06-6614. Medicare Program; Home Health Prospective Payment System Rate Update for Calendar Year 2007 and Deficit Reduction Act of 2005 Changes to Medicare Payment for Oxygen Equipment and Capped Rental Durable Medical Equipment; Proposed Rule
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AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Proposed rule.
SUMMARY:
This proposed rule would set forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health agencies. In addition, this proposed rule would set forth policy changes related to Medicare payment for certain durable medical equipment for the purpose of implementing sections 1834(a)(5) and 1834(a)(7) of the Social Security Act, as amended by section 5101 of the Deficit Reduction Act of 2005. We are also inviting comments on a number of issues including payments based on reporting quality data and health information technology, as well as how to improve data transparency for consumers.
DATES:
To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on September 25, 2006.
ADDRESSES:
In commenting, please refer to file code CMS-1304-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.
You may submit comments in one of four ways (no duplicates, please):
1. Electronically. You may submit electronic comments on specific issues in this regulation to http://www.cms.hhs.gov/eRulemaking. Click on the link “Submit electronic comments on CMS regulations with an open comment period.” (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.)
2. By regular mail. You may mail written comments (one original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1304-P, P.O. Box 8014, Baltimore, MD 21244-8014.
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments (one original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1304-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.
4. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-7195 in advance to schedule your arrival with one of our staff members.
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.
Submission of comments on paperwork requirements. You may submit comments on this document's paperwork requirements by mailing your comments to the addresses provided at the end of the “Collection of Information Requirements” section in this document.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Randy Throndset, (410) 786-0131, or Sharon Ventura, (410) 786-1985 (for issues related to the home health prospective payment system).
Doug Brown, (410) 786-0028 (for issues related to reporting quality data).
Alexis Meholic, (410) 786-2300 (for issues related to implementation of section 5101 of the Deficit Reduction Act of 2005).
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all issues set forth in this rule to assist us in fully considering issues and developing policies. You can assist us by referencing the file code CMS-1304-P and the specific “issue identifier” that precedes the section on which you choose to comment.
Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. We post all comments received before the close of the comment period on the following Web site as soon as possible after they have been received: http://www.cms.hhs.gov/eRulemaking. Click on the link “Electronic Comments on CMS Regulations” on that Web site to view public comments.
Comments received timely would also be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951.
I. Background
[If you choose to comment on issues in this section, please include the caption “BACKGROUND” at the beginning of your comments.]
A. Statutory Background
The Balanced Budget Act of 1997 (BBA) (Pub. L. 105-33), enacted on August 5, 1997, significantly changed the way Medicare pays for Medicare home health services. Until the implementation of a home health prospective payment system (HH PPS) on October 1, 2000, home health agencies (HHAs) received payment under a cost-based reimbursement system. Section 4603 of the BBA governed the development of the HH PPS.
Section 4603(a) of the BBA provides the authority for the development of a PPS for all Medicare-covered home health services provided under a plan of care that were paid on a reasonable cost basis by adding section 1895, entitled “Prospective Payment For Home Health Services,” to the Social Security Act (the Act).
Section 1895(b)(1) of the Act requires the Secretary to establish a PPS for all Start Printed Page 44083costs of home health services paid under Medicare.
Section 1895(b)(3)(A) of the Act requires that (1) the computation of a standard prospective payment amount include all costs of home health services covered and paid for on a reasonable cost basis and be initially based on the most recent audited cost report data available to the Secretary, and (2) the prospective payment amounts be standardized to eliminate the effects of case-mix and wage levels among HHAs.
Section 1895(b)(3)(B) of the Act addresses the annual update to the standard prospective payment amounts by the home health applicable increase percentage as specified in the statute.
Section 1895(b)(4) of the Act governs the payment computation. Sections 1895(b)(4)(A)(i) and (b)(4)(A)(ii) of the Act require the standard prospective payment amount to be adjusted for case-mix and geographic differences in wage levels. Section 1895(b)(4)(B) of the Act requires the establishment of an appropriate case-mix adjustment factor that explains a significant amount of the variation in cost among different units of services. Similarly, section 1895(b)(4)(C) of the Act requires the establishment of wage-adjustment factors that reflect the relative level of wages and wage-related costs applicable to the furnishing of home health services in a geographic area compared to the national average applicable level. These wage-adjustment factors may be the factors used by the Secretary for the different area wage levels for purposes of section 1886(d)(3)(E) of the Act.
Section 1895(b)(5) of the Act gives the Secretary the option to grant additions or adjustments to the payment amount otherwise made in the case of outliers because of unusual variations in the type or amount of medically necessary care. Total outlier payments in a given fiscal year cannot exceed 5 percent of total payments projected or estimated.
On December 8, 2003, the Congress enacted the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Pub. L. 108-173). This legislation affected how we make updates to HH payment rates.
Section 701 of the MMA changed the yearly update cycle of the HH PPS rates from that of a fiscal year to a calendar year update cycle for 2004 and any subsequent year. Generally, section 701(a) of the MMA changed the references in the statute to refer to the calendar year for 2004 and any subsequent year. The changes resulted in updates to the HH PPS rates described as “fiscal year” updates for 2002 and 2003 and as “calendar year” updates for 2004 and any subsequent year (section 1895(b)(3)(B)(i) of the Act). Beginning on January 1, 2005, HH PPS would now be updated on a calendar year update cycle.
In addition to changing the update cycle for HH PPS rates, section 701 of the MMA made adjustments to the home health applicable increase percentage for 2004, 2005, and 2006. Specifically, section 701(a)(2)(D) of the MMA left unchanged the home health market basket update for the last calendar year quarter of 2003 and the first calendar year quarter of 2004 (section 1895(b)(3)(B)(ii)(II) of the Act). Furthermore, section 701(b)(4) of the MMA set the home health applicable percentage increase for the last 3 quarters of 2004 as the home health market basket (3.1 percent) minus 0.8 percentage point (section 1895(b)(3)(B)(ii)(III) of the Act). We implemented this provision through Pub. 100-20, One Time Notification, Transmittal 59, issued February 20, 2004. Section 701(b)(4) of the MMA also provided that updates for CY 2005 and CY 2006 would equal the applicable home health market basket percentage increase minus 0.8 percentage point. Lastly, section 701(b)(3) of the MMA revised the statute to provide that HH PPS rates for CY 2007 and any subsequent year would be updated by that year's home health market basket percentage increase (section 1895(b)(3)(B)(ii)(IV) of the Act).
On February 8, 2006, the Congress enacted the Deficit Reduction Act (DRA) of 2005 (Pub. L. 109-171). This legislation made additional changes to HH PPS.
Section 5201 of the DRA changed the CY 2006 update from the applicable home health market basket percentage increase minus 0.8 percentage point to a 0 percent update.
Section 5201 of the DRA amended section 421(a) of the MMA. The amended section 421(a) of the MMA requires for home health services furnished in a rural area (as defined in section 1886(d)(2)(D) of the Act) on or after January 1, 2006 and before January 1, 2007, that the Secretary increase the payment amount otherwise made under section 1895 of the Act for those services by 5 percent. The statute waives budget neutrality for purposes of this increase as it specifically requires that the Secretary not reduce the standard prospective payment amount (or amounts) under section 1895 of the Act applicable to home health services furnished during a period to offset the increase in payments resulting in the application of this section of the statute.
The 0 percent update to the payment rates and the rural add-on provisions of the DRA were implemented through Pub. 100-20, One Time Notification, Transmittal 211 issued February 10, 2006.
In addition, section 5201(c) of the DRA amends the statute to add section 1895(b)(3)(B)(v) to the Act, requiring HHAs to submit data for purposes of measuring health care quality. This requirement is applicable for 2007 and each subsequent year. For 2007 and each subsequent year, in the case of a HHA that does not submit quality data, the home health market basket percentage increase would be reduced by 2 percentage points.
B. Updates
On July 3, 2000, we published a final rule (65 FR 41128) in the Federal Register to implement the HH PPS legislation. That final rule established requirements for the new PPS for HHAs as required by section 4603 of the BBA, and as subsequently amended by section 5101 of the Omnibus Consolidated and Emergency Supplemental Appropriations Act (OCESAA) for Fiscal Year 1999 (Pub. L. 105-277), enacted on October 21, 1998; and by sections 302, 305, and 306 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act (BBRA) of 1999 (Pub. L. 106-113), enacted on November 29, 1999. The requirements include the implementation of a PPS for HHAs, consolidated billing requirements, and a number of other related changes. The PPS described in that rule replaced the retrospective reasonable-cost-based system that was used by Medicare for the payment of home health services under Part A and Part B.
On November 9, 2005, we published a final rule (70 FR 68132), which set forth an update to the 60-day national episode rates and the national per-visit amounts under the Medicare prospective payment system for home health agencies. As part of that final rule, we adopted revised area labor market Metropolitan Statistical Area designations for CY 2006. In implementing the new area labor market designations, we allowed for a one-year transition period. This transition consists of a blend of 50 percent of the new area labor market designations' wage index and 50 percent of the previous area labor market designations' wage index. In addition, we revised the fixed dollar loss ratio, which is used in the calculation of outlier payments.
C. System for Payment of Home Health Services
Generally, Medicare makes payment under the HH PPS on the basis of a Start Printed Page 44084national standardized 60-day episode payment, adjusted for case mix and wage index. For episodes with four or fewer visits, Medicare pays on the basis of a national per-visit amount by discipline, referred to as a low utilization payment adjustment (LUPA). Medicare also adjusts the 60-day episode payment for certain intervening events that give rise to a partial episode payment adjustment (PEP adjustment) or a significant change in condition adjustment (SCIC). For certain cases that exceed a specific cost threshold, an outlier adjustment may also be available. For a complete and full description of the HH PPS as required by the BBA and as amended by OCESAA and BBRA, see the July 3, 2000 HH PPS final rule (65 FR 41128).
D. Changes in Payment for Oxygen and Oxygen Equipment and Other Durable Medical Equipment (Capped Rental Items)
The Medicare payment rules for durable medical equipment (DME) are set forth in section 1834(a) of the Act and 42 CFR part 414, subpart D of our regulations. General payment rules for DME are set forth in section 1834(a)(1) of the Act and § 414.210 of our regulations, and § 414.210 also contains paragraphs relating to maintenance and servicing of items and replacement of items. Specific rules for oxygen and oxygen equipment are set forth in section 1834(a)(5) of the Act and § 414.226 of our regulations, and specific rules for capped rental items are set forth in section 1834(a)(7) of the Act and § 414.229 of our regulations. Rules for determining a period of continuous use for the rental of DME are set forth in § 414.230 of our regulations. The Medicare payment basis for DME is equal to 80 percent of either the lower of the actual charge or the fee schedule amount for the item. The beneficiary coinsurance is equal to 20 percent of either the lower of the actual charge or the fee schedule amount for the item.
In accordance with the rules set forth in section 1834(a)(5) of the Act and § 414.226 of our regulations, since 1989, suppliers have been paid monthly for furnishing oxygen and oxygen equipment to Medicare beneficiaries. Suppliers have also been paid an add-on fee for furnishing portable oxygen equipment to patients when medically necessary. Before the enactment of the DRA, these monthly payments continued for the duration of use of the equipment, provided that Medicare Part B coverage and eligibility criteria were met. Medicare covers three types of oxygen delivery systems: (1) Stationary or portable oxygen concentrators, which concentrate oxygen in room air; (2) stationary or portable liquid oxygen systems, which use oxygen stored as a very cold liquid in cylinders and tanks; and (3) stationary or portable gaseous oxygen systems, which administer compressed oxygen directly from cylinders. Both liquid and gaseous oxygen systems require delivery of oxygen contents.
Medicare payment for furnishing oxygen and oxygen equipment is made on a monthly basis and the fee schedule amounts vary by State. Payment for oxygen contents for both stationary and portable equipment is included in the fee schedule allowances for stationary equipment. Medicare fee schedules for home oxygen equipment are modality neutral; meaning that in a given State, there is one fee schedule amount that applies to all stationary systems and one fee schedule amount that applies to all portable systems.
Effective January 1, 2006, section 5101(b) of the DRA amended the Act at section 1834(a)(5) of the Act, limiting to 36 months the total number of continuous months for which Medicare will pay for oxygen equipment on a rental basis. At the end of the 36-month period, this section mandates that the supplier transfer title to the stationary and portable oxygen equipment to the beneficiary. Section 5101(b) of the DRA does not, however, limit the number of months for which Medicare will pay for oxygen contents for beneficiary-owned stationary or portable gaseous or liquid systems, and payment will continue to be made as long as the oxygen remains medically necessary. Section 5101(b) of the DRA also provides that payment for reasonable and necessary maintenance and servicing of beneficiary-owned oxygen equipment will be made for parts and labor not covered by a supplier's or manufacturer's warranty. In the case of beneficiaries using oxygen equipment on December 31, 2005, the 36-month rental period prescribed by the DRA begins on January 1, 2006.
In accordance with the rules set forth in section 1834(a)(7) of the Act and § 414.229 of our regulations, before the enactment of the DRA, suppliers of capped rental items (that is, other DME not described in paragraphs (2) through (6) of section 1834(a) of the Act) were paid on a rental or purchase option basis. Payment for most items in the capped rental category was made on a monthly rental basis, with rental payments being capped at 15 months or 13 months, depending on whether the beneficiary chose to continue renting the item or to take over ownership of the item through the “purchase option.” For all capped rental items, the supplier was required to inform the beneficiary of his or her purchase option, during the 10th rental month, to enter into a purchase agreement under which the supplier would transfer title to the item to the beneficiary on the first day after the 13th continuous month during which payment was made for the rental of the item. Therefore, if the beneficiary chose the purchase option, rental payments to the supplier would continue through the 13th month of continuous use of the equipment, after which time title to the equipment would transfer from the supplier to the beneficiary. Medicare would also make payment for any reasonable and necessary repair or maintenance and servicing of the equipment following the transfer of title. If the beneficiary did not choose the purchase option, rental payments would continue through the 15th month of continuous use. In these cases, suppliers would maintain title to the equipment but would have to continue furnishing the item to the beneficiary as long as medically necessity continued. Beginning 6 months after the 15th month of continuous use in which payment was made, Medicare would also make semi-annual maintenance and servicing payments to suppliers. These payments were approximately equal to 10 percent of the purchase price for the equipment as determined by the statute. Total Medicare payments made through the 13th and 15th months of rental equal 105 and 120 percent, respectively, of the purchase price for the equipment.
In the case of power-driven wheelchairs, since 1989 payment has also been made on a lump-sum purchase basis at the time that the item is initially furnished to the beneficiary if the beneficiary chooses to obtain the item in this manner. Most beneficiaries choose to obtain power-driven wheelchairs via this lump-sum purchase option.
Effective for items for which the first rental month occurs on or after January 1, 2006, section 5101(a) of the DRA of 2005 amended section 1834(a)(7) of the Act, limiting to 13 months the total number of continuous months for which Medicare will pay for DME in this category. After a 13-month period of continuous use during which rental payments are made, the statute requires that the supplier transfer title to the equipment to the beneficiary. Beneficiaries may still elect to obtain power-driven wheelchairs on a lump-sum purchase agreement basis. In all cases, payment for reasonable and necessary maintenance and servicing of beneficiary-owned equipment will be made for parts and labor not covered by Start Printed Page 44085the supplier's or manufacturer's warranty.
II. Provisions of the Proposed Regulations
[If you choose to comment on issues in this section, please include the caption “PROVISIONS OF THE PROPOSED REGULATIONS” at the beginning of your comments.]
A. National Standardized 60-Day Episode Rate
Medicare HH PPS has been effective since October 1, 2000. As set forth in the final rule published July 3, 2000 in the Federal Register (65 FR 41128), the unit of payment under Medicare HH PPS is a national standardized 60-day episode rate. As set forth in § 484.220, we adjust the national standardized 60-day episode rate by a case mix grouping and a wage index value based on the site of service for the beneficiary. The proposed CY 2007 HH PPS rates use the same case-mix methodology and application of the wage index adjustment to the labor portion of the HH PPS rates as set forth in the July 3, 2000 final rule. In the October 22, 2004 final rule, we rebased and revised the home health market basket, resulting in a labor-related share of 76.775 percent and a non-labor portion of 23.225 percent (69 FR 62126). We multiply the national 60-day episode rate by the patient's applicable case-mix weight. We divide the case-mix adjusted amount into a labor and non-labor portion. We multiply the labor portion by the applicable wage index based on the site of service of the beneficiary.
As required by section 1895(b)(3)(B) of the Act, we have updated the HH PPS rates annually in a separate Federal Register document. Section 484.225 sets forth the specific annual percentage update. To reflect section 1895(b)(3)(B)(v) of the Act, as added by section 5201 of the DRA, in § 484.225, we are proposing to revise paragraph (g) as follows:
(g) For 2007 and subsequent calendar years, the unadjusted national rate is equal to the rate for the previous calendar year increased by the applicable home health market basket index amount unless the HHA has not submitted quality data in which case the unadjusted national rate is equal to the rate for the previous calendar year increased by the applicable home health market basket index amount minus 2 percentage points.
For CY 2007, we are proposing to use again the design and case-mix methodology described in section III.G of the HH PPS July 3, 2000 final rule (65 FR 41192 through 41203). For CY 2007, we are proposing to base the wage index adjustment to the labor portion of the PPS rates on the most recent pre-floor and pre-reclassified hospital wage index as discussed in section II.F. of this proposed rule (not including any reclassifications under section 1886(d)(8)(B) of the Act).
As discussed in the July 3, 2000 HH PPS final rule, for episodes with four or fewer visits, Medicare pays the national per-visit amount by discipline, referred to as a LUPA. We update the national per-visit amounts by discipline annually by the applicable home health market basket percentage. We adjust the national per-visit amount by the appropriate wage index based on the site of service for the beneficiary as set forth in § 484.230. We propose to adjust the labor portion of the updated national per-visit amounts by discipline used to calculate the LUPA by the most recent pre-floor and pre-reclassified hospital wage index, as discussed in section II.F of this proposed rule.
Medicare pays the 60-day case-mix and wage-adjusted episode payment on a split percentage payment approach. The split percentage payment approach includes an initial percentage payment and a final percentage payment as set forth in § 484.205(b)(1) and § 484.205(b)(2). We may base the initial percentage payment on the submission of a request for anticipated payment (RAP) and the final percentage payment on the submission of the claim for the episode, as discussed in § 409.43. The claim for the episode that the HHA submits for the final percentage payment determines the total payment amount for the episode and whether we make an applicable adjustment to the 60-day case-mix and wage-adjusted episode payment. The end date of the 60-day episode as reported on the claim determines which calendar year rates Medicare would use to pay the claim.
We may also adjust the 60-day case-mix and wage-adjusted episode payment based on the information submitted on the claim to reflect the following:
- A low utilization payment provided on a per-visit basis as set forth in § 484.205(c) and § 484.230.
- A partial episode payment adjustment as set forth in § 484.205(d) and § 484.235.
- A significant change in condition adjustment as set forth in § 484.205(e) and § 484.237.
- An outlier payment as set forth in § 484.205(f) and § 484.240.
This proposed rule reflects the proposed updated CY 2007 rates that would be effective January 1, 2007.
B. Proposed CY 2007 Update to the Home Health Market Basket Index
Section 1895(b)(3)(B) of the Act, as amended by section 5201 of the DRA, requires for CY 2007 that the standard prospective payment amounts be increased by a factor equal to the applicable home health market basket update.
- Proposed CY 2007 Adjustments.
In calculating the annual update for the CY 2007 60-day episode rates, we are proposing to first look at the CY 2006 rates as a starting point. The CY 2006 national 60-day episode rate, as modified by section 5201(a)(4) of the DRA (and implemented through Pub. 100-20, One Time Notification, Transmittal 211 issued February 10, 2006) is $2,264.28.
In order to calculate the CY 2007 national 60-day episode rate, we are proposing to multiply the CY 2006 national 60-day episode rate ($2,264.28) by the proposed estimated home health market basket update of 3.1 percent for CY 2007. The proposed estimated home health market basket percentage increase reflects changes over time in the prices of an appropriate mix of goods and services included in covered home health services. The estimated home health market basket percentage increase is generally used to update the HH PPS rates on an annual basis.
We would increase the 60-day episode payment rate for CY 2007 (episodes ending on or after January 1, 2007, and before January 1, 2008) by the proposed estimated home health market basket update (3.1 percent) ($2,264.28 × 1.031) to yield the proposed updated CY 2007 national 60-day episode rate ($2,334.47) (see Table 1 below).Start Printed Page 44086
Table 1.—Proposed National 60-Day Episode Amounts Updated by the Estimated Home Health Market Basket Update for CY 2007, Before Case-Mix Adjustment
Total CY 2006 prospective payment amount per 60-day episode Multiply by the proposed estimated home health market basket update (3.1 Percent) 1 Proposed CY 2007 updated national 60-day episode rate $2,264.28 × 1.031 $2,334.47 1 The estimated home health market basket update of 3.1 percent for CY 2007 is based on Global Insight, Inc, 2nd Qtr, 2006 forecast with historical data through 1st Qtr, 2006. National Per-visit Amounts Used To Pay LUPAs and Compute Imputed Costs Used in Outlier Calculations
As discussed previously in this proposed rule, the policies governing the LUPAs and outlier calculations set forth in the July 3, 2000 HH PPS final rule would continue during CY 2007. In calculating the annual update for the CY 2007 national per-visit amounts we use to pay LUPAs and to compute the imputed costs in outlier calculations, we are proposing to look again at the CY 2006 rates as a starting point. We then are proposing to multiply those amounts by the proposed estimated home health market basket update (3.1 percent) for CY 2007 to yield the updated per-visit amounts for each home health discipline for CY 2007 (episodes ending on or after January 1, 2007, and before January 1, 2008) (see Table 2 below).
Table 2.—Proposed National Per-Visit Amounts for LUPAs and Outlier Calculations Updated by the Estimated Home Health Market Basket Update for CY 2007
Home health discipline type Final CY 2006 per-visit amounts per 60-day episode for LUPAs Multiply by the proposed estimated home health market basket (3.1 percent) 1 Proposed CY 2007 per-visit payment amount per discipline for LUPAs Home health aide $44.76 × 1.031 $46.15 Medical social services 158.45 × 1.031 163.36 Occupational therapy 108.81 × 1.031 112.18 Physical therapy 108.08 × 1.031 111.43 Skilled nursing 98.85 × 1.031 101.91 Speech-language pathology 117.44 × 1.031 121.08 1 The estimated home health market basket update of 3.1 percent for CY 2007 is based on Global Insight, Inc, 2nd Qtr, 2006 forecast with historical data through 1st Qtr, 2006. C. Rural Add-On
As stated above, section 5201(b) of the DRA requires, for home health services furnished in a rural area (as defined in section 1886(d)(2)(D) of the Act) with respect to episodes and visits beginning on or after January 1, 2006 and before January 1, 2007, that the Secretary increase by 5 percent the payment amount otherwise made under section 1895 of the Act. The statute waives budget neutrality related to this provision as it specifically states that the Secretary shall not reduce the standard prospective payment amount (or amounts) under section 1895 of the Act applicable to home health services furnished during a period to offset the increase in payments resulting in the application of this section of the statute.
While the rural add-on would primarily affect those episodes paid based on CY 2006 rates, it would also affect a number of episodes that would be paid based on CY 2007 rates. For example, an episode that begins on December 20, 2006 and ends on February 17, 2007, for services furnished in a rural area, would be paid based on CY 2007 rates because the episode ends on or after January 1, 2007 and before January 1, 2008; and the episode would also receive the rural add-on because the episode begins on or after January 1, 2006 and before January 1, 2007.
The applicable case-mix and wage index adjustment is subsequently applied to the 60-day episode amount for the provision of home health services where the site of service is the non-Metropolitan Statistical Area (MSA) of the beneficiary. Similarly, the applicable wage index adjustment is subsequently applied to the LUPA per-visit amounts adjusted for the provision of home health services where the site of service for the beneficiary is a non-MSA area. We implemented this provision for CY 2006 on February 13, 2006 through Pub. 100-20, One Time Notification, Transmittal 211 issued February 10, 2006. The 5 percent rural add-on is noted in tables 3 and 4 below.Start Printed Page 44087
Table 3.—Proposed Payment Amounts for 60-Day Episodes Beginning in CY 2006 and Ending in CY 2007 Updated by the Estimated Home Health Market Basket Update for CY 2007 With Rural Add-On, Before Case-Mix Adjustment
Proposed CY 2007 total prospective payment amount per 60-day episode 5 percent rural add-on Proposed CY 2007 payment amount per 60-day episode beginning in CY 2006 and before January 1, 2007 and ending in CY 2007 for a beneficiary who resides in a non-MSA area 2,334.47 × 1.05 $2,451.20 Table 4.—Proposed National Per-Visit Amounts for Episodes Beginning in CY 2006 and Ending in CY 2007 Updated by the Estimated Home Health Market Basket Update for CY 2007 With Rural Add-On
Home health discipline type Proposed CY 2007 per-visit amounts Multiply by the 5 percent rural add-on Proposed CY 2007 per-visit payment amount per discipline for 60-day episodes beginning on or after January 1 in CY 2006 and ending in CY 2007 for a beneficiary who resides in a non-msa area Home health aide $46.15 × 1.05 $48.46 Medical social services 163.36 × 1.05 171.53 Occupational therapy 112.18 × 1.05 117.79 Physical therapy 111.43 × 1.05 117.00 Skilled nursing 101.91 × 1.05 107.01 Speech-language pathology 121.08 × 1.05 127.13 Section 5201(c)(2) of the DRA added section 1895(b)(3)(B)(v)(II) to the Act, requiring that “each home health agency shall submit to the Secretary such data that the Secretary determines are appropriate for the measurement of health care quality. Such data shall be submitted in a form and manner, and at a time, specified by the Secretary for purposes of this clause.” In addition, section 1895(b)(3)(B)(v)(I) of the Act, as also added by section 5201(c)(2) of the DRA, dictates that “for 2007 and each subsequent year, in the case of a home health agency that does not submit data to the Secretary in accordance with subclause (II) with respect to such a year, the home health market basket percentage increase applicable under such clause for such year shall be reduced by 2 percentage points.”
The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) required the use of a standardized assessment instrument for quality oversight of HHAs. A standardized assessment instrument provides an HHA with a uniform mechanism to assess the needs of their patients and provide CMS with a uniform mechanism to assess the HHA's ability to adequately address those needs. To fulfill the OBRA 87 mandate, CMS required that, as part of their comprehensive assessment process, HHAs collect and report Outcome and Assessment Information Set (OASIS) data and later mandated the submission of this data as an HHA condition of participation at 42 CFR 484.20 and 484.55.
The OASIS data provide consumers and HHAs with ten, publicly-reported home health quality measures which have been endorsed by the National Quality Forum (NQF). Reporting this quality data has also required the development of several supporting mechanisms such as the HAVEN software used to encode and transmit data using a CMS standard electronic record layout, edit specifications, and data dictionary. The HAVEN software, which includes the OASIS, has become a standard practice within HHA operations. These early investments in data infrastructure and supporting software that CMS and HHAs have made over the past several years in order to create this quality reporting structure, have made quality reporting and measurement an important component of the HHA industry. The ten measures are:
(1) Improvement in ambulation/locomotion.
(2) Improvement in bathing.
(3) Improvement in transferring.
(4) Improvement in management of oral medications.
(5) Improvement in pain interfering with activity.
(6) Acute care hospitalization.
(7) Emergent care.
(8) Improvement in dyspnea.
(9) Improvement in urinary incontinence.
(10) Discharge to community.
We propose to use OASIS data and the ten quality measures based on those data as the appropriate measure on home health quality. Continuing to use the OASIS instrument would minimize the burden to providers and ensure that costs associated with the development and testing of a new reporting mechanism are not incurred. We believe that at this time the noted ten quality measures are the most appropriate measure of home health quality. Accordingly, for the calendar year (CY) 2007, we propose that the OASIS data, specifically, the ten quality measures, be submitted by HHAs, to meet the requirement that each HHA submit data appropriate for the measurement of health care quality, as determined by the Secretary.
Additionally, section 1895(b)(3)(B)(v)(II) of the Act provides the Secretary with the discretion to submit the required data in a form, Start Printed Page 44088manner, and time specified by him. For CY 2007, we are proposing to consider OASIS data submitted by HHAs to CMS for episodes beginning on or after July 1, 2005 and before July 1, 2006 as meeting the reporting requirement. This reporting time period will allow a full 12 months of data and will provide CMS the time necessary to analyze and make any necessary payment adjustments to the CY 2007 payment rates. HHAs that meet the reporting requirement would be eligible for the full home health market basket percentage increase.
During the next few years, we will be pursuing the development of patient level process measures for home health agencies, as well as continuing to refine the current OASIS tool in response to recommendations from a Technical Expert Panel conducted to review the data elements that make up the OASIS tool. These process measures will refer to specific care practices that are, or are not, followed by the home health agency for each patient. An example of this type of measure may be: the percentage of patients at risk of falls for whom prevention of falls was addressed in the care plan. We expect to introduce these additional measures over 2008 and 2009 so as to complement the existing OASIS outcome measures. During the years leading to calendar year 2010 payments, we will test and refine these measures to determine if they can more accurately reflect the level of quality care being provided at HHAs without being overly burdensome with the data collection instrument. Some process measures are in the very early stages of development. To the extent that evidence-based data are available on which to determine the appropriate measure specifications, and adequate risk-adjustments are made, we anticipate collecting and reporting these measures as part of each agency's home health quality plan. We believe that future modifications to the current OASIS tool including reducing the numbers of questions on the tool, refining possible responses, as well as adding new process measures will be made. In all cases, we anticipate that any future quality measures should be evidence-based, clearly linked to improved outcomes, and able to be reliably captured with the least burden to the provider. We are also beginning work in order to measure patient experience (in the form of a patient satisfaction survey) of care in the home health setting.
We recognize, however, that the conditions of participation (42 CFR part 484) that require OASIS submission also provide for exclusions from this requirement. Generally, agencies are not subject to the OASIS submission requirement, and thus do not receive Medicare payments, for patients that are not Medicare Beneficiaries or the patients are not receiving Medicare-covered home health services. Under the conditions of participation, agencies are excluded from the OASIS reporting requirement on individual patients if:
- Those patients are receiving only non-skilled services,
- Neither Medicare nor Medicaid is paying for home health care (patients receiving care under a Medicare or Medicaid Managed Care Plan are not excluded from the OASIS reporting requirement),
- Those patients are receiving pre- or post-partum services,
- Those patients are under the age of 18 years.
We believe that the rationale behind the exclusion of these agencies from submitting OASIS on patients excluded from OASIS submission as a condition of participation is equally applicable to HHAs for purposes of meeting the DRA quality requirement. If an agency is not submitting OASIS for patients excluded from OASIS submission as a condition of participation, we believe that the submission of OASIS for quality measures for Medicare payment purposes is also not necessary. Therefore, we propose that HHAs do not need to submit quality measures for DRA reporting purposes, for those patients who are excluded from OASIS submission as a condition of participation.
Additionally, we propose that agencies newly certified (on or after May 31, 2006 for payments to be made in CY 2007) be excluded from the DRA reporting requirement as data submission and analysis will not be possible for an agency certified this late in the reporting time period. We propose that in future years, agencies that certify on or after May 31 of the preceding year involved be excluded from any payment penalty under the DRA for the following calendar year. For example, if HHA “X” were to enroll in the Medicare Program on May 30 2007, CMS would expect them to submit the required quality data (unless covered by another exclusion protocol) on or before June 30 2006 (the end of the reporting period for payments effectuated in calendar year 2007. However, if HHA “X” were to enroll in the Medicare Program on May 31, 2006, CMS would automatically exclude them from the requirements under the DRA and the agency would be entitled to the full market basket increase for calendar year 2007. We note these exclusions only affect reporting requirements under the DRA and do not affect the agency's OASIS reporting responsibilities under the conditions of participation.
We propose to require that all HHAs, unless covered by these specific exclusions, meet the reporting requirement, or be subject to a 2 percent reduction in the home health market basket percentage increase in accordance with section 1895(b)(3)(B)(v)(I) of the Act. The 2 percent reduction would apply to all episodes ending on or before December 31, 2007. We provide the reduced payment rates in tables 5, 6, 7, and 8 below.
Start Printed Page 44089Table 5.—For HHAs That Do Not Submit the Required Quality Data—Proposed National 60-Day Episode Amount Updated by the Estimated Home Health Market Basket Update for CY 2007, Minus 2 Percentage Points, Before Case-Mix Adjustment
Total CY 2006 prospective payment amount per 60-day episode Multiply by the proposed estimated home health market basket update (3.1 percent 1 minus 2 percent) Proposed CY 2007 updated national 60-day episode rate for HHAs that do not submit required quality data $2,264.28 × 1.011 $2,289.19 1 The estimated home health market basket update of 3.1 percent for CY 2007 is based on Global Insight, Inc, 2nd Qtr, 2006 forecast with historical data through 1st Qtr, 2006. Table 6.—For HHAs That Do Not Submit the Required Quality Data—Proposed National Per-Visit Amounts Updated by the Estimated Home Health Market Basket Update for CY 2007, Minus 2 Percentage Points
Home health discipline type Final CY 2006 per-visit amounts per 60-day episode Multiply by the proposed estimated home health market basket update (3.1 percent 1 minus 2 percent) Proposed CY 2007 per-visit payment amount per discipline for HHAs that do not submit required quality data Home health aide $44.76 × 1.011 $45.25 Medical social services 158.45 × 1.011 160.19 Occupational therapy 108.81 × 1.011 110.01 Physical therapy 108.08 × 1.011 109.27 Skilled nursing 98.85 × 1.011 99.94 Speech-language pathology 117.44 × 1.011 118.73 1 The estimated home health market basket update of 3.1 percent for CY 2007 is based on Global Insight, Inc, 2nd Qtr, 2006 forecast with historical data through 1st Qtr, 2006. Table 7.—For HHAs That Do Not Submit the Required Quality Data—Proposed Payment Amount for 60-Day Episodes Beginning in CY 2006 and Ending in CY 2007 Updated by the Estimated Home Health Market Basket for CY 2007, Minus 2 Percentage Points, With Rural Add-On, Before Case-Mix Adjustment
Proposed CY 2007 updated national 60-day episode rate for HHAs that do not submit required quality data 5 percent rural add-on Proposed CY 2007 payment amount per 60-day episode beginning in CY 2006 and ending in CY 2007 for a beneficiary who resides in a non-MSA area for HHAs that do not submit required quality data $2,289.19 × 1.05 $2,403.65 Table 8.—For HHAs That Do Not Submit the Required Quality Data—Proposed Per-Visit Payment Amounts for Episodes Beginning in CY 2006 and Ending in CY 2007 Updated by the Estimated Home Health Market Basket for CY 2007, Minus 2 Percentage Points, With Rural Add-On
Home health discipline type Proposed CY 2007 per-visit amounts for HHAs that do not submit required quality data 5 percent rural add-on Proposed CY 2007 per-visit payment amounts for episodes beginning in CY 2006 and ending in CY 2007 for a beneficiary who resides in a non-MSA area for HHAs that do not submit required quality data Home health aide $45.25 × 1.05 $47.51 Medical social services 160.19 × 1.05 168.20 Occupational therapy 110.01 × 1.05 115.51 Physical therapy 109.27 × 1.05 114.73 Skilled nursing 99.94 × 1.05 104.93 Speech-language pathology 118.73 × 1.05 124.67 Section 1895(b)(3)(B)(v)(III) of the Act further requires that the “Secretary shall establish procedures for making data submitted under subclause (II) available to the public.” Additionally, the statute requires that “such procedures shall ensure that a home health agency has the opportunity to review the data that is to be made public with respect to the agency prior to such data being made public.” To meet the requirement for making such data public, we are proposing to continue to use the CMS Home Health Compare Web site whereby HHAs are listed geographically. Currently the 10 proposed quality measures are posted on the CMS Home Health Compare Web site. Consumers can search for all Medicare-approved home health providers that serve their city or zip code and then find the agencies offering the types of services they need as well as the proposed quality measures. See http://www.medicare.gov/HHCompare/Home/. HHAs currently have access (through the Home Health Compare contractor) to their own agency's quality data (updated periodically) and we propose to continue this process thus enabling each agency to know how it is performing before public posting of agency quality data on the CMS Home Health Compare Web site.
Currently, the CMS Home Health Compare Web site does not publicly Start Printed Page 44090report data when agencies have fewer than 20 episodes of care within a reporting period. In light of the DRA requirements we recognize the need to provide the required data to the public and propose to make these statistics available through expansion of the CMS Home Health Compare Web site.
In the July 27, 2005 Medicare Payment Advisory Commission (MedPAC) testimony before the U.S. Senate Committee on Finance, MedPAC expressed support for the concept of differential payments for Medicare providers, which could create incentives to improve quality. To support this initiative, MedPAC stated that “outcome measures from CMS' Outcome-based Quality Indicators” (currently collected through the OASIS instrument) “could form the starter set.” MedPAC further states “* * * the Agency for Healthcare Research and Quality concur(s) that a set of these measures is reliable and adequately risk adjusted.”
The MedPAC testimony recognizes that while the goal of care for many home health patients is improving health and functioning, for some patients the goal of the HHA is to simply stabilize their conditions and prevent further decline. Additionally, the MedPAC testimony reflects that measures of structure and process could also be considered.
Various home health outcome measures are now in common use and have been studied for some time. A number of these measures have been endorsed by the National Quality Forum (NQF) and are evidence-based, well accepted, and not unduly burdensome. When determining outcome measures that would be most appropriate it is important to measure aspects of care that providers can control and are adequately risk-adjusted. Home-based care presents particular difficulties for provider control because patient conditions are compounded by a variety of home environment and support system issues.
We are currently pursuing the development of patient-level process measures for HHAs, as well as refining the current OASIS tool in response to recommendations from a Technical Expert Panel conducted to review the data elements that make up the OASIS tool. These additional measures would complement the existing OASIS outcome measures and would assist us in identifying processes of care that lead to improvements for certain populations of patients. These process measures are currently in the very early stages of development. As we stated previously, to the extent that evidence-based data are available on which to determine the appropriate measure specifications, and adequate risk-adjustments are made, we anticipate collecting and reporting these measures as part of our home health quality plan. Possible modifications to the current OASIS tool include reducing the numbers of questions on the tool, refining possible responses, as well as adding new process measures.
