Columbia County,            52  Rural             0.9478      31540  Urban             1.0659
                    Wisconsin.
52110............  Crawford County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52120............  Dane County,              4720  Urban             1.0754      31540  Urban             1.0659
                    Wisconsin.
52130............  Dodge County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52140............  Door County,                52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52150............  Douglas County,           2240  Urban             1.0213      20260  Urban             1.0213
                    Wisconsin.
52160............  Dunn County,                52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52170............  Eau Claire County,        2290  Urban             0.9201      20740  Urban             0.9201
                    Wisconsin.
52180............  Florence County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52190............  Fond Du Lac County,         52  Rural             0.9478      22540  Urban             0.9640
                    Wisconsin.
52200............  Forest County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52210............  Grant County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52220............  Green County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52230............  Green Lake County,          52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52240............  Iowa County,                52  Rural             0.9478      31540  Urban             1.0659
                    Wisconsin.
52250............  Iron County,                52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52260............  Jackson County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52270............  Jefferson County,           52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52280............  Juneau County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52290............  Kenosha County,           3800  Urban             0.9760      29404  Urban             1.0429
                    Wisconsin.
52300............  Kewaunee County,            52  Rural             0.9478      24580  Urban             0.9483
                    Wisconsin.

[[Page 27133]]

 
52310............  La Crosse County,         3870  Urban             0.9564      29100  Urban             0.9564
                    Wisconsin.
52320............  Lafayette County,           52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52330............  Langlade County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52340............  Lincoln County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52350............  Manitowoc County,           52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52360............  Marathon County,          8940  Urban             0.9590      48140  Urban             0.9590
                    Wisconsin.
52370............  Marinette County,           52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52380............  Marquette County,           52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52381............  Menominee County,           52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52390............  Milwaukee County,         5080  Urban             1.0146      33340  Urban             1.0146
                    Wisconsin.
52400............  Monroe County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52410............  Oconto County,              52  Rural             0.9478      24580  Urban             0.9483
                    Wisconsin.
52420............  Oneida County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52430............  Outagamie County,         0460  Urban             0.9239      11540  Urban             0.9288
                    Wisconsin.
52440............  Ozaukee County,           5080  Urban             1.0146      33340  Urban             1.0146
                    Wisconsin.
52450............  Pepin County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52460............  Pierce County,            5120  Urban             1.1075      33460  Urban             1.1075
                    Wisconsin.
52470............  Polk County,                52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52480............  Portage County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52490............  Price County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52500............  Racine County,            6600  Urban             0.8997      39540  Urban             0.8997
                    Wisconsin.
52510............  Richland County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52520............  Rock County,              3620  Urban             0.9538      27500  Urban             0.9538
                    Wisconsin.
52530............  Rusk County,                52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52540............  St Croix County,          5120  Urban             1.1075      33460  Urban             1.1075
                    Wisconsin.
52550............  Sauk County,                52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52560............  Sawyer County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52570............  Shawano County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52580............  Sheboygan County,         7620  Urban             0.8911      43100  Urban             0.8911
                    Wisconsin.
52590............  Taylor County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52600............  Trempealeau County,         52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52610............  Vernon County,              52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52620............  Vilas County,               52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52630............  Walworth County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52640............  Washburn County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52650............  Washington County,        5080  Urban             1.0146      33340  Urban             1.0146
                    Wisconsin.
52660............  Waukesha County,          5080  Urban             1.0146      33340  Urban             1.0146
                    Wisconsin.
52670............  Waupaca County,             52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52680............  Waushara County,            52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
52690............  Winnebago County,         0460  Urban             0.9239      36780  Urban             0.9183
                    Wisconsin.
52700............  Wood County,                52  Rural             0.9478      99952  Rural             0.9509
                    Wisconsin.
53000............  Albany County,              53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53010............  Big Horn County,            53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53020............  Campbell County,            53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53030............  Carbon County,              53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53040............  Converse County,            53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53050............  Crook County,               53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53060............  Fremont County,             53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53070............  Goshen County,              53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53080............  Hot Springs County,         53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53090............  Johnson County,             53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53100............  Laramie County,           1580  Urban             0.8775      16940  Urban             0.8775
                    Wyoming.
53110............  Lincoln County,             53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53120............  Natrona County,           1350  Urban             0.9026      16220  Urban             0.9026
                    Wyoming.
53130............  Niobrara County,            53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53140............  Park County,                53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53150............  Platte County,              53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53160............  Sheridan County,            53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53170............  Sublette County,            53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53180............  Sweetwater County,          53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53190............  Teton County,               53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53200............  Uinta County,               53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53210............  Washakie County,            53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
53220............  Weston County,              53  Rural             0.9257      99953  Rural             0.9257
                    Wyoming.
65010............  Agana County, Guam.         65  Rural             0.9611      99965  Rural             0.9611
65020............  Agana Heights               65  Rural             0.9611      99965  Rural             0.9611
                    County, Guam.
65030............  Agat County, Guam..         65  Rural             0.9611      99965  Rural             0.9611
65040............  Asan County, Guam..         65  Rural             0.9611      99965  Rural             0.9611
65050............  Barrigada County,           65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65060............  Chalan Pago County,         65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65070............  Dededo County, Guam         65  Rural             0.9611      99965  Rural             0.9611
65080............  Inarajan County,            65  Rural             0.9611      99965  Rural             0.9611
                    Guam.

[[Page 27134]]

 
65090............  Maite County, Guam.         65  Rural             0.9611      99965  Rural             0.9611
65100............  Mangilao County,            65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65110............  Merizo County, Guam         65  Rural             0.9611      99965  Rural             0.9611
65120............  Mongmong County,            65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65130............  Ordot County, Guam.         65  Rural             0.9611      99965  Rural             0.9611
65140............  Piti County, Guam..         65  Rural             0.9611      99965  Rural             0.9611
65150............  Santa Rita County,          65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65160............  Sinajana County,            65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65170............  Talofofo County,            65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65180............  Tamuning County,            65  Rural             0.9611      99965  Rural             0.9611
                    Guam.
65190............  Toto County, Guam..         65  Rural             0.9611      99965  Rural             0.9611
65200............  Umatac County, Guam         65  Rural             0.9611      99965  Rural             0.9611
65210............  Yigo County, Guam..         65  Rural             0.9611      99965  Rural             0.9611
65220............  Yona County, Guam..         65  Rural             0.9611      99965  Rural            0.9611
----------------------------------------------------------------------------------------------------------------
\1\ At this time, there are no hospitals located in these CBSA-based urban areas on which to base a wage index.
  Therefore, the wage index value is based on the average wage index for all urban areas within the state.

Addendum C--Wage Index Tables

    In this addendum, we provide the tables referred to throughout the 
preamble in this final rule. Tables 1 and 2 below provide the CBSA-
based wage index values for urban and rural providers.