We are soliciting comments on how to make the outcome measures more useful. We would also like comments on measures of home health care processes for which there is evidence or improved care to beneficiaries. In all cases, measures should be evidence-based, clearly linked to improved outcomes, and able to be reliably captured with the least burden to the provider. We are also considering measures of patient experience of care in the home health setting, as well as efficiency measures, and soliciting comment on the use of the measures and their importance in the home health setting. We would address any changes to the HH PPS quality data submission requirement in future rulemaking.
It is also our intent to provide guidance on the specifications, definitions, and reporting requirements of any additional measures through the standard protocol for measure development.
We are proposing to revise the regulations at 42 CFR § 484.225 to reflect these new payment requirements which require submission of quality data.
E. Outliers and Fixed Dollar Loss Ratio
Outlier payments are payments made in addition to regular 60-day case-mix and wage-adjusted episode payments for episodes that incur unusually large costs due to patient home health care needs. Outlier payments are made for episodes for which the estimated cost exceeds a threshold amount. The episode's estimated cost is the sum of the national wage-adjusted per-visit payment amounts for all visits delivered during the episode. The outlier threshold for each case-mix group, PEP adjustment, or total SCIC adjustment is defined as the 60-day episode payment amount, PEP adjustment, or total SCIC adjustment for that group plus a fixed dollar loss amount. Both components of the outlier threshold are wage-adjusted.
The wage-adjusted fixed dollar loss (FDL) amount represents the amount of loss that an agency must bear before an episode becomes eligible for outlier payments. The FDL is computed by multiplying the wage-adjusted 60-day episode payment amount by the FDL ratio, which is a proportion expressed in terms of the national standardized episode payment amount. The outlier payment is defined to be a proportion of the wage-adjusted estimated costs beyond the wage-adjusted threshold. The proportion of additional costs paid as outlier payments is referred to as the loss-sharing ratio.
Section 1895(b)(5) of the Act requires that estimated total outlier payments are no more than 5 percent of total estimated HH PPS payments. In response to the concerns about potential financial losses that might result from unusually expensive cases expressed in comments to the October 28, 1999 proposed rule (64 FR 58133), the July 2000 final rule set the target for estimated outlier payments at the 5 percent level. The FDL ratio and the loss-sharing ratio were then selected so that estimated total outlier payments would meet the 5 percent target.
For a given level of outlier payments, there is a trade-off between the values selected for the FDL ratio and the loss-sharing ratio. A high FDL ratio reduces the number of episodes that can receive outlier payments, but makes it possible to select a higher loss-sharing ratio and, therefore, increase outlier payments for outlier episodes. Alternatively, a lower FDL ratio means that more episodes can qualify for outlier payments, but outlier payments per episode must be lower. As a result of public comments on the October 28, 1999 proposed rule, in our July 2000 final rule, we made the decision to attempt to cover a relatively high proportion of the costs of outlier cases for the most expensive episodes that would qualify for outlier payments within the 5 percent constraint.
In the July 2000 final rule, we chose a value of 0.80 for the loss-sharing ratio, which preserves incentives for agencies to attempt to provide care efficiently for outlier cases. A loss-sharing ratio of 0.80 was also consistent with the loss-sharing ratios used in other Medicare PPS outlier policies. Furthermore, we estimated the value of the FDL ratio that would yield estimated total outlier payments that were 5 percent of total home health PPS payments. The resulting value for the FDL ratio, for the July 2000 final rule, was 1.13.
Our CY 2005 update to the HH PPS rates (69 FR 62124) changed the FDL ratio from the original 1.13 to 0.70 to allow more home health episodes to qualify for outlier payments and to better meet the estimated 5 percent target of outlier payments to total HH PPS payments. We stated in that CY 2005 update that we planned to continue to monitor the outlier expenditures on a yearly basis and to make adjustments as necessary (69 FR Start Printed Page 4409162129). To do so, we planned on using the best Medicare data available at the time of publication. For the CY 2005 update, we used CY 2003 home health claims data.
Our CY 2006 update to the HH PPS rates (70 FR 68132) changed the FDL ratio from 0.70 to 0.65 to allow even more home health episodes to qualify for outlier payments and to better meet the estimated 5 percent target of outlier payments to total HH PPS payments. For the CY 2006 update, we used CY 2004 home health claims data.
At this time, we do not have sufficient data to propose any update to the FDL ratio for the CY 2007 update to the HH PPS rates. However, depending on the availability of more recent data at the time of publication of the HH PPS rate update for the CY 2007 final rule, we may, if necessary, implement an update to the FDL ratio for the CY 2007 update to the HH PPS rates. If so, we plan on using the same methodology performed in updating to the current FDL ratio described in the June 2, 2004 proposed rule using any more recent available data.
F. Hospital Wage Index—Revised OMB Definition for Geographical Statistical Areas
Sections 1895(b)(4)(A)(ii) and (b)(4)(C) of the Act require the Secretary to establish area wage adjustment factors that reflect the relative level of wages and wage-related costs applicable to the furnishing of home health services and to provide appropriate adjustments to the episode payment amounts under HH PPS to account for area wage differences. We apply the appropriate wage index value to the labor portion (76.775 percent; see 60 FR 62126) of the HH PPS rates based on the geographic area in which the beneficiary received home health services as discussed in section II.A of this proposed rule. Generally, we determine each HHA's labor market area based on definitions of Metropolitan Statistical Areas (MSAs) issued by the Office of Management and Budget (OMB).
We acknowledged in our October 22, 2004 final rule that on June 6, 2003, the OMB issued an OMB Bulletin (No. 03-04) announcing revised definitions for MSAs, new definitions for Micropolitan Statistical Areas and Combined Statistical Areas, and guidance on using the statistical definitions. A copy of the Bulletin may be obtained at the following Internet address: http://www.whitehouse.gov/omb/bulletins/b03-04.html. At that time, we did not propose to apply these new definitions known as Core-Based Statistical Areas (CBSAs). In the November 9, 2005 final rule, we adopted the OMB-revised definitions to adjust the CY 2006 HH PPS payment rates and revised the regulations at § 484.202 to reflect this proposed change. The Hospital Inpatient PPS (IPPS) also applied these revised definitions as discussed in the August 11, 2004 IPPS final rule (68 FR 49207).
1. Background
As discussed previously and set forth in the July 3, 2000 final rule, the statute provides that the wage adjustment factors may be the factors used by the Secretary for purposes of section 1886(d)(3)(E) of the Act for hospital wage adjustment factors. As discussed in the July 3, 2000 final rule, we are proposing to again use the pre-floor and pre-reclassified hospital wage index data to adjust the labor portion of the HH PPS rates based on the geographic area in which the beneficiary receives the home health services. We believe the use of the pre-floor and pre-reclassified hospital wage index data results in the appropriate adjustment to the labor portion of the costs as required by statute. For the CY 2007 update to the home health payment rates, we would continue to use the most recent pre-floor and pre-reclassified hospital wage index available at the time of publication. See Addenda A and B of this proposed rule, respectively, for the rural and urban hospital wage indices using the CBSA designations. For HH PPS rates addressed in this proposed rule, we use preliminary 2007 pre-floor and pre-reclassified hospital wage index data. We are proposing to incorporate updated hospital wage index data for the 2007 pre-floor and pre-reclassified hospital wage index for use in the final rule for the CY 2007 HH PPS update (not including any reclassifications under section 1886(d)(8)(B) of the Act).
As implemented under the HH PPS in the July 3, 2000 HH PPS final rule, each HHA's labor market is determined based on definitions of MSAs issued by OMB. In general, an urban area is defined as an MSA or New England County Metropolitan Area (NECMA) as defined by OMB. Under § 412.62(f)(1)(iii), a rural area is defined as any area outside of the urban area. The urban and rural area geographic classifications are defined in § 412.62(f)(1)(ii) and § 412.62(f)(1)(iii), respectively, and have been used under HH PPS since it was implemented.
Under the HH PPS, the wage index value is based upon the site of service (defined by section 1861(m) of the Act as the beneficiary's place of residence) for the beneficiary. As has been our longstanding practice, any area not included in an MSA (urban area) is considered to be nonurban (§ 412.64(b)(1)(ii)(C)) and receives the statewide rural wage index value (see, for example, 65 FR 41173).
2. Current Labor Market Areas Based on MSAs, Including CBSAs
In the August 11, 2004 IPPS final rule (69 FR 49206 through 49034), revised labor market area definitions were adopted at § 412.64(b), which were effective October 1, 2004 for acute care hospitals. The new definitions, including CBSAs, were announced by OMB in late 2000 and were also discussed in greater detail in the July 14, 2005 HH PPS proposed rule in which we proposed to move from MSA-based to CBSA-based wage area designations. For the purposes of this proposed rule, the term “MSA-based” refers to wage index values and designations based on the previous MSA designations. Conversely, the term “CBSA-based” refers to wage index values and designations based on the new OMB revised MSA designations which now include CBSAs. Recently other payment systems such as the inpatient rehabilitation facility PPS, the skilled nursing facility PPS, and Medicare payment for hospice care have been updated to use the new revised labor market area definitions.
Based on public comments received in response to the July 14, 2005 HH PPS proposed rule, we decided to adopt a 1-year transition policy consisting of a 50/50 blend of the CBSA-based wage index values and the MSA-based wage index values. This transition policy is discussed in the November 9, 2005 HH PPS final rule (70 FR 68132, 68138). In the final rule, we also noted that for CY 2007, the HH PPS wage index adjustment would be solely based on a CBSA-based wage index.
3. Proposed Revision to the HH PPS Labor Market Areas
For CY 2007, we are proposing to end the 1 year transition policy (implemented for CY 2006) of using a 50/50 blend of MSA-based and CBSA-based wage area designations. For CY 2007, we are proposing to use 100 percent of the CBSA-based wage area designations for purposes of determining the HH PPS wage index adjustment.
In adopting the CBSA designations, we identified some geographic areas where there were no hospitals, and thus no hospital wage data on which to base the calculation of the CY 2006 home health wage index. For CY 2006, we adopted a policy in the HH PPS final rule (70 FR 68132) to use the CY 2005 Start Printed Page 44092pre-floor, pre-reclassified hospital wage index value for rural areas when no rural hospital wage data is available. We also adopted the policy that for urban labor markets without an urban hospital from which a hospital wage index can be derived, all of the urban CBSAs within the State would be used to calculate a statewide urban average wage index to use as a reasonable proxy for these areas. As we stated in the CY 2006 Home Health PPS Final Rule, we believe that this approach serves as a proxy for hospital wage data and provides an appropriate standard that accounts for area wage differences.
For this CY 2007 proposed rule, we are again proposing to apply our policy to use the CY 2005 pre-floor/pre-reclassified hospital wage index for rural areas where no hospital wage data is available.
We have not received any concerns from the industry regarding our policy to calculate a statewide urban average wage index, using all of the urban CBSAs wage index values within the State, for urban labor markets without an urban hospital from which a hospital wage index can be derived. Consequently, for this CY 2007 proposed rule, we again propose to apply our policy to calculate a statewide urban average wage index for urban areas with no hospital wage data available. For this CY 2007 proposed rule, the following areas will be affected by these policies:
Rural Massachusetts—proposed assigned wage index value of 1.0216;
Rural Puerto Rico—proposed assigned wage index value of 0.4047; and
Hinesville, GA (CBSA 25980)—proposed assigned wage index value of 0.9163.
We recognize that since the publication of the CY 2006 HH PPS final rule, representatives of the home health industry have expressed concerns with the policy we apply for rural areas where no hospital wage data is available, particularly as applied to rural Massachusetts facilities. In response to these concerns and in recognition that there may be additional rural areas in the future similarly impacted by a lack of hospital wage data on which to derive a hospital wage index, we are considering alternative methodologies to the methodology proposed above, for imputing a rural wage index for areas in States where no hospital wage data are available. We believe that an evaluation of alternative methodologies for imputing a rural wage index in these areas should adhere to four basic policy criteria. First, an alternative methodology should retain our current longstanding policy to use pre-floor, pre-reclassified hospital wage data to compute wage index values for post acute care facilities, including home health agencies. Second, any methodology to impute a rural wage index should use rural wage data to derive the rural wage index value. Third, any methodology to impute a rural wage index should be easy to evaluate. Fourth, any methodology to impute a rural wage index would be able to update wage data from year-to-year.
We are specifically considering one alternative to the proposal that meets all of the above policy criteria. Under this alternative, we would impute a rural wage index value by using a simple average CBSA-based rural wage index value at the Census Division level. Census Divisions are defined by the U.S. Census Bureau and may be found at (http://www.census.gov/geo/www/us_regdiv.pdf). As stated above, for CY 2007, hospital wage data are not available to compute a rural wage index for HHAs in rural Massachusetts, and this alternative methodology could be applied in this case. Massachusetts is located in Census Division I (New England). The states in this Census Division, and their respective rural wage index values (using hospital cost report wage data for FY 2003) include: Connecticut (1.1753), Maine (0.8410), New Hampshire (1.0800), Vermont (0.9944), Rhode Island (all five counties classified as urban) and Massachusetts. Using this alternative methodology, the states in Census Division I for which rural wage index values are available, as shown above, would be used resulting in a simple average rural wage index value of 1.0227. Although this methodology results in a rural Massachusetts wage index that is currently greater than the value under the current proposed policy (1.0216), we believe this methodology may be able to accurately reflect future increases and/or decreases of wage data for the States within the applicable census division. Wage indices are intended to be redistributive and should not increase total Medicare spending. We believe that the alternative methodology could be a reasonable proxy as it uses current rural wage index values (using rural hospital wage data) from States within the same census bureau divisions, with similar economics.
As defined by the Census Bureau: “Census divisions are grouping of states and the District of Columbia that are subdivisions of the four census regions.” The Census Bureau further specifically states: “Puerto Rico and the Island Areas are not part of any census region or census division.” Therefore, because the Census Bureau does not recognize Puerto Rico as part of any of the Census Bureau divisions, we do not believe that it is appropriate to compute the wage index for rural Puerto Rico using the methodology described in the alternative described above. Consequently, as stated above, we propose to continue to apply the CY 2005 wage index (0.4047) for Puerto Rico to payments for home health services provided to beneficiaries who reside in rural areas of Puerto Rico for CY 2007.
We solicit comments on maintaining our current policy for establishing wage index values for rural and urban areas without hospitals, the alternative approach outlined above in developing wage index values for rural areas without hospitals for CY 2007 and subsequent years, as well as suggestions for determining the wage index for rural Puerto Rico. We note that there are sufficient economic differences between the hospitals in the United States and those in Puerto Rico, and that hospitals in Puerto Rico are paid on a blended Federal/Commonwealth-specific rates. Consequently, any alternative approach/methodology to computing a wage index for rural Puerto Rico would need to take into account those differences. We will also continue to evaluate existing hospital wage data and, possibly, wage data from other sources, such as the Bureau of Labor Statistics, to determine if other methodologies of imputing a wage index value where hospital wage data are not available may be feasible.
G. Payment for Oxygen, Oxygen Equipment and Capped Rental DME Items
This proposed rule would amend our regulations at § 414.226 by revising the payment rules for oxygen and oxygen equipment in paragraph (a), adding a new paragraph (f) that provides that the beneficiary assumes ownership of oxygen equipment on the first day that begins after the 36th continuous month in which rental payments are made, and adding a new paragraph (g) that contains new supplier requirements that we believe are necessary in light of the amendments made to section 1834(a)(5) of the Act by section 5101(b) of the DRA. This proposed rule would amend our regulations at § 414.226 by adding a new paragraph (c) that establishes new classes and national payment amounts for oxygen and oxygen equipment based on our authority in section 1834(a)(9)(D) of the Act. We are also revising paragraph (b) of this section to incorporate the special payment rules for oxygen equipment mandated by Start Printed Page 44093section 1834(a)(21) of the Act. The provisions of section 1834(a)(21), which we believe are self-implementing, resulted in adjustments to Medicare payment amounts for oxygen contents and stationary oxygen equipment as well as portable oxygen equipment in 2005, which were implemented through program instructions. We are now seeking to codify these changes to make our regulations consistent with the payment methodology for these items in 2005 and 2006, and because the payment reductions mandated by section 1834(a)(21) are incorporated into our proposal, as more fully discussed in section I below, to create new payment classes for oxygen and oxygen equipment. This proposed rule would redesignate old paragraph (c) of this section as paragraph (d) and would amend this paragraph to indicate under what situations payments would be made for the items and services described in new paragraph (c). Finally, this proposed rule would redesignate old paragraph (d) of this section as paragraph (e) and would make technical changes to this paragraph so that the cross-references are accurate in light of the other changes we are proposing to make to § 414.226.
This proposed rule would also amend our regulations at § 414.229 by revising the payment rules for capped rental durable medical equipment (DME) items (also called capped rental items) in paragraph (a), revising paragraph (f) to provide for new payment rules for capped rental items furnished beginning on or after January 1, 2006, revising paragraph (g) to provide for supplier requirements that we believe are necessary in light of the amendments made to section 1834(a)(7)(A) of the Act by section 5101(a) of the DRA, and adding a new paragraph (h) to address the lump-sum purchase option for power-driven wheelchairs furnished on or after January 1, 2006. The language in current paragraphs (f) and (g) of this section is obsolete, and therefore, we would propose to delete this language.
This proposed rule would amend our regulations at § 414.210 by revising the maintenance and servicing rules in paragraph (e) and the replacement of equipment rules in paragraph (f) to further implement the new supplier requirements that we are proposing below.
Finally, we are proposing to revise § 414.230(b) to incorporate section 5101(b)(2)(B) of the DRA, which provides that for all beneficiaries receiving oxygen equipment paid for under section 1834(a) on December 31, 2005, the period of continuous use begins on January 1, 2006. We are also proposing to revise § 414.230(f), which governs when a new period of continuous use begins if a beneficiary receives new equipment, to account for the fact that oxygen equipment is paid on a modality neutral basis.
Section 5101(a) of the DRA changes the Medicare payment methodology for capped rental equipment to beneficiary ownership after 13 months of continuous use, for those beneficiaries who need the equipment for more than 13 months. This section also makes the transfer of title for the capped rental items a requirement rather than a beneficiary option after 13 months of continuous use. The changes made by this section of the DRA apply to capped rental items, including rented power-driven wheelchairs, for which the first rental month occurs on or after January 1, 2006. We are proposing to update § 414.229 of our regulations to reflect these new statutory requirements. However, for capped rental items and rented power-driven wheelchairs for which the first rental month occurred before January 1, 2006, the existing rules in § 414.229 would continue to apply. In addition, as was the case before enactment of the DRA, beneficiaries may elect to obtain power-driven wheelchairs furnished on or after January 1, 2006, on a lump-sum purchase basis.
Section 5101(b) of the DRA changes the Medicare payment methodology for oxygen equipment from continuous rental to beneficiary ownership after 36 months of continuous use, for those beneficiaries who medically need the oxygen equipment for more than 36 months. For beneficiaries who were receiving oxygen equipment on December 31, 2005 for which payment was made under section 1834(a) of the Act, the 36-month rental period began on January 1, 2006. For beneficiaries who begin to rent oxygen equipment on or after January 1, 2006, the 36-month rental period commences at the time they begin to rent the equipment. We are proposing to update § 414.226 of our regulations to incorporate these new requirements.
In light of the changes made by sections 5101(a) and (b) of the DRA, we believe it is necessary to propose additional supplier requirements in order to maintain beneficiary protections and access to oxygen, oxygen equipment, and capped rental DME items under section 1834(a) of the Act. For both capped rental DME items and oxygen equipment, the DRA amendments make the transfer of title from the supplier to the beneficiary a requirement rather than an option after the statutorily-prescribed rental period ends for each category of items. Therefore, suppliers and beneficiaries should be aware that title to these items will automatically transfer to the beneficiary if the medical need for the equipment continues for a period of continuous use that is longer than 36 months for oxygen equipment and 13 months for capped rental items. We are concerned that there may be incentives for suppliers to avoid having to transfer title to equipment to beneficiaries as required by the DRA. For example, we are aware of cases where a supplier has informed beneficiaries that it would decline to accept assignment for capped rental items and would charge beneficiaries who elected the purchase option the full retail price for the item during the 13th rental month (which was right before the supplier would be required to transfer title under the purchase option). In these cases, the beneficiary would become financially liable for the total retail price for the equipment in the 13th month if they elected the purchase option. We are making several proposals relating to the furnishing of oxygen equipment and capped rental items which we believe protect beneficiaries from these types of abusive practices and which we believe are reasonable for a supplier to comply with. Our authority to promulgate these requirements stems from our authority to administer the payment rules at section 1834(a)(5) of the Act for oxygen equipment and section 1834(a)(7) of the Act for capped rental items, as well as the general authority provided in section 1871 of the Act for prescribing regulations necessary for administering the Medicare program. Other than the length of the rental periods, which the DRA made effective beginning on January 1, 2006 for all oxygen equipment and for capped rental items for which the first rental period began on or after that date, we are proposing that the requirements presented in this section of the regulations would be effective on January 1, 2007, and would apply to suppliers that furnish oxygen equipment or capped rental items on a rental basis.
We believe that a supplier of an item that is subject to these new payment rules that furnishes the item in the first month for which a rental payment is made has an obligation to continue furnishing the item to the beneficiary for the entire period of medical need in which payments are made, up to and including the time when title to the equipment transfers to the beneficiary. We believe it is reasonable for the beneficiary to have an expectation that he or she will not be forced to change Start Printed Page 44094equipment or suppliers during the period of medical need unless he or she wants to. Therefore, we are proposing that unless an exception applies, the supplier that furnishes oxygen equipment or a capped rental item for the first month of the statutorily prescribed rental period must continue to furnish the oxygen equipment or the capped rental item for as long as the equipment remains medically necessary, up to and including the last month for which a rental payment is made by Medicare. We believe that this proposal is necessary to ensure beneficiary access to equipment during a period of medical need, which we believe could be jeopardized if suppliers have the option to take back the rented equipment just before the rental period expires in order to retain title to that equipment. We propose that this requirement would be subject to the following exceptions: (1) Cases where the item becomes subject to a competitive acquisition program implemented in accordance with section 1847(a) of the Act; (2) cases where a beneficiary relocates on either a temporary or permanent basis to an area that is outside the normal service area of the initial supplier; (3) cases where the beneficiary chooses to obtain equipment from a different supplier; and (4) other cases where CMS or the carrier determine that an exception is warranted. We have proposed rules in connection with the first exception in our Notice of Proposed Rulemaking for Competitive Acquisition for Certain Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Other Issues. These proposed rules are addressed beginning on page 25662 of the May 1, 2006, Federal Register. If the second exception applies, we propose that the supplier or beneficiary would need to arrange for another supplier in the new area to furnish the item on either a temporary or permanent basis. This proposed exception is consistent with what currently happens when beneficiaries move outside a supplier's service area on either a temporary or permanent basis. The third exception is intended to protect a beneficiary's right to obtain the equipment from the supplier of his or her choice. Finally, we are proposing to allow other exceptions to this proposed requirement on a case-by-case basis at the discretion of CMS or the Medicare contractor. CMS will be monitoring the case-by-case determinations made by the Medicare contractor.
We are concerned that there might be potential incentives for a supplier to replace more valuable or newer equipment used by the beneficiary with less valuable or older equipment from its inventory at some point before the 36th rental month for oxygen equipment or 13th rental month for capped rental DME expires in order to avoid losing title to the more valuable equipment. In order to avoid such potential situations, we propose that the supplier may not provide different equipment from that which was initially furnished to the beneficiary at any time during the 36-month period for oxygen equipment or 13th rental month for capped rental DME unless one of the following exceptions applies: (1) The equipment is lost, stolen, or irreparably damaged; (2) the equipment is being repaired while loaner equipment is in use; (3) there is a change in the beneficiary's medical condition such that the equipment initially furnished is no longer appropriate or medically necessary; or (4) the carrier determines that a change in equipment is warranted. However, we are proposing that a change from one oxygen equipment modality to another without physician documentation that such a change is medically necessary for the individual would not be considered a change in equipment that is warranted under the fourth exception stated above since there is no medical basis for the change. In those cases where the equipment is replaced, we propose that the replacement item must be equipment that is, at minimum, in the same condition as the equipment being replaced. This proposal is intended to safeguard beneficiary access to quality oxygen equipment and capped rental items throughout the duration of the rental period.
Under Medicare, suppliers who furnish items of DME can accept assignment on all claims for Medicare services or on a claim-by-claim basis. Assignment is an agreement between the supplier and the beneficiary under which the supplier agrees to request direct payment from Medicare for the item, to accept 80 percent of the Medicare allowed payment amount for the item from the carrier, and to charge the beneficiary not more than the remaining 20 percent of the Medicare approved payment amount, plus any unmet deductible. If a supplier elects not to accept assignment, Medicare pays the beneficiary 80 percent of the Medicare allowed payment amount, after subtracting any unmet deductible, and there is no limit under Title XVIII of the Act on the amount the supplier can charge the beneficiary for rental of the DME item. The beneficiary, in these situations, is financially responsible for the difference between 80 percent of the Medicare allowed payment amount and the amount the supplier charges for the rental of the DME item.
Section 1842(h) allows suppliers to sign a participation agreement where the supplier agrees voluntarily, before a calendar year, to accept assignment for all Medicare items and services furnished to a beneficiary for the following calendar year. Current supplier participation agreements are renewable annually. However, the agreements do not apply for a full period of medical need for specific beneficiaries in cases where such need extends for more than a calendar year. Nor do current participation agreements apply to periods of medical need where such a period overlaps calendar years. In the latter case, while a supplier may renew its participation agreement annually, a beneficiary would not know before choosing a supplier whether the supplier would be willing to accept assignment of all claims during the 13-month or 36-month rental period.
In order for the beneficiary to make an informed choice, we propose that before furnishing the oxygen equipment or a capped rental item, the supplier must disclose to the beneficiary its intentions regarding whether it will accept assignment of all monthly rental claims for the equipment during the period of medical necessity, up to and including the 36th month of continuous use for oxygen equipment or the 13th rental month of continuous use for capped rental DME in which rental payments could potentially be made. We believe that it is reasonable for the supplier to disclose to each beneficiary its intentions regarding assignment of claims for all months during a rental period as this decision has a direct financial effect on the beneficiary. A supplier's intentions could be expressed in the form of a written agreement between the supplier and a beneficiary. This proposal would require suppliers to give beneficiaries advance notice of the possible extent of their financial liability during the period of medical need in which monthly rental payments are made for the equipment, so that they can use this information to help select a supplier. Additionally, to promote informed beneficiary choices, we plan to post information on a CMS and/or CMS contractor Web site(s) indicating supplier specific information on oxygen equipment and capped rental items such as (1) the percentage of beneficiaries for whom each supplier accepted assignment during a prior period of time (for example, a quarter), and/or (2) the percentage of cases in which the supplier accepted assignment Start Printed Page 44095during the beneficiary's entire rental period. We believe that these proposals create reasonable rules for suppliers that furnish oxygen equipment and capped rental items and ensure that beneficiaries have information necessary to make informed choices that could have significant financial consequences for them.
H. Payment for Oxygen Contents for Beneficiary-Owned Oxygen Equipment
Section 1834(a)(5) of the Act, as amended by section 5101(b)(1) of the DRA, requires that Medicare continue to make monthly payments for the delivery and refilling of oxygen contents for the period of medical need after beneficiaries own their own gaseous or liquid oxygen stationary or portable equipment. Before the enactment of the DRA, Medicare made monthly payments for the delivery and refilling of oxygen contents for beneficiaries who own their own stationary and/or portable equipment (equipment they obtained on a purchase basis before June 1, 1989, out-of-pocket, or before they enrolled in Medicare Part B). In accordance with the DRA, we propose that after the supplier transfers title to the stationary and/or portable oxygen equipment to the beneficiary, Medicare would continue to make separate monthly payments for gaseous or liquid oxygen contents until medical necessity ends. We are also proposing that if the beneficiary-owned equipment is replaced, and Medicare pays for the replacement in accordance with proposed revised § 414.210(f) (see section K of this proposed rule for a more complete discussion of our proposed oxygen equipment replacement policies), a new 36-month rental period start and the payment for oxygen contents would be included in the monthly rental payments. We are proposing that all oxygen content payment amounts would be based on new rates developed in accordance with our proposal to establish new payment classes, as discussed in section I below.
In transferring title to gaseous or liquid oxygen equipment used during the 36-month rental period, we propose that suppliers must transfer title for all equipment that will meet the beneficiary's continued medical need, including those oxygen cylinders or vessels that are refilled at the supplier's place of business. Customary practice by suppliers for refilling oxygen contents is to deliver to the beneficiary cylinders filled with contents and take back the empty cylinders to the supplier's place of business to refill the oxygen contents. Under our proposal, title would transfer for both sets of cylinders, meaning the ones that are being used by the beneficiary for the month and the ones that the supplier refills in its business location and delivers for use during the next subsequent month. This policy would apply to both gaseous and liquid oxygen stationary equipment and portable systems. Similarly, in those cases where the beneficiary uses an oxygen equipment system which includes a compressor which fills portable gaseous cylinders in the beneficiary's home, we propose that suppliers must transfer title for this equipment to the beneficiary.
Concerns have been raised regarding beneficiary access to, and safety issues associated with, the delivery of oxygen contents for beneficiary-owned stationary and portable gaseous or liquid equipment. We believe that these concerns are based on the misconception that beneficiaries become responsible for filling their own cylinders. To the contrary, there are numerous State and Federal regulations governing the safe handling, filling, and transport of oxygen and those regulations are unaffected by the DRA oxygen provisions. We expect that suppliers will continue to furnish replacement contents for beneficiary-owned gaseous and liquid systems in the same way that they have furnished replacement contents for beneficiary-owned equipment in the past. For example, suppliers that deliver a one-month supply of gaseous cylinders to a beneficiary's home at the same time that they are picking up empty cylinders that the beneficiary used during the previous month could continue this practice under section 5101(b) of the DRA.
I. Classes of Oxygen and Oxygen Equipment
Based on information from paid Medicare claims with dates of service in calendar year 2004, distribution of usage among the four general categories of oxygen systems was: (a) 69 percent of beneficiaries used both a stationary concentrator (which does not require delivery of oxygen contents) and a portable system that requires delivery of gaseous or liquid oxygen, (b) 5 percent of beneficiaries used a stationary system that requires delivery of gaseous or liquid oxygen and a portable system that requires delivery of gaseous or liquid oxygen, (c) 24 percent of beneficiaries used a stationary concentrator system only, and (d) 2 percent of beneficiaries used only a stationary system that requires delivery of liquid or gaseous oxygen. The prevalent use of stationary concentrator systems is due, in part, to the fact that this system is the most cost-effective and dependable of the stationary oxygen modalities. The main reason that the concentrator system is the most cost-effective system is that the oxygen is concentrated from room air, and therefore, the high cost of delivering contents to the beneficiary's residence is removed when this system is used. Medicare's current payment structure results in two separate payments for beneficiaries using both stationary and portable systems, both of which are modality neutral, meaning that the payment amount does not differ depending on the type of oxygen delivery system (gaseous, liquid, or concentrator) that is furnished. One payment, hereinto referred to as the “stationary payment,” includes payment for the rental of stationary equipment, delivery of stationary oxygen contents (for gaseous or liquid systems), and delivery of portable oxygen contents (for gaseous or liquid systems). A separate add-on payment, hereinto referred to as the “portable add-on,” is also made in cases where the beneficiary is renting portable oxygen equipment. As a result of this payment methodology which has been in place since 1989, suppliers have a financial incentive to furnish low cost concentrator systems as opposed to more expensive gaseous or liquid systems because the monthly payment is the same regardless of which system is used. Finally, in implementing section 1834(a)(5) and (9) of the Act, monthly payment amounts were established through regulations at § 414.226 for (1) stationary and portable oxygen contents (for beneficiaries who use stationary and, if applicable, portable equipment), and (2) portable oxygen contents only (for beneficiaries who only use portable oxygen equipment).
The current average statewide monthly payment amounts are:
Start Printed Page 44096Equipment & contents Oxygen contents only Stationary pmt $199 Stationary & portable $156 Portable add-on 32 Portable only 21 Based on our data, 36 percent of Medicare beneficiaries continue using oxygen equipment for more than three years, that is, beyond the 36th month after which title for the equipment would transfer to the beneficiary in accordance with the DRA.
We have heard concerns about the appropriateness of the current payment structure for oxygen and oxygen equipment in light of changes in the technologies for oxygen delivery systems that have occurred since 1989, and these concerns have been amplified in light of the recent changes made by the DRA. The specific concerns pertain to beneficiary access to (1) portable oxygen contents after title to the equipment transfers to the beneficiary, (2) devices that allow a beneficiary to fill portable tanks at home (otherwise referred to in the oxygen equipment industry as transfilling systems), and (3) portable oxygen concentrators. As we implement the DRA provisions for oxygen equipment and propose to promulgate additional supplier requirements, we want to ensure that the Medicare payment methodology results in payments for oxygen and oxygen equipment that are accurate, do not impede beneficiary access to innovations in technology, and do not create inappropriate incentives for suppliers.
Some believe that Medicare's stationary payment for equipment and contents (average of $199) is “too high” and that Medicare's payment for portable oxygen contents only for beneficiary-owned portable equipment (average of $21) is “too low”. While some contend that the overall payment (stationary payment plus portable add-on) for oxygen and oxygen equipment is adequate as long as the beneficiary continues to rent the equipment, they are concerned about the adequacy of Medicare's $21 monthly payment for furnishing oxygen contents for beneficiary-owned portable equipment. Some believe that Medicare's current average monthly payment of $156 for oxygen contents, which includes payment for both stationary and portable systems, is high enough to create an incentive for suppliers to furnish stationary oxygen systems that require the ongoing delivery of oxygen contents, rather than stationary concentrator systems that do not require delivery of oxygen contents.
Some technologies provide an attachment to a stationary oxygen concentrator that allows beneficiaries to fill their own portable tanks at home. Delivery of portable oxygen contents to the beneficiary's home is, therefore, not necessary since this equipment refills the beneficiary's rented or owned portable oxygen tanks. This transfilling technology eliminates the need for frequent and costly trips by a supplier to a beneficiary's home to refill portable oxygen tanks and would save the Medicare program and beneficiaries who use portable equipment the expense of paying for delivery of portable oxygen contents. We note that we are not aware that a similar “transfilling” technology has been developed that would be capable of filling stationary tanks in the beneficiary's home. Therefore, there remains a need for ongoing delivery of gaseous or liquid oxygen contents for stationary equipment. In accordance with the DRA, after 36 months of continuous use, title for the transfilling equipment and accompanying portable oxygen tanks would transfer to the beneficiary who would then own a portable equipment system that self-generates oxygen in their home. However, some are concerned that current Medicare payment rules that allow payment for oxygen contents for stationary equipment creates an incentive for suppliers to furnish stationary oxygen equipment that require liquid or gaseous oxygen deliveries, rather than concentrators and transfilling equipment that self-generate oxygen in the beneficiary's home. In addition, portable oxygen concentrators are now available that meet both the beneficiary's stationary and portable oxygen needs. Some have raised concern about whether the combination of the Medicare stationary payment and portable add-on payment (approximately $231 per month), which is what is currently paid for portable oxygen concentrators, is sufficient to facilitate use of this new technology which, like a transfilling system, eliminates the need for delivery of oxygen contents, but is more expensive than a “standard” or “non-portable” concentrator.
In light of these concerns, we are proposing regulatory changes to address the Medicare payment rates for oxygen and oxygen equipment. We are proposing to address these issues by using our authority under section 1834(a)(9)(D) of the Act to establish separate classes and monthly payment rates for items of oxygen and oxygen equipment. Specifically, there are two changes we are proposing for oxygen and oxygen equipment:
1. We propose to establish a new class and monthly payment amount for oxygen generating portable oxygen equipment (for example, portable concentrators and transfilling systems).
2. We propose to establish separate classes and monthly payment amounts for gaseous and liquid oxygen contents that must be delivered for beneficiary-owned stationary and portable oxygen equipment.
The first change involves creating a new separate class for portable oxygen systems that generate their own oxygen and therefore eliminate the need for delivery of oxygen contents (for example, portable concentrator systems or transfilling systems). A higher monthly payment amount would be allowed, as described below, for these systems to account for the increased, up-front costs to the supplier of furnishing these more expensive concentrator or transfilling systems, which would be partially offset by the reduced payments that the supplier would receive from the Medicare program and beneficiaries due to the fact that these systems do not require the delivery of oxygen contents.
The second change involves creating two separate classes (stationary contents only and portable contents only) and monthly payment rates for furnishing oxygen contents for beneficiary-owned stationary and portable systems. Currently, the combined average monthly payment amount of $156 for furnishing oxygen contents for beneficiary-owned stationary and portable systems includes payment for both stationary contents and portable contents. The current fee schedule amounts for oxygen contents are based on calendar year data from 1986 for the combined average Medicare monthly payment for both stationary and portable contents divided by number of rental months for stationary liquid and gaseous oxygen equipment. As a result, the current combined stationary/portable contents payment results in Medicare payments for portable contents even in those cases where the beneficiary does not use portable oxygen equipment. Under our proposal to create one payment class for oxygen contents used for stationary equipment, and a separate class for oxygen contents used for portable equipment, new national monthly payment amounts for stationary contents delivery and portable contents delivery would be established by splitting the combined payment of $156 into two new payments as explained below. This change would increase the monthly payment for furnishing portable oxygen contents and would address the concerns that the monthly payment rate of $21 is too low for the delivery and filling of portable tanks after the beneficiary assumes ownership of the equipment in accordance with the DRA.Start Printed Page 44097
In order to achieve budget neutrality for the new classes of oxygen and increase payment amounts for furnishing portable contents, we would need to reduce other Medicare oxygen payment rates. Budget neutrality would require that Medicare's total spending for all modalities of stationary and portable systems, including contents, be the same under the proposed change as they would be without the change.