Table 1.--Proposed Wage Index For Urban Areas Based On CBSA Labor Market
                                  Areas
------------------------------------------------------------------------
                                                                   Wage
    CBSA code            Urban area (constituent counties)        index
------------------------------------------------------------------------
10180............  Abilene, TX.................................   0.7896
                    Callahan County, TX........................
                    Jones County, TX...........................
                    Taylor County, TX..........................
10380............  Aguadilla-Isabela-San Sebasti[aacute]n, PR..   0.4738
                    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 Sebastia1n Municipio, PR...............
10420............  Akron, OH...................................   0.8982
                    Portage County, OH.........................
                    Summit County, OH..........................
10500............  Albany, GA..................................   0.8628
                    Baker County, GA...........................
                    Dougherty County, GA.......................
                    Lee County, GA.............................
                    Terrell County, GA.........................
                    Worth County, GA...........................
10580............  Albany-Schenectady-Troy, NY.................   0.8589
                    Albany County, NY..........................
                    Rensselaer County, NY......................
                    Saratoga County, NY........................
                    Schenectady County, NY.....................
                    Schoharie County, NY.......................
10740............  Albuquerque, NM.............................   0.9684
                    Bernalillo County, NM......................
                    Sandoval County, NM........................
                    Torrance County, NM........................
                    Valencia County, NM........................
10780............  Alexandria, LA..............................   0.8033
                    Grant Parish, LA...........................
                    Rapides Parish, LA.........................
10900............  Allentown-Bethlehem-Easton, PA-NJ...........   0.9818
                    Warren County, NJ..........................
                    Carbon County, PA..........................
                    Lehigh County, PA..........................
                    Northampton County, PA.....................
11020............  Altoona, PA.................................   0.8944
                    Blair County, PA...........................
11100............  Amarillo, TX................................   0.9156

[[Page 27135]]

 
                    Armstrong County, TX.......................
                    Carson County, TX..........................
                    Potter County, TX..........................
                    Randall County, TX.........................
11180............  Ames, IA....................................   0.9536
                    Story County, IA...........................
11260............  Anchorage, AK...............................   1.1895
                    Anchorage Municipality, AK.................
                    Matanuska-Susitna Borough, AK..............
11300............  Anderson, IN................................   0.8586
                    Madison County, IN.........................
11340............  Anderson, SC................................   0.8997
                    Anderson County, SC........................
11460............  Ann Arbor, MI...............................   1.0859
                    Washtenaw County, MI.......................
11500............  Anniston-Oxford, AL.........................   0.7682
                    Calhoun County, AL.........................
11540............  Appleton, WI................................   0.9288
                    Calumet County, WI.........................
                    Outagamie County, WI.......................
11700............  Asheville, NC...............................   0.9285
                    Buncombe County, NC........................
                    Haywood County, NC.........................
                    Henderson County, NC.......................
                    Madison County, NC.........................
12020............  Athens-Clarke County, GA....................   0.9855
                    Clarke County, GA..........................
                    Madison County, GA.........................
                    Oconee County, GA..........................
                    Oglethorpe County, GA......................
12060............  Atlanta-Sandy Springs-Marietta, GA..........   0.9793
                    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...........................
                    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...........................   1.1615
                    Atlantic County, NJ........................
12220............  Auburn-Opelika, AL..........................   0.8100
                    Lee County, AL.............................
12260............  Augusta-Richmond County, GA-SC..............   0.9748
                    Burke County, GA...........................
                    Columbia County, GA........................
                    McDuffie County, GA........................
                    Richmond County, GA........................
                    Aiken County, SC...........................
                    Edgefield County, SC.......................
12420............  Austin-Round Rock, TX.......................   0.9437

[[Page 27136]]

 
                    Bastrop County, TX.........................
                    Caldwell County, TX........................
                    Hays County, TX............................
                    Travis County, TX..........................
                    Williamson County, TX......................
12540............  Bakersfield, CA.............................   1.0470
                    Kern County, CA............................
12580............  Baltimore-Towson, MD........................   0.9897
                    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..................................   0.9993
                    Penobscot County, ME.......................
12700............  Barnstable Town, MA.........................   1.2600
                    Barnstable County, MA......................
12940............  Baton Rouge, LA.............................   0.8593
                    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............................   0.9508
                    Calhoun County, MI.........................
13020............  Bay City, MI................................   0.9343
                    Bay County, MI.............................
13140............  Beaumont-Port Arthur, TX....................   0.8412
                    Hardin County, TX..........................
                    Jefferson County, TX.......................
                    Orange County, TX..........................
13380............  Bellingham, WA..............................   1.1731
                    Whatcom County, WA.........................
13460............  Bend, OR....................................   1.0786
                    Deschutes County, OR.......................
13644............  Bethesda-Gaithersburg-Frederick, MD.........   1.1483
                    Frederick County, MD.......................
                    Montgomery County, MD......................
13740............  Billings, MT................................   0.8834
                    Carbon County, MT..........................
                    Yellowstone County, MT.....................
13780............  Binghamton, NY..............................   0.8562
                    Broome County, NY..........................
                    Tioga County, NY...........................
13820............  Birmingham-Hoover, AL.......................   0.8959
                    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................................   0.7574
                    Burleigh County, ND........................
                    Morton County, ND..........................
13980............  Blacksburg-Christiansburg-Radford, VA.......   0.7954
                    Giles County, VA...........................
                    Montgomery County, VA......................
                    Pulaski County, VA.........................
                    Radford City, VA...........................
14020............  Bloomington, IN.............................   0.8447
                    Greene County, IN..........................
                    Monroe County, IN..........................
                    Owen County, IN............................
14060............  Bloomington-Normal, IL......................   0.9075

[[Page 27137]]

 
                    McLean County, IL..........................
14260............  Boise City-Nampa, ID........................   0.9052
                    Ada County, ID.............................
                    Boise County, ID...........................
                    Canyon County, ID..........................
                    Gem County, ID.............................
                    Owyhee County, ID..........................
14484............  Boston-Quincy, MA...........................   1.1558
                    Norfolk County, MA.........................
                    Plymouth County, MA........................
                    Suffolk County, MA.........................
14500............  Boulder, CO.................................   0.9734
                    Boulder County, CO.........................
14540............  Bowling Green, KY...........................   0.8211
                    Edmonson County, KY........................
                    Warren County, KY..........................
14740............  Bremerton-Silverdale, WA....................   1.0675
                    Kitsap County, WA..........................
14860............  Bridgeport-Stamford-Norwalk, CT.............   1.2592
                    Fairfield County, CT.......................
15180............  Brownsville-Harlingen, TX...................   0.9804
                    Cameron County, TX.........................
15260............  Brunswick, GA...............................   0.9311
                    Brantley County, GA........................
                    Glynn County, GA...........................
                    McIntosh County, GA........................
15380............  Buffalo-Niagara Falls, NY...................   0.9511
                    Erie County, NY............................
                    Niagara County, NY.........................
15500............  Burlington, NC..............................   0.8905
                    Alamance County, NC........................
15540............  Burlington-South Burlington, VT.............   0.9410
                    Chittenden County, VT......................
                    Franklin County, VT........................
                    Grand Isle County, VT......................
15764............  Cambridge-Newton-Framingham, MA.............   1.1172
                    Middlesex County, MA.......................
15804............  Camden, NJ..................................   1.0517
                    Burlington County, NJ......................
                    Camden County, NJ..........................
                    Gloucester County, NJ......................
15940............  Canton-Massillon, OH........................   0.8935
                    Carroll County, OH.........................
                    Stark County, OH...........................
15980............  Cape Coral-Fort Myers, FL...................   0.9356
                    Lee County, FL.............................
16180............  Carson City, NV.............................   1.0234
                    Carson City, NV............................
16220............  Casper, WY..................................   0.9026
                    Natrona County, WY.........................
16300............  Cedar Rapids, IA............................   0.8825
                    Benton County, IA..........................
                    Jones County, IA...........................
                    Linn County, IA............................
16580............  Champaign-Urbana, IL........................   0.9594
                    Champaign County, IL.......................
                    Ford County, IL............................
                    Piatt County, IL...........................
16620............  Charleston, WV..............................   0.8445
                    Boone County, WV...........................
                    Clay County, WV............................
                    Kanawha County, WV.........................
                    Lincoln County, WV.........................
                    Putnam County, WV..........................
16700............  Charleston-North Charleston, SC.............   0.9245
                    Berkeley County, SC........................
                    Charleston County, SC......................
                    Dorchester County, SC......................
16740............  Charlotte-Gastonia-Concord, NC-SC...........   0.9750
                    Anson County, NC...........................
                    Cabarrus County, NC........................