We would propose to achieve budget neutrality by reducing the current monthly payment amounts (the stationary payment) for stationary oxygen equipment and oxygen contents (for stationary or portable equipment) made during the rental period. This reduction in payment is necessary to offset increased payments for the changes identified above and to meet the requirement in section 1834(a)(9)(D)(ii) that the classes and payments be established in a budget neutral fashion. In most cases, suppliers furnish Medicare beneficiaries with stationary oxygen concentrators. These devices can be purchased for $1,000 or less and the current, average Medicare payment of $199 pays suppliers $1,990 over 10 months. We believe that these facts indicate that making a reduction (from $199 on average to $177) in Medicare payment for this relatively inexpensive oxygen equipment in order to pay oxygen suppliers adequately for furnishing portable oxygen contents and more expensive portable oxygen equipment technologies is warranted. With this approach, the proposed new classes, as well as proposed new national monthly payment rates, would be as follows:
1. Stationary Payment: $177.
2. Portable Add-On: $32.
3. Oxygen Generating Portable Equipment Add-On (portable concentrators or transfilling systems): $64.
4. Stationary Contents Delivery: $101.
5. Portable Contents Delivery: $55.
We provide a detailed discussion of the payment rate calculations/adjustments in the paragraphs that follow. Under the proposed new oxygen and oxygen equipment class structure described above, in those cases where the beneficiary needs both stationary and portable oxygen, monthly payments of $241 or $209 (proposed revised stationary payment of $177 plus one of two proposed portable equipment payments, $32 or $64) would be made during rental months 1 through 36. The stationary payment (which includes payment for stationary equipment, as well as oxygen contents for stationary and portable systems) of $177 would be made during rental months 1 through 36 for beneficiaries who only need stationary oxygen and oxygen equipment. Monthly payments of $101 for stationary oxygen contents and/or $55 for portable oxygen contents would be made in cases where beneficiaries own their stationary and/or portable oxygen equipment. As explained in more detail in the paragraphs that follow, the $101 payment is for stationary oxygen contents only and is derived from the current payment of $156, which is made for both stationary and portable oxygen contents. The $55 payment for portable oxygen contents only is also derived from the current payment of $156 that is made for both stationary and portable oxygen contents and would replace the current statewide portable oxygen contents fees (average of $21), which was based on a relatively small number of claims and allowed services compared to the number of claims and allowed services that were used in computing the statewide fees (average of $156) for a combination of stationary and portable oxygen contents.
As noted above, the proposed national payment rates for delivery of oxygen contents for beneficiary owned gaseous/liquid equipment were derived from the current average payment for a combined oxygen contents delivery of $156. We propose to establish $101, or 65 percent of $156, as the monthly payment rate for delivery of larger, heavier, beneficiary-owned stationary gaseous oxygen cylinders or liquid oxygen vessels and $55, or 35 percent of $156, as the monthly payment rate for delivery of smaller, lighter, beneficiary-owned portable gaseous oxygen cylinders or liquid oxygen vessels. The 65/35 split is based on our understanding that there are higher costs associated with delivering stationary tanks (cylinders of gaseous oxygen and vessels of liquid oxygen) which are approximately twice as large as the portable tanks. Such costs include supplier overhead costs, including the costs to purchase, maintain, and dispatch trucks, obtain insurance, and purchase fuel. The 65/35 split is intended to account for the difference in costs associated with the size of the tanks. Larger tanks take up more space on the trucks, take longer to fill, are harder to move, and result in increased fuel costs.
We estimate that the increase from $21 to $55 in the monthly payment rate for delivery of oxygen contents for beneficiary-owned portable equipment will result in increased expenditures of approximately $22 million over a 24 month period, or $11 million annually. This figure is based on current data on utilization of portable oxygen by Medicare beneficiaries.
The add-on payment amount of $64 for the oxygen generating portable equipment class was calculated based on data indicating long term savings generated from use of equipment that eliminated the need for payment of $55 per month for portable oxygen contents. The first step in calculating the proposed $64 payment for oxygen generating portable equipment involves the computation of a national, enhanced, modality neutral monthly payment amount of $241 for new technology systems (stationary concentrators and transfilling systems, as well as portable concentrators), which was derived from the sum of the current average stationary payment ($199), the current average portable add-on payment ($32), and an additional $10 to pay suppliers for furnishing more expensive equipment that eliminates the need for delivery of portable oxygen contents. Specifically, we calculated the modality neutral increased payment (that is, $10 above the current combination of the stationary payment and portable add-on payment) by estimating potential savings that the Medicare program would realize as a result of not having to pay for delivery of oxygen contents for beneficiary-owned portable oxygen systems in the fourth and fifth years of use. We calculated the increased payment to be equal to potential savings from not delivering oxygen contents. In calculating this increased payment, we are only factoring in savings from the fourth and fifth years of use since we assume that most beneficiaries will elect to obtain replacement equipment after the 5-year reasonable useful lifetime for their equipment has expired. Since our data indicates that 35.8 percent of beneficiaries will use oxygen equipment for more than three years, and that approximately 74 percent of these beneficiaries use portable equipment, the $10 amount is calculated based on the following formula, and is rounded to the nearest dollar:
We estimate that the additional $10 payment per month for oxygen generating portable equipment (transfilling units and portable concentrators) will result in increased expenditures of approximately $15 million over a 36 month period, or $5 million annually. This figure is based on current data on utilization of stationary and portable oxygen by Medicare beneficiaries over 36 months.
The second step in calculating the proposed $64 add-on payment for the Start Printed Page 44098proposed new class of oxygen generating portable equipment involves subtracting the proposed new stationary payment. Therefore, the national monthly payment of $241 computed in the first step above would be reduced by $177, the proposed new adjusted stationary payment amount, to arrive at the proposed add-on payment of $64 for just the oxygen generating portable equipment. In addition, to offset the increased annual payments of approximately $16 million that will result from increased payments for portable oxygen contents ($11 million) and newer technology oxygen generating portable equipment ($5 million), we would propose to decrease the current stationary payment by $22 ($199 − $177). We estimate that this offset would result in annual Medicare savings of approximately $16 million, and would therefore offset the increased payments for new technology oxygen generating portable equipment and delivery of oxygen contents for other beneficiary-owned portable equipment. We are proposing that these fees be established on a nationwide basis due to the fact that the variation in the current statewide fee schedule amounts for oxygen and oxygen equipment, as well as the portable equipment add-on payment, are currently only 3 percent and 5 percent, respectively.
We are proposing that the $64 add-on payment would be made for oxygen generating portable equipment only if the equipment eliminates the need for delivery or portable oxygen contents. However, if transfilling equipment is used in connection with a stationary oxygen concentrator (whether as an integrated system component or as a separate part) to both deliver stationary oxygen and fill portable oxygen tanks, Medicare would make both a $177 stationary payment for the stationary oxygen concentrator and stationary oxygen contents, and a separate $64 oxygen generating portable equipment payment for the portable oxygen transfilling equipment.
There are also portable oxygen transfilling products that are not part of or used in conjunction with a stationary oxygen concentrator. These products are only used to fill portable oxygen tanks in the beneficiary's home. If the beneficiary is using one of these products, Medicare would make a $64 oxygen generating portable equipment payment. If the patient is also renting any type of stationary oxygen equipment (gaseous, liquid, or concentrator), Medicare would make a separate, additional $177 stationary equipment payment for that equipment.
If a portable oxygen concentrator is furnished, Medicare would make the $64 oxygen generating portable equipment add-on payment if the portable oxygen concentrator is used as both the beneficiary's stationary oxygen equipment and portable oxygen equipment. In this case, the portable oxygen concentrator equipment would fall under both the stationary oxygen equipment class and the oxygen generating portable equipment class. Therefore, the $177 stationary payment would also be made in this situation, since the equipment being furnished meets the beneficiary's needs for both stationary and portable oxygen equipment. In this case, it would be necessary for the supplier to use two HCPCS codes to bill for this device since it is being used as both the stationary and portable oxygen equipment for the beneficiary. If the beneficiary owns any type of stationary equipment (concentrator, liquid, or gaseous), and is also furnished with a portable oxygen concentrator, only the oxygen generating payment of $64 would be made (that is, the supplier would not also receive the $177 payment) and the portable oxygen concentrator equipment would fall under the oxygen generating portable equipment class because it is only being used to meet the beneficiary's need for portable oxygen equipment. Finally, if, the beneficiary is renting any type of stationary equipment (concentrator, liquid, or gaseous), and is also furnished with a portable oxygen concentrator, the oxygen generating add-on payment of $64 would be paid for the portable oxygen concentrator and the stationary payment of $177 would be paid separately for the stationary oxygen equipment and contents.
In summary, we are proposing new payment classes for oxygen contents for beneficiary-owned stationary equipment, oxygen contents for beneficiary-owned portable equipment, and oxygen generating portable equipment. Payments for oxygen contents for beneficiary-owned portable equipment and oxygen generating portable equipment would exceed what is currently paid for these items to ensure access to portable oxygen regardless of the type of equipment used. These increased payments would be offset by a reduction in the stationary payment. The six broad categories of oxygen equipment used by beneficiaries are as follows:
A. Concentrator and liquid or gaseous portable equipment
B. Concentrator and/or oxygen generating portable equipment
C. Liquid or gaseous stationary equipment and liquid or gaseous portable equipment
D. Liquid or gaseous stationary equipment and oxygen generating portable equipment
E. Concentrator only
F. Liquid or gaseous stationary equipment only
Based on our proposed new payment classes, Medicare payment under these six categories would be as follows:
Category Equipment rental and contents Contents for beneficiary-owned equipment A $209 ($177 + $32) $55 B 241 ($177 + $64) 0 C 209 ($177 + $32) 156 ($101 + $55) D 241 ($177 + $64) 101 E 177 0 F 177 101 We are proposing to revise our regulations in order to implement these new payment classes and payment amounts, effective for claims with dates of service on or after January 1, 2007.
J. Payment for Maintenance and Servicing of Oxygen and Oxygen Equipment and Capped Rental Items
Immediately following passage of the DRA, concerns were raised regarding the ability of a beneficiary to obtain maintenance and servicing of his or her DME once he or she has taken title to it. We believe that these concerns are largely based on misconceptions that the beneficiary will “be on his or her own” in terms of maintenance and Start Printed Page 44099servicing of equipment and submission of claims for payment for these services. We believe that these concerns are unfounded because Medicare payment has traditionally been made for reasonable and necessary repair and maintenance of beneficiary-owned DME. In addition, section 1834(a)(5)(F)(ii)(II)(bb) of the Act, as amended by section 5101(b)(1)(B) of the DRA, requires that Medicare continue to pay for reasonable and necessary maintenance and servicing for parts and labor that is not covered under a manufacturer's or supplier's warranty in amounts determined to be appropriate by the Secretary.
Medicare has also traditionally paid for loaner equipment used while the beneficiary's equipment is being repaired, or in some cases, when the beneficiary does not have access to the equipment (for example, in cases when a natural disaster such as a hurricane forces the beneficiary to be evacuated from his or her home). We are proposing to continue Medicare payment for such loaner equipment.
We are not aware of instances where beneficiaries have encountered problems in finding suppliers to provide maintenance and servicing of beneficiary-owned DME. Section 414.210(e) of our regulations currently provides that reasonable and necessary charges for maintenance and servicing of DME are those charges made for parts and labor not otherwise covered under a manufacturer's or supplier's warranty. This definition has been applied in paying claims for maintenance and servicing of beneficiary-owned DME for several years, and the wording of this regulatory definition is parallel to that used in amended sections 1834(a)(7)(A)(iv) and (a)(5)(F)(ii)(II)(bb) of the Act in describing the “maintenance and servicing” payments that are permitted for capped rental DME and oxygen equipment after title has transferred to the beneficiary. We are proposing to continue use of this existing regulatory definition to define “maintenance and servicing” in section 5101 of the DRA. We would, however, also propose to apply our existing policy of not covering certain routine maintenance or periodic servicing of purchased equipment, such as testing, cleaning, regulating, changing filters, and general inspection of beneficiary-owned DME that can be done by the beneficiary or caregiver, to beneficiary-owned oxygen equipment and to continue that policy for beneficiary-owned capped rental equipment. As specified in current program instructions at section 110.2.B of chapter 15 of the Medicare Benefit Policy Manual (Pub. 100-02), “the owner [of the equipment] is expected to perform such routine maintenance rather than a retailer or some other person who charges the beneficiary.” We expect that the supplier, when transferring title to the equipment to the beneficiary, would also provide to the beneficiary any operating manuals published by the manufacturer which describe the servicing an owner may perform to properly maintain the equipment. We also believe that these owner manuals are commonly available at the various manufacturer Web sites. In addition, the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier standards at § 424.57(c)(12) require suppliers to provide the beneficiary with necessary information and instructions on how to use DME items safely and effectively. We believe that after receiving this information, and after becoming familiar with the equipment during the 13 or 36 month rental period, the beneficiary and/or caregiver should be very knowledgeable regarding the routine maintenance required for the item. All non-routine maintenance of beneficiary-owned oxygen equipment and capped rental items which would need to be performed by authorized technicians would be covered as reasonable and necessary maintenance and servicing. Examples of the types of maintenance that would be covered are currently listed in program instructions at section 110.2.B of chapter 15 of the Medicare Benefit Policy Manual (Pub. 100-02) and include “breaking down sealed components and performing tests which require specialized testing equipment not available to the beneficiary.”
We are proposing that maintenance and servicing of beneficiary-owned oxygen equipment and capped rental items would be reasonable and necessary if it is non-routine maintenance and servicing necessary to make the equipment serviceable. Payment is currently made under the Medicare program for parts and labor associated with repairing beneficiary-owned DME. Medicare allowed payment amounts for replacement parts are currently paid based on the carrier's individual consideration of the item. With regard to replacement parts for beneficiary-owned oxygen equipment or capped rental equipment, we propose that the carrier pay for the parts in a lump sum amount based on its consideration of the cost of the item, as is consistent with what our carriers currently do when evaluating maintenance and servicing claims for other beneficiary-owned DME. Currently, payment for labor is based on 15-minute increments in amounts that are established by the carriers and updated on an annual basis by the same factor specified in section 1834(a)(14) of the Act, which is used to update fee schedule amounts for DME. We are proposing that the carriers use the same fee for labor that is currently used in paying for labor associated with repairing, maintaining, and servicing other beneficiary-owned DME, as we are not aware of any past problems associated with access to these services paid at these rates. We believe that the current methods and fees used by carriers in paying for maintenance and servicing of beneficiary-owned DME are reasonable given that we are not aware of any past problems associated with access to these services paid at these rates. In most cases, neither the Medicare program nor the beneficiary actually pays the full amount for repairing or maintaining an item since manufacturer warranties that cover all or part of these costs are widespread. For example, some manufacturers of commonly used oxygen concentrators offer full warranties that cover all parts and labor for 5 years. Rules in § 414.210(f) regarding replacement of DME that has been in continuous use for the equipment's reasonable useful lifetime provide that the beneficiary can elect to obtain replacement equipment after the reasonable useful lifetime for the equipment has expired. Therefore, we believe that the beneficiary should incur little, if any, expense for repair or maintenance of necessary equipment in cases where manufacturer warranties exist that cover parts and labor necessary to repair a new item during a 5-year period.
K. Payment for Replacement of Beneficiary-Owned Oxygen Equipment, Capped Rental Items, and Associated Supplies and Accessories
Medicare has traditionally paid for replacement beneficiary-owned DME after the expiration of the equipment's useful lifetime (see § 414.210(f) and § 414.229(g) of our regulations), and for replacement supplies and accessories used in conjunction with beneficiary-owned DME when these supplies and accessories are necessary for the effective use of the DME (see § 110.3 of Chapter 15 of the Medicare Benefit Policy Manual (Pub. 100-02)). Examples of supplies include drugs and administration sets used with infusion pumps. Examples of accessories include masks and tubing used with respiratory equipment. We are proposing to apply these policies to beneficiary-owned oxygen equipment, as well as the Start Printed Page 44100supplies and accessories used in conjunction with this equipment, and to continue to apply these policies to beneficiary-owned capped rental items, as well as the supplies and accessories used in conjunction with these items.
Specifically, we are proposing to update § 414.210(f) and § 414.229(g) of our regulations to reflect that payment may be made for the replacement of beneficiary-owned oxygen equipment and capped rental DME in cases where the item is lost, stolen, or irreparably damaged, or in cases where the item has been in continuous use for its reasonable useful lifetime. We propose that payment for the replacement be made on a rental basis in accordance with the payment rules in § 414.226 for oxygen equipment and § 414.229 for capped rental items. We also propose to revise § 414.229 to reflect that these proposed changes to the replacement policy for beneficiary-owned capped rental items only apply to those items for which the first rental month occurs on or after January 1, 2007 since the DRA does not apply to capped rental items for which the first rental month occurs before January 1, 2006. The current rules will remain in place for capped rental items to which the DRA does not apply.
We are aware that some manufacturer warranties may cover replacement of oxygen or capped rental equipment within a certain time period after the item is furnished. As was our policy prior to the enactment of DRA (see § 110.2.C of Chapter 15 of the Medicare Benefit Policy Manual (Pub. 100-02)), we are proposing that Medicare not pay for the replacement of beneficiary-owned oxygen equipment or capped rental items covered by a manufacturer's or supplier's warranty. In cases where equipment replacement is not covered by a manufacturer's or supplier's warranty, we propose that the supplier must still replace beneficiary-owned oxygen equipment or beneficiary-owned capped rental items at no cost to the beneficiary or to the Medicare program if: (1) The total accumulated costs, as illustrated in the example below, to repair the item after transfer of title to the beneficiary exceed 60 percent of the replacement cost; and (2) the item has been in continuous use for less than its reasonable useful lifetime, as established in accordance with the procedures set forth in proposed revised § 414.210(f). For example, a capped rental item that can be replaced for $1,000 (total of fee schedule payments after 13 rental months) and for which title has transferred to the beneficiary in accordance with section 1834(a)(7)(A)(ii) of the Act can be used to illustrate what we mean when we use the term “accumulated costs” above. In this example, if Medicare has paid a total of $500 for 3 repairs necessary to make the item functional, and a fourth repair costing $200 is needed in order to make the item functional, the accumulated costs for repair in this case will equal $700, which exceeds $600 or 60 percent of the $1,000 cost to replace the item. In this case, and therefore the supplier would be required to furnish a replacement item. The greater than 60 percent of cost threshold for replacement is consistent with the threshold repair costs that can result in the replacement of prosthetics (artificial limbs) in accordance with section 1834(h)(1)(G) of the Act. We believe this threshold should apply to oxygen equipment and capped rental items as well, because artificial limbs, like these items, are built to withstand repeated use.
We propose that the supplier be responsible for the cost of the replacement equipment because we believe that the item in this case did not last for the entire reasonable useful lifetime. After the beneficiary acquires title to the item, the supplier that transferred title would be responsible for furnishing the replacement item. We are proposing this provision to safeguard the beneficiary from receiving, and the Medicare program from paying for, substandard equipment, and to avoid creating an incentive for suppliers to increase the number of claims submitted for repairs in an effort to recover revenue lost as a result of DRA section 5101. We believe that this requirement is not unreasonable since suppliers should be furnishing items in good working order and are otherwise bound by regulations at § 424.57(c)(15) to accept returns from beneficiaries of substandard items. Exceptions to this rule may be granted by CMS or the carrier as appropriate (for example, the supplier would not be responsible for replacing an item in need of repair due to beneficiary neglect or abuse).
L. Periods of Continuous Use
Rules that apply in determining a period of continuous use for rental of DME are found at § 414.230 of our regulations. We are proposing that these rules would continue to apply in implementing section 5101 of the DRA, with one exception. The rules in § 414.230(f) provide that a new period of continuous use begins for new or additional equipment prescribed by a physician and found to be medically necessary, even if the new or additional equipment is similar to the old equipment.
Medicare payments for stationary and portable oxygen and oxygen equipment are currently modality neutral, which means that the same payment amounts apply to the different types of oxygen equipment furnished to Medicare beneficiaries. Since there is no distinction made between oxygen equipment modalities for payment purposes under the Medicare program, we do not believe that it is necessary or appropriate to begin a new period of continuous use when the beneficiary changes from one oxygen equipment modality to another. We are proposing to revise § 414.230(f) of our regulations to designate the existing language in this section as paragraph (f)(1) and to add a new paragraph (f)(2) to reflect this exception, effective for oxygen equipment furnished on or after January 1, 2007. We are also proposing to revise § 414.230(b) to incorporate section 5101(b)(2)(B) of the DRA, which provides that for all beneficiaries receiving oxygen equipment paid for under section 1834(a) on December 31, 2005, the period of continuous use begins on January 1, 2006.
M. Health Care Information Transparency and Health Information Technology
(If you choose to comment on issues in this section, please include the caption “Health Care Information Transparency and Health Information Technology” at the beginning of your comment.)
In the April 25, 2006 Inpatient Prospective Payment Systems proposed rule (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 discussed several potential options for making 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 sought comments 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 Start Printed Page 44101use 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 sought comments on the appropriate role of HIT in potential value-based purchasing programs, 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 sought comments on promotion of the use of effective HIT and how CMS can encourage its use in HHAs.
We intend to consider both the health care information transparency initiative and the use of HIT as we refine and update all Medicare payment systems. Therefore, we seek comments on these initiatives as applied to HH PPS in this proposed rule, including the Department's statutory authority to impose any such requirements. We may address these initiatives in the final HH PPS rule. For example, a HIT proposal could include adding a requirement that HHAs use HIT that is compliant with and certified by the Certification Commission for Health Information Technology (CCHIT) in the areas in which the technology is available. As noted previously, we currently collect home health quality information and propose to collect additional quality data and report it on the CMS Home Health Compare Web site. We note that we are in the process of seeking input on these initiatives in various proposed Medicare payment rules being issued this year.
III. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, we are required to provide 60-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues:
- The need for the information collection and its usefulness in carrying out the proper functions of our agency.
- The accuracy of our estimate of the information collection burden.
- The quality, utility, and clarity of the information to be collected.
- Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.
We are soliciting public comment on each of these issues for the following sections of this document that contain information collection requirements:
Section 414.226—Oxygen and Oxygen Equipment
This section proposes to require a supplier to disclose to the beneficiary whether or not the supplier will accept assignment of all monthly rental claims for oxygen equipment for the duration of the 36-month rental period.
The burden associated with this requirement is the time and effort put forth by the supplier to disclose this information. While this information collection is subject to the PRA, we believe this requirement meets the requirements of 5 CFR 1320.3(b)(2), and as such, the burden associated with this requirement is exempt from the PRA.
Section 414.229—Other Durable Medical Equipment-Capped Rental Items
This section proposes to require a supplier to disclose to the beneficiary whether or not the supplier will accept assignment of all monthly rental claims for capped rental DME for the duration of the 13-month rental period.
The burden associated with this requirement is the time and effort put forth by the supplier to disclose this information. While this information collection is subject to the PRA, we believe this requirement meets the requirements of 5 CFR 1320.3(b)(2), and as such, the burden associated with this requirement is exempt from the PRA.
We have submitted a copy of this proposed rule to OMB for its review of the information collection requirements described above. These requirements are not effective until they have been approved by OMB.
If you comment on these information collection and recordkeeping requirements, please mail copies directly to the following:
Centers for Medicare & Medicaid Services, Office of Strategic Operations and Regulatory Affairs, Division of Regulations Development, Attn: Melissa Musotto, [CMS-1304-P], Room C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850; and
Office of Information and Regulatory Affairs, Office of Management and Budget, Room 10235, New Executive Office Building, Washington, DC 20503, Attn: Carolyn Lovette, CMS Desk Officer, CMS-1304-P, carolyn_lovett@omb.eop.gov. Fax (202) 395-6974.
IV. Response to Comments
Because of the large number of public comments we normally receive on Federal Register documents, we are not able to acknowledge or respond to them individually. We would consider all comments we receive by the date and time specified in the DATES section of this preamble, and, when we proceed with a subsequent document, we would respond to the comments in the preamble to that document.
V. Regulatory Impact Analysis
[If you choose to comment on issues in this section, please include the caption “REGULATORY IMPACT ANALYSIS” at the beginning of your comments.]
A. Overall Impact
We have examined the impacts of this 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 (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). This proposed rule would be a major rule, as defined in Title 5, United States Code, section 804(2), because we estimate the impact to the Medicare Program, and the annual effects to the overall economy, would be more than $100 million. The update set forth in this proposed rule would apply to Medicare payments under HH PPS in CY 2007. Accordingly, the following analysis describes the impact in CY 2007 only. We estimate that there would be an additional $420 million in CY 2007 expenditures attributable to the CY 2007 proposed estimated home health market basket update of 3.1 percent.
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 small government agencies. Most hospitals and most other providers and suppliers Start Printed Page 44102are small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year. For purposes of the RFA, approximately 75 percent of HHAs are considered small businesses according to the Small Business Administration's size standards with total revenues of $11.5 million or less in any 1 year. Individuals and States are not included in the definition of a small entity. As stated above, this proposed rule would provide an update to all HHAs for CY 2007 as required by statute. This proposed rule would have a significant positive effect upon small entities that are HHAs.
Based on our analysis of 2003 claims data, we also estimate that approximately 90 percent of registered DME suppliers are considered small businesses according to the Small Business Administration's size standards. The size standard for NAICS code, 532291, Home Health Equipment Rental is $6 million. (see http://www.sba.gov/size/sizetable2002.html, read May 9, 2005.) This proposed rule would reduce payments for oxygen equipment and capped rental items; and therefore, would have a significant negative effect upon small entities that are DME suppliers overall. However, as explained in detail below, we believe that Medicare payments would still be adequate for the items affected by this rule and that suppliers whose primary line of business involves furnishing these items will remain profitable.
In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area and has fewer than 100 beds. We have determined that this proposed rule would not have a significant economic impact on the operations of a substantial number of small rural hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4) also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditure in any 1 year by State, local, or tribal governments, in the aggregate, or by the private sector, of $120 million. We believe this proposed rule would not mandate expenditures in that amount.
Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. We have reviewed this rule under the threshold criteria of Executive Order 13132, Federalism. We have determined that this proposed rule would not have substantial direct effects on the rights, roles, and responsibilities of States.
B. Anticipated Effects
1. Home Health PPS
This proposed rule would update the HH PPS rates contained in Pub. 100-20, One Time Notification, Transmittal 211, published February 10, 2006. We updated the rates in the CY 2006 final rule (70 FR 68132, November 9, 2005) through Transmittal 211 to take account of the DRA changes, specifically the 0 percent update and the rural add-on. The impact analysis of this proposed rule presents the projected effects of the proposed change from the CY 2006 transition wage index (50/50 blend of MSA-based and CBSA-based designations) to the CY 2007 proposed CBSA-based designations in determining the wage index used to calculate the HH PPS rates for CY 2007. We estimate the effects by estimating payments while holding all other payment variables constant. We use the best data available, but we do not attempt to predict behavioral responses to these changes, and we do not make adjustments for future changes in such variables as days or case-mix.
This analysis incorporates the latest estimates of growth in service use and payments under the Medicare home health benefit, based on the latest available Medicare claims from 2004. We note that certain events may combine to limit the scope or accuracy of our impact analysis, because such an analysis is future-oriented and, thus, susceptible to forecasting errors due to other changes in the forecasted impact time period. Some examples of such possible events are newly-legislated general Medicare program funding changes made by the Congress, or changes specifically related to HHAs. In addition, changes to the Medicare program may continue to be made as a result of the BBA, the BBRA, the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, the MMA, the DRA, or new statutory provisions. Although these changes may not be specific to HH PPS, the nature of the Medicare program is such that the changes may interact, and the complexity of the interaction of these changes could make it difficult to predict accurately the full scope of the impact upon HHAs.
Our discussion for this proposed rule will focus on the impact of changes in the wage index, most notably the adoption of the full CBSA designations. The impacts of the updated wage data are shown in Table 9 below. The breakdown of the various impacts displayed in the table follows.
The rows display the estimated effect of the proposed changes on different categories. The first row of figures represents the estimated effects on all facilities. The next 2 rows show the effect on urban and rural facilities. This is followed, in the next 4 rows, by impacts on urban and rural facilities based on whether they are a hospital-based or freestanding facility. The next 20 rows show the effect on urban and rural facilities based on the census region in which they are located.
The first column shows the breakdown of all HHAs by urban or rural status, hospital-based or freestanding status, and census division.
The second column in the table shows the number of facilities in the impact database. A facility is considered urban if it is located in a CBSA and, conversely, rural if it is not located in a CBSA.
The third column of the table shows the effect of the proposed annual update to the wage index. This represents the effect of using the most recent wage data available to determine the proposed estimated home health market basket update. The total impact of this change is −0.1 percent; however, there are distributional effects of the change.
The fourth column of the table shows the effect of all the changes on the proposed CY 2007 payments. The proposed estimated market basket update of 3.1 percentage points is constant for all providers and, though not shown individually, is included in this column. It is projected that total aggregate payments would increase by 3.0 percent, assuming facilities do not change their care delivery and billing practices in response.
As can be seen from this table, the combined effects of all of the changes would vary by specific types of providers and by location. For example, HHAs in the rural Pacific show the largest estimated increase in payment at 10.3 percent, while HHAs in the rural Mountain census division show the smallest increase in payments at 0.5 percent. Rural HHAs do somewhat better than urban HHAs, seeing an estimated increase in payments of 3.3 percent and 2.9 percent respectively. Amongst the different type of facility categories, freestanding rural HHAs do Start Printed Page 44103best, with an estimated increase in payments of 3.5 percent. Hospital-based urban HHAs are next with an estimated increase in payments of 3.2 percent with hospital-based rural and freestanding urban HHAs with estimated increases of 3.1 percent and 2.8 percent, respectively.
Table 9.—Projected Impact of CY 2007 Update to the HH PPS
Number of facilities Updated wage data (percent) Total CY 2007 change (percent) Total 7,370 −0.1 3.0 Urban 2,097 −0.2 2.9 Rural 5,273 0.2 3.3 Hospital based urban 1,988 0.1 3.2 Freestanding urban 3,285 −0.3 2.8 Hospital based rural 1,201 0.0 3.1 Freestanding rural 896 0.4 3.5 Urban by region: New England 254 −1.1 2.0 Middle Atlantic 423 0.0 3.1 South Atlantic 913 −0.5 2.6 East North Central 886 0.3 3.5 East South Central 222 −0.4 2.7 West North Central 304 0.3 3.4 West South Central 1,300 −0.6 2.4 Mountain 281 1.7 4.8 Pacific 649 0.2 3.3 Outlying 41 −4.8 −1.8 Rural by region: New England 43 −0.7 2.3 Middle Atlantic 82 0.3 3.4 South Atlantic 239 −0.6 2.5 East North Central 284 1.5 4.6 East South Central 215 −0.3 2.8 West North Central 488 0.3 3.4 West South Central 475 −0.3 2.8 Mountain 173 −2.5 0.5 Pacific 88 6.9 10.3 Outlying 10 7.7 11.1 The impact of the proposed wage index for CY 2007 is shown in Addendum C to this document. Addendum C to this document shows a side-by-side comparison, by State and county code, of the CY 2006 transition wage index, which was a 50/50 blend of MSA-based and CBSA-based pre-floor, pre-reclassified hospital wage indexes, and the proposed CY 2007 pre-floor, pre-reclassified hospital wage index for the CY 2007 HH PPS update. In the last column of Addendum C to this document, we show the percentage change in the wage index from CY 2006 to the proposed wage index for CY 2007.
We estimate that there would be an additional $420 million in CY 2007 expenditures attributable to the CY 2007 proposed estimated market basket (3.1 percent) increase. Thus, the anticipated expenditures outlined in this proposed rule would exceed the $100 million annual threshold for a major rule as defined in Title 5, USC, section 804(2).
This proposed rule would have a positive effect on providers of Medicare home health services by increasing their Medicare payment rates. It is anticipated that very few HHAs will not submit the quality data required by section 1895(b)(3)(B)(v)(II)of the Act necessary to receive the full market basket percentage increase. Submission of OASIS data is a Medicare condition of participation for HHAs. Therefore, one would expect that no HHA would be subject to the 2 percent reduction in payments in CY 2007. As indicated in the rule, most HHAs that do not report OASIS provide pediatric, non-Medicare, or personal care only. However, CMS is aware of instances of non-compliance among a very small portion of HHAs with regard to OASIS submission.
For the purposes of the CY 2007 impact analysis, we anticipate that less than 1 percent of HHAs, involving less than 1 percent of total Medicare HH payments, would fail to submit quality data and hence would be subject to the 2 percent reduction. This is not enough to impact the estimated $420 million in additional expenditures. Finally, we do not believe there is a differential impact due to the aggregate nature of the update. We do not anticipate specific effects on other providers.
2. Oxygen and Oxygen Equipment Provisions
As mandated by the DRA of 2005, this proposed rule limits to 36 months the total number of continuous months for which Medicare would pay for oxygen equipment, after which the title to the oxygen equipment would be transferred from the supplier to the beneficiary. Since Medicare currently pays for oxygen equipment on a monthly basis for as long as it is medically necessary, this change would result in savings to Medicare. In addition, the DRA mandates that Medicare continue to make monthly payments for furnishing contents for beneficiary-owned oxygen equipment.
Close to a million patients now receive oxygen therapy. Although monthly rental payments already have been reduced by 30 percent by section 4552 of the Balanced Budget Act of 1997 and approximately 10 percent by section 302(c)(2) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Medicare allowed charges rose to $2.78 billion by 2004, a 71 percent increase since 1998 that reflects the growing use. Before the Start Printed Page 44104amendments to section 1834(a)(5) of the Act made by the DRA, Medicare continued to make rental payments for as long as medical necessity continued, even when the total payments greatly exceeded the cost of purchasing the equipment and the supplier retained title to the equipment. We believe the DRA amendments to the Act will result in a loss of revenue to suppliers that will no longer receive payments for oxygen equipment after the 36th month of continuous use.
Based on data for items furnished in calendar year 2004, oxygen concentrators accounted for over 93 percent of Medicare utilization for stationary oxygen systems, in terms of both allowed charges and allowed services. Since oxygen concentrators can typically be purchased for $1,000 or less, we believe that 36 months of payment at approximately $200 per month would ensure the supplier is reimbursed for its cost for furnishing the equipment. The $200 allowed payment amount may be re-adjusted in the future to assure that payments are adequate, but not excessive. This could be accomplished though the competitive acquisition programs mandated by section 1847 of the Act or in accordance with our authority for adjusting fee schedule amounts at section 1842(b)(8) and (9) of the Act. Based on our data, approximately 36 percent of Medicare beneficiaries use oxygen equipment for more than 3 years and approximately 20 percent of Medicare beneficiaries use oxygen equipment for more than 5 years. In section K of the “provisions of the proposed regulation section of this preamble,” we propose to allow beneficiaries to obtain replacement oxygen equipment in cases where their equipment has been in continuous use for the reasonable useful lifetime of the equipment. Unless CMS or its carriers establish a specific reasonable useful lifetime for oxygen equipment, the default lifetime for DME of 5 years would apply. The main effect of this rule on suppliers is that they will not be able to receive payment for the equipment beyond 36 months for approximately 36 percent of Medicare patients. They will also not be able to receive payment for furnishing the same item to subsequent patients in these cases since they lose title to the equipment. In the case of oxygen concentrator systems and portable oxygen transfilling systems, delivery of oxygen contents is not necessary, and therefore, payment will not be made for the furnishing of contents for these types of beneficiary owned equipment. Under the old payment rules, payment for oxygen concentrators used for stationary equipment purposes would have continued at approximately $200 per month for the entire period of medical need. Section 5101(b) of the DRA mandates that payment for oxygen equipment end and that title to the equipment transfer after 36 months of continuous use.
In the case of liquid and gaseous oxygen systems, suppliers will continue to be paid for furnishing oxygen contents for beneficiary-owned systems. The current statewide monthly payment amounts for oxygen and oxygen equipment that would be paid during the 36-month period of continuous use for beneficiaries who only use stationary equipment range from $194.48 to $200.41, with the average statewide fee being $199.36. The current statewide monthly payment amount for furnishing oxygen contents for beneficiary owned equipment range from $137.54 to $198.12, with the average statewide fee being $156.07. The average decrease in Medicare fee schedule amounts that may result from the DRA changes for liquid and gaseous systems after the 36-month period (that is, shift from monthly payments for equipment and contents to monthly payments for contents only), is expected to be $43.29 ($199.36−$156.07). Therefore, this is the level of monthly reimbursement that would be lost after the 36-month period for suppliers that furnish oxygen and oxygen equipment to beneficiaries in these situations and who continue to furnish contents to these beneficiaries. Based on current fee schedule amounts for all oxygen and oxygen equipment, this equates to an average reduction in payment (from $199.36 to $156.07) of approximately 22 percent.
At the current monthly statewide fee schedule rates, which range from $194.48 to $200.41, suppliers of oxygen equipment are expected to be paid from $7,001.28 to $7,214.76 over 36 months. By comparison, a medical center operated by the Department of Veterans Affairs (VA) in Tampa, Florida, is the largest VA center in terms of number of veterans on oxygen therapy and services approximately 1,000 patients on oxygen by contracting with a locally based manufacturer to purchase the oxygen concentrators for $895 each. The medical center contracts with a local supplier for $90 to deliver and set up the concentrator to the patient's home. This local supplier also provides service and maintenance of the equipment at any time throughout the year for $48 per service episode. If the equipment needs to be replaced, the local supplier will furnish another concentrator for a $90 fee. The VA total payments over 5 years for an oxygen concentrator used by a veteran in this center plus payment for ten episodes of maintenance and servicing, assuming servicing every 6 months, would be $1,435, compared to total Medicare allowed charges of $7,164, on average, for a Medicare beneficiary. Based on this comparison, the Medicare payment amounts and methodology appear to be more than adequate.
We do not anticipate that transfer of ownership for oxygen equipment to the beneficiary after 36 months of continuous use would be a significant financial burden to suppliers because the effect is limited to a maximum of 36 percent of a supplier's Medicare business and because suppliers of oxygen equipment primarily furnish lower cost oxygen concentrators. We also do not anticipate a significant change in the rate of assignment of claims for oxygen equipment based on our belief that suppliers will be adequately reimbursed for furnishing the oxygen equipment.