[[Page 27138]]

 
                    Gaston County, NC..........................
                    Mecklenburg County, NC.....................
                    Union County, NC...........................
                    York County, SC............................
16820............  Charlottesville, VA.........................   1.0187
                    Albemarle County, VA.......................
                    Fluvanna County, VA........................
                    Greene County, VA..........................
                    Nelson County, VA..........................
                    Charlottesville City, VA...................
16860............  Chattanooga, TN-GA..........................   0.9088
                    Catoosa County, GA.........................
                    Dade County, GA............................
                    Walker County, GA..........................
                    Hamilton County, TN........................
                    Marion County, TN..........................
                    Sequatchie County, TN......................
16940............  Cheyenne, WY................................   0.8775
                    Laramie County, WY.........................
16974............  Chicago-Naperville-Joliet, IL...............   1.0790
                    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............  Chico, CA...................................   1.0511
                    Butte County, CA...........................
17140............  Cincinnati-Middletown, OH-KY-IN.............   0.9615
                    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..........................   0.8284
                    Christian County, KY.......................
                    Trigg County, KY...........................
                    Montgomery County, TN......................
                    Stewart County, TN.........................
17420............  Cleveland, TN...............................   0.8139
                    Bradley County, TN.........................
                    Polk County, TN............................
17460............  Cleveland-Elyria-Mentor, OH.................   0.9213
                    Cuyahoga County, OH........................
                    Geauga County, OH..........................
                    Lake County, OH............................
                    Lorain County, OH..........................
                    Medina County, OH..........................
17660............  Coeur d'Alene, ID...........................   0.9647
                    Kootenai County, ID........................
17780............  College Station-Bryan, TX...................   0.8900
                    Brazos County, TX..........................
                    Burleson County, TX........................
                    Robertson County, TX.......................
17820............  Colorado Springs, CO........................   0.9468
                    El Paso County, CO.........................
                    Teller County, CO..........................
17860............  Columbia, MO................................   0.8345
                    Boone County, MO...........................

[[Page 27139]]

 
                    Howard County, MO..........................
17900............  Columbia, SC................................   0.9057
                    Calhoun County, SC.........................
                    Fairfield County, SC.......................
                    Kershaw County, SC.........................
                    Lexington County, SC.......................
                    Richland County, SC........................
                    Saluda County, SC..........................
17980............  Columbus, GA-AL.............................   0.8560
                    Russell County, AL.........................
                    Chattahoochee County, GA...................
                    Harris County, GA..........................
                    Marion County, GA..........................
                    Muscogee County, GA........................
18020............  Columbus, IN................................   0.9588
                    Bartholomew County, IN.....................
18140............  Columbus, OH................................   0.9860
                    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..........................   0.8550
                    Aransas County, TX.........................
                    Nueces County, TX..........................
                    San Patricio County, TX....................
18700............  Corvallis, OR...............................   1.0729
                    Benton County, OR..........................
19060............  Cumberland, MD-WV...........................   0.9317
                    Allegany County, MD........................
                    Mineral County, WV.........................
19124............  Dallas-Plano-Irving, TX.....................   1.0228
                    Collin County, TX..........................
                    Dallas County, TX..........................
                    Delta County, TX...........................
                    Denton County, TX..........................
                    Ellis County, TX...........................
                    Hunt County, TX............................
                    Kaufman County, TX.........................
                    Rockwall County, TX........................
19140............  Dalton, GA..................................   0.9079
                    Murray County, GA..........................
                    Whitfield County, GA.......................
19180............  Danville, IL................................   0.9028
                    Vermilion County, IL.......................
19260............  Danville, VA................................   0.8489
                    Pittsylvania County, VA....................
                    Danville City, VA..........................
19340............  Davenport-Moline-Rock Island, IA-IL.........   0.8724
                    Henry County, IL...........................
                    Mercer County, IL..........................
                    Rock Island County, IL.....................
                    Scott County, IA...........................
19380............  Dayton, OH..................................   0.9064
                    Greene County, OH..........................
                    Miami County, OH...........................
                    Montgomery County, OH......................
                    Preble County, OH..........................
19460............  Decatur, AL.................................   0.8469
                    Lawrence County, AL........................
                    Morgan County, AL..........................
19500............  Decatur, IL.................................   0.8067
                    Macon County, IL...........................
19660............  Deltona-Daytona Beach-Ormond Beach, FL......   0.9299
                    Volusia County, FL.........................
19740............  Denver-Aurora, CO...........................   1.0723
                    Adams County, CO...........................
                    Arapahoe County, CO........................

[[Page 27140]]

 
                    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, IA..............   0.9669
                    Dallas County, IA..........................
                    Guthrie County, IA.........................
                    Madison County, IA.........................
                    Polk County, IA............................
                    Warren County, IA..........................
19804............  Detroit-Livonia-Dearborn, MI................   1.0424
                    Wayne County, MI...........................
20020............  Dothan, AL..................................   0.7721
                    Geneva County, AL..........................
                    Henry County, AL...........................
                    Houston County, AL.........................
20100............  Dover, DE...................................   0.9776
                    Kent County, DE............................
20220............  Dubuque, IA.................................   0.9024
                    Dubuque County, IA.........................
20260............  Duluth, MN-WI...............................   1.0213
                    Carlton County, MN.........................
                    St. Louis County, MN.......................
                    Douglas County, WI.........................
20500............  Durham, NC..................................   1.0244
                    Chatham County, NC.........................
                    Durham County, NC..........................
                    Orange County, NC..........................
                    Person County, NC..........................
20740............  Eau Claire, WI..............................   0.9201
                    Chippewa County, WI........................
                    Eau Claire County, WI......................
20764............  Edison, NJ..................................   1.1249
                    Middlesex County, NJ.......................
                    Monmouth County, NJ........................
                    Ocean County, NJ...........................
                    Somerset County, NJ........................
20940............  El Centro, CA...............................   0.8906
                    Imperial County, CA........................
21060............  Elizabethtown, KY...........................   0.8802
                    Hardin County, KY..........................
                    Larue County, KY...........................
21140............  Elkhart-Goshen, IN..........................   0.9627
                    Elkhart County, IN.........................
21300............  Elmira, NY..................................   0.8250
                    Chemung County, NY.........................
21340............  El Paso, TX.................................   0.8977
                    El Paso County, TX.........................
21500............  Erie, PA....................................   0.8737
                    Erie County, PA............................
21604............  Essex County, MA............................   1.0538
                    Essex County, MA...........................
21660............  Eugene-Springfield, OR......................   1.0818
                    Lane County, OR............................
21780............  Evansville, IN-KY...........................   0.8713
                    Gibson County, IN..........................
                    Posey County, IN...........................
                    Vanderburgh County, IN.....................
                    Warrick County, IN.........................
                    Henderson County, KY.......................
                    Webster County, KY.........................
21820............  Fairbanks, AK...............................   1.1408
                    Fairbanks North Star Borough, AK...........
21940............  Fajardo, PR.................................   0.4153
                    Ceiba Municipio, PR........................
                    Fajardo Municipio, PR......................
                    Luquillo Municipio, PR.....................