Finally, if new oxygen and oxygen equipment classes and payment amounts are established in accordance with the proposed provisions in section I of this rule, there could potentially be a shift in utilization between the various oxygen equipment modalities, which could impact supplier revenues and sales volume for certain oxygen equipment manufacturers. However, since use of the authority to create such classes under section 1834(a)(9)(D) of the Act requires that these changes be budget-neutral, there would not a significant impact on overall Medicare payments to suppliers.
3. Capped Rental DME
This proposed rule, which limits to 13 months the total number of continuous months for which Medicare would pay for capped rental DME, after which the ownership of the capped rental item would be transferred from the supplier to the beneficiary, would result in significant savings for the Medicare program. Savings would be realized through: (1) The gradual elimination of rental payments for the 14th and 15th months of continuous use; and (2) changing the semi-annual payment for maintenance and servicing to payment only when reasonable and necessary maintenance and servicing is needed. We anticipate that suppliers may lose money due to the loss of 1 to 2 months rental in cases where beneficiaries need the item for more than 13 months and would not have otherwise selected the purchase option currently described in § 414.229(d). The average of the 2006 fee schedule amounts for all capped rental Start Printed Page 44105items for months 14 and 15 is approximately $152. We do not believe suppliers will suffer financially as a result of this provision based on data which shows that in 2004, 97 percent of suppliers accepted assignment for beneficiaries who chose the purchase option (§ 414.229(d)) in the 11th month of a capped rental period. This is an indication that suppliers were willing to accept the Medicare payment as payment in full for the capped rental item, even though they had been informed that the beneficiary would take over ownership of the item after the 13th month of continuous use. Therefore, we do not anticipate that transfer of ownership for capped rental equipment to the beneficiary after 13 months of continuous use would be a significant financial burden to suppliers.
For items for which the first rental payment falls on or after January 1, 2006, Medicare would only pay for maintenance and servicing as necessary. In a June 2002 report (OEI-03-00-00410), the Office of Inspector General (OIG) indicated that only 9 percent of the capped rental equipment with a June 2000 service date actually received any servicing between June and December 2000. Out of the $7.3 million Medicare paid for maintenance services from June 2000, we estimate that $6.5 million was paid for equipment that received no actual servicing. The OIG recommended to CMS in 2002 that we eliminate the semi-annual maintenance payment currently allowed for capped rental equipment and pay only for repairs when needed.
The combination of these two factors provides strong evidence that the Medicare rules for paying for maintenance and servicing of capped rental equipment furnished before January 1, 2006, were not cost-effective.
Impact on Beneficiaries
The DRA provisions and this proposed rule would result in savings for Medicare beneficiaries using oxygen equipment and capped rental items. For capped rental items, Medicare payments will be made for 13 continuous months and for oxygen equipment, payments will be made for 36 continuous months. After the rental period for each category of equipment expires, ownership of the equipment will transfer from the suppliers to the beneficiaries. Beneficiaries will continue to be financially responsible for a 20 percent coinsurance payment during the 13 or 36 month rental periods for capped rental items and oxygen equipment, respectively. However, beneficiaries will no longer have to make a monthly 20 percent coinsurance payment for the equipment after they own it. This will result in significant savings to beneficiaries.
For example, before the DRA, Medicare and the beneficiary made continuous payments for the rental of oxygen equipment that totaled about $200 per month. Of this amount, the beneficiary paid coinsurance of $40 which would equal $480 for a single year's rental, $1,440 over 36 months, and $2,400 over 5 years. After the DRA, beneficiaries will only pay a coinsurance amount for up to 36 months for the rental of oxygen equipment, after which time they will own the equipment. Thus, the DRA oxygen provisions result in savings of approximately $480 if beneficiaries use the equipment for 4 years, and $960 if they use the equipment for 5 years.
For capped rental items, beneficiaries will save coinsurance by not being responsible for any equipment payment after the 13th rental month or the semi-annual maintenance and servicing payment that was approximately equal to 10 percent of the purchase price for the equipment. Before the DRA, Medicare and the beneficiary would pay up to 15 months for capped rental items, and Medicare and the beneficiary would also pay for maintenance and servicing every six months. Thus, beneficiaries will save coinsurance payments related to both the equipment itself and the maintenance and servicing of that equipment.
The proposed rule would assure beneficiaries that suppliers that furnish the equipment for the first month would continue to furnish the equipment for the entire 36-month period of continuous use for oxygen equipment or the 13-month period of continuous use for capped rental.
Beneficiaries would also be assured that their oxygen and capped rental equipment would not be impermissibly swapped by the supplier at any time during the rental period. Under the proposed rule, we propose that a supplier may not provide different rented equipment to the beneficiary at any time during the 36 rental months for oxygen equipment or the 13 rental months for capped rental DME unless one of the following exceptions apply: The equipment is lost, stolen, or irreparably damaged; the equipment is being repaired while loaner equipment is in use; there is a change in the beneficiary's medical condition; or the carrier determines that a change in equipment is otherwise warranted.
We are proposing that suppliers inform beneficiaries whether they will accept or not accept assignment on all monthly rental claims during the 13-month rental period for capped rental items or the 36-month rental period for oxygen equipment in an upfront manner.
The proposed rule would also assure beneficiaries that following the transfer of title, the supplier would replace the item at no cost to the beneficiary in cases where the accumulated costs of repair exceed 60 percent of the cost of replacement, if the reasonable useful lifetime of the item (currently a default period of 5 years) has not expired.
C. Accounting Statement
As required by OMB Circular A-4 (available at ), http://www.whitehouse.gov/omb/circulars/a004/a-4.pdf) in Table 10 below, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this proposed rule. This table provides our best estimate of the increase in Medicare payments under the HH PPS as a result of the changes presented in this final rule based on the data for 7,370 HHAs in our database. All expenditures are classified as transfers to Medicare providers (that is, HHAs).
Table 10.—Accounting Statement: Classification of Estimated Expenditures, From CY 2006 to CY 2007
[In millions]
Category Transfers Annualized monetized transfers $420 From whom to whom? Federal Government to HHAs. In Table 11 below, we have prepared an accounting statement showing the classification of the expenditures associated with the DME provisions of this final rule. This table provides our best estimate of the decrease in Medicare payments under the DME benefit as a result of the changes presented in this final rule based on the 2004 allowed charge data for oxygen and capped rental DME in our database. All expenditures are classified as transfers to the Medicare program and its beneficiaries.
Table 11.—Accounting Statement: Classification of Estimated Expenditures
[In millions]
Category Transfers Monetized transfers in FY 2007 $80 Start Printed Page 44106 Monetized transfers in FY 2008 130 Monetized transfers in FY 2009 170 Monetized transfers in FY 2010 220 Monetized transfers in FY 2011 280 From whom to whom? Suppliers to Federal Government and beneficiaries. In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
Start List of SubjectsList of Subjects
42 CFR Part 414
- Administrative practice and procedure
- Health facilities
- Health professions
- Kidney diseases
- Medicare
- Reporting and recordkeeping requirements
42 CFR Part 484
- Health facilities
- Health professions
- Medicare
- Reporting and recordkeeping requirements
For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services would amend 42 CFR chapter IV as set forth below:
Start PartPART 414—PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES
Subpart D—Payment for Durable Medical Equipment and Prosthetic and Orthotic Devices
1. The authority citation for part 414 continues to read as follows:
2. Amend § 414.210 as follows:
A. Revise paragraph (e).
B. Revise the introductory text to paragraph (f).
C. Revise paragraph (f)(2)
D. Add new paragraphs (f)(3) and (f)(4).
The revisions read as follows:
General payment rules.* * * * *(e) Maintenance and servicing.—(1) General rule. Except as provided in paragraph (e)(2) of this section, the carrier pays the reasonable and necessary charges for maintenance and servicing of beneficiary-owned equipment. Reasonable and necessary charges are those made for parts and labor not otherwise covered under a manufacturer's or supplier's warranty. Payment is made for replacement parts in a lump sum based on the carrier's consideration of the item. The carrier establishes a reasonable fee for labor associated with repairing, maintaining, and servicing the item. Payment is not made for maintenance and servicing of a rented item other than the maintenance and servicing fee for other durable medical equipment as described in § 414.229(e).
(2) Exception. For items purchased on or after June 1, 1989, no payment is made under the provisions of paragraph (e)(1) of this section for the maintenance and servicing of:
(i) Items requiring frequent and substantial servicing, as defined in § 414.222(a);
(ii) Capped rental items, as defined in § 414.229(a), that are not beneficiary-owned in accordance with § 414.229(d) or § 414.229(h); and
(iii) Oxygen equipment, as described in § 414.226, that is not beneficiary-owned in accordance with § 414.226(e).
(3) Supplier replacement of beneficiary-owned equipment based on accumulated repair costs. A supplier that transfers title to oxygen equipment or a capped rental item to a beneficiary in accordance with § 414.226(f) or § 414.229(f)(2) is responsible for furnishing replacement equipment at no cost to the beneficiary or to the Medicare program if the total repair costs that accumulate for the equipment after transfer of title exceed 60 percent of the cost to replace the equipment and the equipment has been in use for less than its reasonable useful lifetime, as determined under § 414.210(f)(1).
(f) Payment for replacement of equipment. If a beneficiary-owned item of DME or a prosthetic or orthotic device paid for under this subpart has been in continuous use by the patient for the equipment's reasonable useful lifetime or if the carrier determines that the item is lost, stolen, or irreparably damaged, the patient may elect to obtain a new piece of equipment.
* * * * *(2) If the beneficiary elects to obtain replacement oxygen equipment, payment is made in accordance with § 414.226(a).
(3) If the beneficiary elects to obtain a replacement capped rental item, payment is made in accordance with § 414.229(a)(2) or (a)(3).
(4) For all other beneficiary-owned items, if the beneficiary elects to obtain replacement equipment, payment is made on a purchase basis.
3. Amend § 414.226 by—
A. Revising paragraph (a) and the heading of paragraph (b).
B. Revising paragraph (b)(3).
C. Adding paragraphs (b)(4) and (b)(5).
D. Redesignating paragraph (d) as paragraph (e).
E. Redesignating paragraph (c) as paragraph (d).
F. Revising newly redesignated paragraph (d).
G. Adding a new paragraph (c).
H. Revising newly redesignated paragraph (e)(1) introductory text.
I. Revising newly redesignated paragraph (e)(1)(i).
. Revising newly redesignated paragraph (e)(2)(i).
K. Revising newly redesignated paragraph (e)(2)(ii).
L. Adding new paragraphs (f) and (g).
The revisions and additions read as follows:
Oxygen and oxygen equipment.(a) Payment rules. (1) Oxygen equipment. Payment for rental of oxygen equipment is made based on a monthly fee schedule amount during the period of medical need, but for no longer than a period of continuous use of 36 months. A period of continuous use is determined under the provisions in § 414.230.
(2) Oxygen contents. Payment for purchase of oxygen contents is made based on a monthly fee schedule amount until medical necessity ends.
(b) Monthly fee schedule amount for items furnished prior to 2007.
* * * * *(3) For 1991 through 2006, the fee schedule amounts for items described in paragraphs (b)(1)(iii) and (iv) of this section are determined using the methodology contained in § 414.220 (d), (e), and (f).
(4) For 1991 through 2006, the fee schedule amounts for items described in paragraphs (b)(1)(i) and (ii) of this section are determined using the methodology contained in § 414.220 (d), (e), and (f).
(5) For 2005 and 2006, the fee schedule amounts determined under paragraph (b)(4) of this section are reduced using the methodology described in § 1834(a)(21)(A) of the Act.
(c) Monthly fee schedule amount for items furnished for years after 2006. (1) Monthly fee schedule amounts are separately calculated for the following items:
(i) Stationary oxygen equipment (including stationary concentrators) and oxygen contents (stationary and portable). Start Printed Page 44107
(ii) Portable equipment only (gaseous or liquid tanks).
(iii) Oxygen generating portable equipment only.
(iv) Stationary oxygen contents only.
(v) Portable oxygen contents only.
(2) The nationwide fee schedule amount for items described in paragraph (c)(1)(i) of this section is equal to the average fee schedule amount established under paragraph (b)(5) of this section reduced by $22.
(3) The nationwide fee schedule amount for items described in paragraph (c)(1)(ii) of this section is equal to the average of the fee schedule amounts established under paragraph (b)(5) of this section.
(4) The nationwide fee schedule amount for items described in paragraph (c)(1)(iii) of this section is equal to the sum of the average of the fee schedule amounts established under paragraph (b)(5) of this section for items described in paragraph (b)(1)(i) of this section and the average of the fee schedule amounts established under paragraph (b)(5) of this section for items described in paragraph (b)(1)(ii) of this section, increased by $10, and reduced by the nationwide fee schedule amount established under paragraph (c)(2) of this section.
(5) The nationwide fee schedule amount for items described in paragraph (c)(1)(iv) of this section is equal to 65 percent of the average fee schedule amount established under paragraph (b)(3) of this section for items described in paragraph (b)(1)(iii) of this section.
(6) The nationwide fee schedule amount for items described in paragraph (c)(1)(v) of this section is equal to 35 percent of the average fee schedule amount established under paragraph (b)(3) of this section for items described in paragraph (b)(1)(iii) of this section.
(d) Application of monthly fee schedule amounts. (1) The fee schedule amount for items described in paragraph (c)(1)(i) of this section is paid when the beneficiary rents stationary oxygen equipment.
(2) Subject to the limitation set forth in paragraph (e)(2) of this section, the fee schedule amount for items described in paragraph (c)(1)(ii) and (iii) of this section is paid when the beneficiary rents portable oxygen equipment.
(3) The fee schedule amount for items described in paragraph (c)(1)(iv) of this section is paid when the beneficiary owns stationary oxygen equipment that requires delivery of gaseous or liquid oxygen contents.
(4) The fee schedule amount for items described in paragraph (c)(1)(v) of this section is paid when the beneficiary owns portable oxygen equipment described in paragraph (c)(1)(ii) of this section, or rents portable oxygen equipment described in paragraph (c)(1)(ii) of this section and does not rent stationary oxygen equipment.
(e) Volume adjustments. (1) The fee schedule amount for an item described in paragraph (c)(1)(i) of this section is adjusted as follows:
(i) If the attending physician prescribes an oxygen flow rate exceeding four liters per minute, the fee schedule amount is increased by 50 percent, subject to the limit in paragraph (e)(2) of this section.
* * * * *(2) * * *
(i) The sum of the monthly fee schedule amount for the items described in paragraphs (c)(1)(i) and (ii) or (iii) of this section; or
(ii) The adjusted fee schedule amount described in paragraph (e)(1)(i) of this section.
* * * * *(f) Ownership of equipment. On the first day that begins after the 36th continuous month in which payment is made for oxygen equipment under paragraph (a)(1) of this section, the supplier must transfer title to the oxygen equipment to the beneficiary.
(g) Additional supplier requirements for rentals that begin on or after January 1, 2007. (1) The supplier that furnishes oxygen equipment for the first month during which payment is made under this section must continue to furnish the equipment until medical necessity ends, or the 36-month period of continuous use ends, whichever is earlier, unless-(i) The item becomes subject to a competitive acquisition program implemented in accordance with section 1847(a) of the Act;
(ii) The beneficiary relocates to an area that is outside the normal service area of the supplier that initially furnished the equipment;
(iii) The beneficiary elects to obtain oxygen equipment from a different supplier prior to the expiration of the 36-month rental period; or
(iv) CMS or the carrier determines that an exception should apply in an individual case based on the circumstances.
(2) Oxygen equipment furnished under this section may not be replaced by the supplier prior to the expiration of the 36-month rental period unless:
(i) The equipment is lost, stolen, or irreparably damaged;
(ii) The furnishing of loaner equipment is necessary while the equipment is being repaired;
(iii) The equipment is no longer medically necessary; or
(iv) The equipment is replaced in accordance with § 414.210(e)(3) or (f).
(3) Before furnishing oxygen equipment, the supplier must disclose to the beneficiary its intentions regarding whether it will accept assignment of all monthly rental claims for the duration of the rental period. A supplier's intentions could be expressed in the form of a written agreement between the supplier and the beneficiary.
4. Amend § 414.229 by—
A. Revising paragraphs (a), (f) and (g).
B. Adding paragraph (h).
The revisions and additions read as follows:
Other durable medical equipment-capped rental items.(a) General payment rule. Payment is made for other durable medical equipment that is not subject to the payment provisions set forth in §§ 414.220 through 414.228 as follows:
(1) For items furnished prior to January 1, 2006, payment is made on a rental or purchase option basis in accordance with the rules set forth in paragraphs (b) through (e) of this section.
(2) For items other than power-driven wheelchairs furnished on or after January 1, 2006, payment is made in accordance with the rules set forth in paragraph (f) of this section.
(3) For power-driven wheelchairs furnished on or after January 1, 2006, payment is made in accordance with the rules set forth in paragraphs (f) or (h) of this section.
* * * * *(f) Rules for Capped Rental Items Furnished Beginning on or after January 1, 2006. (1) For items furnished on or after January 1, 2006, payment is made based on a monthly rental fee schedule amount during the period of medical need, but for no longer than a period of continuous use of 13 months. A period of continuous use is determined under the provisions in § 414.230.
(2) The supplier must transfer title to the item to the beneficiary on the first day that begins after the 13th continuous month in which payments are made under paragraph (f)(1) of this section.
(3) Payment for maintenance and servicing of beneficiary-owned equipment is made in accordance with § 414.210(e).
(g) Additional supplier requirements for capped rental items that are furnished beginning on or after January 1, 2007. (1) The supplier that furnishes an item for the first month during which payment is made using the methodology described in paragraph (f)(1) of this Start Printed Page 44108section must continue to furnish the equipment until medical necessity ends, or the 13-month period of continuous use ends, whichever is earlier, unless—
(i) The item becomes subject to a competitive acquisition program implemented in accordance with section 1847(a) of the Act;
(ii) The beneficiary relocates to an area that is outside the normal service area of the supplier that initially furnished the equipment;
(iii) The beneficiary elects to obtain the equipment from a different supplier prior to the expiration of the 13-month rental period; or
(iv) CMS or the carrier determines that an exception should apply in an individual case based on the circumstances.
(2) A capped rental item furnished under this section may not be replaced by the supplier prior to the expiration of the 13-month rental period unless:
(i) The item is lost, stolen, or irreparably damaged;
(ii) The furnishing of a loaner item is necessary while the item is being repaired;
(iii) The item is no longer medically necessary; or
(iv) The item is replaced in accordance with § 414.210(e)(3) or (f).
(3) Before furnishing a capped rental item, the supplier must disclose to the beneficiary its intentions regarding whether it will accept assignment of all monthly rental claims for the duration of the rental period. A supplier's intentions could be expressed in the form of a written agreement between the supplier and the beneficiary.
(h) Purchase of power-driven wheelchairs furnished on or after January 1, 2006. Suppliers must offer beneficiaries the option to purchase power-driven wheelchairs at the time the equipment is initially furnished. Payment is made on a lump-sum purchase basis if the beneficiary chooses this option.
5. Amend § 414.230 by—
A. Revising paragraphs (b)(1) and (b)(2).
B. Revising paragraph (f).
The revisions read as follows:
Determining a period of continuous use.* * * * *(b) Continuous use. (1) A period of continuous use begins with the first month of medical need and lasts until a beneficiary's medical need for a particular item of durable medical equipment ends.
(2) In the case of a beneficiary receiving oxygen equipment on December 31, 2005, the period of continuous use for the equipment begins on January 1, 2006.
* * * * *(f) New equipment. (1) If a beneficiary changes equipment or requires additional equipment based on a physician's prescription, and the new or additional equipment is found to be necessary, a new period of continuous use begins for the new or additional equipment. A new period of continuous use does not begin for base equipment that is modified by an addition.
(2) A new period of continuous use does not begin when a beneficiary changes from one oxygen equipment modality to another.
* * * * *PART 484—HOME HEALTH SERVICES
6. The authority citation for part 484 continues to read as follows:
7. Amend § 484.225 as follows:
A. Revise paragraph (f).
B. Redesignate paragraph (g) as paragraph (h).
C. Add new paragraph (g).
D. Revise newly redesignated paragraph (h).
E. Add new paragraph (i).
The revisions and additions read as follows:
Annual update of the unadjusted national prospective 60-day episode payment rate.* * * * *(f) For calendar year 2005, the unadjusted national prospective 60-day episode payment rate is equal to the rate from the previous calendar year, increased by the applicable home health market basket minus 0.8 percentage points.
(g) For calendar year 2006, the unadjusted national prospective 60-day episode payment rate is equal to the rate from calendar year 2005.
(h) For 2007 and subsequent calendar years, in the case of a home health agency that submits home health quality data, as specified by the Secretary, the unadjusted national prospective 60-day episode rate is equal to the rate for the previous calendar year increased by the applicable home health market basket index amount.
(i) For 2007 and subsequent calendar years, in the case of a home health agency that does not submit home health quality data, as specified by the Secretary, the unadjusted national prospective 60-day episode rate is equal to the rate for the previous calendar year increased by the applicable home health market basket index amount minus 2 percentage points. Any reduction of the percentage change will apply only to the calendar year involved and will not be taken into account in computing the prospective payment amount for a subsequent calendar year.
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
Dated: June 16, 2006.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
Approved: July 14, 2006.
Michael O. Leavitt,
Secretary.
Addendum A.—Proposed CY 2007 Wage Index for Rural Areas by CBSA; Applicable Pre-Floor and Pre-Reclassified Hospital Wage Index
CBSA code Nonurban Area Wage index 01 Alabama 0.7652 02 Alaska 1.0680 03 Arizona 0.8924 04 Arkansas 0.7335 05 California 1.1302 06 Colorado 0.9342 07 Connecticut 1.1753 08 Delaware 0.9723 10 Florida 0.8595 11 Georgia 0.7560 12 Hawaii 1.0467 13 Idaho 0.8134 14 Illinois 0.8327 15 Indiana 0.8477 16 Iowa 0.8697 17 Kansas 0.8000 18 Kentucky 0.7780 19 Louisiana 0.7450 20 Maine 0.8410 21 Maryland 0.8942 22 Massachusetts1 1.0216 23 Michigan 0.9052 24 Minnesota 0.9167 25 Mississippi 0.7565 26 Missouri 0.7934 27 Montana 0.8605 28 Nebraska 0.8693 29 Nevada 0.8960 30 New Hampshire 1.0800 31 New Jersey1 32 New Mexico 0.8347 33 New York 0.8250 34 North Carolina 0.8599 35 North Dakota 0.7228 36 Ohio 0.8674 37 Oklahoma 0.7640 38 Oregon 0.9770 39 Pennsylvania 0.8332 40 Puerto Rico 1 0.4047 41 Rhode Island 1 42 South Carolina 0.8583 43 South Dakota 0.8496 44 Tennessee 0.7841 45 Texas 0.7973 46 Utah 0.8154 47 Vermont 0.9944 48 Virgin Islands 0.7615 49 Virginia 0.7954 50 Washington 1.0281 51 West Virginia 0.7620 52 Wisconsin 0.9468 53 Wyoming 0.9311 65 Guam 0.9611 1 All counties within the State are classified as urban, with the exception of Massaschusetts and Puerto Pico. Massachusetts and Puerto Rico have areas designated as rural, however, no short-term, acute care hospitals are located in the area(s) for CY 2007. Addendum B.—Proposed CY 2007 Wage Index for Urban Areas by CBSA; Applicable Pre-Floor and Pre-Reclassified Hospital Wage Index
CBSA code Urban area (constituent counties) Wage index 10180 Abilene, TX 0.8014 Callahan County, TX Jones County, TX Taylor County, TX 10380 Aguadilla-Isabela-San Sebastian, PR 0.3922 Aguada Municipio, PR Aguadilla Municipio, PR Anasco Municipio, PR Isabela Municipio, PR Lares Municipio, PR Moca Municipio, PR Rincon Municipio, PR San Sebastian Municipio, PR 10420 Akron, OH 0.8639 Portage County, OH Summit County, OH 10500 Albany, GA 0.8962 Baker County, GA Dougherty County, GA Lee County, GA Terrell County, GA Worth County, GA 10580 Albany-Schenectady-Troy, NY 0.8735 Albany County, NY Rensselaer County, NY Saratoga County, NY Schenectady County, NY Schoharie County, NY 10740 Albuquerque, NM 0.9474 Bernalillo County, NM Sandoval County, NM Torrance County, NM Valencia County, NM 10780 Alexandria, LA 0.8020 Grant Parish, LA Rapides Parish, LA 10900 Allentown-Bethlehem-Easton, PA-NJ 0.9910 Warren County, NJ Carbon County, PA Start Printed Page 44110 Lehigh County, PA Northampton County, PA 11020 Altoona, PA 0.8727 Blair County, PA 11100 Amarillo, TX 0.9177 Armstrong County, TX Carson County, TX Potter County, TX Randall County, TX 11180 Ames, IA 0.9777 Story County, IA 11260 Anchorage, AK 1.2045 Anchorage Municipality, AK Matanuska-Susitna Borough, AK 11300 Anderson, IN 0.8790 Madison County, IN 11340 Anderson, SC 0.8959 Anderson County, SC 11460 Ann Arbor, MI 1.0838 Washtenaw County, MI 11500 Anniston-Oxford, AL 0.7868 Calhoun County, AL 11540 Appleton, WI 0.9472 Calumet County, WI Outagamie County, WI 11700 Asheville, NC 0.9093 Buncombe County, NC Haywood County, NC Henderson County, NC Madison County, NC 12020 Athens-Clarke County, GA 0.9857 Clarke County, GA Madison County, GA Oconee County, GA Oglethorpe County, GA 12060 Atlanta-Sandy Springs-Marietta, GA 0.9772 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 1.1751 Atlantic County, NJ 12220 Auburn-Opelika, AL 0.8110 Lee County, AL 12260 Augusta-Richmond County, GA-SC 0.9678 Burke County, GA Start Printed Page 44111 Columbia County, GA McDuffie County, GA Richmond County, GA Aiken County, SC Edgefield County, SC 12420 Austin-Round Rock, TX 0.9360 Bastrop County, TX Caldwell County, TX Hays County, TX Travis County, TX Williamson County, TX 12540 Bakersfield, CA 1.0605 Kern County, CA 12580 Baltimore-Towson, MD 1.0106 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 0.9719 Penobscot County, ME 12700 Barnstable Town, MA 1.2561 Barnstable County, MA 12940 Baton Rouge, LA 0.8099 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 0.9746 Calhoun County, MI 13020 Bay City, MI 0.9271 Bay County, MI 13140 Beaumont-Port Arthur, TX 0.8610 Hardin County, TX Jefferson County, TX Orange County, TX 13380 Bellingham, WA 1.1124 Whatcom County, WA 13460 Bend, OR 1.0762 Deschutes County, OR 13644 Bethesda-Frederick-Gaithersburg, MD 1.0923 Frederick County, MD Montgomery County, MD 13740 Billings, MT 0.8728 Carbon County, MT Yellowstone County, MT 13780 Binghamton, NY 0.8798 Broome County, NY Tioga County, NY 13820 Birmingham-Hoover, AL 0.8919 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 0.7253 Burleigh County, ND Morton County, ND 13980 Blacksburg-Christiansburg-Radford, VA 0.8227 Giles County, VA Montgomery County, VA Start Printed Page 44112 Pulaski County, VA Radford City, VA 14020 Bloomington, IN 0.8548 Greene County, IN Monroe County, IN Owen County, IN 14060 Bloomington-Normal, IL 0.8960 McLean County, IL 14260 Boise City-Nampa, ID 0.9417 Ada County, ID Boise County, ID Canyon County, ID Gem County, ID Owyhee County, ID 14484 Boston-Quincy, MA 1.1693 Norfolk County, MA Plymouth County, MA Suffolk County, MA 14500 Boulder, CO 1.0368 Boulder County, CO 14540 Bowling Green, KY 0.8162 Edmonson County, KY Warren County, KY 14740 Bremerton-Silverdale, WA 1.0932 Kitsap County, WA 14860 Bridgeport-Stamford-Norwalk, CT 1.2681 Fairfield County, CT 15180 Brownsville-Harlingen, TX 0.9446 Cameron County, TX 15260 Brunswick, GA 1.0097 Brantley County, GA Glynn County, GA McIntosh County, GA 15380 Buffalo-Niagara Falls, NY 0.9483 Erie County, NY Niagara County, NY 15500 Burlington, NC 0.8689 Alamance County, NC 15540 Burlington-South Burlington, VT 0.9491 Chittenden County, VT Franklin County, VT Grand Isle County, VT 15764 Cambridge-Newton-Framingham, MA 1.0918 Middlesex County, MA 15804 Camden, NJ 1.0411 Burlington County, NJ Camden County, NJ Gloucester County, NJ 15940 Canton-Massillon, OH 0.9047 Carroll County, OH Stark County, OH 15980 Cape Coral-Fort Myers, FL 0.9359 Lee County, FL 16180 Carson City, NV 1.0043 Carson City, NV 16220 Casper, WY 0.9161 Natrona County, WY 16300 Cedar Rapids, IA 0.8903 Benton County, IA Jones County, IA Linn County, IA 16580 Champaign-Urbana, IL 0.9661 Champaign County, IL Ford County, IL Piatt County, IL 16620 Charleston, WV 0.8558 Boone County, WV Clay County, WV Kanawha County, WV Lincoln County, WV Start Printed Page 44113 Putnam County, WV 16700 Charleston-North Charleston, SC 0.9156 Berkeley County, SC Charleston County, SC Dorchester County, SC 16740 Charlotte-Gastonia-Concord, NC-SC 0.9564 Anson County, NC Cabarrus County, NC Gaston County, NC Mecklenburg County, NC Union County, NC York County, SC 16820 Charlottesville, VA 1.0143 Albemarle County, VA Fluvanna County, VA Greene County, VA Nelson County, VA Charlottesville City, VA 16860 Chattanooga, TN-GA 0.8963 Catoosa County, GA Dade County, GA Walker County, GA Hamilton County, TN Marion County, TN Sequatchie County, TN 16940 Cheyenne, WY 0.9076 Laramie County, WY 16974 Chicago-Naperville-Joliet, IL 1.0745 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 1.1073 Butte County, CA 17140 Cincinnati-Middletown, OH-KY-IN 0.9617 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 0.8451 Christian County, KY Trigg County, KY Montgomery County, TN Stewart County, TN 17420 Cleveland, TN 0.8124 Bradley County, TN Polk County, TN 17460 Cleveland-Elyria-Mentor, OH 0.9385 Cuyahoga County, OH Geauga County, OH Lake County, OH Lorain County, OH Medina County, OH 17660 Coeur d'Alene, ID 0.9360 Kootenai County, ID Start Printed Page 44114 17780 College Station-Bryan, TX 0.9061 Brazos County, TX Burleson County, TX Robertson County, TX 17820 Colorado Springs, CO 0.9718 El Paso County, CO Teller County, CO 17860 Columbia, MO 0.8557 Boone County, MO Howard County, MO 17900 Columbia, SC 0.8028 Calhoun County, SC Fairfield County, SC Kershaw County, SC Lexington County, SC Richland County, SC Saluda County, SC 17980 Columbus, GA-AL 0.8254 Russell County, AL Chattahoochee County, GA Harris County, GA Marion County, GA Muscogee County, GA 18020 Columbus, IN 0.9334 Bartholomew County, IN 18140 Columbus, OH 1.0122 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 0.8579 Aransas County, TX Nueces County, TX San Patricio County, TX 18700 Corvallis, OR 1.1566 Benton County, OR 19060 Cumberland, MD-WV 0.8859 Allegany County, MD Mineral County, WV 19124 Dallas-Plano-Irving, TX 1.0093 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 0.9061 Murray County, GA Whitfield County, GA 19180 Danville, IL 0.9283 Vermilion County, IL 19260 Danville, VA 0.8466 Pittsylvania County, VA Danville City, VA 19340 Davenport-Moline-Rock Island, IA-IL 0.8557 Henry County, IL Mercer County, IL Rock Island County, IL Scott County, IA 19380 Dayton, OH 0.9053 Greene County, OH Miami County, OH Montgomery County, OH Preble County, OH Start Printed Page 44115 19460 Decatur, AL 0.8220 Lawrence County, AL Morgan County, AL 19500 Decatur, IL 0.8187 Macon County, IL 19660 Deltona-Daytona Beach-Ormond Beach, FL 0.9280 Volusia County, FL 19740 Denver-Aurora, CO 1.0947 Adams County, CO Arapahoe County, CO Broomfield County, CO Clear Creek County, CO Denver County, CO Douglas County, CO Elbert County, CO Gilpin County, CO Jefferson County, CO Park County, CO 19780 Des Moines, IA 0.9136 Dallas County, IA Guthrie County, IA Madison County, IA Polk County, IA Warren County, IA 19804 Detroit-Livonia-Dearborn, MI 1.0223 Wayne County, MI 20020 Dothan, AL 0.7438 Geneva County, AL Henry County, AL Houston County, AL 20100 Dover, DE 0.9865 Kent County, DE 20220 Dubuque, IA 0.9150 Dubuque County, IA 20260 Duluth, MN-WI 1.0070 Carlton County, MN St. Louis County, MN Douglas County, WI 20500 Durham, NC 0.9843 Chatham County, NC Durham County, NC Orange County, NC Person County, NC 20740 Eau Claire, WI 0.9647 Chippewa County, WI Eau Claire County, WI 20764 Edison, NJ 1.1207 Middlesex County, NJ Monmouth County, NJ Ocean County, NJ Somerset County, NJ 20940 El Centro, CA 0.9092 Imperial County, CA 21060 Elizabethtown, KY 0.8713 Hardin County, KY Larue County, KY 21140 Elkhart-Goshen, IN 0.9442 Elkhart County, IN 21300 Elmira, NY 0.8213 Chemung County, NY 21340 El Paso, TX 0.9069 El Paso County, TX 21500 Erie, PA 0.8704 Erie County, PA 21604 Essex County, MA 1.0437 Essex County, MA 21660 Eugene-Springfield, OR 1.0896 Lane County, OR 21780 Evansville, IN-KY 0.8830 Gibson County, IN Start Printed Page 44116 Posey County, IN Vanderburgh County, IN Warrick County, IN Henderson County, KY Webster County, KY 21820 Fairbanks, AK 1.1079 Fairbanks North Star Borough, AK 21940 Fajardo, PR 0.4044 Ceiba Municipio, PR Fajardo Municipio, PR Luquillo Municipio, PR 22020 Fargo, ND-MN 0.8265 Cass County, ND Clay County, MN 22140 Farmington, NM 0.8604 San Juan County, NM 22180 Fayetteville, NC 0.8961 Cumberland County, NC Hoke County, NC 22220 Fayetteville-Springdale-Rogers, AR-MO 0.8761 Benton County, AR Madison County, AR Washington County, AR McDonald County, MO 22380 Flagstaff, AZ 1.1621 Coconino County, AZ 22420 Flint, MI 1.0988 Genesee County, MI 22500 Florence, SC 0.8421 Darlington County, SC Florence County, SC 22520 Florence-Muscle Shoals, AL 0.7967 Colbert County, AL Lauderdale County, AL 22540 Fond du Lac, WI 1.0081 Fond du Lac County, WI 22660 Fort Collins-Loveland, CO 0.9561 Larimer County, CO 22744 Fort Lauderdale-Pompano Beach-Deerfield 1.0151 Beach, FL Broward County, FL 22900 Fort Smith, AR-OK 0.7745 Crawford County, AR Franklin County, AR Sebastian County, AR Le Flore County, OK Sequoyah County, OK 23020 Fort Walton Beach-Crestview-Destin, FL 0.8658 Okaloosa County, FL 23060 Fort Wayne, IN 0.9504 Allen County, IN Wells County, IN Whitley County, IN 23104 Fort Worth-Arlington, TX 0.9587 Johnson County, TX Parker County, TX Tarrant County, TX Wise County, TX 23420 Fresno, CA 1.0965 Fresno County, CA 23460 Gadsden, AL 0.8080 Etowah County, AL 23540 Gainesville, FL 0.9312 Alachua County, FL Gilchrist County, FL 23580 Gainesville, GA 0.8974 Hall County, GA 23844 Gary, IN 0.9281 Jasper County, IN Lake County, IN Start Printed Page 44117 Newton County, IN Porter County, IN 24020 Glens Falls, NY 0.8339 Warren County, NY Washington County, NY 24140 Goldsboro, NC 0.9187 Wayne County, NC 24220 Grand Forks, ND-MN 0.7963 Polk County, MN Grand Forks County, ND 24300 Grand Junction, CO 0.9685 Mesa County, CO 24340 Grand Rapids-Wyoming, MI 0.9470 Barry County, MI Ionia County, MI Kent County, MI Newaygo County, MI 24500 Great Falls, MT 0.8613 Cascade County, MT 24540 Greeley, CO 0.9619 Weld County, CO 24580 Green Bay, WI 0.9804 Brown County, WI Kewaunee County, WI Oconto County, WI 24660 Greensboro-High Point, NC 0.8735 Guilford County, NC Randolph County, NC Rockingham County, NC 24780 Greenville, NC 0.9449 Greene County, NC Pitt County, NC 24860 Greenville, SC 0.9733 Greenville County, SC Laurens County, SC Pickens County, SC 25020 Guayama, PR 0.3241 Arroyo Municipio, PR Guayama Municipio, PR Patillas Municipio, PR 25060 Gulfport-Biloxi, MS 0.8931 Hancock County, MS Harrison County, MS Stone County, MS 25180 Hagerstown-Martinsburg, MD-WV 0.9054 Washington County, MD Berkeley County, WV Morgan County, WV 25260 Hanford-Corcoran, CA 1.0142 Kings County, CA 25420 Harrisburg-Carlisle, PA 0.9419 Cumberland County, PA Dauphin County, PA Perry County, PA 25500 Harrisonburg, VA 0.9090 Rockingham County, VA Harrisonburg City, VA 25540 Hartford-West Hartford-East Hartford, CT 1.0916 Hartford County, CT Litchfield County, CT Middlesex County, CT Tolland County, CT 25620 Hattiesburg, MS 0.7443 Forrest County, MS Lamar County, MS Perry County, MS 25860 Hickory-Lenoir-Morganton, NC 0.9021 Alexander County, NC Burke County, NC Caldwell County, NC Start Printed Page 44118 Catawba County, NC 25980 \2 Hinesville-Fort Stewart, GA 0.9163 Liberty County, GA Long County, GA 26100 Holland-Grand Haven, MI 0.9205 Ottawa County, MI 26180 Honolulu, HI 1.1067 Honolulu County, HI 26300 Hot Springs, AR 0.8797 Garland County, AR 26380 Houma-Bayou Cane-Thibodaux, LA 0.8003 Lafourche Parish, LA Terrebonne Parish, LA 26420 Houston-Baytown-Sugar Land, TX 1.0026 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 0.9013 Boyd County, KY Greenup County, KY Lawrence County, OH Cabell County, WV Wayne County, WV 26620 Huntsville, AL 0.9051 Limestone County, AL Madison County, AL 26820 Idaho Falls, ID 0.9104 Bonneville County, ID Jefferson County, ID 26900 Indianapolis, IN 0.9766 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 0.9731 Johnson County, IA Washington County, IA 27060 Ithaca, NY 0.9831 Tompkins County, NY 27100 Jackson, MI 0.9577 Jackson County, MI 27140 Jackson, MS 0.8286 Copiah County, MS Hinds County, MS Madison County, MS Rankin County, MS Simpson County, MS 27180 Jackson, TN 0.8869 Chester County, TN Madison County, TN 27260 Jacksonville, FL 0.9042 Baker County, FL Clay County, FL Duval County, FL Nassau County, FL St. Johns County, FL 27340 Jacksonville, NC 0.8245 Start Printed Page 44119 Onslow County, NC 27500 Janesville, WI 0.9672 Rock County, WI 27620 Jefferson City, MO 0.8347 Callaway County, MO Cole County, MO Moniteau County, MO Osage County, MO 27740 Johnson City, TN 0.8057 Carter County, TN Unicoi County, TN Washington County, TN 27780 Johnstown, PA 0.8635 Cambria County, PA 27860 Jonesboro, AR 0.7609 Craighead County, AR Poinsett County, AR 27900 Joplin, MO 0.8620 Jasper County, MO Newton County, MO 28020 Kalamazoo-Portage, MI 1.0723 Kalamazoo County, MI Van Buren County, MI 28100 Kankakee-Bradley, IL 0.9990 Kankakee County, IL 28140 Kansas City, MO-KS 0.9514 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 1.0361 Benton County, WA Franklin County, WA 28660 Killeen-Temple-Fort Hood, TX 0.9098 Bell County, TX Coryell County, TX Lampasas County, TX 28700 Kingsport-Bristol-Bristol, TN-VA 0.7975 Hawkins County, TN Sullivan County, TN Bristol City, VA Scott County, VA Washington County, VA 28740 Kingston, NY 0.9383 Ulster County, NY 28940 Knoxville, TN 0.8263 Anderson County, TN Blount County, TN Knox County, TN Loudon County, TN Union County, TN 29020 Kokomo, IN 0.9460 Howard County, IN Tipton County, IN 29100 La Crosse, WI-MN 0.9442 Houston County, MN La Crosse County, WI 29140 Lafayette, IN 0.8972 Benton County, IN Start Printed Page 44120 Carroll County, IN Tippecanoe County, IN 29180 Lafayette, LA 0.8293 Lafayette Parish, LA St. Martin Parish, LA 29340 Lake Charles, LA 0.7928 Calcasieu Parish, LA Cameron Parish, LA 29404 Lake County-Kenosha County, IL-WI 1.0406 Lake County, IL Kenosha County, WI 29460 Lakeland, FL 0.8895 Polk County, FL 29540 Lancaster, PA 0.9644 Lancaster County, PA 29620 Lansing-East Lansing, MI 1.0102 Clinton County, MI Eaton County, MI Ingham County, MI 29700 Laredo, TX 0.7825 Webb County, TX 29740 Las Cruces, NM 0.9290 Dona Ana County, NM 29820 Las Vegas-Paradise, NV 1.1450 Clark County, NV 29940 Lawrence, KS 0.8353 Douglas County, KS 30020 Lawton, OK 0.8080 Comanche County, OK 30140 Lebanon, PA 0.8695 Lebanon County, PA 30300 Lewiston, ID-WA 0.9871 Nez Perce County, ID Asotin County, WA 30340 Lewiston-Auburn, ME 0.9148 Androscoggin County, ME 30460 Lexington-Fayette, KY 0.9191 Bourbon County, KY Clark County, KY Fayette County, KY Jessamine County, KY Scott County, KY Woodford County, KY 30620 Lima, OH 0.9058 Allen County, OH 30700 Lincoln, NE 1.0110 Lancaster County, NE Seward County, NE 30780 Little Rock-North Little Rock, AR 0.8906 Faulkner County, AR Grant County, AR Lonoke County, AR Perry County, AR Pulaski County, AR Saline County, AR 30860 Logan, UT-ID 0.9038 Franklin County, ID Cache County, UT 30980 Longview, TX 0.8803 Gregg County, TX Rusk County, TX Upshur County, TX 31020 Longview, WA 1.0029 Cowlitz County, WA 31084 Los Angeles-Long Beach-Glendale, CA 1.1752 Los Angeles County, CA 31140 Louisville, KY-IN 0.9135 Clark County, IN Floyd County, IN Harrison County, IN Start Printed Page 44121 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 0.8628 Crosby County, TX Lubbock County, TX 31340 Lynchburg, VA 0.8710 Amherst County, VA Appomattox County, VA Bedford County, VA Campbell County, VA Bedford City, VA Lynchburg City, VA 31420 Macon, GA 0.9518 Bibb County, GA Crawford County, GA Jones County, GA Monroe County, GA Twiggs County, GA 31460 Madera, CA 0.8169 Madera County, CA 31540 Madison, WI 1.0736 Columbia County, WI Dane County, WI Iowa County, WI 31700 Manchester-Nashua, NH 1.0261 Hillsborough County, NH Merrimack County, NH 31900 Mansfield, OH 0.9287 Richland County, OH 32420 Mayaguez, PR 0.3857 Hormigueros Municipio, PR Mayaguez Municipio, PR 32580 McAllen-Edinburg-Pharr, TX 0.8788 Hidalgo County, TX 32780 Medford, OR 1.0837 Jackson County, OR 32820 Memphis, TN-MS-AR 0.9361 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 1.1415 Merced County, CA 33124 Miami-Miami Beach-Kendall, FL 0.9830 Miami-Dade County, FL 33140 Michigan City-La Porte, IN 0.9093 LaPorte County, IN 33260 Midland, TX 0.9803 Midland County, TX 33340 Milwaukee-Waukesha-West Allis, WI 1.0236 Milwaukee County, WI Ozaukee County, WI Washington County, WI Waukesha County, WI 33460 Minneapolis-St. Paul-Bloomington, MN-WI 1.0965 Anoka County, MN Carver County, MN Chisago County, MN Start Printed Page 44122 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 0.8944 Missoula County, MT 33660 Mobile, AL 0.7947 Mobile County, AL 33700 Modesto, CA 1.1590 Stanislaus County, CA 33740 Monroe, LA 0.8011 Ouachita Parish, LA Union Parish, LA 33780 Monroe, MI 0.9725 Monroe County, MI 33860 Montgomery, AL 0.8023 Autauga County, AL Elmore County, AL Lowndes County, AL Montgomery County, AL 34060 Morgantown, WV 0.8438 Monongalia County, WV Preston County, WV 34100 Morristown, TN 0.7944 Grainger County, TN Hamblen County, TN Jefferson County, TN 34580 Mount Vernon-Anacortes, WA 1.0536 Skagit County, WA 34620 Muncie, IN 0.8299 Delaware County, IN 34740 Muskegon-Norton Shores, MI 0.9957 Muskegon County, MI 34820 Myrtle Beach-Conway-North Myrtle Beach, SC 0.8824 Horry County, SC 34900 Napa, CA 1.3496 Napa County, CA 34940 Naples-Marco Island, FL 0.9959 Collier County, FL 34980 Nashville-Davidson--Murfreesboro, TN 0.9862 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 1.2681 Nassau County, NY Suffolk County, NY 35084 Newark-Union, NJ-PA 1.1890 Essex County, NJ Hunterdon County, NJ Morris County, NJ Sussex County, NJ Union County, NJ Pike County, PA 35300 New Haven-Milford, CT 1.1974 Start Printed Page 44123 New Haven County, CT 35380 New Orleans-Metairie-Kenner, LA 0.8858 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-Wayne-White Plains, NY-NJ 1.3208 Bergen County, NJ Hudson County, NJ Passaic County, NJ Bronx County, NY Kings County, NY New York County, NY Putnam County, NY Queens County, NY Richmond County, NY Rockland County, NY Westchester County, NY 35660 Niles-Benton Harbor, MI 0.8931 Berrien County, MI 35980 Norwich-New London, CT 1.1953 New London County, CT 36084 Oakland-Fremont-Hayward, CA 1.5420 Alameda County, CA Contra Costa County, CA 36100 Ocala, FL 0.8883 Marion County, FL 36140 Ocean City, NJ 1.0490 Cape May County, NJ 36220 Odessa, TX 1.0119 Ector County, TX 36260 Ogden-Clearfield, UT 0.9011 Davis County, UT Morgan County, UT Weber County, UT 36420 Oklahoma City, OK 0.8853 Canadian County, OK Cleveland County, OK Grady County, OK Lincoln County, OK Logan County, OK McClain County, OK Oklahoma County, OK 36500 Olympia, WA 1.1100 Thurston County, WA 36540 Omaha-Council Bluffs, NE-IA 0.9467 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, FL 0.9422 Lake County, FL Orange County, FL Osceola County, FL Seminole County, FL 36780 Oshkosh-Neenah, WI 0.9332 Winnebago County, WI 36980 Owensboro, KY 0.8763 Daviess County, KY Hancock County, KY McLean County, KY 37100 Oxnard-Thousand Oaks-Ventura, CA 1.1591 Ventura County, CA Start Printed Page 44124 37340 Palm Bay-Melbourne-Titusville, FL 0.9448 Brevard County, FL 37460 Panama City-Lynn Haven, FL 0.8087 Bay County, FL 37620 Parkersburg-Marietta, WV-OH 0.7940 Washington County, OH Pleasants County, WV Wirt County, WV Wood County, WV 37700 Pascagoula, MS 0.8230 George County, MS Jackson County, MS 37860 Pensacola-Ferry Pass-Brent, FL 0.8014 Escambia County, FL Santa Rosa County, FL 37900 Peoria, IL 0.8998 Marshall County, IL Peoria County, IL Stark County, IL Tazewell County, IL Woodford County, IL 37964 Philadelphia, PA 1.1018 Bucks County, PA Chester County, PA Delaware County, PA Montgomery County, PA Philadelphia County, PA 38060 Phoenix-Mesa-Scottsdale, AZ 1.0305 Maricopa County, AZ Pinal County, AZ 38220 Pine Bluff, AR 0.8398 Cleveland County, AR Jefferson County, AR Lincoln County, AR 38300 Pittsburgh, PA 0.8685 Allegheny County, PA Armstrong County, PA Beaver County, PA Butler County, PA Fayette County, PA Washington County, PA Westmoreland County, PA 38340 Pittsfield, MA 1.0284 Berkshire County, MA 38540 Pocatello, ID 0.9417 Bannock County, ID Power County, ID 38660 Ponce, PR 0.4851 Juana Diaz Municipio, PR Ponce Municipio, PR Villalba Municipio, PR 38860 Portland-South Portland-Biddeford, ME 0.9926 Cumberland County, ME Sagadahoc County, ME York County, ME 38900 Portland-Vancouver-Beaverton, OR-WA 1.1436 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 0.9851 Martin County, FL St. Lucie County, FL 39100 Poughkeepsie-Newburgh-Middletown, NY 1.0913 Dutchess County, NY Orange County, NY 39140 Prescott, AZ 0.9853 Start Printed Page 44125 Yavapai County, AZ 39300 Providence-New Bedford-Fall River, RI-MA 1.0804 Bristol County, MA Bristol County, RI Kent County, RI Newport County, RI Providence County, RI Washington County, RI 39340 Provo-Orem, UT 0.9554 Juab County, UT Utah County, UT 39380 Pueblo, CO 0.8552 Pueblo County, CO 39460 Punta Gorda, FL 0.9421 Charlotte County, FL 39540 Racine, WI 0.9192 Racine County, WI 39580 Raleigh-Cary, NC 0.9879 Franklin County, NC Johnston County, NC Wake County, NC 39660 Rapid City, SD 1.0351 Meade County, SD Pennington County, SD 39740 Reading, PA 0.9639 Berks County, PA 39820 Redding, CA 1.3221 Shasta County, CA 39900 Reno-Sparks, NV 1.1984 Storey County, NV Washoe County, NV 40060 Richmond, VA 0.9193 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 1.0934 Riverside County, CA San Bernardino County, CA 40220 Roanoke, VA 0.8662 Botetourt County, VA Craig County, VA Franklin County, VA Roanoke County, VA Roanoke City, VA Salem City, VA 40340 Rochester, MN 1.1260 Dodge County, MN Olmsted County, MN Wabasha County, MN 40380 Rochester, NY 0.9005 Livingston County, NY Monroe County, NY Ontario County, NY Start Printed Page 44126 Orleans County, NY Wayne County, NY 40420 Rockford, IL 1.0007 Boone County, IL Winnebago County, IL 40484 Rockingham County-Strafford County, NH 1.0177 Rockingham County, NH Strafford County, NH 40580 Rocky Mount, NC 0.8869 Edgecombe County, NC Nash County, NC 40660 Rome, GA 0.9316 Floyd County, GA 40900 Sacramento-Arden-Arcade-Roseville, CA 1.3373 El Dorado County, CA Placer County, CA Sacramento County, CA Yolo County, CA 40980 Saginaw-Saginaw Township North, MI 0.8889 Saginaw County, MI 41060 St. Cloud, MN 1.0380 Benton County, MN Stearns County, MN 41100 St. George, UT 0.9281 Washington County, UT 41140 St. Joseph, MO-KS 1.0136 Doniphan County, KS Andrew County, MO Buchanan County, MO DeKalb County, MO 41180 St. Louis, MO-IL 0.9013 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 1.0457 Marion County, OR Polk County, OR 41500 Salinas, CA 1.4459 Monterey County, CA 41540 Salisbury, MD 0.8969 Somerset County, MD Wicomico County, MD 41620 Salt Lake City, UT 0.9418 Salt Lake County, UT Summit County, UT Tooele County, UT 41660 San Angelo, TX 0.8377 Irion County, TX Tom Green County, TX 41700 San Antonio, TX 0.8860 Atascosa County, TX Bandera County, TX Bexar County, TX Comal County, TX Guadalupe County, TX Kendall County, TX Start Printed Page 44127 Medina County, TX Wilson County, TX 41740 San Diego-Carlsbad-San Marcos, CA 1.1374 San Diego County, CA 41780 Sandusky, OH 0.9319 Erie County, OH 41884 San Francisco-San Mateo-Redwood City, CA 1.5071 Marin County, CA San Francisco County, CA San Mateo County, CA 41900 San German-Cabo Rojo, PR 0.4893 Cabo Rojo Municipio, PR Lajas Municipio, PR Sabana Grande Municipio, PR San German Municipio, PR 41940 San Jose-Sunnyvale-Santa Clara, CA 1.5293 San Benito County, CA Santa Clara County, CA 41980 San Juan-Caguas-Guaynabo, PR 0.4397 Aguas Buenas Municipio, PR Aibonito Municipio, PR Arecibo Municipio, PR Barceloneta Municipio, PR Barranquitas Municipio, PR Bayamon Municipio, PR Caguas Municipio, PR Camuy Municipio, PR Canovanas Municipio, PR Carolina Municipio, PR Catano Municipio, PR Cayey Municipio, PR Ciales Municipio, PR Cidra Municipio, PR Comerio 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 Loiza Municipio, PR Manati Municipio, PR Maunabo Municipio, PR Morovis Municipio, PR Naguabo Municipio, PR Naranjito Municipio, PR Orocovis Municipio, PR Quebradillas Municipio, PR Rio 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 1.1619 San Luis Obispo County, CA 42044 Santa Ana-Anaheim-Irvine, CA 1.1294 Orange County, CA 42060 Santa Barbara-Santa Maria-Goleta, CA 1.1075 Santa Barbara County, CA 42100 Santa Cruz-Watsonville, CA 1.5531 Santa Cruz County, CA 42140 Santa Fe, NM 1.0843 Santa Fe County, NM Start Printed Page 44128 42220 Santa Rosa-Petaluma, CA 1.4489 Sonoma County, CA 42260 Sarasota-Bradenton-Venice, FL 0.9885 Manatee County, FL Sarasota County, FL 42340 Savannah, GA 0.9087 Bryan County, GA Chatham County, GA Effingham County, GA 42540 Scranton--Wilkes-Barre, PA 0.8521 Lackawanna County, PA Luzerne County, PA Wyoming County, PA 42644 Seattle-Bellevue-Everett, WA 1.1454 King County, WA Snohomish County, WA 42680 Sebastian-Vero Beach, FL 0.9590 43100 Sheboygan, WI 0.9042 Sheboygan County, WI 43300 Sherman-Denison, TX 0.8517 Grayson County, TX 43340 Shreveport-Bossier City, LA 0.8881 Bossier Parish, LA Caddo Parish, LA De Soto Parish, LA 43580 Sioux City, IA-NE-SD 0.9217 Woodbury County, IA Dakota County, NE Dixon County, NE Union County, SD 43620 Sioux Falls, SD 0.9587 Lincoln County, SD McCook County, SD Minnehaha County, SD Turner County, SD 43780 South Bend-Mishawaka, IN-MI 0.9690 St. Joseph County, IN Cass County, MI 43900 Spartanburg, SC 0.9190 Spartanburg County, SC 44060 Spokane, WA 1.0465 Spokane County, WA 44100 Springfield, IL 0.8905 Menard County, IL Sangamon County, IL 44140 Springfield, MA 1.0080 Franklin County, MA Hampden County, MA Hampshire County, MA 44180 Springfield, MO 0.8484 Christian County, MO Dallas County, MO Greene County, MO Polk County, MO Webster County, MO 44220 Springfield, OH 0.8462 Clark County, OH 44300 State College, PA 0.8799 Centre County, PA 44700 Stockton, CA 1.1462 San Joaquin County, CA 44940 Sumter, SC 0.8098 Sumter County, SC 45060 Syracuse, NY 0.9709 Madison County, NY Onondaga County, NY Oswego County, NY 45104 Tacoma, WA 1.0808 Pierce County, WA 45220 Tallahassee, FL 0.9299 Start Printed Page 44129 Gadsden County, FL Jefferson County, FL Leon County, FL Wakulla County, FL 45300 Tampa-St. Petersburg-Clearwater, FL 0.9160 Hernando County, FL Hillsborough County, FL Pasco County, FL Pinellas County, FL 45460 Terre Haute, IN 0.8661 Clay County, IN Sullivan County, IN Vermillion County, IN Vigo County, IN 45500 Texarkana, TX-Texarkana, AR 0.8118 Miller County, AR Bowie County, TX 45780 Toledo, OH 0.9599 Fulton County, OH Lucas County, OH Ottawa County, OH Wood County, OH 45820 Topeka, KS 0.8746 Jackson County, KS Jefferson County, KS Osage County, KS Shawnee County, KS Wabaunsee County, KS 45940 Trenton-Ewing, NJ 1.0877 Mercer County, NJ 46060 Tucson, AZ 0.9219 Pima County, AZ 46140 Tulsa, OK 0.8104 Creek County, OK Okmulgee County, OK Osage County, OK Pawnee County, OK Rogers County, OK Tulsa County, OK Wagoner County, OK 46220 Tuscaloosa, AL 0.8641 Greene County, AL Hale County, AL Tuscaloosa County, AL 46340 Tyler, TX 0.8827 Smith County, TX 46540 Utica-Rome, NY 0.8402 Herkimer County, NY Oneida County, NY 46660 Valdosta, GA 0.8344 Brooks County, GA Echols County, GA Lanier County, GA Lowndes County, GA 46700 Vallejo-Fairfield, CA 1.5164 Solano County, CA 47020 Victoria, TX 0.8575 Calhoun County, TX Goliad County, TX Victoria County, TX 47220 Vineland-Millville-Bridgeton, NJ 0.9849 Cumberland County, NJ 47260 Virginia Beach-Norfolk-Newport News, VA-NC 0.8805 Currituck County, NC Gloucester County, VA Isle of Wight County, VA James City County, VA Mathews County, VA Surry County, VA York County, VA Start Printed Page 44130 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 0.9986 Tulare County, CA 47380 Waco, TX 0.8648 McLennan County, TX 47580 Warner Robins, GA 0.8394 Houston County, GA 47644 Warren-Farmington Hills-Troy, MI 1.0126 Lapeer County, MI Livingston County, MI Macomb County, MI Oakland County, MI St. Clair County, MI 47894 Washington-Arlington-Alexandria, DC-VA-MD-WV 1.1074 District of Columbia, DC Calvert County, MD Charles County, MD Prince George's County, MD Arlington County, VA Clarke County, VA Fairfax County, VA Fauquier County, VA 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 0.8422 Black Hawk County, IA Bremer County, IA Grundy County, IA 48140 Wausau, WI 0.9740 Marathon County, WI 48260 Weirton-Steubenville, WV-OH 0.8078 Jefferson County, OH Brooke County, WV Hancock County, WV 48300 Wenatchee, WA 1.0365 Chelan County, WA Douglas County, WA 48424 West Palm Beach-Boca Raton-Boynton Beach, FL 0.9657 Palm Beach County, FL 48540 Wheeling, WV-OH 0.7022 Belmont County, OH Marshall County, WV Ohio County, WV 48620 Wichita, KS 0.9079 Butler County, KS Harvey County, KS Sedgwick County, KS Sumner County, KS 48660 Wichita Falls, TX 0.8326 Archer County, TX Clay County, TX Wichita County, TX Start Printed Page 44131 48700 Williamsport, PA 0.8126 Lycoming County, PA 48864 Wilmington, DE-MD-NJ 1.0703 New Castle County, DE Cecil County, MD Salem County, NJ 48900 Wilmington, NC 0.9853 Brunswick County, NC New Hanover County, NC Pender County, NC 49020 Winchester, VA-WV 1.0109 Frederick County, VA Winchester City, VA Hampshire County, WV 49180 Winston-Salem, NC 0.9293 Davie County, NC Forsyth County, NC Stokes County, NC Yadkin County, NC 49340 Worcester, MA 1.0741 Worcester County, MA 49420 Yakima, WA 0.9865 Yakima County, WA 49500 Yauco, PR 0.3861 Guanica Municipio, PR Guayanilla Municipio, PR Penuelas Municipio, PR Yauco Municipio, PR 49620 York-Hanover, PA 0.9414 York County, PA 49660 Youngstown-Warren-Boardman, OH-PA 0.8817 Mahoning County, OH Trumbull County, OH Mercer County, PA 49700 Yuba City, CA 1.0749 Sutter County, CA Yuba County, CA 49740 Yuma, AZ 0.9125 Yuma County, AZ 2 At this time, there are no hospitals in these urban areas on which to base a wage index. Therefore, the urban wage index value is based on the average wage index of all urban areas within the State. End Part End Supplemental InformationAddendum C.—Comparison of HH PPS Transition Wage Index for CY 2006 and Pre-Floor and Pre-Reclassified Hospital Wage Index for CY 2007