[[Page 27141]]

 
22020............  Fargo, ND-MN................................   0.8486
                    Cass County, ND............................
                    Clay County, MN............................
22140............  Farmington, NM..............................   0.8509
                    San Juan County, NM........................
22180............  Fayetteville, NC............................   0.9416
                    Cumberland County, NC......................
                    Hoke County, NC............................
22220............  Fayetteville-Springdale-Rogers, AR-MO.......   0.8661
                    Benton County, AR..........................
                    Madison County, AR.........................
                    Washington County, AR......................
                    McDonald County, MO........................
22380............  Flagstaff, AZ...............................   1.2092
                    Coconino County, AZ........................
22420............  Flint, MI...................................   1.0655
                    Genesee County, MI.........................
22500............  Florence, SC................................   0.8947
                    Darlington County, SC......................
                    Florence County, SC........................
22520............  Florence-Muscle Shoals, AL..................   0.8272
                    Colbert County, AL.........................
                    Lauderdale County, AL......................
22540............  Fond du Lac, WI.............................   0.9640
                    Fond du Lac County, WI.....................
22660............  Fort Collins-Loveland, CO...................   1.0122
                    Larimer County, CO.........................
22744............  Fort Lauderdale-Pompano Beach-Deerfield        1.0432
                    Beach, FL.
                    Broward County, FL.........................
22900............  Fort Smith, AR-OK...........................   0.8230
                    Crawford County, AR........................
                    Franklin County, AR........................
                    Sebastian County, AR.......................
                    Le Flore County, OK........................
                    Sequoyah County, OK........................
23020............  Fort Walton Beach-Crestview-Destin, FL......   0.8872
                    Okaloosa County, FL........................
23060............  Fort Wayne, IN..............................   0.9793
                    Allen County, IN...........................
                    Wells County, IN...........................
                    Whitley County, IN.........................
23104............  Fort Worth-Arlington, TX....................   0.9486
                    Johnson County, TX.........................
                    Parker County, TX..........................
                    Tarrant County, TX.........................
                    Wise County, TX............................
23420............  Fresno, CA..................................   1.0538
                    Fresno County, CA..........................
23460............  Gadsden, AL.................................   0.7938
                    Etowah County, AL..........................
23540............  Gainesville, FL.............................   0.9388
                    Alachua County, FL.........................
                    Gilchrist County, FL.......................
23580............  Gainesville, GA.............................   0.8874
                    Hall County, GA............................
23844............  Gary, IN....................................   0.9395
                    Jasper County, IN..........................
                    Lake County, IN............................
                    Newton County, IN..........................
                    Porter County, IN..........................
24020............  Glens Falls, NY.............................   0.8559
                    Warren County, NY..........................
                    Washington County, NY......................
24140............  Goldsboro, NC...............................   0.8775
                    Wayne County, NC...........................
24220............  Grand Forks, ND-MN..........................   0.7901
                    Polk County, MN............................
                    Grand Forks County, ND.....................
24300............  Grand Junction, CO..........................   0.9550
                    Mesa County, CO............................
24340............  Grand Rapids-Wyoming, MI....................   0.9390

[[Page 27142]]

 
                    Barry County, MI...........................
                    Ionia County, MI...........................
                    Kent County, MI............................
                    Newaygo County, MI.........................
24500............  Great Falls, MT.............................   0.9052
                    Cascade County, MT.........................
24540............  Greeley, CO.................................   0.9570
                    Weld County, CO............................
24580............  Green Bay, WI...............................   0.9483
                    Brown County, WI...........................
                    Kewaunee County, WI........................
                    Oconto County, WI..........................
24660............  Greensboro-High Point, NC...................   0.9104
                    Guilford County, NC........................
                    Randolph County, NC........................
                    Rockingham County, NC......................
24780............  Greenville, NC..............................   0.9425
                    Greene County, NC..........................
                    Pitt County, NC............................
24860............  Greenville, SC..............................   1.0027
                    Greenville County, SC......................
                    Laurens County, SC.........................
                    Pickens County, SC.........................
25020............  Guayama, PR.................................   0.3181
                    Arroyo Municipio, PR.......................
                    Guayama Municipio, PR......................
                    Patillas Municipio, PR.....................
25060............  Gulfport-Biloxi, MS.........................   0.8929
                    Hancock County, MS.........................
                    Harrison County, MS........................
                    Stone County, MS...........................
25180............  Hagerstown-Martinsburg, MD-WV...............   0.9489
                    Washington County, MD......................
                    Berkeley County, WV........................
                    Morgan County, WV..........................
25260............  Hanford-Corcoran, CA........................   1.0036
                    Kings County, CA...........................
25420............  Harrisburg-Carlisle, PA.....................   0.9313
                    Cumberland County, PA......................
                    Dauphin County, PA.........................
                    Perry County, PA...........................
25500............  Harrisonburg, VA............................   0.9088
                    Rockingham County, VA......................
                    Harrisonburg City, VA......................
25540............  Hartford-West Hartford-East Hartford, CT....   1.1073
                    Hartford County, CT........................
                    Litchfield County, CT......................
                    Middlesex County, CT.......................
                    Tolland County, CT.........................
25620............  Hattiesburg, MS.............................   0.7601
                    Forrest County, MS.........................
                    Lamar County, MS...........................
                    Perry County, MS...........................
25860............  Hickory-Lenoir-Morganton, NC................   0.8921
                    Alexander County, NC.......................
                    Burke County, NC...........................
                    Caldwell County, NC........................
                    Catawba County, NC.........................
25980............  Hinesville-Fort Stewart, GA1................   0.9198
                    Liberty County, GA.........................
                    Long County, GA............................
26100............  Holland-Grand Haven, MI.....................   0.9055
                    Ottawa County, MI..........................
26180............  Honolulu, HI................................   1.1214
                    Honolulu County, HI........................
26300............  Hot Springs, AR.............................   0.9005
                    Garland County, AR.........................
26380............  Houma-Bayou Cane-Thibodaux, LA..............   0.7894
                    Lafourche Parish, LA.......................
                    Terrebonne Parish, LA......................
26420............  Houston-Sugar Land-Baytown, TX..............   0.9996

[[Page 27143]]

 
                    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-OH................   0.9477
                    Boyd County, KY............................
                    Greenup County, KY.........................
                    Lawrence County, OH........................
                    Cabell County, WV..........................
                    Wayne County, WV...........................
26620............  Huntsville, AL..............................   0.9146
                    Limestone County, AL.......................
                    Madison County, AL.........................
26820............  Idaho Falls, ID.............................   0.9420
                    Bonneville County, ID......................
                    Jefferson County, ID.......................
26900............  Indianapolis-Carmel, IN.....................   0.9920
                    Boone County, IN...........................
                    Brown County, IN...........................
                    Hamilton County, IN........................
                    Hancock County, IN.........................
                    Hendricks County, IN.......................
                    Johnson County, IN.........................
                    Marion County, IN..........................
                    Morgan County, IN..........................
                    Putnam County, IN..........................
                    Shelby County, IN..........................
26980............  Iowa City, IA...............................   0.9747
                    Johnson County, IA.........................
                    Washington County, IA......................
27060............  Ithaca, NY..................................   0.9793
                    Tompkins County, NY........................
27100............  Jackson, MI.................................   0.9304
                    Jackson County, MI.........................
27140............  Jackson, MS.................................   0.8311
                    Copiah County, MS..........................
                    Hinds County, MS...........................
                    Madison County, MS.........................
                    Rankin County, MS..........................
                    Simpson County, MS.........................
27180............  Jackson, TN.................................   0.8964
                    Chester County, TN.........................
                    Madison County, TN.........................
27260............  Jacksonville, FL............................   0.9290
                    Baker County, FL...........................
                    Clay County, FL............................
                    Duval County, FL...........................
                    Nassau County, FL..........................
                    St. Johns County, FL.......................
27340............  Jacksonville, NC............................   0.8236
                    Onslow County, NC..........................
27500............  Janesville, WI..............................   0.9538
                    Rock County, WI............................
27620............  Jefferson City, MO..........................   0.8387
                    Callaway County, MO........................
                    Cole County, MO............................
                    Moniteau County, MO........................
                    Osage County, MO...........................
27740............  Johnson City, TN............................   0.7937
                    Carter County, TN..........................
                    Unicoi County, TN..........................
                    Washington County, TN......................
27780............  Johnstown, PA...............................   0.8354
                    Cambria County, PA.........................
27860............  Jonesboro, AR...............................   0.7911

[[Page 27144]]

 
                    Craighead County, AR.......................
                    Poinsett County, AR........................
27900............  Joplin, MO..................................   0.8582
                    Jasper County, MO..........................
                    Newton County, MO..........................
28020............  Kalamazoo-Portage, MI.......................   1.0381
                    Kalamazoo County, MI.......................
                    Van Buren County, MI.......................
28100............  Kankakee-Bradley, IL........................   1.0721
                    Kankakee County, IL........................
28140............  Kansas City, MO-KS..........................   0.9476
                    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............  Kennewick-Richland-Pasco, WA................   1.0619
                    Benton County, WA..........................
                    Franklin County, WA........................
28660............  Killeen-Temple-Fort Hood, TX................   0.8526
                    Bell County, TX............................
                    Coryell County, TX.........................
                    Lampasas County, TX........................
28700............  Kingsport-Bristol-Bristol, TN-VA............   0.8054
                    Hawkins County, TN.........................
                    Sullivan County, TN........................
                    Bristol City, VA...........................
                    Scott County, VA...........................
                    Washington County, VA......................
28740............  Kingston, NY................................   0.9255
                    Ulster County, NY..........................
28940............  Knoxville, TN...............................   0.8441
                    Anderson County, TN........................
                    Blount County, TN..........................
                    Knox County, TN............................
                    Loudon County, TN..........................
                    Union County, TN...........................
29020............  Kokomo, IN..................................   0.9508
                    Howard County, IN..........................
                    Tipton County, IN..........................
29100............  La Crosse, WI-MN............................   0.9564
                    Houston County, MN.........................
                    La Crosse County, WI.......................
29140............  Lafayette, IN...............................   0.8736
                    Benton County, IN..........................
                    Carroll County, IN.........................
                    Tippecanoe County, IN......................
29180............  Lafayette, LA...............................   0.8428
                    Lafayette Parish, LA.......................
                    St. Martin Parish, LA......................
29340............  Lake Charles, LA............................   0.7833
                    Calcasieu Parish, LA.......................
                    Cameron Parish, LA.........................
29404............  Lake County-Kenosha County, IL-WI...........   1.0429
                    Lake County, IL............................
                    Kenosha County, WI.........................
29460............  Lakeland, FL................................   0.8912
                    Polk County, FL............................
29540............  Lancaster, PA...............................   0.9694
                    Lancaster County, PA.......................
29620............  Lansing-East Lansing, MI....................   0.9794

[[Page 27145]]

 
                    Clinton County, MI.........................
                    Eaton County, MI...........................
                    Ingham County, MI..........................
29700............  Laredo, TX..................................   0.8068
                    Webb County, TX............................
29740............  Las Cruces, NM..............................   0.8467
                    Dona Ana County, NM........................
29820............  Las Vegas-Paradise, NV......................   1.1437
                    Clark County, NV...........................
29940............  Lawrence, KS................................   0.8537
                    Douglas County, KS.........................
30020............  Lawton, OK..................................   0.7872
                    Comanche County, OK........................
30140............  Lebanon, PA.................................   0.8459
                    Lebanon County, PA.........................
30300............  Lewiston, ID-WA.............................   0.9886
                    Nez Perce County, ID.......................
                    Asotin County, WA..........................
30340............  Lewiston-Auburn, ME.........................   0.9331
                    Androscoggin County, ME....................
30460............  Lexington-Fayette, KY.......................   0.9075
                    Bourbon County, KY.........................
                    Clark County, KY...........................
                    Fayette County, KY.........................
                    Jessamine County, KY.......................
                    Scott County, KY...........................
                    Woodford County, KY........................
30620............  Lima, OH....................................   0.9225
                    Allen County, OH...........................
30700............  Lincoln, NE.................................   1.0214
                    Lancaster County, NE.......................
                    Seward County, NE..........................
30780............  Little Rock-North Little Rock, AR...........   0.8747
                    Faulkner County, AR........................
                    Grant County, AR...........................
                    Lonoke County, AR..........................
                    Perry County, AR...........................
                    Pulaski County, AR.........................
                    Saline County, AR..........................
30860............  Logan, UT-ID................................   0.9164
                    Franklin County, ID........................
                    Cache County, UT...........................
30980............  Longview, TX................................   0.8730
                    Gregg County, TX...........................
                    Rusk County, TX............................
                    Upshur County, TX..........................
31020............  Longview, WA................................   0.9579
                    Cowlitz County, WA.........................
31084............  Los Angeles-Long Beach-Glendale, CA.........   1.1783
                    Los Angeles County, CA.....................
31140............  Louisville-Jefferson County, KY-IN..........   0.9251
                    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.................................   0.8783
                    Crosby County, TX..........................
                    Lubbock County, TX.........................
31340............  Lynchburg, VA...............................   0.8691
                    Amherst County, VA.........................
                    Appomattox County, VA......................
                    Bedford County, VA.........................

[[Page 27146]]

 
                    Campbell County, VA........................
                    Bedford City, VA...........................
                    Lynchburg City, VA.........................
31420............  Macon, GA...................................   0.9443
                    Bibb County, GA............................
                    Crawford County, GA........................
                    Jones County, GA...........................
                    Monroe County, GA..........................
                    Twiggs County, GA..........................
31460............  Madera, CA..................................   0.8713
                    Madera County, CA..........................
31540............  Madison, WI.................................   1.0659
                    Columbia County, WI........................
                    Dane County, WI............................
                    Iowa County, WI............................
31700............  Manchester-Nashua, NH.......................   1.0354
                    Hillsborough County, NH....................
                    Merrimack County, NH.......................
31900............  Mansfield, OH...............................   0.9891
                    Richland County, OH........................
32420............  Mayag[uuml]ez, PR...........................   0.4020
                    Hormigueros Municipio, PR..................
                    Mayag[uuml]ez Municipio, PR................
32580............  McAllen-Edinburg-Mission, TX................   0.8934
                    Hidalgo County, TX.........................
32780............  Medford, OR.................................   1.0225
                    Jackson County, OR.........................
32820............  Memphis, TN-MS-AR...........................   0.9397
                    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..................................   1.1109
                    Merced County, CA..........................
33124............  Miami-Miami Beach-Kendall, FL...............   0.9750
                    Miami-Dade County, FL......................
33140............  Michigan City-La Porte, IN..................   0.9399
                    LaPorte County, IN.........................
33260............  Midland, TX.................................   0.9514
                    Midland County, TX.........................
33340............  Milwaukee-Waukesha-West Allis, WI...........   1.0146
                    Milwaukee County, WI.......................
                    Ozaukee County, WI.........................
                    Washington County, WI......................
                    Waukesha County, WI........................
33460............  Minneapolis-St. Paul-Bloomington, MN-WI.....   1.1075
                    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................................   0.9473
                    Missoula County, MT........................
33660............  Mobile, AL..................................   0.7891
                    Mobile County, AL..........................
33700............  Modesto, CA.................................   1.1885
                    Stanislaus County, CA......................
33740............  Monroe, LA..................................   0.8031
                    Ouachita Parish, LA........................