SSA state/county code County name CBSA No. CY 2006 HH PPS transition wage index Proposed CY 2007 CBSA-based wage index Percent change CY 2006-CY 2007 01000 Autauga County, Alabama 33860 0.8618 0.8023 -6.90 01010 Baldwin County, Alabama 99901 0.7654 0.7652 -0.03 01020 Barbour County, Alabama 99901 0.7439 0.7652 2.86 01030 Bibb County, Alabama 13820 0.8196 0.8919 8.82 01040 Blount County, Alabama 13820 0.8980 0.8919 -0.68 01050 Bullock County, Alabama 99901 0.7439 0.7652 2.86 01060 Butler County, Alabama 99901 0.7439 0.7652 2.86 01070 Calhoun County, Alabama 11500 0.7682 0.7868 2.42 01080 Chambers County, Alabama 99901 0.7439 0.7652 2.86 01090 Cherokee County, Alabama 99901 0.7439 0.7652 2.86 01100 Chilton County, Alabama 13820 0.8196 0.8919 8.82 01110 Choctaw County, Alabama 99901 0.7439 0.7652 2.86 01120 Clarke County, Alabama 99901 0.7439 0.7652 2.86 01130 Clay County, Alabama 99901 0.7439 0.7652 2.86 01140 Cleburne County, Alabama 99901 0.7439 0.7652 2.86 01150 Coffee County, Alabama 99901 0.7439 0.7652 2.86 01160 Colbert County, Alabama 22520 0.8272 0.7967 -3.69 01170 Conecuh County, Alabama 99901 0.7439 0.7652 2.86 Start Printed Page 44132 01180 Coosa County, Alabama 99901 0.7439 0.7652 2.86 01190 Covington County, Alabama 99901 0.7439 0.7652 2.86 01200 Crenshaw County, Alabama 99901 0.7439 0.7652 2.86 01210 Cullman County, Alabama 99901 0.7439 0.7652 2.86 01220 Dale County, Alabama 99901 0.7574 0.7652 1.03 01230 Dallas County, Alabama 99901 0.7439 0.7652 2.86 01240 De Kalb County, Alabama 99901 0.7439 0.7652 2.86 01250 Elmore County, Alabama 33860 0.8618 0.8023 -6.90 01260 Escambia County, Alabama 99901 0.7439 0.7652 2.86 01270 Etowah County, Alabama 23460 0.7938 0.8080 1.79 01280 Fayette County, Alabama 99901 0.7439 0.7652 2.86 01290 Franklin County, Alabama 99901 0.7439 0.7652 2.86 01300 Geneva County, Alabama 20020 0.7577 0.7438 -1.83 01310 Greene County, Alabama 46220 0.8039 0.8641 7.49 01320 Hale County, Alabama 46220 0.8039 0.8641 7.49 01330 Henry County, Alabama 20020 0.7577 0.7438 -1.83 01340 Houston County, Alabama 20020 0.7711 0.7438 -3.54 01350 Jackson County, Alabama 99901 0.7439 0.7652 2.86 01360 Jefferson County, Alabama 13820 0.8980 0.8919 -0.68 01370 Lamar County, Alabama 99901 0.7439 0.7652 2.86 01380 Lauderdale County, Alabama 22520 0.8272 0.7967 -3.69 01390 Lawrence County, Alabama 19460 0.8469 0.8220 -2.94 01400 Lee County, Alabama 12220 0.8100 0.8110 0.12 01410 Limestone County, Alabama 26620 0.9146 0.9051 -1.04 01420 Lowndes County, Alabama 33860 0.8025 0.8023 -0.02 01430 Macon County, Alabama 99901 0.7439 0.7652 2.86 01440 Madison County, Alabama 26620 0.9146 0.9051 -1.04 01450 Marengo County, Alabama 99901 0.7439 0.7652 2.86 01460 Marion County, Alabama 99901 0.7439 0.7652 2.86 01470 Marshall County, Alabama 99901 0.7439 0.7652 2.86 01480 Mobile County, Alabama 33660 0.7876 0.7947 0.90 01490 Monroe County, Alabama 99901 0.7439 0.7652 2.86 01500 Montgomery County, Alabama 33860 0.8618 0.8023 -6.90 01510 Morgan County, Alabama 19460 0.8469 0.8220 -2.94 01520 Perry County, Alabama 99901 0.7439 0.7652 2.86 01530 Pickens County, Alabama 99901 0.7439 0.7652 2.86 01540 Pike County, Alabama 99901 0.7439 0.7652 2.86 01550 Randolph County, Alabama 99901 0.7439 0.7652 2.86 01560 Russell County, Alabama 17980 0.8560 0.8254 -3.57 01570 St Clair County, Alabama 13820 0.8980 0.8919 -0.68 01580 Shelby County, Alabama 13820 0.8980 0.8919 -0.68 01590 Sumter County, Alabama 99901 0.7439 0.7652 2.86 01600 Talladega County, Alabama 99901 0.7439 0.7652 2.86 01610 Tallapoosa County, Alabama 99901 0.7439 0.7652 2.86 01620 Tuscaloosa County, Alabama 46220 0.8705 0.8641 -0.74 01630 Walker County, Alabama 13820 0.8196 0.8919 8.82 01640 Washington County, Alabama 99901 0.7439 0.7652 2.86 01650 Wilcox County, Alabama 99901 0.7439 0.7652 2.86 01660 Winston County, Alabama 99901 0.7439 0.7652 2.86 02013 Aleutians County East, Alaska 99902 1.1933 1.0680 -10.50 02016 Aleutians County West, Alaska 99902 1.1933 1.0680 -10.50 02020 Anchorage County, Alaska 11260 1.1840 1.2045 1.73 02030 Angoon County, Alaska 99902 1.1933 1.0680 -10.50 02040 Barrow-North Slope County, Alaska 99902 1.1933 1.0680 -10.50 02050 Bethel County, Alaska 99902 1.1933 1.0680 -10.50 02060 Bristol Bay Borough County, Alaska 99902 1.1933 1.0680 -10.50 02068 Denali County, Alaska 99902 1.1933 1.0680 -10.50 02070 Bristol Bay County, Alaska 99902 1.1933 1.0680 -10.50 02080 Cordova-Mc Carthy County, Alaska 99902 1.1933 1.0680 -10.50 02090 Fairbanks County, Alaska 21820 1.1648 1.1079 -4.88 02100 Haines County, Alaska 99902 1.1933 1.0680 -10.50 02110 Juneau County, Alaska 99902 1.1933 1.0680 -10.50 02120 Kenai-Cook Inlet County, Alaska 99902 1.1933 1.0680 -10.50 02122 Kenai Peninsula Borough, Alaska 99902 1.1933 1.0680 -10.50 02130 Ketchikan County, Alaska 99902 1.1933 1.0680 -10.50 02140 Kobuk County, Alaska 99902 1.1933 1.0680 -10.50 02150 Kodiak County, Alaska 99902 1.1933 1.0680 -10.50 Start Printed Page 44133 02160 Kuskokwin County, Alaska 99902 1.1933 1.0680 -10.50 02164 Lake and Peninsula Borough, Alaska 99902 1.1933 1.0680 -10.50 02170 Matanuska County, Alaska 11260 1.1892 1.2045 1.29 02180 Nome County, Alaska 99902 1.1933 1.0680 -10.50 02185 North Slope Borough, Alaska 99902 1.1933 1.0680 -10.50 02188 Northwest Arctic Borough, Alaska 99902 1.1933 1.0680 -10.50 02190 Outer Ketchikan County, Alaska 99902 1.1933 1.0680 -10.50 02200 Prince Of Wales County, Alaska 99902 1.1933 1.0680 -10.50 02201 Prince of Wales-Outer Ketchikan Census Area,AK 99902 1.1933 1.0680 -10.50 02210 Seward County, Alaska 99902 1.1933 1.0680 -10.50 02220 Sitka County, Alaska 99902 1.1933 1.0680 -10.50 02230 Skagway-Yakutat County, Alaska 99902 1.1933 1.0680 -10.50 02231 Skagway-Yakutat-Angoon Census Area, Alaska 99902 1.1933 1.0680 -10.50 02232 Skagway-Hoonah-Angoon Census Area, Alaska 99902 1.1933 1.0680 -10.50 02240 Southeast Fairbanks County, Alaska 99902 1.1933 1.0680 -10.50 02250 Upper Yukon County, Alaska 99902 1.1933 1.0680 -10.50 02260 Valdz-Chitna-Whitier County, Alaska 99902 1.1933 1.0680 -10.50 02261 Valdex-Cordove Census Area, Alaska 99902 1.1933 1.0680 -10.50 02270 Wade Hampton County, Alaska 99902 1.1933 1.0680 -10.50 02280 Wrangell-Petersburg County, Alaska 99902 1.1933 1.0680 -10.50 02282 Yakutat Borough, Alaska 99902 1.1933 1.0680 -10.50 02290 Yukon-Koyukuk County, Alaska 99902 1.1933 1.0680 -10.50 03000 Apache County, Arizona 99903 0.8907 0.8924 0.19 03010 Cochise County, Arizona 99903 0.8907 0.8924 0.19 03020 Coconino County, Arizona 22380 1.1969 1.1621 -2.91 03030 Gila County, Arizona 99903 0.8907 0.8924 0.19 03040 Graham County, Arizona 99903 0.8907 0.8924 0.19 03050 Greenlee County, Arizona 99903 0.8907 0.8924 0.19 03055 La Paz County, Arizona 99903 0.8907 0.8924 0.19 03060 Maricopa County, Arizona 38060 1.0127 1.0305 1.76 03070 Mohave County, Arizona 99903 0.9962 0.8924 -10.42 03080 Navajo County, Arizona 99903 0.8907 0.8924 0.19 03090 Pima County, Arizona 46060 0.9007 0.9219 2.35 03100 Pinal County, Arizona 38060 1.0127 1.0305 1.76 03110 Santa Cruz County, Arizona 99903 0.8907 0.8924 0.19 03120 Yavapai County, Arizona 39140 0.9457 0.9853 4.19 03130 Yuma County, Arizona 49740 0.9126 0.9125 -0.01 04000 Arkansas County, Arkansas 99904 0.7605 0.7335 -3.55 04010 Ashley County, Arkansas 99904 0.7605 0.7335 -3.55 04020 Baxter County, Arkansas 99904 0.7605 0.7335 -3.55 04030 Benton County, Arkansas 22220 0.8661 0.8761 1.15 04040 Boone County, Arkansas 99904 0.7605 0.7335 -3.55 04050 Bradley County, Arkansas 99904 0.7605 0.7335 -3.55 04060 Calhoun County, Arkansas 99904 0.7605 0.7335 -3.55 04070 Carroll County, Arkansas 99904 0.7605 0.7335 -3.55 04080 Chicot County, Arkansas 99904 0.7605 0.7335 -3.55 04090 Clark County, Arkansas 99904 0.7605 0.7335 -3.55 04100 Clay County, Arkansas 99904 0.7605 0.7335 -3.55 04110 Cleburne County, Arkansas 99904 0.7605 0.7335 -3.55 04120 Cleveland County, Arkansas 38220 0.8212 0.8398 2.26 04130 Columbia County, Arkansas 99904 0.7605 0.7335 -3.55 04140 Conway County, Arkansas 99904 0.7605 0.7335 -3.55 04150 Craighead County, Arkansas 27860 0.7911 0.7609 -3.82 04160 Crawford County, Arkansas 22900 0.8238 0.7745 -5.98 04170 Crittenden County, Arkansas 32820 0.9407 0.9361 -0.49 04180 Cross County, Arkansas 99904 0.7605 0.7335 -3.55 04190 Dallas County, Arkansas 99904 0.7605 0.7335 -3.55 04200 Desha County, Arkansas 99904 0.7605 0.7335 -3.55 04210 Drew County, Arkansas 99904 0.7605 0.7335 -3.55 04220 Faulkner County, Arkansas 30780 0.8747 0.8906 1.82 04230 Franklin County, Arkansas 22900 0.7987 0.7745 -3.03 04240 Fulton County, Arkansas 99904 0.7605 0.7335 -3.55 04250 Garland County, Arkansas 26300 0.8375 0.8797 5.04 04260 Grant County, Arkansas 30780 0.8246 0.8906 8.00 04270 Greene County, Arkansas 99904 0.7605 0.7335 -3.55 04280 Hempstead County, Arkansas 99904 0.7605 0.7335 -3.55 04290 Hot Spring County, Arkansas 99904 0.7605 0.7335 -3.55 Start Printed Page 44134 04300 Howard County, Arkansas 99904 0.7605 0.7335 -3.55 04310 Independence County, Arkansas 99904 0.7605 0.7335 -3.55 04320 Izard County, Arkansas 99904 0.7605 0.7335 -3.55 04330 Jackson County, Arkansas 99904 0.7605 0.7335 -3.55 04340 Jefferson County, Arkansas 38220 0.8680 0.8398 -3.25 04350 Johnson County, Arkansas 99904 0.7605 0.7335 -3.55 04360 Lafayette County, Arkansas 99904 0.7605 0.7335 -3.55 04370 Lawrence County, Arkansas 99904 0.7605 0.7335 -3.55 04380 Lee County, Arkansas 99904 0.7605 0.7335 -3.55 04390 Lincoln County, Arkansas 38220 0.8212 0.8398 2.26 04400 Little River County, Arkansas 99904 0.7605 0.7335 -3.55 04410 Logan County, Arkansas 99904 0.7605 0.7335 -3.55 04420 Lonoke County, Arkansas 30780 0.8747 0.8906 1.82 04430 Madison County, Arkansas 22220 0.8203 0.8761 6.80 04440 Marion County, Arkansas 99904 0.7605 0.7335 -3.55 04450 Miller County, Arkansas 45500 0.8283 0.8118 -1.99 04460 Mississippi County, Arkansas 99904 0.7605 0.7335 -3.55 04470 Monroe County, Arkansas 99904 0.7605 0.7335 -3.55 04480 Montgomery County, Arkansas 99904 0.7605 0.7335 -3.55 04490 Nevada County, Arkansas 99904 0.7605 0.7335 -3.55 04500 Newton County, Arkansas 99904 0.7605 0.7335 -3.55 04510 Ouachita County, Arkansas 99904 0.7605 0.7335 -3.55 04520 Perry County, Arkansas 30780 0.8246 0.8906 8.00 04530 Phillips County, Arkansas 99904 0.7605 0.7335 -3.55 04540 Pike County, Arkansas 99904 0.7605 0.7335 -3.55 04550 Poinsett County, Arkansas 27860 0.7828 0.7609 -2.80 04560 Polk County, Arkansas 99904 0.7605 0.7335 -3.55 04570 Pope County, Arkansas 99904 0.7605 0.7335 -3.55 04580 Prairie County, Arkansas 99904 0.7605 0.7335 -3.55 04590 Pulaski County, Arkansas 30780 0.8747 0.8906 1.82 04600 Randolph County, Arkansas 99904 0.7605 0.7335 -3.55 04610 St Francis County, Arkansas 99904 0.7605 0.7335 -3.55 04620 Saline County, Arkansas 30780 0.8747 0.8906 1.82 04630 Scott County, Arkansas 99904 0.7605 0.7335 -3.55 04640 Searcy County, Arkansas 99904 0.7605 0.7335 -3.55 04650 Sebastian County, Arkansas 22900 0.8238 0.7745 -5.98 04660 Sevier County, Arkansas 99904 0.7605 0.7335 -3.55 04670 Sharp County, Arkansas 99904 0.7605 0.7335 -3.55 04680 Stone County, Arkansas 99904 0.7605 0.7335 -3.55 04690 Union County, Arkansas 99904 0.7605 0.7335 -3.55 04700 Van Buren County, Arkansas 99904 0.7605 0.7335 -3.55 04710 Washington County, Arkansas 22220 0.8661 0.8761 1.15 04720 White County, Arkansas 99904 0.7605 0.7335 -3.55 04730 Woodruff County, Arkansas 99904 0.7605 0.7335 -3.55 04740 Yell County, Arkansas 99904 0.7605 0.7335 -3.55 05000 Alameda County, California 36084 1.5346 1.5420 0.48 05010 Alpine County, California 99905 1.0915 1.1302 3.55 05020 Amador County, California 99905 1.0915 1.1302 3.55 05030 Butte County, California 17020 1.0511 1.1073 5.35 05040 Calaveras County, California 99905 1.0915 1.1302 3.55 05050 Colusa County, California 99905 1.0915 1.1302 3.55 05060 Contra Costa County, California 36084 1.5346 1.5420 0.48 05070 Del Norte County, California 99905 1.0915 1.1302 3.55 05080 Eldorado County, California 40900 1.3056 1.3373 2.43 05090 Fresno County, California 23420 1.0483 1.0965 4.60 05100 Glenn County, California 99905 1.0915 1.1302 3.55 05110 Humboldt County, California 99905 1.0915 1.1302 3.55 05120 Imperial County, California 20940 0.9841 0.9092 -7.61 05130 Inyo County, California 99905 1.0915 1.1302 3.55 05140 Kern County, California 12540 1.0470 1.0605 1.29 05150 Kings County, California 25260 1.0406 1.0142 -2.54 05160 Lake County, California 99905 1.0915 1.1302 3.55 05170 Lassen County, California 99905 1.0915 1.1302 3.55 05200 Los Angeles County, California 31084 1.1783 1.1752 -0.26 05210 Los Angeles County, California 31084 1.1783 1.1752 -0.26 05300 Madera County, California 31460 0.9571 0.8169 -14.65 05310 Marin County, California 41884 1.4994 1.5071 0.51 Start Printed Page 44135 05320 Mariposa County, California 99905 1.0915 1.1302 3.55 05330 Mendocino County, California 99905 1.0915 1.1302 3.55 05340 Merced County, California 32900 1.1109 1.1415 2.75 05350 Modoc County, California 99905 1.0915 1.1302 3.55 05360 Mono County, California 99905 1.0915 1.1302 3.55 05370 Monterey County, California 41500 1.4128 1.4459 2.34 05380 Napa County, California 34900 1.3313 1.3496 1.37 05390 Nevada County, California 99905 1.0915 1.1302 3.55 05400 Orange County, California 42044 1.1559 1.1294 -2.29 05410 Placer County, California 40900 1.3056 1.3373 2.43 05420 Plumas County, California 99905 1.0915 1.1302 3.55 05430 Riverside County, California 40140 1.1027 1.0934 -0.84 05440 Sacramento County, California 40900 1.3056 1.3373 2.43 05450 San Benito County, California 41940 1.2937 1.5293 18.21 05460 San Bernardino County, California 40140 1.1027 1.0934 -0.84 05470 San Diego County, California 41740 1.1413 1.1374 -0.34 05480 San Francisco County, California 41884 1.4994 1.5071 0.51 05490 San Joaquin County, California 44700 1.1307 1.1462 1.37 05500 San Luis Obispo County, California 42020 1.1349 1.1619 2.38 05510 San Mateo County, California 41884 1.4994 1.5071 0.51 05520 Santa Barbara County, California 42060 1.1694 1.1075 -5.29 05530 Santa Clara County, California 41940 1.5109 1.5293 1.22 05540 Santa Cruz County, California 42100 1.5166 1.5531 2.41 05550 Shasta County, California 39820 1.2203 1.3221 8.34 05560 Sierra County, California 99905 1.0915 1.1302 3.55 05570 Siskiyou County, California 99905 1.0915 1.1302 3.55 05580 Solano County, California 46700 1.4460 1.5164 4.87 05590 Sonoma County, California 42220 1.3493 1.4489 7.38 05600 Stanislaus County, California 33700 1.1885 1.1590 -2.48 05610 Sutter County, California 49700 1.0921 1.0749 -1.57 05620 Tehama County, California 99905 1.0915 1.1302 3.55 05630 Trinity County, California 99905 1.0915 1.1302 3.55 05640 Tulare County, California 47300 1.0123 0.9986 -1.35 05650 Tuolumne County, California 99905 1.0915 1.1302 3.55 05660 Ventura County, California 37100 1.1622 1.1591 -0.27 05670 Yolo County, California 40900 1.1460 1.3373 16.69 05680 Yuba County, California 49700 1.0921 1.0749 -1.57 06000 Adams County, Colorado 19740 1.0723 1.0947 2.09 06010 Alamosa County, Colorado 99906 0.9380 0.9342 -0.41 06020 Arapahoe County, Colorado 19740 1.0723 1.0947 2.09 06030 Archuleta County, Colorado 99906 0.9380 0.9342 -0.41 06040 Baca County, Colorado 99906 0.9380 0.9342 -0.41 06050 Bent County, Colorado 99906 0.9380 0.9342 -0.41 06060 Boulder County, Colorado 14500 0.9734 1.0368 6.51 06070 Chaffee County, Colorado 99906 0.9380 0.9342 -0.41 06080 Cheyenne County, Colorado 99906 0.9380 0.9342 -0.41 06090 Clear Creek County, Colorado 19740 1.0052 1.0947 8.90 06100 Conejos County, Colorado 99906 0.9380 0.9342 -0.41 06110 Costilla County, Colorado 99906 0.9380 0.9342 -0.41 06120 Crowley County, Colorado 99906 0.9380 0.9342 -0.41 06130 Custer County, Colorado 99906 0.9380 0.9342 -0.41 06140 Delta County, Colorado 99906 0.9380 0.9342 -0.41 06150 Denver County, Colorado 19740 1.0723 1.0947 2.09 06160 Dolores County, Colorado 99906 0.9380 0.9342 -0.41 06170 Douglas County, Colorado 19740 1.0723 1.0947 2.09 06180 Eagle County, Colorado 99906 0.9380 0.9342 -0.41 06190 Elbert County, Colorado 19740 1.0052 1.0947 8.90 06200 El Paso County, Colorado 17820 0.9468 0.9718 2.64 06210 Fremont County, Colorado 99906 0.9380 0.9342 -0.41 06220 Garfield County, Colorado 99906 0.9380 0.9342 -0.41 06230 Gilpin County, Colorado 19740 1.0052 1.0947 8.90 06240 Grand County, Colorado 99906 0.9380 0.9342 -0.41 06250 Gunnison County, Colorado 99906 0.9380 0.9342 -0.41 06260 Hinsdale County, Colorado 99906 0.9380 0.9342 -0.41 06270 Huerfano County, Colorado 99906 0.9380 0.9342 -0.41 06280 Jackson County, Colorado 99906 0.9380 0.9342 -0.41 06290 Jefferson County, Colorado 19740 1.0723 1.0947 2.09 Start Printed Page 44136 06300 Kiowa County, Colorado 99906 0.9380 0.9342 -0.41 06310 Kit Carson County, Colorado 99906 0.9380 0.9342 -0.41 06320 Lake County, Colorado 99906 0.9380 0.9342 -0.41 06330 La Plata County, Colorado 99906 0.9380 0.9342 -0.41 06340 Larimer County, Colorado 22660 1.0122 0.9561 -5.54 06350 Las Animas County, Colorado 99906 0.9380 0.9342 -0.41 06360 Lincoln County, Colorado 99906 0.9380 0.9342 -0.41 06370 Logan County, Colorado 99906 0.9380 0.9342 -0.41 06380 Mesa County, Colorado 24300 0.9550 0.9685 1.41 06390 Mineral County, Colorado 99906 0.9380 0.9342 -0.41 06400 Moffat County, Colorado 99906 0.9380 0.9342 -0.41 06410 Montezuma County, Colorado 99906 0.9380 0.9342 -0.41 06420 Montrose County, Colorado 99906 0.9380 0.9342 -0.41 06430 Morgan County, Colorado 99906 0.9380 0.9342 -0.41 06440 Otero County, Colorado 99906 0.9380 0.9342 -0.41 06450 Ouray County, Colorado 99906 0.9380 0.9342 -0.41 06460 Park County, Colorado 19740 1.0052 1.0947 8.90 06470 Phillips County, Colorado 99906 0.9380 0.9342 -0.41 06480 Pitkin County, Colorado 99906 0.9380 0.9342 -0.41 06490 Prowers County, Colorado 99906 0.9380 0.9342 -0.41 06500 Pueblo County, Colorado 39380 0.8623 0.8552 -0.82 06510 Rio Blanco County, Colorado 99906 0.9380 0.9342 -0.41 06520 Rio Grande County, Colorado 99906 0.9380 0.9342 -0.41 06530 Routt County, Colorado 99906 0.9380 0.9342 -0.41 06540 Saguache County, Colorado 99906 0.9380 0.9342 -0.41 06550 San Juan County, Colorado 99906 0.9380 0.9342 -0.41 06560 San Miguel County, Colorado 99906 0.9380 0.9342 -0.41 06570 Sedgwick County, Colorado 99906 0.9380 0.9342 -0.41 06580 Summit County, Colorado 99906 0.9380 0.9342 -0.41 06590 Teller County, Colorado 17820 0.9424 0.9718 3.12 06600 Washington County, Colorado 99906 0.9380 0.9342 -0.41 06610 Weld County, Colorado 24540 0.9570 0.9619 0.51 06620 Yuma County, Colorado 99906 0.9380 0.9342 -0.41 06630 Broomfield County, Colorado 19740 1.0723 1.0947 2.09 07000 Fairfield County, Connecticut 14860 1.2394 1.2681 2.32 07010 Hartford County, Connecticut 25540 1.1073 1.0916 -1.42 07020 Litchfield County, Connecticut 25540 1.1073 1.0916 -1.42 07030 Middlesex County, Connecticut 25540 1.1073 1.0916 -1.42 07040 New Haven County, Connecticut 35300 1.2042 1.1974 -0.56 07050 New London County, Connecticut 35980 1.1345 1.1953 5.36 07060 Tolland County, Connecticut 25540 1.1073 1.0916 -1.42 07070 Windham County, Connecticut 99907 1.1730 1.1753 0.20 08000 Kent County, Delaware 20100 0.9776 0.9865 0.91 08010 New Castle County, Delaware 48864 1.0499 1.0703 1.94 08020 Sussex County, Delaware 99908 0.9579 0.9723 1.50 09000 Washington Dc County, Dist Of Col 47894 1.0951 1.1074 1.12 10000 Alachua County, Florida 23540 0.9388 0.9312 -0.81 10010 Baker County, Florida 27260 0.8984 0.9042 0.65 10020 Bay County, Florida 37460 0.8005 0.8087 1.02 10030 Bradford County, Florida 99910 0.8623 0.8595 -0.32 10040 Brevard County, Florida 37340 0.9839 0.9448 -3.97 10050 Broward County, Florida 22744 1.0432 1.0151 -2.69 10060 Calhoun County, Florida 99910 0.8623 0.8595 -0.32 10070 Charlotte County, Florida 39460 0.9255 0.9421 1.79 10080 Citrus County, Florida 99910 0.8623 0.8595 -0.32 10090 Clay County, Florida 27260 0.9295 0.9042 -2.72 10100 Collier County, Florida 34940 1.0139 0.9959 -1.78 10110 Columbia County, Florida 99910 0.8623 0.8595 -0.32 10120 Dade County, Florida 33124 0.9750 0.9830 0.82 10130 De Soto County, Florida 99910 0.8623 0.8595 -0.32 10140 Dixie County, Florida 99910 0.8623 0.8595 -0.32 10150 Duval County, Florida 27260 0.9295 0.9042 -2.72 10160 Escambia County, Florida 37860 0.8096 0.8014 -1.01 10170 Flagler County, Florida 99910 0.8947 0.8595 -3.93 10180 Franklin County, Florida 99910 0.8623 0.8595 -0.32 10190 Gadsden County, Florida 45220 0.8688 0.9299 7.03 10200 Gilchrist County, Florida 23540 0.9033 0.9312 3.09 Start Printed Page 44137 10210 Glades County, Florida 99910 0.8623 0.8595 -0.32 10220 Gulf County, Florida 99910 0.8623 0.8595 -0.32 10230 Hamilton County, Florida 99910 0.8623 0.8595 -0.32 10240 Hardee County, Florida 99910 0.8623 0.8595 -0.32 10250 Hendry County, Florida 99910 0.8623 0.8595 -0.32 10260 Hernando County, Florida 45300 0.9233 0.9160 -0.79 10270 Highlands County, Florida 99910 0.8623 0.8595 -0.32 10280 Hillsborough County, Florida 45300 0.9233 0.9160 -0.79 10290 Holmes County, Florida 99910 0.8623 0.8595 -0.32 10300 Indian River County, Florida 42680 0.9056 0.9590 5.90 10310 Jackson County, Florida 99910 0.8623 0.8595 -0.32 10320 Jefferson County, Florida 45220 0.8683 0.9299 7.09 10330 Lafayette County, Florida 99910 0.8623 0.8595 -0.32 10340 Lake County, Florida 36740 0.9464 0.9422 -0.44 10350 Lee County, Florida 15980 0.9356 0.9359 0.03 10360 Leon County, Florida 45220 0.8688 0.9299 7.03 10370 Levy County, Florida 99910 0.8623 0.8595 -0.32 10380 Liberty County, Florida 99910 0.8623 0.8595 -0.32 10390 Madison County, Florida 99910 0.8623 0.8595 -0.32 10400 Manatee County, Florida 42260 0.9639 0.9885 2.55 10410 Marion County, Florida 36100 0.8925 0.8883 -0.47 10420 Martin County, Florida 38940 1.0123 0.9851 -2.69 10430 Monroe County, Florida 99910 0.8623 0.8595 -0.32 10440 Nassau County, Florida 27260 0.9295 0.9042 -2.72 10450 Okaloosa County, Florida 23020 0.8872 0.8658 -2.41 10460 Okeechobee County, Florida 99910 0.8623 0.8595 -0.32 10470 Orange County, Florida 36740 0.9464 0.9422 -0.44 10480 Osceola County, Florida 36740 0.9464 0.9422 -0.44 10490 Palm Beach County, Florida 48424 1.0067 0.9657 -4.07 10500 Pasco County, Florida 45300 0.9233 0.9160 -0.79 10510 Pinellas County, Florida 45300 0.9233 0.9160 -0.79 10520 Polk County, Florida 29460 0.8912 0.8895 -0.19 10530 Putnam County, Florida 99910 0.8623 0.8595 -0.32 10540 Johns County, Florida 27260 0.9295 0.9042 -2.72 10550 St Lucie County, Florida 38940 1.0123 0.9851 -2.69 10560 Santa Rosa County, Florida 37860 0.8096 0.8014 -1.01 10570 Sarasota County, Florida 42260 0.9639 0.9885 2.55 10580 Seminole County, Florida 36740 0.9464 0.9422 -0.44 10590 Sumter County, Florida 99910 0.8623 0.8595 -0.32 10600 Suwannee County, Florida 99910 0.8623 0.8595 -0.32 10610 Taylor County, Florida 99910 0.8623 0.8595 -0.32 10620 Union County, Florida 99910 0.8623 0.8595 -0.32 10630 Volusia County, Florida 19660 0.9312 0.9280 -0.34 10640 Wakulla County, Florida 45220 0.8683 0.9299 7.09 10650 Walton County, Florida 99910 0.8623 0.8595 -0.32 10660 Washington County, Florida 99910 0.8623 0.8595 -0.32 11000 Appling County, Georgia 99911 0.7914 0.7560 -4.47 11010 Atkinson County, Georgia 99911 0.7914 0.7560 -4.47 11011 Bacon County, Georgia 99911 0.7914 0.7560 -4.47 11020 Baker County, Georgia 10500 0.8397 0.8962 6.73 11030 Baldwin County, Georgia 99911 0.7914 0.7560 -4.47 11040 Banks County, Georgia 99911 0.7914 0.7560 -4.47 11050 Barrow County, Georgia 12060 0.9793 0.9772 -0.21 11060 Bartow County, Georgia 12060 0.9793 0.9772 -0.21 11070 Ben Hill County, Georgia 99911 0.7914 0.7560 -4.47 11080 Berrien County, Georgia 99911 0.7914 0.7560 -4.47 11090 Bibb County, Georgia 31420 0.9360 0.9518 1.69 11100 Bleckley County, Georgia 99911 0.7914 0.7560 -4.47 11110 Brantley County, Georgia 15260 0.8739 1.0097 15.54 11120 Brooks County, Georgia 46660 0.8516 0.8344 -2.02 11130 Bryan County, Georgia 42340 0.9461 0.9087 -3.95 11140 Bulloch County, Georgia 99911 0.7914 0.7560 -4.47 11150 Burke County, Georgia 12260 0.8957 0.9678 8.05 11160 Butts County, Georgia 12060 0.8980 0.9772 8.82 11161 Calhoun County, Georgia 99911 0.7914 0.7560 -4.47 11170 Camden County, Georgia 99911 0.7914 0.7560 -4.47 11180 Candler County, Georgia 99911 0.7914 0.7560 -4.47 Start Printed Page 44138 11190 Carroll County, Georgia 12060 0.9793 0.9772 -0.21 11200 Catoosa County, Georgia 16860 0.9088 0.8963 -1.38 11210 Charlton County, Georgia 99911 0.7914 0.7560 -4.47 11220 Chatham County, Georgia 42340 0.9461 0.9087 -3.95 11230 Chattahoochee County, Georgia 17980 0.8560 0.8254 -3.57 11240 Chattooga County, Georgia 99911 0.7914 0.7560 -4.47 11250 Cherokee County, Georgia 12060 0.9793 0.9772 -0.21 11260 Clarke County, Georgia 12020 0.9855 0.9857 0.02 11270 Clay County, Georgia 99911 0.7914 0.7560 -4.47 11280 Clayton County, Georgia 12060 0.9793 0.9772 -0.21 11281 Clinch County, Georgia 99911 0.7914 0.7560 -4.47 11290 Cobb County, Georgia 12060 0.9793 0.9772 -0.21 11291 Coffee County, Georgia 99911 0.7914 0.7560 -4.47 11300 Colquitt County, Georgia 99911 0.7914 0.7560 -4.47 11310 Columbia County, Georgia 12260 0.9778 0.9678 -1.02 11311 Cook County, Georgia 99911 0.7914 0.7560 -4.47 11320 Coweta County, Georgia 12060 0.9793 0.9772 -0.21 11330 Crawford County, Georgia 31420 0.8805 0.9518 8.10 11340 Crisp County, Georgia 99911 0.7914 0.7560 -4.47 11341 Dade County, Georgia 16860 0.9088 0.8963 -1.38 11350 Dawson County, Georgia 12060 0.8980 0.9772 8.82 11360 Decatur County, Georgia 99911 0.7914 0.7560 -4.47 11370 De Kalb County, Georgia 12060 0.9793 0.9772 -0.21 11380 Dodge County, Georgia 99911 0.7914 0.7560 -4.47 11381 Dooly County, Georgia 99911 0.7914 0.7560 -4.47 11390 Dougherty County, Georgia 10500 0.8628 0.8962 3.87 11400 Douglas County, Georgia 12060 0.9793 0.9772 -0.21 11410 Early County, Georgia 99911 0.7914 0.7560 -4.47 11420 Echols County, Georgia 46660 0.8516 0.8344 -2.02 11421 Effingham County, Georgia 42340 0.9461 0.9087 -3.95 11430 Elbert County, Georgia 99911 0.7914 0.7560 -4.47 11440 Emanuel County, Georgia 99911 0.7914 0.7560 -4.47 11441 Evans County, Georgia 99911 0.7914 0.7560 -4.47 11450 Fannin County, Georgia 99911 0.7914 0.7560 -4.47 11451 Fayette County, Georgia 12060 0.9793 0.9772 -0.21 11460 Floyd County, Georgia 40660 0.8790 0.9316 5.98 11461 Forsyth County, Georgia 12060 0.9793 0.9772 -0.21 11462 Franklin County, Georgia 99911 0.7914 0.7560 -4.47 11470 Fulton County, Georgia 12060 0.9793 0.9772 -0.21 11471 Gilmer County, Georgia 99911 0.7914 0.7560 -4.47 11480 Glascock County, Georgia 99911 0.7914 0.7560 -4.47 11490 Glynn County, Georgia 15260 0.8739 1.0097 15.54 11500 Gordon County, Georgia 99911 0.7914 0.7560 -4.47 11510 Grady County, Georgia 99911 0.7914 0.7560 -4.47 11520 Greene County, Georgia 99911 0.7914 0.7560 -4.47 11530 Gwinnett County, Georgia 12060 0.9793 0.9772 -0.21 11540 Habersham County, Georgia 99911 0.7914 0.7560 -4.47 11550 Hall County, Georgia 23580 0.8520 0.8974 5.33 11560 Hancock County, Georgia 99911 0.7914 0.7560 -4.47 11570 Haralson County, Georgia 12060 0.8980 0.9772 8.82 11580 Harris County, Georgia 17980 0.8560 0.8254 -3.57 11581 Hart County, Georgia 99911 0.7914 0.7560 -4.47 11590 Heard County, Georgia 12060 0.8980 0.9772 8.82 11591 Henry County, Georgia 12060 0.9793 0.9772 -0.21 11600 Houston County, Georgia 47580 0.8961 0.8394 -6.33 11601 Irwin County, Georgia 99911 0.7914 0.7560 -4.47 11610 Jackson County, Georgia 99911 0.7914 0.7560 -4.47 11611 Jasper County, Georgia 12060 0.8980 0.9772 8.82 11612 Jeff Davis County, Georgia 99911 0.7914 0.7560 -4.47 11620 Jefferson County, Georgia 99911 0.7914 0.7560 -4.47 11630 Jenkins County, Georgia 99911 0.7914 0.7560 -4.47 11640 Johnson County, Georgia 99911 0.7914 0.7560 -4.47 11650 Jones County, Georgia 31420 0.9360 0.9518 1.69 11651 Lamar County, Georgia 12060 0.8980 0.9772 8.82 11652 Lanier County, Georgia 46660 0.8516 0.8344 -2.02 11660 Laurens County, Georgia 99911 0.7914 0.7560 -4.47 11670 Lee County, Georgia 10500 0.8628 0.8962 3.87 Start Printed Page 44139 11680 Liberty County, Georgia 25980 0.8973 0.9163 2.12 11690 Lincoln County, Georgia 99911 0.7914 0.7560 -4.47 11691 Long County, Georgia 25980 0.8973 0.9163 2.12 11700 Lowndes County, Georgia 46660 0.8516 0.8344 -2.02 11701 Lumpkin County, Georgia 99911 0.7914 0.7560 -4.47 11702 Mc Duffie County, Georgia 12260 0.9778 0.9678 -1.02 11703 Mc Intosh County, Georgia 15260 0.8739 1.0097 15.54 11710 Macon County, Georgia 99911 0.7914 0.7560 -4.47 11720 Madison County, Georgia 12020 0.9855 0.9857 0.02 11730 Marion County, Georgia 17980 0.8363 0.8254 -1.30 11740 Meriwether County, Georgia 12060 0.8980 0.9772 8.82 11741 Miller County, Georgia 99911 0.7914 0.7560 -4.47 11750 Mitchell County, Georgia 99911 0.7914 0.7560 -4.47 11760 Monroe County, Georgia 31420 0.8805 0.9518 8.10 11770 Montgomery County, Georgia 99911 0.7914 0.7560 -4.47 11771 Morgan County, Georgia 99911 0.7914 0.7560 -4.47 11772 Murray County, Georgia 19140 0.8623 0.9061 5.08 11780 Muscogee County, Georgia 17980 0.8560 0.8254 -3.57 11790 Newton County, Georgia 12060 0.9793 0.9772 -0.21 11800 Oconee County, Georgia 12020 0.9855 0.9857 0.02 11801 Oglethorpe County, Georgia 12020 0.9011 0.9857 9.39 11810 Paulding County, Georgia 12060 0.9793 0.9772 -0.21 11811 Peach County, Georgia 99911 0.8470 0.7560 -10.74 11812 Pickens County, Georgia 12060 0.9793 0.9772 -0.21 11820 Pierce County, Georgia 99911 0.7914 0.7560 -4.47 11821 Pike County, Georgia 12060 0.8980 0.9772 8.82 11830 Polk County, Georgia 99911 0.7914 0.7560 -4.47 11831 Pulaski County, Georgia 99911 0.7914 0.7560 -4.47 11832 Putnam County, Georgia 99911 0.7914 0.7560 -4.47 11833 Quitman County, Georgia 99911 0.7914 0.7560 -4.47 11834 Rabun County, Georgia 99911 0.7914 0.7560 -4.47 11835 Randolph County, Georgia 99911 0.7914 0.7560 -4.47 11840 Richmond County, Georgia 12260 0.9778 0.9678 -1.02 11841 Rockdale County, Georgia 12060 0.9793 0.9772 -0.21 11842 Schley County, Georgia 99911 0.7914 0.7560 -4.47 11850 Screven County, Georgia 99911 0.7914 0.7560 -4.47 11851 Seminole County, Georgia 99911 0.7914 0.7560 -4.47 11860 Spalding County, Georgia 12060 0.9793 0.9772 -0.21 11861 Stephens County, Georgia 99911 0.7914 0.7560 -4.47 11862 Stewart County, Georgia 99911 0.7914 0.7560 -4.47 11870 Sumter County, Georgia 99911 0.7914 0.7560 -4.47 11880 Talbot County, Georgia 99911 0.7914 0.7560 -4.47 11881 Taliaferro County, Georgia 99911 0.7914 0.7560 -4.47 11882 Tattnall County, Georgia 99911 0.7914 0.7560 -4.47 11883 Taylor County, Georgia 99911 0.7914 0.7560 -4.47 11884 Telfair County, Georgia 99911 0.7914 0.7560 -4.47 11885 Terrell County, Georgia 10500 0.8397 0.8962 6.73 11890 Thomas County, Georgia 99911 0.7914 0.7560 -4.47 11900 Tift County, Georgia 99911 0.7914 0.7560 -4.47 11901 Toombs County, Georgia 99911 0.7914 0.7560 -4.47 11902 Towns County, Georgia 99911 0.7914 0.7560 -4.47 11903 Treutlen County, Georgia 99911 0.7914 0.7560 -4.47 11910 Troup County, Georgia 99911 0.7914 0.7560 -4.47 11911 Turner County, Georgia 99911 0.7914 0.7560 -4.47 11912 Twiggs County, Georgia 31420 0.9360 0.9518 1.69 11913 Union County, Georgia 99911 0.7914 0.7560 -4.47 11920 Upson County, Georgia 99911 0.7914 0.7560 -4.47 11921 Walker County, Georgia 16860 0.9088 0.8963 -1.38 11930 Walton County, Georgia 12060 0.9793 0.9772 -0.21 11940 Ware County, Georgia 99911 0.7914 0.7560 -4.47 11941 Warren County, Georgia 99911 0.7914 0.7560 -4.47 11950 Washington County, Georgia 99911 0.7914 0.7560 -4.47 11960 Wayne County, Georgia 99911 0.7914 0.7560 -4.47 11961 Webster County, Georgia 99911 0.7914 0.7560 -4.47 11962 Wheeler County, Georgia 99911 0.7914 0.7560 -4.47 11963 White County, Georgia 99911 0.7914 0.7560 -4.47 11970 Whitfield County, Georgia 19140 0.8623 0.9061 5.08 Start Printed Page 44140 11971 Wilcox County, Georgia 99911 0.7914 0.7560 -4.47 11972 Wilkes County, Georgia 99911 0.7914 0.7560 -4.47 11973 Wilkinson County, Georgia 99911 0.7914 0.7560 -4.47 11980 Worth County, Georgia 10500 0.8397 0.8962 6.73 12005 Kalawao County, Hawaii 99912 1.0551 1.0467 -0.80 12010 Hawaii County, Hawaii 99912 1.0551 1.0467 -0.80 12020 Honolulu County, Hawaii 26180 1.1214 1.1067 -1.31 12040 Kauai County, Hawaii 99912 1.0551 1.0467 -0.80 12050 Maui County, Hawaii 99912 1.0551 1.0467 -0.80 13000 Ada County, Idaho 14260 0.9052 0.9417 4.03 13010 Adams County, Idaho 99913 0.8567 0.8134 -5.05 13020 Bannock County, Idaho 38540 0.9351 0.9417 0.71 13030 Bear Lake County, Idaho 99913 0.8567 0.8134 -5.05 13040 Benewah County, Idaho 99913 0.8567 0.8134 -5.05 13050 Bingham County, Idaho 99913 0.8567 0.8134 -5.05 13060 Blaine County, Idaho 99913 0.8567 0.8134 -5.05 13070 Boise County, Idaho 14260 0.9075 0.9417 3.77 13080 Bonner County, Idaho 99913 0.8567 0.8134 -5.05 13090 Bonneville County, Idaho 26820 0.9259 0.9104 -1.67 13100 Boundary County, Idaho 99913 0.8567 0.8134 -5.05 13110 Butte County, Idaho 99913 0.8567 0.8134 -5.05 