[[Page 27147]]

 
                    Union Parish, LA...........................
33780............  Monroe, MI..................................   0.9468
                    Monroe County, MI..........................
33860............  Montgomery, AL..............................   0.8618
                    Autauga County, AL.........................
                    Elmore County, AL..........................
                    Lowndes County, AL.........................
                    Montgomery County, AL......................
34060............  Morgantown, WV..............................   0.8420
                    Monongalia County, WV......................
                    Preston County, WV.........................
34100............  Morristown, TN..............................   0.7961
                    Grainger County, TN........................
                    Hamblen County, TN.........................
                    Jefferson County, TN.......................
34580............  Mount Vernon-Anacortes, WA..................   1.0454
                    Skagit County, WA..........................
34620............  Muncie, IN..................................   0.8930
                    Delaware County, IN........................
34740............  Muskegon-Norton Shores, MI..................   0.9664
                    Muskegon County, MI........................
34820............  Myrtle Beach-Conway-North Myrtle Beach, SC..   0.8934
                    Horry County, SC...........................
34900............  Napa, CA....................................   1.2643
                    Napa County, CA............................
34940............  Naples-Marco Island, FL.....................   1.0139
                    Collier County, FL.........................
34980............  Nashville-Davidson--Murfreesboro, TN........   0.9790
                    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............  Nassau-Suffolk, NY..........................   1.2719
                    Nassau County, NY..........................
                    Suffolk County, NY.........................
35084............  Newark-Union, NJ-PA.........................   1.1883
                    Essex County, NJ...........................
                    Hunterdon County, NJ.......................
                    Morris County, NJ..........................
                    Sussex County, NJ..........................
                    Union County, NJ...........................
                    Pike County, PA............................
35300............  New Haven-Milford, CT.......................   1.1887
                    New Haven County, CT.......................
35380............  New Orleans-Metairie-Kenner, LA.............   0.8995
                    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............  New York-White Plains-Wayne, NY-NJ..........   1.3188
                    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........................

[[Page 27148]]

 
                    Rockland County, NY........................
                    Westchester County, NY.....................
35660............  Niles-Benton Harbor, MI.....................   0.8879
                    Berrien County, MI.........................
35980............  Norwich-New London, CT......................   1.1345
                    New London County, CT......................
36084............  Oakland-Fremont-Hayward, CA.................   1.5346
                    Alameda County, CA.........................
                    Contra Costa County, CA....................
36100............  Ocala, FL...................................   0.8925
                    Marion County, FL..........................
36140............  Ocean City, NJ..............................   1.1011
                    Cape May County, NJ........................
36220............  Odessa, TX..................................   0.9884
                    Ector County, TX...........................
36260............  Ogden-Clearfield, UT........................   0.9029
                    Davis County, UT...........................
                    Morgan County, UT..........................
                    Weber County, UT...........................
36420............  Oklahoma City, OK...........................   0.9031
                    Canadian County, OK........................
                    Cleveland County, OK.......................
                    Grady County, OK...........................
                    Lincoln County, OK.........................
                    Logan County, OK...........................
                    McClain County, OK.........................
                    Oklahoma County, OK........................
36500............  Olympia, WA.................................   1.0927
                    Thurston County, WA........................
36540............  Omaha-Council Bluffs, NE-IA.................   0.9560
                    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............  Orlando-Kissimmee, FL.......................   0.9464
                    Lake County, FL............................
                    Orange County, FL..........................
                    Osceola County, FL.........................
                    Seminole County, FL........................
36780............  Oshkosh-Neenah, WI..........................   0.9183
                    Winnebago County, WI.......................
36980............  Owensboro, KY...............................   0.8780
                    Daviess County, KY.........................
                    Hancock County, KY.........................
                    McLean County, KY..........................
37100............  Oxnard-Thousand Oaks-Ventura, CA............   1.1622
                    Ventura County, CA.........................
37340............  Palm Bay-Melbourne-Titusville, FL...........   0.9839
                    Brevard County, FL.........................
37460............  Panama City-Lynn Haven, FL..................   0.8005
                    Bay County, FL.............................
37620............  Parkersburg-Marietta-Vienna, WV-OH..........   0.8270
                    Washington County, OH......................
                    Pleasants County, WV.......................
                    Wirt County, WV............................
                    Wood County, WV............................
37700............  Pascagoula, MS..............................   0.8156
                    George County, MS..........................
                    Jackson County, MS.........................
37860............  Pensacola-Ferry Pass-Brent, FL..............   0.8096
                    Escambia County, FL........................
                    Santa Rosa County, FL......................
37900............  Peoria, IL..................................   0.8870
                    Marshall County, IL........................
                    Peoria County, IL..........................
                    Stark County, IL...........................
                    Tazewell County, IL........................

[[Page 27149]]

 
                    Woodford County, IL........................
37964............  Philadelphia, PA............................   1.1038
                    Bucks County, PA...........................
                    Chester County, PA.........................
                    Delaware County, PA........................
                    Montgomery County, PA......................
                    Philadelphia County, PA....................
38060............  Phoenix-Mesa-Scottsdale, AZ.................   1.0127
                    Maricopa County, AZ........................
                    Pinal County, AZ...........................
38220............  Pine Bluff, AR..............................   0.8680
                    Cleveland County, AR.......................
                    Jefferson County, AR.......................
                    Lincoln County, AR.........................
38300............  Pittsburgh, PA..............................   0.8845
                    Allegheny County, PA.......................
                    Armstrong County, PA.......................
                    Beaver County, PA..........................
                    Butler County, PA..........................
                    Fayette County, PA.........................
                    Washington County, PA......................
                    Westmoreland County, PA....................
38340............  Pittsfield, MA..............................   1.0181
                    Berkshire County, MA.......................
38540............  Pocatello, ID...............................   0.9351
                    Bannock County, ID.........................
                    Power County, ID...........................
38660............  Ponce, PR...................................   0.4939
                    Juana D[iacute]az Municipio, PR............
                    Ponce Municipio, PR........................
                    Villalba Municipio, PR.....................
38860............  Portland-South Portland-Biddeford, ME.......   1.0382
                    Cumberland County, ME......................
                    Sagadahoc County, ME.......................
                    York County, ME............................
38900............  Portland-Vancouver-Beaverton, OR-WA.........   1.1266
                    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, FL..............   1.0123
                    Martin County, FL..........................
                    St. Lucie County, FL.......................
39100............  Poughkeepsie-Newburgh-Middletown, NY........   1.0891
                    Dutchess County, NY........................
                    Orange County, NY..........................
39140............  Prescott, AZ................................   0.9869
                    Yavapai County, AZ.........................
39300............  Providence-New Bedford-Fall River, RI-MA....   1.0966
                    Bristol County, MA.........................
                    Bristol County, RI.........................
                    Kent County, RI............................
                    Newport County, RI.........................
                    Providence County, RI......................
                    Washington County, RI......................
39340............  Provo-Orem, UT..............................   0.9500
                    Juab County, UT............................
                    Utah County, UT............................
39380............  Pueblo, CO..................................   0.8623
                    Pueblo County, CO..........................
39460............  Punta Gorda, FL.............................   0.9255
                    Charlotte County, FL.......................
39540............  Racine, WI..................................   0.8997
                    Racine County, WI..........................
39580............  Raleigh-Cary, NC............................   0.9691
                    Franklin County, NC........................
                    Johnston County, NC........................
                    Wake County, NC............................