13120 Camas County, Idaho 99913 0.8567 0.8134 -5.05 13130 Canyon County, Idaho 14260 0.9052 0.9417 4.03 13140 Caribou County, Idaho 99913 0.8567 0.8134 -5.05 13150 Cassia County, Idaho 99913 0.8567 0.8134 -5.05 13160 Clark County, Idaho 99913 0.8567 0.8134 -5.05 13170 Clearwater County, Idaho 99913 0.8567 0.8134 -5.05 13180 Custer County, Idaho 99913 0.8567 0.8134 -5.05 13190 Elmore County, Idaho 99913 0.8567 0.8134 -5.05 13200 Franklin County, Idaho 30860 0.9131 0.9038 -1.02 13210 Fremont County, Idaho 99913 0.8567 0.8134 -5.05 13220 Gem County, Idaho 14260 0.9075 0.9417 3.77 13230 Gooding County, Idaho 99913 0.8567 0.8134 -5.05 13240 Idaho County, Idaho 99913 0.8567 0.8134 -5.05 13250 Jefferson County, Idaho 26820 0.9259 0.9104 -1.67 13260 Jerome County, Idaho 99913 0.8567 0.8134 -5.05 13270 Kootenai County, Idaho 17660 0.9372 0.9360 -0.13 13280 Latah County, Idaho 99913 0.8567 0.8134 -5.05 13290 Lemhi County, Idaho 99913 0.8567 0.8134 -5.05 13300 Lewis County, Idaho 99913 0.8567 0.8134 -5.05 13310 Lincoln County, Idaho 99913 0.8567 0.8134 -5.05 13320 Madison County, Idaho 99913 0.8567 0.8134 -5.05 13330 Minidoka County, Idaho 99913 0.8567 0.8134 -5.05 13340 Nez Perce County, Idaho 30300 0.9492 0.9871 3.99 13350 Oneida County, Idaho 99913 0.8567 0.8134 -5.05 13360 Owyhee County, Idaho 14260 0.9075 0.9417 3.77 13370 Payette County, Idaho 99913 0.8567 0.8134 -5.05 13380 Power County, Idaho 38540 0.9224 0.9417 2.09 13390 Shoshone County, Idaho 99913 0.8567 0.8134 -5.05 13400 Teton County, Idaho 99913 0.8567 0.8134 -5.05 13410 Twin Falls County, Idaho 99913 0.8567 0.8134 -5.05 13420 Valley County, Idaho 99913 0.8567 0.8134 -5.05 13430 Washington County, Idaho 99913 0.8567 0.8134 -5.05 14000 Adams County, Illinois 99914 0.8286 0.8327 0.49 14010 Alexander County, Illinois 99914 0.8286 0.8327 0.49 14020 Bond County, Illinois 41180 0.8628 0.9013 4.46 14030 Boone County, Illinois 40420 0.9984 1.0007 0.23 14040 Brown County, Illinois 99914 0.8286 0.8327 0.49 14050 Bureau County, Illinois 99914 0.8286 0.8327 0.49 14060 Calhoun County, Illinois 41180 0.8628 0.9013 4.46 14070 Carroll County, Illinois 99914 0.8286 0.8327 0.49 14080 Cass County, Illinois 99914 0.8286 0.8327 0.49 14090 Champaign County, Illinois 16580 0.9594 0.9661 0.70 14100 Christian County, Illinois 99914 0.8286 0.8327 0.49 14110 Clark County, Illinois 99914 0.8286 0.8327 0.49 14120 Clay County, Illinois 99914 0.8286 0.8327 0.49 14130 Clinton County, Illinois 41180 0.8958 0.9013 0.61 Start Printed Page 44141 14140 Coles County, Illinois 99914 0.8286 0.8327 0.49 14141 Cook County, Illinois 16974 1.0787 1.0745 -0.39 14150 Crawford County, Illinois 99914 0.8286 0.8327 0.49 14160 Cumberland County, Illinois 99914 0.8286 0.8327 0.49 14170 De Kalb County, Illinois 16974 1.0787 1.0745 -0.39 14180 De Witt County, Illinois 99914 0.8286 0.8327 0.49 14190 Douglas County, Illinois 99914 0.8286 0.8327 0.49 14250 Du Page County, Illinois 16974 1.0787 1.0745 -0.39 14310 Edgar County, Illinois 99914 0.8286 0.8327 0.49 14320 Edwards County, Illinois 99914 0.8286 0.8327 0.49 14330 Effingham County, Illinois 99914 0.8286 0.8327 0.49 14340 Fayette County, Illinois 99914 0.8286 0.8327 0.49 14350 Ford County, Illinois 16580 0.8948 0.9661 7.97 14360 Franklin County, Illinois 99914 0.8286 0.8327 0.49 14370 Fulton County, Illinois 99914 0.8286 0.8327 0.49 14380 Gallatin County, Illinois 99914 0.8286 0.8327 0.49 14390 Greene County, Illinois 99914 0.8286 0.8327 0.49 14400 Grundy County, Illinois 16974 1.0787 1.0745 -0.39 14410 Hamilton County, Illinois 99914 0.8286 0.8327 0.49 14420 Hancock County, Illinois 99914 0.8286 0.8327 0.49 14421 Hardin County, Illinois 99914 0.8286 0.8327 0.49 14440 Henderson County, Illinois 99914 0.8286 0.8327 0.49 14450 Henry County, Illinois 19340 0.8724 0.8557 -1.91 14460 Iroquois County, Illinois 99914 0.8286 0.8327 0.49 14470 Jackson County, Illinois 99914 0.8286 0.8327 0.49 14480 Jasper County, Illinois 99914 0.8286 0.8327 0.49 14490 Jefferson County, Illinois 99914 0.8286 0.8327 0.49 14500 Jersey County, Illinois 41180 0.8958 0.9013 0.61 14510 Jo Daviess County, Illinois 99914 0.8286 0.8327 0.49 14520 Johnson County, Illinois 99914 0.8286 0.8327 0.49 14530 Kane County, Illinois 16974 1.0787 1.0745 -0.39 14540 Kankakee County, Illinois 28100 1.0721 0.9990 -6.82 14550 Kendall County, Illinois 16974 1.0787 1.0745 -0.39 14560 Knox County, Illinois 99914 0.8286 0.8327 0.49 14570 Lake County, Illinois 29404 1.0606 1.0406 -1.89 14580 La Salle County, Illinois 99914 0.8286 0.8327 0.49 14590 Lawrence County, Illinois 99914 0.8286 0.8327 0.49 14600 Lee County, Illinois 99914 0.8286 0.8327 0.49 14610 Livingston County, Illinois 99914 0.8286 0.8327 0.49 14620 Logan County, Illinois 99914 0.8286 0.8327 0.49 14630 Mc Donough County, Illinois 99914 0.8286 0.8327 0.49 14640 Mc Henry County, Illinois 16974 1.0787 1.0745 -0.39 14650 Mclean County, Illinois 14060 0.9075 0.8960 -1.27 14660 Macon County, Illinois 19500 0.8067 0.8187 1.49 14670 Macoupin County, Illinois 41180 0.8628 0.9013 4.46 14680 Madison County, Illinois 41180 0.8958 0.9013 0.61 14690 Marion County, Illinois 99914 0.8286 0.8327 0.49 14700 Marshall County, Illinois 37900 0.8586 0.8998 4.80 14710 Mason County, Illinois 99914 0.8286 0.8327 0.49 14720 Massac County, Illinois 99914 0.8286 0.8327 0.49 14730 Menard County, Illinois 44100 0.8792 0.8905 1.29 14740 Mercer County, Illinois 19340 0.8513 0.8557 0.52 14750 Monroe County, Illinois 41180 0.8958 0.9013 0.61 14760 Montgomery County, Illinois 99914 0.8286 0.8327 0.49 14770 Morgan County, Illinois 99914 0.8286 0.8327 0.49 14780 Moultrie County, Illinois 99914 0.8286 0.8327 0.49 14790 Ogle County, Illinois 99914 0.9128 0.8327 -8.78 14800 Peoria County, Illinois 37900 0.8870 0.8998 1.44 14810 Perry County, Illinois 99914 0.8286 0.8327 0.49 14820 Piatt County, Illinois 16580 0.8948 0.9661 7.97 14830 Pike County, Illinois 99914 0.8286 0.8327 0.49 14831 Pope County, Illinois 99914 0.8286 0.8327 0.49 14850 Pulaski County, Illinois 99914 0.8286 0.8327 0.49 14860 Putnam County, Illinois 99914 0.8286 0.8327 0.49 14870 Randolph County, Illinois 99914 0.8286 0.8327 0.49 14880 Richland County, Illinois 99914 0.8286 0.8327 0.49 14890 Rock Island County, Illinois 19340 0.8724 0.8557 -1.91 Start Printed Page 44142 14900 St Clair County, Illinois 41180 0.8958 0.9013 0.61 14910 Saline County, Illinois 99914 0.8286 0.8327 0.49 14920 Sangamon County, Illinois 44100 0.8792 0.8905 1.29 14921 Schuyler County, Illinois 99914 0.8286 0.8327 0.49 14940 Scott County, Illinois 99914 0.8286 0.8327 0.49 14950 Shelby County, Illinois 99914 0.8286 0.8327 0.49 14960 Stark County, Illinois 37900 0.8586 0.8998 4.80 14970 Stephenson County, Illinois 99914 0.8286 0.8327 0.49 14980 Tazewell County, Illinois 37900 0.8870 0.8998 1.44 14981 Union County, Illinois 99914 0.8286 0.8327 0.49 14982 Vermilion County, Illinois 19180 0.8665 0.9283 7.13 14983 Wabash County, Illinois 99914 0.8286 0.8327 0.49 14984 Warren County, Illinois 99914 0.8286 0.8327 0.49 14985 Washington County, Illinois 99914 0.8286 0.8327 0.49 14986 Wayne County, Illinois 99914 0.8286 0.8327 0.49 14987 White County, Illinois 99914 0.8286 0.8327 0.49 14988 Whiteside County, Illinois 99914 0.8286 0.8327 0.49 14989 Will County, Illinois 16974 1.0787 1.0745 -0.39 14990 Williamson County, Illinois 99914 0.8286 0.8327 0.49 14991 Winnebago County, Illinois 40420 0.9984 1.0007 0.23 14992 Woodford County, Illinois 37900 0.8870 0.8998 1.44 15000 Adams County, Indiana 99915 0.9165 0.8477 -7.51 15010 Allen County, Indiana 23060 0.9750 0.9504 -2.52 15020 Bartholomew County, Indiana 18020 0.9164 0.9334 1.86 15030 Benton County, Indiana 29140 0.8738 0.8972 2.68 15040 Blackford County, Indiana 99915 0.8682 0.8477 -2.36 15050 Boone County, Indiana 26900 0.9893 0.9766 -1.28 15060 Brown County, Indiana 26900 0.9330 0.9766 4.67 15070 Carroll County, Indiana 29140 0.8738 0.8972 2.68 15080 Cass County, Indiana 99915 0.8682 0.8477 -2.36 15090 Clark County, Indiana 31140 0.9272 0.9135 -1.48 15100 Clay County, Indiana 45460 0.8321 0.8661 4.09 15110 Clinton County, Indiana 99915 0.8680 0.8477 -2.34 15120 Crawford County, Indiana 99915 0.8682 0.8477 -2.36 15130 Daviess County, Indiana 99915 0.8682 0.8477 -2.36 15140 Dearborn County, Indiana 17140 0.9675 0.9617 -0.60 15150 Decatur County, Indiana 99915 0.8682 0.8477 -2.36 15160 De Kalb County, Indiana 99915 0.9165 0.8477 -7.51 15170 Delaware County, Indiana 34620 0.8930 0.8299 -7.07 15180 Dubois County, Indiana 99915 0.8682 0.8477 -2.36 15190 Elkhart County, Indiana 21140 0.9627 0.9442 -1.92 15200 Fayette County, Indiana 99915 0.8682 0.8477 -2.36 15210 Floyd County, Indiana 31140 0.9272 0.9135 -1.48 15220 Fountain County, Indiana 99915 0.8682 0.8477 -2.36 15230 Franklin County, Indiana 17140 0.9177 0.9617 4.79 15240 Fulton County, Indiana 99915 0.8682 0.8477 -2.36 15250 Gibson County, Indiana 21780 0.8726 0.8830 1.19 15260 Grant County, Indiana 99915 0.8682 0.8477 -2.36 15270 Greene County, Indiana 14020 0.8593 0.8548 -0.52 15280 Hamilton County, Indiana 26900 0.9893 0.9766 -1.28 15290 Hancock County, Indiana 26900 0.9893 0.9766 -1.28 15300 Harrison County, Indiana 31140 0.9272 0.9135 -1.48 15310 Hendricks County, Indiana 26900 0.9893 0.9766 -1.28 15320 Henry County, Indiana 99915 0.8682 0.8477 -2.36 15330 Howard County, Indiana 29020 0.9508 0.9460 -0.50 15340 Huntington County, Indiana 99915 0.9165 0.8477 -7.51 15350 Jackson County, Indiana 99915 0.8682 0.8477 -2.36 15360 Jasper County, Indiana 23844 0.9067 0.9281 2.36 15370 Jay County, Indiana 99915 0.8682 0.8477 -2.36 15380 Jefferson County, Indiana 99915 0.8682 0.8477 -2.36 15390 Jennings County, Indiana 99915 0.8682 0.8477 -2.36 15400 Johnson County, Indiana 26900 0.9893 0.9766 -1.28 15410 Knox County, Indiana 99915 0.8682 0.8477 -2.36 15420 Kosciusko County, Indiana 99915 0.8682 0.8477 -2.36 15430 Lagrange County, Indiana 99915 0.8682 0.8477 -2.36 15440 Lake County, Indiana 23844 0.9395 0.9281 -1.21 15450 La Porte County, Indiana 33140 0.9069 0.9093 0.26 Start Printed Page 44143 15460 Lawrence County, Indiana 99915 0.8682 0.8477 -2.36 15470 Madison County, Indiana 11300 0.9226 0.8790 -4.73 15480 Marion County, Indiana 26900 0.9893 0.9766 -1.28 15490 Marshall County, Indiana 99915 0.8682 0.8477 -2.36 15500 Martin County, Indiana 99915 0.8682 0.8477 -2.36 15510 Miami County, Indiana 99915 0.8682 0.8477 -2.36 15520 Monroe County, Indiana 14020 0.8447 0.8548 1.20 15530 Montgomery County, Indiana 99915 0.8682 0.8477 -2.36 15540 Morgan County, Indiana 26900 0.9893 0.9766 -1.28 15550 Newton County, Indiana 23844 0.9067 0.9281 2.36 15560 Noble County, Indiana 99915 0.8682 0.8477 -2.36 15570 Ohio County, Indiana 17140 0.9675 0.9617 -0.60 15580 Orange County, Indiana 99915 0.8682 0.8477 -2.36 15590 Owen County, Indiana 14020 0.8593 0.8548 -0.52 15600 Parke County, Indiana 99915 0.8682 0.8477 -2.36 15610 Perry County, Indiana 99915 0.8682 0.8477 -2.36 15620 Pike County, Indiana 99915 0.8682 0.8477 -2.36 15630 Porter County, Indiana 23844 0.9395 0.9281 -1.21 15640 Posey County, Indiana 21780 0.8713 0.8830 1.34 15650 Pulaski County, Indiana 99915 0.8682 0.8477 -2.36 15660 Putnam County, Indiana 26900 0.9330 0.9766 4.67 15670 Randolph County, Indiana 99915 0.8682 0.8477 -2.36 15680 Ripley County, Indiana 99915 0.8682 0.8477 -2.36 15690 Rush County, Indiana 99915 0.8682 0.8477 -2.36 15700 St Joseph County, Indiana 43780 0.9788 0.9690 -1.00 15710 Scott County, Indiana 99915 0.8959 0.8477 -5.38 15720 Shelby County, Indiana 26900 0.9893 0.9766 -1.28 15730 Spencer County, Indiana 99915 0.8682 0.8477 -2.36 15740 Starke County, Indiana 99915 0.8682 0.8477 -2.36 15750 Steuben County, Indiana 99915 0.8682 0.8477 -2.36 15760 Sullivan County, Indiana 45460 0.8522 0.8661 1.63 15770 Switzerland County, Indiana 99915 0.8682 0.8477 -2.36 15780 Tippecanoe County, Indiana 29140 0.8736 0.8972 2.70 15790 Tipton County, Indiana 29020 0.9508 0.9460 -0.50 15800 Union County, Indiana 99915 0.8682 0.8477 -2.36 15810 Vanderburgh County, Indiana 21780 0.8713 0.8830 1.34 15820 Vermillion County, Indiana 45460 0.8321 0.8661 4.09 15830 Vigo County, Indiana 45460 0.8321 0.8661 4.09 15840 Wabash County, Indiana 99915 0.8682 0.8477 -2.36 15850 Warren County, Indiana 99915 0.8682 0.8477 -2.36 15860 Warrick County, Indiana 21780 0.8713 0.8830 1.34 15870 Washington County, Indiana 31140 0.8995 0.9135 1.56 15880 Wayne County, Indiana 99915 0.8682 0.8477 -2.36 15890 Wells County, Indiana 23060 0.9750 0.9504 -2.52 15900 White County, Indiana 99915 0.8682 0.8477 -2.36 15910 Whitley County, Indiana 23060 0.9750 0.9504 -2.52 16000 Adair County, Iowa 99916 0.8552 0.8697 1.70 16010 Adams County, Iowa 99916 0.8552 0.8697 1.70 16020 Allamakee County, Iowa 99916 0.8552 0.8697 1.70 16030 Appanoose County, Iowa 99916 0.8552 0.8697 1.70 16040 Audubon County, Iowa 99916 0.8552 0.8697 1.70 16050 Benton County, Iowa 16300 0.8710 0.8903 2.22 16060 Black Hawk County, Iowa 47940 0.8557 0.8422 -1.58 16070 Boone County, Iowa 99916 0.8552 0.8697 1.70 16080 Bremer County, Iowa 47940 0.8576 0.8422 -1.80 16090 Buchanan County, Iowa 99916 0.8552 0.8697 1.70 16100 Buena Vista County, Iowa 99916 0.8552 0.8697 1.70 16110 Butler County, Iowa 99916 0.8552 0.8697 1.70 16120 Calhoun County, Iowa 99916 0.8552 0.8697 1.70 16130 Carroll County, Iowa 99916 0.8552 0.8697 1.70 16140 Cass County, Iowa 99916 0.8552 0.8697 1.70 16150 Cedar County, Iowa 99916 0.8552 0.8697 1.70 16160 Cerro Gordo County, Iowa 99916 0.8552 0.8697 1.70 16170 Cherokee County, Iowa 99916 0.8552 0.8697 1.70 16180 Chickasaw County, Iowa 99916 0.8552 0.8697 1.70 16190 Clarke County, Iowa 99916 0.8552 0.8697 1.70 16200 Clay County, Iowa 99916 0.8552 0.8697 1.70 Start Printed Page 44144 16210 Clayton County, Iowa 99916 0.8552 0.8697 1.70 16220 Clinton County, Iowa 99916 0.8552 0.8697 1.70 16230 Crawford County, Iowa 99916 0.8552 0.8697 1.70 16240 Dallas County, Iowa 19780 0.9669 0.9136 -5.51 16250 Davis County, Iowa 99916 0.8552 0.8697 1.70 16260 Decatur County, Iowa 99916 0.8552 0.8697 1.70 16270 Delaware County, Iowa 99916 0.8552 0.8697 1.70 16280 Des Moines County, Iowa 99916 0.8552 0.8697 1.70 16290 Dickinson County, Iowa 99916 0.8552 0.8697 1.70 16300 Dubuque County, Iowa 20220 0.9024 0.9150 1.40 16310 Emmet County, Iowa 99916 0.8552 0.8697 1.70 16320 Fayette County, Iowa 99916 0.8552 0.8697 1.70 16330 Floyd County, Iowa 99916 0.8552 0.8697 1.70 16340 Franklin County, Iowa 99916 0.8552 0.8697 1.70 16350 Fremont County, Iowa 99916 0.8552 0.8697 1.70 16360 Greene County, Iowa 99916 0.8552 0.8697 1.70 16370 Grundy County, Iowa 47940 0.8576 0.8422 -1.80 16380 Guthrie County, Iowa 19780 0.9132 0.9136 0.04 16390 Hamilton County, Iowa 99916 0.8552 0.8697 1.70 16400 Hancock County, Iowa 99916 0.8552 0.8697 1.70 16410 Hardin County, Iowa 99916 0.8552 0.8697 1.70 16420 Harrison County, Iowa 36540 0.9077 0.9467 4.30 16430 Henry County, Iowa 99916 0.8552 0.8697 1.70 16440 Howard County, Iowa 99916 0.8552 0.8697 1.70 16450 Humboldt County, Iowa 99916 0.8552 0.8697 1.70 16460 Ida County, Iowa 99916 0.8552 0.8697 1.70 16470 Iowa County, Iowa 99916 0.8552 0.8697 1.70 16480 Jackson County, Iowa 99916 0.8552 0.8697 1.70 16490 Jasper County, Iowa 99916 0.8552 0.8697 1.70 16500 Jefferson County, Iowa 99916 0.8552 0.8697 1.70 16510 Johnson County, Iowa 26980 0.9747 0.9731 -0.16 16520 Jones County, Iowa 16300 0.8710 0.8903 2.22 16530 Keokuk County, Iowa 99916 0.8552 0.8697 1.70 16540 Kossuth County, Iowa 99916 0.8552 0.8697 1.70 16550 Lee County, Iowa 99916 0.8552 0.8697 1.70 16560 Linn County, Iowa 16300 0.8825 0.8903 0.88 16570 Louisa County, Iowa 99916 0.8552 0.8697 1.70 16580 Lucas County, Iowa 99916 0.8552 0.8697 1.70 16590 Lyon County, Iowa 99916 0.8552 0.8697 1.70 16600 Madison County, Iowa 19780 0.9132 0.9136 0.04 16610 Mahaska County, Iowa 99916 0.8552 0.8697 1.70 16620 Marion County, Iowa 99916 0.8552 0.8697 1.70 16630 Marshall County, Iowa 99916 0.8552 0.8697 1.70 16640 Mills County, Iowa 36540 0.9077 0.9467 4.30 16650 Mitchell County, Iowa 99916 0.8552 0.8697 1.70 16660 Monona County, Iowa 99916 0.8552 0.8697 1.70 16670 Monroe County, Iowa 99916 0.8552 0.8697 1.70 16680 Montgomery County, Iowa 99916 0.8552 0.8697 1.70 16690 Muscatine County, Iowa 99916 0.8552 0.8697 1.70 16700 O Brien County, Iowa 99916 0.8552 0.8697 1.70 16710 Osceola County, Iowa 99916 0.8552 0.8697 1.70 16720 Page County, Iowa 99916 0.8552 0.8697 1.70 16730 Palo Alto County, Iowa 99916 0.8552 0.8697 1.70 16740 Plymouth County, Iowa 99916 0.8552 0.8697 1.70 16750 Pocahontas County, Iowa 99916 0.8552 0.8697 1.70 16760 Polk County, Iowa 19780 0.9669 0.9136 -5.51 16770 Pottawattamie County, Iowa 36540 0.9560 0.9467 -0.97 16780 Poweshiek County, Iowa 99916 0.8552 0.8697 1.70 16790 Ringgold County, Iowa 99916 0.8552 0.8697 1.70 16800 Sac County, Iowa 99916 0.8552 0.8697 1.70 16810 Scott County, Iowa 19340 0.8724 0.8557 -1.91 16820 Shelby County, Iowa 99916 0.8552 0.8697 1.70 16830 Sioux County, Iowa 99916 0.8552 0.8697 1.70 16840 Story County, Iowa 11180 0.9065 0.9777 7.85 16850 Tama County, Iowa 99916 0.8552 0.8697 1.70 16860 Taylor County, Iowa 99916 0.8552 0.8697 1.70 16870 Union County, Iowa 99916 0.8552 0.8697 1.70 Start Printed Page 44145 16880 Van Buren County, Iowa 99916 0.8552 0.8697 1.70 16890 Wapello County, Iowa 99916 0.8552 0.8697 1.70 16900 Warren County, Iowa 19780 0.9669 0.9136 -5.51 16910 Washington County, Iowa 26980 0.9171 0.9731 6.11 16920 Wayne County, Iowa 99916 0.8552 0.8697 1.70 16930 Webster County, Iowa 99916 0.8552 0.8697 1.70 16940 Winnebago County, Iowa 99916 0.8552 0.8697 1.70 16950 Winneshiek County, Iowa 99916 0.8552 0.8697 1.70 16960 Woodbury County, Iowa 43580 0.9399 0.9217 -1.94 16970 Worth County, Iowa 99916 0.8552 0.8697 1.70 16980 Wright County, Iowa 99916 0.8552 0.8697 1.70 17000 Allen County, Kansas 99917 0.8038 0.8000 -0.47 17010 Anderson County, Kansas 99917 0.8038 0.8000 -0.47 17020 Atchison County, Kansas 99917 0.8038 0.8000 -0.47 17030 Barber County, Kansas 99917 0.8038 0.8000 -0.47 17040 Barton County, Kansas 99917 0.8038 0.8000 -0.47 17050 Bourbon County, Kansas 99917 0.8038 0.8000 -0.47 17060 Brown County, Kansas 99917 0.8038 0.8000 -0.47 17070 Butler County, Kansas 48620 0.9164 0.9079 -0.93 17080 Chase County, Kansas 99917 0.8038 0.8000 -0.47 17090 Chautauqua County, Kansas 99917 0.8038 0.8000 -0.47 17100 Cherokee County, Kansas 99917 0.8038 0.8000 -0.47 17110 Cheyenne County, Kansas 99917 0.8038 0.8000 -0.47 17120 Clark County, Kansas 99917 0.8038 0.8000 -0.47 17130 Clay County, Kansas 99917 0.8038 0.8000 -0.47 17140 Cloud County, Kansas 99917 0.8038 0.8000 -0.47 17150 Coffey County, Kansas 99917 0.8038 0.8000 -0.47 17160 Comanche County, Kansas 99917 0.8038 0.8000 -0.47 17170 Cowley County, Kansas 99917 0.8038 0.8000 -0.47 17180 Crawford County, Kansas 99917 0.8038 0.8000 -0.47 17190 Decatur County, Kansas 99917 0.8038 0.8000 -0.47 17200 Dickinson County, Kansas 99917 0.8038 0.8000 -0.47 17210 Doniphan County, Kansas 41140 0.8780 1.0136 15.44 17220 Douglas County, Kansas 29940 0.8537 0.8353 -2.16 17230 Edwards County, Kansas 99917 0.8038 0.8000 -0.47 17240 Elk County, Kansas 99917 0.8038 0.8000 -0.47 17250 Ellis County, Kansas 99917 0.8038 0.8000 -0.47 17260 Ellsworth County, Kansas 99917 0.8038 0.8000 -0.47 17270 Finney County, Kansas 99917 0.8038 0.8000 -0.47 17280 Ford County, Kansas 99917 0.8038 0.8000 -0.47 17290 Franklin County, Kansas 28140 0.8758 0.9514 8.63 17300 Geary County, Kansas 99917 0.8038 0.8000 -0.47 17310 Gove County, Kansas 99917 0.8038 0.8000 -0.47 17320 Graham County, Kansas 99917 0.8038 0.8000 -0.47 17330 Grant County, Kansas 99917 0.8038 0.8000 -0.47 17340 Gray County, Kansas 99917 0.8038 0.8000 -0.47 17350 Greeley County, Kansas 99917 0.8038 0.8000 -0.47 17360 Greenwood County, Kansas 99917 0.8038 0.8000 -0.47 17370 Hamilton County, Kansas 99917 0.8038 0.8000 -0.47 17380 Harper County, Kansas 99917 0.8038 0.8000 -0.47 17390 Harvey County, Kansas 48620 0.9164 0.9079 -0.93 17391 Haskell County, Kansas 99917 0.8038 0.8000 -0.47 17410 Hodgeman County, Kansas 99917 0.8038 0.8000 -0.47 17420 Jackson County, Kansas 45820 0.8480 0.8746 3.14 17430 Jefferson County, Kansas 45820 0.8480 0.8746 3.14 17440 Jewell County, Kansas 99917 0.8038 0.8000 -0.47 17450 Johnson County, Kansas 28140 0.9483 0.9514 0.33 17451 Kearny County, Kansas 99917 0.8038 0.8000 -0.47 17470 Kingman County, Kansas 99917 0.8038 0.8000 -0.47 17480 Kiowa County, Kansas 99917 0.8038 0.8000 -0.47 17490 Labette County, Kansas 99917 0.8038 0.8000 -0.47 17500 Lane County, Kansas 99917 0.8038 0.8000 -0.47 17510 Leavenworth County, Kansas 28140 0.9483 0.9514 0.33 17520 Lincoln County, Kansas 99917 0.8038 0.8000 -0.47 17530 Linn County, Kansas 28140 0.8758 0.9514 8.63 17540 Logan County, Kansas 99917 0.8038 0.8000 -0.47 17550 Lyon County, Kansas 99917 0.8038 0.8000 -0.47 Start Printed Page 44146 17560 Mc Pherson County, Kansas 99917 0.8038 0.8000 -0.47 17570 Marion County, Kansas 99917 0.8038 0.8000 -0.47 17580 Marshall County, Kansas 99917 0.8038 0.8000 -0.47 17590 Meade County, Kansas 99917 0.8038 0.8000 -0.47 17600 Miami County, Kansas 28140 0.9483 0.9514 0.33 17610 Mitchell County, Kansas 99917 0.8038 0.8000 -0.47 17620 Montgomery County, Kansas 99917 0.8038 0.8000 -0.47 17630 Morris County, Kansas 99917 0.8038 0.8000 -0.47 17640 Morton County, Kansas 99917 0.8038 0.8000 -0.47 17650 Nemaha County, Kansas 99917 0.8038 0.8000 -0.47 17660 Neosho County, Kansas 99917 0.8038 0.8000 -0.47 17670 Ness County, Kansas 99917 0.8038 0.8000 -0.47 17680 Norton County, Kansas 99917 0.8038 0.8000 -0.47 17690 Osage County, Kansas 45820 0.8480 0.8746 3.14 17700 Osborne County, Kansas 99917 0.8038 0.8000 -0.47 17710 Ottawa County, Kansas 99917 0.8038 0.8000 -0.47 17720 Pawnee County, Kansas 99917 0.8038 0.8000 -0.47 17730 Phillips County, Kansas 99917 0.8038 0.8000 -0.47 17740 Pottawatomie County, Kansas 99917 0.8038 0.8000 -0.47 17750 Pratt County, Kansas 99917 0.8038 0.8000 -0.47 17760 Rawlins County, Kansas 99917 0.8038 0.8000 -0.47 17770 Reno County, Kansas 99917 0.8038 0.8000 -0.47 17780 Republic County, Kansas 99917 0.8038 0.8000 -0.47 17790 Rice County, Kansas 99917 0.8038 0.8000 -0.47 17800 Riley County, Kansas 99917 0.8038 0.8000 -0.47 17810 Rooks County, Kansas 99917 0.8038 0.8000 -0.47 17820 Rush County, Kansas 99917 0.8038 0.8000 -0.47 17830 Russell County, Kansas 99917 0.8038 0.8000 -0.47 17840 Saline County, Kansas 99917 0.8038 0.8000 -0.47 17841 Scott County, Kansas 99917 0.8038 0.8000 -0.47 17860 Sedgwick County, Kansas 48620 0.9164 0.9079 -0.93 17870 Seward County, Kansas 99917 0.8038 0.8000 -0.47 17880 Shawnee County, Kansas 45820 0.8920 0.8746 -1.95 17890 Sheridan County, Kansas 99917 0.8038 0.8000 -0.47 17900 Sherman County, Kansas 99917 0.8038 0.8000 -0.47 17910 Smith County, Kansas 99917 0.8038 0.8000 -0.47 17920 Stafford County, Kansas 99917 0.8038 0.8000 -0.47 17921 Stanton County, Kansas 99917 0.8038 0.8000 -0.47 17940 Stevens County, Kansas 99917 0.8038 0.8000 -0.47 17950 Sumner County, Kansas 48620 0.8597 0.9079 5.61 17960 Thomas County, Kansas 99917 0.8038 0.8000 -0.47 17970 Trego County, Kansas 99917 0.8038 0.8000 -0.47 17980 Wabaunsee County, Kansas 45820 0.8480 0.8746 3.14 17981 Wallace County, Kansas 99917 0.8038 0.8000 -0.47 17982 Washington County, Kansas 99917 0.8038 0.8000 -0.47 17983 Wichita County, Kansas 99917 0.8038 0.8000 -0.47 17984 Wilson County, Kansas 99917 0.8038 0.8000 -0.47 17985 Woodson County, Kansas 99917 0.8038 0.8000 -0.47 17986 Wyandotte County, Kansas 28140 0.9483 0.9514 0.33 18000 Adair County, Kentucky 99918 0.7812 0.7780 -0.41 18010 Allen County, Kentucky 99918 0.7812 0.7780 -0.41 18020 Anderson County, Kentucky 99918 0.7812 0.7780 -0.41 18030 Ballard County, Kentucky 99918 0.7812 0.7780 -0.41 18040 Barren County, Kentucky 99918 0.7812 0.7780 -0.41 18050 Bath County, Kentucky 99918 0.7812 0.7780 -0.41 18060 Bell County, Kentucky 99918 0.7812 0.7780 -0.41 18070 Boone County, Kentucky 17140 0.9675 0.9617 -0.60 18080 Bourbon County, Kentucky 30460 0.9032 0.9191 1.76 18090 Boyd County, Kentucky 26580 0.9477 0.9013 -4.90 18100 Boyle County, Kentucky 99918 0.7812 0.7780 -0.41 18110 Bracken County, Kentucky 17140 0.8737 0.9617 10.07 18120 Breathitt County, Kentucky 99918 0.7812 0.7780 -0.41 18130 Breckinridge County, Kentucky 99918 0.7812 0.7780 -0.41 18140 Bullitt County, Kentucky 31140 0.9272 0.9135 -1.48 18150 Butler County, Kentucky 99918 0.7812 0.7780 -0.41 18160 Caldwell County, Kentucky 99918 0.7812 0.7780 -0.41 18170 Calloway County, Kentucky 99918 0.7812 0.7780 -0.41 Start Printed Page 44147 18180 Campbell County, Kentucky 17140 0.9675 0.9617 -0.60 18190 Carlisle County, Kentucky 99918 0.7812 0.7780 -0.41 18191 Carroll County, Kentucky 99918 0.7812 0.7780 -0.41 18210 Carter County, Kentucky 99918 0.8622 0.7780 -9.77 18220 Casey County, Kentucky 99918 0.7812 0.7780 -0.41 18230 Christian County, Kentucky 17300 0.8284 0.8451 2.02 18240 Clark County, Kentucky 30460 0.9032 0.9191 1.76 18250 Clay County, Kentucky 99918 0.7812 0.7780 -0.41 18260 Clinton County, Kentucky 99918 0.7812 0.7780 -0.41 18270 Crittenden County, Kentucky 99918 0.7812 0.7780 -0.41 18271 Cumberland County, Kentucky 99918 0.7812 0.7780 -0.41 18290 Daviess County, Kentucky 36980 0.8780 0.8763 -0.19 18291 Edmonson County, Kentucky 14540 0.8035 0.8162 1.58 18310 Elliott County, Kentucky 99918 0.7812 0.7780 -0.41 18320 Estill County, Kentucky 99918 0.7812 0.7780 -0.41 18330 Fayette County, Kentucky 30460 0.9032 0.9191 1.76 18340 Fleming County, Kentucky 99918 0.7812 0.7780 -0.41 18350 Floyd County, Kentucky 99918 0.7812 0.7780 -0.41 18360 Franklin County, Kentucky 99918 0.7812 0.7780 -0.41 18361 Fulton County, Kentucky 99918 0.7812 0.7780 -0.41 18362 Gallatin County, Kentucky 17140 0.9675 0.9617 -0.60 18390 Garrard County, Kentucky 99918 0.7812 0.7780 -0.41 18400 Grant County, Kentucky 17140 0.9675 0.9617 -0.60 18410 Graves County, Kentucky 99918 0.7812 0.7780 -0.41 18420 Grayson County, Kentucky 99918 0.7812 0.7780 -0.41 18421 Green County, Kentucky 99918 0.7812 0.7780 -0.41 18440 Greenup County, Kentucky 26580 0.9477 0.9013 -4.90 18450 Hancock County, Kentucky 36980 0.8319 0.8763 5.34 18460 Hardin County, Kentucky 21060 0.8330 0.8713 4.60 18470 Harlan County, Kentucky 99918 0.7812 0.7780 -0.41 18480 Harrison County, Kentucky 99918 0.7812 0.7780 -0.41 18490 Hart County, Kentucky 99918 0.7812 0.7780 -0.41 18500 Henderson County, Kentucky 21780 0.8713 0.8830 1.34 18510 Henry County, Kentucky 31140 0.8555 0.9135 6.78 18511 Hickman County, Kentucky 99918 0.7812 0.7780 -0.41 18530 Hopkins County, Kentucky 99918 0.7812 0.7780 -0.41 18540 Jackson County, Kentucky 99918 0.7812 0.7780 -0.41 18550 Jefferson County, Kentucky 31140 0.9272 0.9135 -1.48 18560 Jessamine County, Kentucky 30460 0.9032 0.9191 1.76 18570 Johnson County, Kentucky 99918 0.7812 0.7780 -0.41 18580 Kenton County, Kentucky 17140 0.9675 0.9617 -0.60 18590 Knott County, Kentucky 99918 0.7812 0.7780 -0.41 18600 Knox County, Kentucky 99918 0.7812 0.7780 -0.41 18610 Larue County, Kentucky 21060 0.8330 0.8713 4.60 18620 Laurel County, Kentucky 99918 0.7812 0.7780 -0.41 18630 Lawrence County, Kentucky 99918 0.7812 0.7780 -0.41 18640 Lee County, Kentucky 99918 0.7812 0.7780 -0.41 18650 Leslie County, Kentucky 99918 0.7812 0.7780 -0.41 18660 Letcher County, Kentucky 99918 0.7812 0.7780 -0.41 18670 Lewis County, Kentucky 99918 0.7812 0.7780 -0.41 18680 Lincoln County, Kentucky 99918 0.7812 0.7780 -0.41 18690 Livingston County, Kentucky 99918 0.7812 0.7780 -0.41 18700 Logan County, Kentucky 99918 0.7812 0.7780 -0.41 18710 Lyon County, Kentucky 99918 0.7812 0.7780 -0.41 18720 Mc Cracken County, Kentucky 99918 0.7812 0.7780 -0.41 18730 Mc Creary County, Kentucky 99918 0.7812 0.7780 -0.41 18740 Mc Lean County, Kentucky 36980 0.8319 0.8763 5.34 18750 Madison County, Kentucky 99918 0.8377 0.7780 -7.13 18760 Magoffin County, Kentucky 99918 0.7812 0.7780 -0.41 18770 Marion County, Kentucky 99918 0.7812 0.7780 -0.41 18780 Marshall County, Kentucky 99918 0.7812 0.7780 -0.41 18790 Martin County, Kentucky 99918 0.7812 0.7780 -0.41 18800 Mason County, Kentucky 99918 0.7812 0.7780 -0.41 18801 Meade County, Kentucky 31140 0.8555 0.9135 6.78 18802 Menifee County, Kentucky 99918 0.7812 0.7780 -0.41 18830 Mercer County, Kentucky 99918 0.7812 0.7780 -0.41 18831 Metcalfe County, Kentucky 99918 0.7812 0.7780 -0.41 Start Printed Page 44148 18850 Monroe County, Kentucky 99918 0.7812 0.7780 -0.41 18860 Montgomery County, Kentucky 99918 0.7812 0.7780 -0.41 18861 Morgan County, Kentucky 99918 0.7812 0.7780 -0.41 18880 Muhlenberg County, Kentucky 99918 0.7812 0.7780 -0.41 18890 Nelson County, Kentucky 31140 0.8555 0.9135 6.78 18900 Nicholas County, Kentucky 99918 0.7812 0.7780 -0.41 18910 Ohio County, Kentucky 99918 0.7812 0.7780 -0.41 18920 Oldham County, Kentucky 31140 0.9272 0.9135 -1.48 18930 Owen County, Kentucky 99918 0.7812 0.7780 -0.41 18931 Owsley County, Kentucky 99918 0.7812 0.7780 -0.41 18932 Pendleton County, Kentucky 17140 0.9675 0.9617 -0.60 18960 Perry County, Kentucky 99918 0.7812 0.7780 -0.41 18970 Pike County, Kentucky 99918 0.7812 0.7780 -0.41 18971 Powell County, Kentucky 99918 0.7812 0.7780 -0.41 18972 Pulaski County, Kentucky 99918 0.7812 0.7780 -0.41 18973 Robertson County, Kentucky 99918 0.7812 0.7780 -0.41 18974 Rockcastle County, Kentucky 99918 0.7812 0.7780 -0.41 18975 Rowan County, Kentucky 99918 0.7812 0.7780 -0.41 18976 Russell County, Kentucky 99918 0.7812 0.7780 -0.41 18977 Scott County, Kentucky 30460 0.9032 0.9191 1.76 18978 Shelby County, Kentucky 31140 0.8555 0.9135 6.78 18979 Simpson County, Kentucky 99918 0.7812 0.7780 -0.41 18980 Spencer County, Kentucky 31140 0.8555 0.9135 6.78 18981 Taylor County, Kentucky 99918 0.7812 0.7780 -0.41 18982 Todd County, Kentucky 99918 0.7812 0.7780 -0.41 18983 Trigg County, Kentucky 17300 0.8071 0.8451 4.71 18984 Trimble County, Kentucky 31140 0.8555 0.9135 6.78 18985 Union County, Kentucky 99918 0.7812 0.7780 -0.41 18986 Warren County, Kentucky 14540 0.8035 0.8162 1.58 18987 Washington County, Kentucky 99918 0.7812 0.7780 -0.41 18988 Wayne County, Kentucky 99918 0.7812 0.7780 -0.41 18989 Webster County, Kentucky 21780 0.8286 0.8830 6.57 18990 Whitley County, Kentucky 99918 0.7812 0.7780 -0.41 18991 Wolfe County, Kentucky 99918 0.7812 0.7780 -0.41 18992 Woodford County, Kentucky 30460 0.9032 0.9191 1.76 19000 Acadia County, Louisiana 99919 0.7831 0.7450 -4.87 19010 Allen County, Louisiana 99919 0.7376 0.7450 1.00 19020 Ascension County, Louisiana 12940 0.8618 0.8099 -6.02 19030 Assumption County, Louisiana 99919 0.7376 0.7450 1.00 19040 Avoyelles