[[Page 27150]]

 
39660............  Rapid City, SD..............................   0.8987
                    Meade County, SD...........................
                    Pennington County, SD......................
39740............  Reading, PA.................................   0.9686
                    Berks County, PA...........................
39820............  Redding, CA.................................   1.2203
                    Shasta County, CA..........................
39900............  Reno-Sparks, NV.............................   1.0982
                    Storey County, NV..........................
                    Washoe County, NV..........................
40060............  Richmond, VA................................   0.9328
                    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............  Riverside-San Bernardino-Ontario, CA........   1.1027
                    Riverside County, CA.......................
                    San Bernardino County, CA..................
40220............  Roanoke, VA.................................   0.8374
                    Botetourt County, VA.......................
                    Craig County, VA...........................
                    Franklin County, VA........................
                    Roanoke County, VA.........................
                    Roanoke City, VA...........................
                    Salem City, VA.............................
40340............  Rochester, MN...............................   1.1131
                    Dodge County, MN...........................
                    Olmsted County, MN.........................
                    Wabasha County, MN.........................
40380............  Rochester, NY...............................   0.9121
                    Livingston County, NY......................
                    Monroe County, NY..........................
                    Ontario County, NY.........................
                    Orleans County, NY.........................
                    Wayne County, NY...........................
40420............  Rockford, IL................................   0.9984
                    Boone County, IL...........................
                    Winnebago County, IL.......................
40484............  Rockingham County-Strafford County, NH......   1.0374
                    Rockingham County, NH......................
                    Strafford County, NH.......................
40580............  Rocky Mount, NC.............................   0.8915
                    Edgecombe County, NC.......................
                    Nash County, NC............................
40660............  Rome, GA....................................   0.9414
                    Floyd County, GA...........................
40900............  Sacramento--Arden-Arcade--Roseville, CA.....   1.2969
                    El Dorado County, CA.......................
                    Placer County, CA..........................
                    Sacramento County, CA......................
                    Yolo County, CA............................
40980............  Saginaw-Saginaw Township North, MI..........   0.9088
                    Saginaw County, MI.........................
41060............  St. Cloud, MN...............................   0.9965
                    Benton County, MN..........................

[[Page 27151]]

 
                    Stearns County, MN.........................
41100............  St. George, UT..............................   0.9392
                    Washington County, UT......................
41140............  St. Joseph, MO-KS...........................   0.9519
                    Doniphan County, KS........................
                    Andrew County, MO..........................
                    Buchanan County, MO........................
                    DeKalb County, MO..........................
41180............  St. Louis, MO-IL............................   0.8954
                    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...................................   1.0442
                    Marion County, OR..........................
                    Polk County, OR............................
41500............  Salinas, CA.................................   1.4128
                    Monterey County, CA........................
41540............  Salisbury, MD...............................   0.9064
                    Somerset County, MD........................
                    Wicomico County, MD........................
41620............  Salt Lake City, UT..........................   0.9421
                    Salt Lake County, UT.......................
                    Summit County, UT..........................
                    Tooele County, UT..........................
41660............  San Angelo, TX..............................   0.8271
                    Irion County, TX...........................
                    Tom Green County, TX.......................
41700............  San Antonio, TX.............................   0.8980
                    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............  San Diego-Carlsbad-San Marcos, CA...........   1.1413
                    San Diego County, CA.......................
41780............  Sandusky, OH................................   0.9019
                    Erie County, OH............................
41884............  San Francisco-San Mateo-Redwood City, CA....   1.4994
                    Marin County, CA...........................
                    San Francisco County, CA...................
                    San Mateo County, CA.......................
41900............  San Germ[aacute]n-Cabo Rojo, PR.............   0.4650
                    Cabo Rojo Municipio, PR....................
                    Lajas Municipio, PR........................
                    Sabana Grande Municipio, PR................
                    San Germ[aacute]n Municipio, PR............
41940............  San Jose-Sunnyvale-Santa Clara, CA..........   1.5099
                    San Benito County, CA......................
                    Santa Clara County, CA.....................
41980............  San Juan-Caguas-Guaynabo, PR................   0.4621
                    Aguas Buenas Municipio, PR.................
                    Aibonito Municipio, PR.....................
                    Arecibo Municipio, PR......................
                    Barceloneta Municipio, PR..................

[[Page 27152]]

 
                    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........................
                    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 Robles, CA.............   1.1349
                    San Luis Obispo County, CA.................
42044............  Santa Ana-Anaheim-Irvine, CA................   1.1559
                    Orange County, CA..........................
42060............  Santa Barbara-Santa Maria, CA...............   1.1694
                    Santa Barbara County, CA...................
42100............  Santa Cruz-Watsonville, CA..................   1.5166
                    Santa Cruz County, CA......................
42140............  Santa Fe, NM................................   1.0920
                    Santa Fe County, NM........................
42220............  Santa Rosa-Petaluma, CA.....................   1.3493
                    Sonoma County, CA..........................
42260............  Sarasota-Bradenton-Venice, FL...............   0.9639
                    Manatee County, FL.........................
                    Sarasota County, FL........................
42340............  Savannah, GA................................   0.9461
                    Bryan County, GA...........................
                    Chatham County, GA.........................
                    Effingham County, GA.......................
42540............  Scranton-Wilkes-Barre, PA...................   0.8540
                    Lackawanna County, PA......................
                    Luzerne County, PA.........................
                    Wyoming County, PA.........................
42644............  Seattle-Bellevue-Everett, WA................   1.1577
42680............  Sebastian-Vero Beach, FL....................   0.9434
                    Indian River County, FL....................
43100............  Sheboygan, WI...............................   0.8911
                    Sheboygan County, WI.......................
43300............  Sherman-Denison, TX.........................   0.9507
                    Grayson County, TX.........................
43340............  Shreveport-Bossier City, LA.................   0.8760
                    Bossier Parish, LA.........................
                    Caddo Parish, LA...........................
                    De Soto Parish, LA.........................

[[Page 27153]]

 
43580............  Sioux City, IA-NE-SD........................   0.9381
                    Woodbury County, IA........................
                    Dakota County, NE..........................
                    Dixon County, NE...........................
                    Union County, SD...........................
43620............  Sioux Falls, SD.............................   0.9635
                    Lincoln County, SD.........................
                    McCook County, SD..........................
                    Minnehaha County, SD.......................
                    Turner County, SD..........................
43780............  South Bend-Mishawaka, IN-MI.................   0.9788
                    St. Joseph County, IN......................
                    Cass County, MI............................
43900............  Spartanburg, SC.............................   0.9172
                    Spartanburg County, SC.....................
44060............  Spokane, WA.................................   1.0905
                    Spokane County, WA.........................
44100............  Springfield, IL.............................   0.8792
                    Menard County, IL..........................
                    Sangamon County, IL........................
44140............  Springfield, MA.............................   1.0248
                    Franklin County, MA........................
                    Hampden County, MA.........................
                    Hampshire County, MA.......................
44180............  Springfield, MO.............................   0.8237
                    Christian County, MO.......................
                    Dallas County, MO..........................
                    Greene County, MO..........................
                    Polk County, MO............................
                    Webster County, MO.........................
44220............  Springfield, OH.............................   0.8396
                    Clark County, OH...........................
44300............  State College, PA...........................   0.8356
                    Centre County, PA..........................
44700............  Stockton, CA................................   1.1307
                    San Joaquin County, CA.....................
44940............  Sumter, SC..................................   0.8377
                    Sumter County, SC..........................
45060............  Syracuse, NY................................   0.9574
                    Madison County, NY.........................
                    Onondaga County, NY........................
                    Oswego County, NY..........................
45104............  Tacoma, WA..................................   1.0742
                    Pierce County, WA..........................
45220............  Tallahassee, FL.............................   0.8688
                    Gadsden County, FL.........................
                    Jefferson County, FL.......................
                    Leon County, FL............................
                    Wakulla County, FL.........................
45300............  Tampa-St. Petersburg-Clearwater, FL.........   0.9233
                    Hernando County, FL........................
                    Hillsborough County, FL....................
                    Pasco County, FL...........................
                    Pinellas County, FL........................
45460............  Terre Haute, IN.............................   0.8304
                    Clay County, IN............................
                    Sullivan County, IN........................
                    Vermillion County, IN......................
                    Vigo County, IN............................
45500............  Texarkana, TX-Texarkana, AR.................   0.8283
                    Miller County, AR..........................
                    Bowie County, TX...........................
45780............  Toledo, OH..................................   0.9574
                    Fulton County, OH..........................
                    Lucas County, OH...........................
                    Ottawa County, OH..........................
                    Wood County, OH............................
45820............  Topeka, KS..................................   0.8920
                    Jackson County, KS.........................
                    Jefferson County, KS.......................
                    Osage County, KS...........................

[[Page 27154]]

 
                    Shawnee County, KS.........................
                    Wabaunsee County, KS.......................
45940............  Trenton-Ewing, NJ...........................   1.0834
                    Mercer County, NJ..........................
46060............  Tucson, AZ..................................   0.9007
                    Pima County, AZ............................
46140............  Tulsa, OK...................................   0.8543
                    Creek County, OK...........................
                    Okmulgee County, OK........................
                    Osage County, OK...........................
                    Pawnee County, OK..........................
                    Rogers County, OK..........................
                    Tulsa County, OK...........................
                    Wagoner County, OK.........................
46220............  Tuscaloosa, AL..............................   0.8645
                    Greene County, AL..........................
                    Hale County, AL............................
                    Tuscaloosa County, AL......................
46340............  Tyler, TX...................................   0.9168
                    Smith County, TX...........................
46540............  Utica-Rome, NY..............................   0.8358
                    Herkimer County, NY........................
                    Oneida County, NY..........................
46660............  Valdosta, GA................................   0.8866
                    Brooks County, GA..........................
                    Echols County, GA..........................
                    Lanier County, GA..........................
                    Lowndes County, GA.........................
46700............  Vallejo-Fairfield, CA.......................   1.4936
                    Solano County, CA..........................
47020............  Victoria, TX................................   0.8160
                    Calhoun County, TX.........................
                    Goliad County, TX..........................
                    Victoria County, TX........................
47220............  Vineland-Millville-Bridgeton, NJ............   0.9827
                    Cumberland County, NJ......................
47260............  Virginia Beach-Norfolk-Newport News, VA-NC..   0.8799
                    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............  Visalia-Porterville, CA.....................   1.0123
                    Tulare County, CA..........................
47380............  Waco, TX....................................   0.8518
                    McLennan County, TX........................
47580............  Warner Robins, GA...........................   0.8645
                    Houston County, GA.........................
47644............  Warren-Troy-Farmington Hills, MI............   0.9871
                    Lapeer County, MI..........................
                    Livingston County, MI......................
                    Macomb County, MI..........................
                    Oakland County, MI.........................
                    St. Clair County, MI.......................
47894............  Washington-Arlington-Alexandria, DC-VA-MD-WV   1.0926
                    District of Columbia, DC...................
                    Calvert County, MD.........................
                    Charles County, MD.........................
                    Prince George's County, MD.................
                    Arlington County, VA.......................

[[Page 27155]]

 
                    Clarke County, VA..........................
                    Fairfax County, VA.........................
                    Fauquier County, VA........................
                    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............  Waterloo-Cedar Falls, IA....................   0.8557
                    Black Hawk County, IA......................
                    Bremer County, IA..........................
                    Grundy County, IA..........................
48140............  Wausau, WI..................................   0.9590
                    Marathon County, WI........................
48260............  Weirton-Steubenville, WV-OH.................   0.7819
                    Jefferson County, OH.......................
                    Brooke County, WV..........................
                    Hancock County, WV.........................
48300............  Wenatchee, WA...............................   1.0070
                    Chelan County, WA..........................
                    Douglas County, WA.........................
48424............  West Palm Beach-Boca Raton-Boynton Beach, FL   1.0067
                    Palm Beach County, FL......................
48540............  Wheeling, WV-OH.............................   0.7161
                    Belmont County, OH.........................
                    Marshall County, WV........................
                    Ohio County, WV............................
48620............  Wichita, KS.................................   0.9153
                    Butler County, KS..........................
                    Harvey County, KS..........................
                    Sedgwick County, KS........................
                    Sumner County, KS..........................
48660............  Wichita Falls, TX...........................   0.8285
                    Archer County, TX..........................
                    Clay County, TX............................
                    Wichita County, TX.........................
48700............  Williamsport, PA............................   0.8364
                    Lycoming County, PA........................
48864............  Wilmington, DE-MD-NJ........................   1.0471
                    New Castle County, DE......................
                    Cecil County, MD...........................
                    Salem County, NJ...........................
48900............  Wilmington, NC..............................   0.9582
                    Brunswick County, NC.......................
                    New Hanover County, NC.....................
                    Pender County, NC..........................
49020............  Winchester, VA-WV...........................   1.0214
                    Frederick County, VA.......................
                    Winchester City, VA........................
                    Hampshire County, WV.......................
49180............  Winston-Salem, NC...........................   0.8944
                    Davie County, NC...........................
                    Forsyth County, NC.........................
                    Stokes County, NC..........................
                    Yadkin County, NC..........................
49340............  Worcester, MA...............................   1.1028
                    Worcester County, MA.......................
49420............  Yakima, WA..................................   1.0155
                    Yakima County, WA..........................
49500............  Yauco, PR...................................   0.4408
                    Gua1nica Municipio, PR.....................
                    Guayanilla Municipio, PR...................
                    Pe[ntilde]uelas Municipio, PR..............
                    Yauco Municipio, PR........................

[[Page 27156]]

 
49620............  York-Hanover, PA............................   0.9347
                    York County, PA............................
49660............  Youngstown-Warren-Boardman, OH-PA...........   0.8603
                    Mahoning County, OH........................
                    Trumbull County, OH........................
                    Mercer County, PA..........................
49700............  Yuba City, CA...............................   1.0921
                    Sutter County, CA..........................
                    Yuba County, CA............................
49740............  Yuma, AZ....................................   0.9126
                    Yuma County, AZ............................
------------------------------------------------------------------------
\1\ At this time, there are no hospitals located in this urban area on
  which to base a wage index. Therefore, the urban wage index value is
  based on the average wage index for all urban areas within the State.


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

[FR Doc. 06-4202 Filed 5-1-06; 4:00 pm]
BILLING CODE 4120-01-P