County, Louisiana 99919 0.7376 0.7450 1.00 19050 Beauregard County, Louisiana 99919 0.7376 0.7450 1.00 19060 Bienville County, Louisiana 99919 0.7376 0.7450 1.00 19070 Bossier County, Louisiana 43340 0.8749 0.8881 1.51 19080 Caddo County, Louisiana 43340 0.8749 0.8881 1.51 19090 Calcasieu County, Louisiana 29340 0.7846 0.7928 1.05 19100 Caldwell County, Louisiana 99919 0.7376 0.7450 1.00 19110 Cameron County, Louisiana 29340 0.7587 0.7928 4.49 19120 Catahoula County, Louisiana 99919 0.7376 0.7450 1.00 19130 Claiborne County, Louisiana 99919 0.7376 0.7450 1.00 19140 Concordia County, Louisiana 99919 0.7376 0.7450 1.00 19150 De Soto County, Louisiana 43340 0.8050 0.8881 10.32 19160 East Baton Rouge County, Louisiana 12940 0.8618 0.8099 -6.02 19170 East Carroll County, Louisiana 99919 0.7376 0.7450 1.00 19180 East Feliciana County, Louisiana 12940 0.7967 0.8099 1.66 19190 Evangeline County, Louisiana 99919 0.7376 0.7450 1.00 19200 Franklin County, Louisiana 99919 0.7376 0.7450 1.00 19210 Grant County, Louisiana 10780 0.7687 0.8020 4.33 19220 Iberia County, Louisiana 99919 0.7376 0.7450 1.00 19230 Iberville County, Louisiana 12940 0.7967 0.8099 1.66 19240 Jackson County, Louisiana 99919 0.7376 0.7450 1.00 19250 Jefferson County, Louisiana 35380 0.8995 0.8858 -1.52 19260 Jefferson Davis County, Louisiana 99919 0.7376 0.7450 1.00 19270 Lafayette County, Louisiana 29180 0.8340 0.8293 -0.56 19280 Lafourche County, Louisiana 26380 0.7894 0.8003 1.38 19290 La Salle County, Louisiana 99919 0.7376 0.7450 1.00 19300 Lincoln County, Louisiana 99919 0.7376 0.7450 1.00 19310 Livingston County, Louisiana 12940 0.8618 0.8099 -6.02 Start Printed Page 44149 19320 Madison County, Louisiana 99919 0.7376 0.7450 1.00 19330 Morehouse County, Louisiana 99919 0.7376 0.7450 1.00 19340 Natchitoches County, Louisiana 99919 0.7376 0.7450 1.00 19350 Orleans County, Louisiana 35380 0.8995 0.8858 -1.52 19360 Ouachita County, Louisiana 33740 0.8038 0.8011 -0.34 19370 Plaquemines County, Louisiana 35380 0.8995 0.8858 -1.52 19380 Pointe Coupee County, Louisiana 12940 0.7967 0.8099 1.66 19390 Rapides County, Louisiana 10780 0.8033 0.8020 -0.16 19400 Red River County, Louisiana 99919 0.7376 0.7450 1.00 19410 Richland County, Louisiana 99919 0.7376 0.7450 1.00 19420 Sabine County, Louisiana 99919 0.7376 0.7450 1.00 19430 St Bernard County, Louisiana 35380 0.8995 0.8858 -1.52 19440 St Charles County, Louisiana 35380 0.8995 0.8858 -1.52 19450 St Helena County, Louisiana 12940 0.7967 0.8099 1.66 19460 St James County, Louisiana 99919 0.8203 0.7450 -9.18 19470 St John Baptist County, Louisiana 35380 0.8995 0.8858 -1.52 19480 St Landry County, Louisiana 99919 0.7831 0.7450 -4.87 19490 St Martin County, Louisiana 29180 0.8340 0.8293 -0.56 19500 St Mary County, Louisiana 99919 0.7376 0.7450 1.00 19510 St Tammany County, Louisiana 35380 0.8995 0.8858 -1.52 19520 Tangipahoa County, Louisiana 99919 0.7376 0.7450 1.00 19530 Tensas County, Louisiana 99919 0.7376 0.7450 1.00 19540 Terrebonne County, Louisiana 26380 0.7894 0.8003 1.38 19550 Union County, Louisiana 33740 0.7686 0.8011 4.23 19560 Vermilion County, Louisiana 99919 0.7376 0.7450 1.00 19570 Vernon County, Louisiana 99919 0.7376 0.7450 1.00 19580 Washington County, Louisiana 99919 0.7376 0.7450 1.00 19590 Webster County, Louisiana 99919 0.8074 0.7450 -7.73 19600 West Baton Rouge County, Louisiana 12940 0.8618 0.8099 -6.02 19610 West Carroll County, Louisiana 99919 0.7376 0.7450 1.00 19620 West Feliciana County, Louisiana 12940 0.7967 0.8099 1.66 19630 Winn County, Louisiana 99919 0.7376 0.7450 1.00 20000 Androscoggin County, Maine 30340 0.9331 0.9148 -1.96 20010 Aroostook County, Maine 99920 0.8843 0.8410 -4.90 20020 Cumberland County, Maine 38860 1.0382 0.9926 -4.39 20030 Franklin County, Maine 99920 0.8843 0.8410 -4.90 20040 Hancock County, Maine 99920 0.8843 0.8410 -4.90 20050 Kennebec County, Maine 99920 0.8843 0.8410 -4.90 20060 Knox County, Maine 99920 0.8843 0.8410 -4.90 20070 Lincoln County, Maine 99920 0.8843 0.8410 -4.90 20080 Oxford County, Maine 99920 0.8843 0.8410 -4.90 20090 Penobscot County, Maine 12620 0.9993 0.9719 -2.74 20100 Piscataquis County, Maine 99920 0.8843 0.8410 -4.90 20110 Sagadahoc County, Maine 38860 1.0382 0.9926 -4.39 20120 Somerset County, Maine 99920 0.8843 0.8410 -4.90 20130 Waldo County, Maine 99920 0.8843 0.8410 -4.90 20140 Washington County, Maine 99920 0.8843 0.8410 -4.90 20150 York County, Maine 38860 1.0382 0.9926 -4.39 21000 Allegany County, Maryland 19060 0.9317 0.8859 -4.92 21010 Anne Arundel County, Maryland 12580 0.9897 1.0106 2.11 21020 Baltimore County, Maryland 12580 0.9897 1.0106 2.11 21030 Baltimore City County, Maryland 12580 0.9897 1.0106 2.11 21040 Calvert County, Maryland 47894 1.0951 1.1074 1.12 21050 Caroline County, Maryland 99921 0.9292 0.8942 -3.77 21060 Carroll County, Maryland 12580 0.9897 1.0106 2.11 21070 Cecil County, Maryland 48864 1.0499 1.0703 1.94 21080 Charles County, Maryland 47894 1.0951 1.1074 1.12 21090 Dorchester County, Maryland 99921 0.9292 0.8942 -3.77 21100 Frederick County, Maryland 13644 1.1230 1.0923 -2.73 21110 Garrett County, Maryland 99921 0.9292 0.8942 -3.77 21120 Harford County, Maryland 12580 0.9897 1.0106 2.11 21130 Howard County, Maryland 12580 0.9897 1.0106 2.11 21140 Kent County, Maryland 99921 0.9292 0.8942 -3.77 21150 Montgomery County, Maryland 13644 1.1230 1.0923 -2.73 21160 Prince Georges County, Maryland 47894 1.0951 1.1074 1.12 21170 Queen Annes County, Maryland 12580 0.9897 1.0106 2.11 21180 St Marys County, Maryland 99921 0.9292 0.8942 -3.77 Start Printed Page 44150 21190 Somerset County, Maryland 41540 0.9147 0.8969 -1.95 21200 Talbot County, Maryland 99921 0.9292 0.8942 -3.77 21210 Washington County, Maryland 25180 0.9679 0.9054 -6.46 21220 Wicomico County, Maryland 41540 0.9147 0.8969 -1.95 21230 Worcester County, Maryland 99921 0.9292 0.8942 -3.77 22000 Barnstable County, Massachusetts 12700 1.2600 1.2561 -0.31 22010 Berkshire County, Massachusetts 38340 1.0181 1.0284 1.01 22020 Bristol County, Massachusetts 39300 1.1072 1.0804 -2.42 22030 Dukes County, Massachusetts 99922 1.0216 1.0216 0.00 22040 Essex County, Massachusetts 21604 1.0858 1.0437 -3.88 22060 Franklin County, Massachusetts 44140 1.0232 1.0080 -0.63 22070 Hampden County, Massachusetts 44140 1.0256 1.0080 -1.72 22080 Hampshire County, Massachusetts 44140 1.0256 1.0080 -1.72 22090 Middlesex County, Massachusetts 15764 1.1175 1.0918 -2.30 22120 Nantucket County, Massachusetts 99922 1.0216 1.0216 0.00 22130 Norfolk County, Massachusetts 14484 1.1368 1.1693 2.86 22150 Plymouth County, Massachusetts 14484 1.1368 1.1693 2.86 22160 Suffolk County, Massachusetts 14484 1.1368 1.1693 2.86 22170 Worcester County, Massachusetts 49340 1.1103 1.0741 -3.26 23000 Alcona County, Michigan 99923 0.8860 0.9052 2.17 23010 Alger County, Michigan 99923 0.8860 0.9052 2.17 23020 Allegan County, Michigan 99923 0.9170 0.9052 -1.29 23030 Alpena County, Michigan 99923 0.8860 0.9052 2.17 23040 Antrim County, Michigan 99923 0.8860 0.9052 2.17 23050 Arenac County, Michigan 99923 0.8860 0.9052 2.17 23060 Baraga County, Michigan 99923 0.8860 0.9052 2.17 23070 Barry County, Michigan 24340 0.9107 0.9470 3.99 23080 Bay County, Michigan 13020 0.9292 0.9271 -0.23 23090 Benzie County, Michigan 99923 0.8860 0.9052 2.17 23100 Berrien County, Michigan 35660 0.8879 0.8931 0.59 23110 Branch County, Michigan 99923 0.8860 0.9052 2.17 23120 Calhoun County, Michigan 12980 0.9826 0.9746 -0.81 23130 Cass County, Michigan 43780 0.9306 0.9690 4.13 23140 Charlevoix County, Michigan 99923 0.8860 0.9052 2.17 23150 Cheboygan County, Michigan 99923 0.8860 0.9052 2.17 23160 Chippewa County, Michigan 99923 0.8860 0.9052 2.17 23170 Clare County, Michigan 99923 0.8860 0.9052 2.17 23180 Clinton County, Michigan 29620 0.9794 1.0102 3.14 23190 Crawford County, Michigan 99923 0.8860 0.9052 2.17 23200 Delta County, Michigan 99923 0.8860 0.9052 2.17 23210 Dickinson County, Michigan 99923 0.8860 0.9052 2.17 23220 Eaton County, Michigan 29620 0.9794 1.0102 3.14 23230 Emmet County, Michigan 99923 0.8860 0.9052 2.17 23240 Genesee County, Michigan 22420 1.0655 1.0988 3.13 23250 Gladwin County, Michigan 99923 0.8860 0.9052 2.17 23260 Gogebic County, Michigan 99923 0.8860 0.9052 2.17 23270 Grand Traverse County, Michigan 99923 0.8860 0.9052 2.17 23280 Gratiot County, Michigan 99923 0.8860 0.9052 2.17 23290 Hillsdale County, Michigan 99923 0.8860 0.9052 2.17 23300 Houghton County, Michigan 99923 0.8860 0.9052 2.17 23310 Huron County, Michigan 99923 0.8860 0.9052 2.17 23320 Ingham County, Michigan 29620 0.9794 1.0102 3.14 23330 Ionia County, Michigan 24340 0.9107 0.9470 3.99 23340 Iosco County, Michigan 99923 0.8860 0.9052 2.17 23350 Iron County, Michigan 99923 0.8860 0.9052 2.17 23360 Isabella County, Michigan 99923 0.8860 0.9052 2.17 23370 Jackson County, Michigan 27100 0.9304 0.9577 2.93 23380 Kalamazoo County, Michigan 28020 1.0262 1.0723 4.49 23390 Kalkaska County, Michigan 99923 0.8860 0.9052 2.17 23400 Kent County, Michigan 24340 0.9418 0.9470 0.55 23410 Keweenaw County, Michigan 99923 0.8860 0.9052 2.17 23420 Lake County, Michigan 99923 0.8860 0.9052 2.17 23430 Lapeer County, Michigan 47644 1.0009 1.0126 1.17 23440 Leelanau County, Michigan 99923 0.8860 0.9052 2.17 23450 Lenawee County, Michigan 99923 0.9801 0.9052 -7.64 23460 Livingston County, Michigan 47644 1.0289 1.0126 -1.58 23470 Luce County, Michigan 99923 0.8860 0.9052 2.17 Start Printed Page 44151 23480 Mackinac County, Michigan 99923 0.8860 0.9052 2.17 23490 Macomb County, Michigan 47644 1.0009 1.0126 1.17 23500 Manistee County, Michigan 99923 0.8860 0.9052 2.17 23510 Marquette County, Michigan 99923 0.8860 0.9052 2.17 23520 Mason County, Michigan 99923 0.8860 0.9052 2.17 23530 Mecosta County, Michigan 99923 0.8860 0.9052 2.17 23540 Menominee County, Michigan 99923 0.8860 0.9052 2.17 23550 Midland County, Michigan 99923 0.9068 0.9052 -0.18 23560 Missaukee County, Michigan 99923 0.8860 0.9052 2.17 23570 Monroe County, Michigan 33780 0.9808 0.9725 -0.85 23580 Montcalm County, Michigan 99923 0.8860 0.9052 2.17 23590 Montmorency County, Michigan 99923 0.8860 0.9052 2.17 23600 Muskegon County, Michigan 34740 0.9555 0.9957 4.21 23610 Newaygo County, Michigan 24340 0.9107 0.9470 3.99 23620 Oakland County, Michigan 47644 1.0009 1.0126 1.17 23630 Oceana County, Michigan 99923 0.8860 0.9052 2.17 23640 Ogemaw County, Michigan 99923 0.8860 0.9052 2.17 23650 Ontonagon County, Michigan 99923 0.8860 0.9052 2.17 23660 Osceola County, Michigan 99923 0.8860 0.9052 2.17 23670 Oscoda County, Michigan 99923 0.8860 0.9052 2.17 23680 Otsego County, Michigan 99923 0.8860 0.9052 2.17 23690 Ottawa County, Michigan 26100 0.9250 0.9205 -0.49 23700 Presque Isle County, Michigan 99923 0.8860 0.9052 2.17 23710 Roscommon County, Michigan 99923 0.8860 0.9052 2.17 23720 Saginaw County, Michigan 40980 0.9165 0.8889 -3.01 23730 St Clair County, Michigan 47644 1.0009 1.0126 1.17 23740 St Joseph County, Michigan 99923 0.8860 0.9052 2.17 23750 Sanilac County, Michigan 99923 0.8860 0.9052 2.17 23760 Schoolcraft County, Michigan 99923 0.8860 0.9052 2.17 23770 Shiawassee County, Michigan 99923 0.8860 0.9052 2.17 23780 Tuscola County, Michigan 99923 0.8860 0.9052 2.17 23790 Van Buren County, Michigan 28020 1.0262 1.0723 4.49 23800 Washtenaw County, Michigan 11460 1.0783 1.0838 0.51 23810 Wayne County, Michigan 19804 1.0286 1.0223 -0.61 23830 Wexford County, Michigan 99923 0.8860 0.9052 2.17 24000 Aitkin County, Minnesota 99924 0.9132 0.9167 0.38 24010 Anoka County, Minnesota 33460 1.1075 1.0965 -0.99 24020 Becker County, Minnesota 99924 0.9132 0.9167 0.38 24030 Beltrami County, Minnesota 99924 0.9132 0.9167 0.38 24040 Benton County, Minnesota 41060 0.9965 1.0380 4.16 24050 Big Stone County, Minnesota 99924 0.9132 0.9167 0.38 24060 Blue Earth County, Minnesota 99924 0.9132 0.9167 0.38 24070 Brown County, Minnesota 99924 0.9132 0.9167 0.38 24080 Carlton County, Minnesota 20260 0.9673 1.0070 4.10 24090 Carver County, Minnesota 33460 1.1075 1.0965 -0.99 24100 Cass County, Minnesota 99924 0.9132 0.9167 0.38 24110 Chippewa County, Minnesota 99924 0.9132 0.9167 0.38 24120 Chisago County, Minnesota 33460 1.1075 1.0965 -0.99 24130 Clay County, Minnesota 22020 0.8486 0.8265 -2.60 24140 Clearwater County, Minnesota 99924 0.9132 0.9167 0.38 24150 Cook County, Minnesota 99924 0.9132 0.9167 0.38 24160 Cottonwood County, Minnesota 99924 0.9132 0.9167 0.38 24170 Crow Wing County, Minnesota 99924 0.9132 0.9167 0.38 24180 Dakota County, Minnesota 33460 1.1075 1.0965 -0.99 24190 Dodge County, Minnesota 40340 1.0132 1.1260 11.13 24200 Douglas County, Minnesota 99924 0.9132 0.9167 0.38 24210 Faribault County, Minnesota 99924 0.9132 0.9167 0.38 24220 Fillmore County, Minnesota 99924 0.9132 0.9167 0.38 24230 Freeborn County, Minnesota 99924 0.9132 0.9167 0.38 24240 Goodhue County, Minnesota 99924 0.9132 0.9167 0.38 24250 Grant County, Minnesota 99924 0.9132 0.9167 0.38 24260 Hennepin County, Minnesota 33460 1.1075 1.0965 -0.99 24270 Houston County, Minnesota 29100 0.9564 0.9442 -1.28 24280 Hubbard County, Minnesota 99924 0.9132 0.9167 0.38 24290 Isanti County, Minnesota 33460 1.1075 1.0965 -0.99 24300 Itasca County, Minnesota 99924 0.9132 0.9167 0.38 24310 Jackson County, Minnesota 99924 0.9132 0.9167 0.38 Start Printed Page 44152 24320 Kanabec County, Minnesota 99924 0.9132 0.9167 0.38 24330 Kandiyohi County, Minnesota 99924 0.9132 0.9167 0.38 24340 Kittson County, Minnesota 99924 0.9132 0.9167 0.38 24350 Koochiching County, Minnesota 99924 0.9132 0.9167 0.38 24360 Lac Qui Parle County, Minnesota 99924 0.9132 0.9167 0.38 24370 Lake County, Minnesota 99924 0.9132 0.9167 0.38 24380 Lake Of Woods County, Minnesota 99924 0.9132 0.9167 0.38 24390 Le Sueur County, Minnesota 99924 0.9132 0.9167 0.38 24400 Lincoln County, Minnesota 99924 0.9132 0.9167 0.38 24410 Lyon County, Minnesota 99924 0.9132 0.9167 0.38 24420 Mc Leod County, Minnesota 99924 0.9132 0.9167 0.38 24430 Mahnomen County, Minnesota 99924 0.9132 0.9167 0.38 24440 Marshall County, Minnesota 99924 0.9132 0.9167 0.38 24450 Martin County, Minnesota 99924 0.9132 0.9167 0.38 24460 Meeker County, Minnesota 99924 0.9132 0.9167 0.38 24470 Mille Lacs County, Minnesota 99924 0.9132 0.9167 0.38 24480 Morrison County, Minnesota 99924 0.9132 0.9167 0.38 24490 Mower County, Minnesota 99924 0.9132 0.9167 0.38 24500 Murray County, Minnesota 99924 0.9132 0.9167 0.38 24510 Nicollet County, Minnesota 99924 0.9132 0.9167 0.38 24520 Nobles County, Minnesota 99924 0.9132 0.9167 0.38 24530 Norman County, Minnesota 99924 0.9132 0.9167 0.38 24540 Olmsted County, Minnesota 40340 1.1131 1.1260 1.16 24550 Otter Tail County, Minnesota 99924 0.9132 0.9167 0.38 24560 Pennington County, Minnesota 99924 0.9132 0.9167 0.38 24570 Pine County, Minnesota 99924 0.9132 0.9167 0.38 24580 Pipestone County, Minnesota 99924 0.9132 0.9167 0.38 24590 Polk County, Minnesota 24220 0.7901 0.7963 0.78 24600 Pope County, Minnesota 99924 0.9132 0.9167 0.38 24610 Ramsey County, Minnesota 33460 1.1075 1.0965 -0.99 24620 Red Lake County, Minnesota 99924 0.9132 0.9167 0.38 24630 Redwood County, Minnesota 99924 0.9132 0.9167 0.38 24640 Renville County, Minnesota 99924 0.9132 0.9167 0.38 24650 Rice County, Minnesota 99924 0.9132 0.9167 0.38 24660 Rock County, Minnesota 99924 0.9132 0.9167 0.38 24670 Roseau County, Minnesota 99924 0.9132 0.9167 0.38 24680 St Louis County, Minnesota 20260 1.0213 1.0070 -1.40 24690 Scott County, Minnesota 33460 1.1075 1.0965 -0.99 24700 Sherburne County, Minnesota 33460 1.1075 1.0965 -0.99 24710 Sibley County, Minnesota 99924 0.9132 0.9167 0.38 24720 Stearns County, Minnesota 41060 0.9965 1.0380 4.16 24730 Steele County, Minnesota 99924 0.9132 0.9167 0.38 24740 Stevens County, Minnesota 99924 0.9132 0.9167 0.38 24750 Swift County, Minnesota 99924 0.9132 0.9167 0.38 24760 Todd County, Minnesota 99924 0.9132 0.9167 0.38 24770 Traverse County, Minnesota 99924 0.9132 0.9167 0.38 24780 Wabasha County, Minnesota 40340 1.0132 1.1260 11.13 24790 Wadena County, Minnesota 99924 0.9132 0.9167 0.38 24800 Waseca County, Minnesota 99924 0.9132 0.9167 0.38 24810 Washington County, Minnesota 33460 1.1075 1.0965 -0.99 24820 Watonwan County, Minnesota 99924 0.9132 0.9167 0.38 24830 Wilkin County, Minnesota 99924 0.9132 0.9167 0.38 24840 Winona County, Minnesota 99924 0.9132 0.9167 0.38 24850 Wright County, Minnesota 33460 1.1075 1.0965 -0.99 24860 Yellow Medicine County, Minnesota 99924 0.9132 0.9167 0.38 25000 Adams County, Mississippi 99925 0.7654 0.7565 -1.16 25010 Alcorn County, Mississippi 99925 0.7654 0.7565 -1.16 25020 Amite County, Mississippi 99925 0.7654 0.7565 -1.16 25030 Attala County, Mississippi 99925 0.7654 0.7565 -1.16 25040 Benton County, Mississippi 99925 0.7654 0.7565 -1.16 25050 Bolivar County, Mississippi 99925 0.7654 0.7565 -1.16 25060 Calhoun County, Mississippi 99925 0.7654 0.7565 -1.16 25070 Carroll County, Mississippi 99925 0.7654 0.7565 -1.16 25080 Chickasaw County, Mississippi 99925 0.7654 0.7565 -1.16 25090 Choctaw County, Mississippi 99925 0.7654 0.7565 -1.16 25100 Claiborne County, Mississippi 99925 0.7654 0.7565 -1.16 25110 Clarke County, Mississippi 99925 0.7654 0.7565 -1.16 Start Printed Page 44153 25120 Clay County, Mississippi 99925 0.7654 0.7565 -1.16 25130 Coahoma County, Mississippi 99925 0.7654 0.7565 -1.16 25140 Copiah County, Mississippi 27140 0.7973 0.8286 3.93 25150 Covington County, Mississippi 99925 0.7654 0.7565 -1.16 25160 Desoto County, Mississippi 32820 0.9407 0.9361 -0.49 25170 Forrest County, Mississippi 25620 0.7601 0.7443 -2.08 25180 Franklin County, Mississippi 99925 0.7654 0.7565 -1.16 25190 George County, Mississippi 37700 0.7895 0.8230 4.24 25200 Greene County, Mississippi 99925 0.7654 0.7565 -1.16 25210 Grenada County, Mississippi 99925 0.7654 0.7565 -1.16 25220 Hancock County, Mississippi 25060 0.8818 0.8931 1.28 25230 Harrison County, Mississippi 25060 0.8818 0.8931 1.28 25240 Hinds County, Mississippi 27140 0.8347 0.8286 -0.73 25250 Holmes County, Mississippi 99925 0.7654 0.7565 -1.16 25260 Humphreys County, Mississippi 99925 0.7654 0.7565 -1.16 25270 Issaquena County, Mississippi 99925 0.7654 0.7565 -1.16 25280 Itawamba County, Mississippi 99925 0.7654 0.7565 -1.16 25290 Jackson County, Mississippi 37700 0.8431 0.8230 -2.38 25300 Jasper County, Mississippi 99925 0.7654 0.7565 -1.16 25310 Jefferson County, Mississippi 99925 0.7654 0.7565 -1.16 25320 Jefferson Davis County, Mississippi 99925 0.7654 0.7565 -1.16 25330 Jones County, Mississippi 99925 0.7654 0.7565 -1.16 25340 Kemper County, Mississippi 99925 0.7654 0.7565 -1.16 25350 Lafayette County, Mississippi 99925 0.7654 0.7565 -1.16 25360 Lamar County, Mississippi 25620 0.7601 0.7443 -2.08 25370 Lauderdale County, Mississippi 99925 0.7654 0.7565 -1.16 25380 Lawrence County, Mississippi 99925 0.7654 0.7565 -1.16 25390 Leake County, Mississippi 99925 0.7654 0.7565 -1.16 25400 Lee County, Mississippi 99925 0.7654 0.7565 -1.16 25410 Leflore County, Mississippi 99925 0.7654 0.7565 -1.16 25420 Lincoln County, Mississippi 99925 0.7654 0.7565 -1.16 25430 Lowndes County, Mississippi 99925 0.7654 0.7565 -1.16 25440 Madison County, Mississippi 27140 0.8347 0.8286 -0.73 25450 Marion County, Mississippi 99925 0.7654 0.7565 -1.16 25460 Marshall County, Mississippi 32820 0.8516 0.9361 9.92 25470 Monroe County, Mississippi 99925 0.7654 0.7565 -1.16 25480 Montgomery County, Mississippi 99925 0.7654 0.7565 -1.16 25490 Neshoba County, Mississippi 99925 0.7654 0.7565 -1.16 25500 Newton County, Mississippi 99925 0.7654 0.7565 -1.16 25510 Noxubee County, Mississippi 99925 0.7654 0.7565 -1.16 25520 Oktibbeha County, Mississippi 99925 0.7654 0.7565 -1.16 25530 Panola County, Mississippi 99925 0.7654 0.7565 -1.16 25540 Pearl River County, Mississippi 99925 0.7654 0.7565 -1.16 25550 Perry County, Mississippi 25620 0.7618 0.7443 -2.30 25560 Pike County, Mississippi 99925 0.7654 0.7565 -1.16 25570 Pontotoc County, Mississippi 99925 0.7654 0.7565 -1.16 25580 Prentiss County, Mississippi 99925 0.7654 0.7565 -1.16 25590 Quitman County, Mississippi 99925 0.7654 0.7565 -1.16 25600 Rankin County, Mississippi 27140 0.8347 0.8286 -0.73 25610 Scott County, Mississippi 99925 0.7654 0.7565 -1.16 25620 Sharkey County, Mississippi 99925 0.7654 0.7565 -1.16 25630 Simpson County, Mississippi 27140 0.7973 0.8286 3.93 25640 Smith County, Mississippi 99925 0.7654 0.7565 -1.16 25650 Stone County, Mississippi 25060 0.8282 0.8931 7.84 25660 Sunflower County, Mississippi 99925 0.7654 0.7565 -1.16 25670 Tallahatchie County, Mississippi 99925 0.7654 0.7565 -1.16 25680 Tate County, Mississippi 32820 0.8516 0.9361 9.92 25690 Tippah County, Mississippi 99925 0.7654 0.7565 -1.16 25700 Tishomingo County, Mississippi 99925 0.7654 0.7565 -1.16 25710 Tunica County, Mississippi 32820 0.8516 0.9361 9.92 25720 Union County, Mississippi 99925 0.7654 0.7565 -1.16 25730 Walthall County, Mississippi 99925 0.7654 0.7565 -1.16 25740 Warren County, Mississippi 99925 0.7654 0.7565 -1.16 25750 Washington County, Mississippi 99925 0.7654 0.7565 -1.16 25760 Wayne County, Mississippi 99925 0.7654 0.7565 -1.16 25770 Webster County, Mississippi 99925 0.7654 0.7565 -1.16 25780 Wilkinson County, Mississippi 99925 0.7654 0.7565 -1.16 Start Printed Page 44154 25790 Winston County, Mississippi 99925 0.7654 0.7565 -1.16 25800 Yalobusha County, Mississippi 99925 0.7654 0.7565 -1.16 25810 Yazoo County, Mississippi 99925 0.7654 0.7565 -1.16 26000 Adair County, Missouri 99926 0.7930 0.7934 0.05 26010 Andrew County, Missouri 41140 0.9519 1.0136 6.48 26020 Atchison County, Missouri 99926 0.7930 0.7934 0.05 26030 Audrain County, Missouri 99926 0.7930 0.7934 0.05 26040 Barry County, Missouri 99926 0.7930 0.7934 0.05 26050 Barton County, Missouri 99926 0.7930 0.7934 0.05 26060 Bates County, Missouri 28140 0.8718 0.9514 9.13 26070 Benton County, Missouri 99926 0.7930 0.7934 0.05 26080 Bollinger County, Missouri 99926 0.7930 0.7934 0.05 26090 Boone County, Missouri 17860 0.8345 0.8557 2.54 26100 Buchanan County, Missouri 41140 0.9519 1.0136 6.48 26110 Butler County, Missouri 99926 0.7930 0.7934 0.05 26120 Caldwell County, Missouri 28140 0.8718 0.9514 9.13 26130 Callaway County, Missouri 27620 0.8173 0.8347 2.13 26140 Camden County, Missouri 99926 0.7930 0.7934 0.05 26150 Cape Girardeau County, Missouri 99926 0.7930 0.7934 0.05 26160 Carroll County, Missouri 99926 0.7930 0.7934 0.05 26170 Carter County, Missouri 99926 0.7930 0.7934 0.05 26180 Cass County, Missouri 28140 0.9483 0.9514 0.33 26190 Cedar County, Missouri 99926 0.7930 0.7934 0.05 26200 Chariton County, Missouri 99926 0.7930 0.7934 0.05 26210 Christian County, Missouri 44180 0.8244 0.8484 2.91 26220 Clark County, Missouri 99926 0.7930 0.7934 0.05 26230 Clay County, Missouri 28140 0.9483 0.9514 0.33 26240 Clinton County, Missouri 28140 0.9483 0.9514 0.33 26250 Cole County, Missouri 27620 0.8173 0.8347 2.13 26260 Cooper County, Missouri 99926 0.7930 0.7934 0.05 26270 Crawford County, Missouri 41180 0.8457 0.9013 6.57 26280 Dade County, Missouri 99926 0.7930 0.7934 0.05 26290 Dallas County, Missouri 44180 0.8098 0.8484 4.77 26300 Daviess County, Missouri 99926 0.7930 0.7934 0.05 26310 De Kalb County, Missouri 41140 0.8739 1.0136 15.99 26320 Dent County, Missouri 99926 0.7930 0.7934 0.05 26330 Douglas County, Missouri 99926 0.7930 0.7934 0.05 26340 Dunklin County, Missouri 99926 0.7930 0.7934 0.05 26350 Franklin County, Missouri 41180 0.8958 0.9013 0.61 26360 Gasconade County, Missouri 99926 0.7930 0.7934 0.05 26370 Gentry County, Missouri 99926 0.7930 0.7934 0.05 26380 Greene County, Missouri 44180 0.8244 0.8484 2.91 26390 Grundy County, Missouri 99926 0.7930 0.7934 0.05 26400 Harrison County, Missouri 99926 0.7930 0.7934 0.05 26410 Henry County, Missouri 99926 0.7930 0.7934 0.05 26411 Hickory County, Missouri 99926 0.7930 0.7934 0.05 26412 Holt County, Missouri 99926 0.7930 0.7934 0.05 26440 Howard County, Missouri 17860 0.8152 0.8557 4.97 26450 Howell County, Missouri 99926 0.7930 0.7934 0.05 26460 Iron County, Missouri 99926 0.7930 0.7934 0.05 26470 Jackson County, Missouri 28140 0.9483 0.9514 0.33 26480 Jasper County, Missouri 27900 0.8582 0.8620 0.44 26490 Jefferson County, Missouri 41180 0.8958 0.9013 0.61 26500 Johnson County, Missouri 99926 0.7930 0.7934 0.05 26510 Knox County, Missouri 99926 0.7930 0.7934 0.05 26520 Laclede County, Missouri 99926 0.7930 0.7934 0.05 26530 Lafayette County, Missouri 28140 0.9483 0.9514 0.33 26540 Lawrence County, Missouri 99926 0.7930 0.7934 0.05 26541 Lewis County, Missouri 99926 0.7930 0.7934 0.05 26560 Lincoln County, Missouri 41180 0.8958 0.9013 0.61 26570 Linn County, Missouri 99926 0.7930 0.7934 0.05 26580 Livingston County, Missouri 99926 0.7930 0.7934 0.05 26590 Mc Donald County, Missouri 22220 0.8310 0.8761 5.43 26600 Macon County, Missouri 99926 0.7930 0.7934 0.05 26601 Madison County, Missouri 99926 0.7930 0.7934 0.05 26620 Maries County, Missouri 99926 0.7930 0.7934 0.05 26630 Marion County, Missouri 99926 0.7930 0.7934 0.05 Start Printed Page 44155 26631 Mercer County, Missouri 99926 0.7930 0.7934 0.05 26650 Miller County, Missouri 99926 0.7930 0.7934 0.05 26660 Mississippi County, Missouri 99926 0.7930 0.7934 0.05 26670 Moniteau County, Missouri 27620 0.8173 0.8347 2.13 26680 Monroe County, Missouri 99926 0.7930 0.7934 0.05 26690 Montgomery County, Missouri 99926 0.7930 0.7934 0.05 26700 Morgan County, Missouri 99926 0.7930 0.7934 0.05 26710 New Madrid County, Missouri 99926 0.7930 0.7934 0.05 26720 Newton County, Missouri 27900 0.8582 0.8620 0.44 26730 Nodaway County, Missouri 99926 0.7930 0.7934 0.05 26740 Oregon County, Missouri 99926 0.7930 0.7934 0.05 26750 Osage County, Missouri 27620 0.8173 0.8347 2.13 26751 Ozark County, Missouri 99926 0.7930 0.7934 0.05 26770 Pemiscot County, Missouri 99926 0.7930 0.7934 0.05 26780 Perry County, Missouri 99926 0.7930 0.7934 0.05 26790 Pettis County, Missouri 99926 0.7930 0.7934 0.05 26800 Phelps County, Missouri 99926 0.7930 0.7934 0.05 26810 Pike County, Missouri 99926 0.7930 0.7934 0.05 26820 Platte County, Missouri 28140 0.9483 0.9514 0.33 26821 Polk County, Missouri 44180 0.8098 0.8484 4.77 26840 Pulaski County, Missouri 99926 0.7930 0.7934 0.05 26850 Putnam County, Missouri 99926 0.7930 0.7934 0.05 26860 Ralls County, Missouri 99926 0.7930 0.7934 0.05 26870 Randolph County, Missouri 99926 0.7930 0.7934 0.05 26880 Ray County, Missouri 28140 0.9483 0.9514 0.33 26881 Reynolds County, Missouri 99926 0.7930 0.7934 0.05 26900 Ripley County, Missouri 99926 0.7930 0.7934 0.05 26910 St Charles County, Missouri 41180 0.8958 0.9013 0.61 26911 St Clair County, Missouri 99926 0.7930 0.7934 0.05 26930 St Francois County, Missouri 99926 0.7930 0.7934 0.05 26940 St Louis County, Missouri 41180 0.8958 0.9013 0.61 26950 St Louis City County, Missouri 41180 0.8958 0.9013 0.61 26960 Ste Genevieve County, Missouri 99926 0.7930 0.7934 0.05 26970 Saline County, Missouri 99926 0.7930 0.7934 0.05 26980 Schuyler County, Missouri 99926 0.7930 0.7934 0.05 26981 Scotland County, Missouri 99926 0.7930 0.7934 0.05 26982 Scott County, Missouri 99926 0.7930 0.7934 0.05 26983 Shannon County, Missouri 99926 0.7930 0.7934 0.05 26984 Shelby County, Missouri 99926 0.7930 0.7934 0.05 26985 Stoddard County, Missouri 99926 0.7930 0.7934 0.05 26986 Stone County, Missouri 99926 0.7930 0.7934 0.05 26987 Sullivan County, Missouri 99926 0.7930 0.7934 0.05 26988 Taney County, Missouri 99926 0.7930 0.7934 0.05 26989 Texas County, Missouri 99926 0.7930 0.7934 0.05 26990 Vernon County, Missouri 99926 0.7930 0.7934 0.05 26991 Warren County, Missouri 41180 0.8958 0.9013 0.61 26992 Washington County, Missouri 41180 0.8457 0.9013 6.57 26993 Wayne County, Missouri 99926 0.7930 0.7934 0.05 26994 Webster County, Missouri 44180 0.8244 0.8484 2.91 26995 Worth County, Missouri 99926 0.7930 0.7934 0.05 26996 Wright County, Missouri 99926 0.7930 0.7934 0.05 27000 Beaverhead County, Montana 99927 0.8762 0.8605 -1.79 27010 Big Horn County, Montana 99927 0.8762 0.8605 -1.79 27020 Blaine County, Montana 99927 0.8762 0.8605 -1.79 27030 Broadwater County, Montana 99927 0.8762 0.8605 -1.79 27040 Carbon County, Montana 13740 0.8798 0.8728 -0.80 27050 Carter County, Montana 99927 0.8762 0.8605 -1.79 27060 Cascade County, Montana 24500 0.9052 0.8613 -4.85 27070 Chouteau County, Montana 99927 0.8762 0.8605 -1.79 27080 Custer County, Montana 99927 0.8762 0.8605 -1.79 27090 Daniels County, Montana 99927 0.8762 0.8605 -1.79 27100 Dawson County, Montana 99927 0.8762 0.8605 -1.79 27110 Deer Lodge County, Montana 99927 0.8762 0.8605 -1.79 27113 Yellowstone National Park, Montana 99927 0.8762 0.8605 -1.79 27120 Fallon County, Montana 99927 0.8762 0.8605 -1.79 27130 Fergus County, Montana 99927 0.8762 0.8605 -1.79 27140 Flathead County, Montana 99927 0.8762 0.8605 -1.79 Start Printed Page 44156 27150 Gallatin County, Montana 99927 0.8762 0.8605 -1.79 27160 Garfield County, Montana 99927 0.8762 0.8605 -1.79 27170 Glacier County, Montana 99927 0.8762 0.8605 -1.79 27180 Golden Valley County, Montana 99927 0.8762 0.8605 -1.79 27190 Granite County, Montana 99927 0.8762 0.8605 -1.79 27200 Hill County, Montana 99927 0.8762 0.8605 -1.79 27210 Jefferson County, Montana 99927 0.8762 0.8605 -1.79 27220 Judith Basin County, Montana 99927 0.8762 0.8605 -1.79 27230 Lake County, Montana 99927 0.8762 0.8605 -1.79 27240 Lewis And Clark County, Montana 99927 0.8762 0.8605 -1.79 27250 Liberty County, Montana 99927 0.8762 0.8605 -1.79 27260 Lincoln County, Montana 99927 0.8762 0.8605 -1.79 27270 Mc Cone County, Montana 99927 0.8762 0.8605 -1.79 27280 Madison County, Montana 99927 0.8762 0.8605 -1.79 27290 Meagher County, Montana 99927 0.8762 0.8605 -1.79 27300 Mineral County, Montana 99927 0.8762 0.8605 -1.79 27310 Missoula County, Montana 33540 0.9473 0.8944 -5.58 27320 Musselshell County, Montana 99927 0.8762 0.8605 -1.79 27330 Park County, Montana 99927 0.8762 0.8605 -1.79 27340 Petroleum County, Montana 99927 0.8762 0.8605 -1.79 27350 Phillips County, Montana 99927 0.8762 0.8605 -1.79 27360 Pondera County, Montana 99927 0.8762 0.8605 -1.79 27370 Powder River County, Montana 99927 0.8762 0.8605 -1.79 27380 Powell County, Montana 99927 0.8762 0.8605 -1.79 27390 Prairie County, Montana 99927 0.8762 0.8605 -1.79 27400 Ravalli County, Montana 99927 0.8762 0.8605 -1.79 27410 Richland County, Montana 99927 0.8762 0.8605 -1.79 27420 Roosevelt County, Montana 99927 0.8762 0.8605 -1.79 27430 Rosebud County, Montana 99927 0.8762 0.8605 -1.79 27440 Sanders County, Montana 99927 0.8762 0.8605 -1.79 27450 Sheridan County, Montana 99927 0.8762 0.8605 -1.79 27460 Silver Bow County, Montana 99927 0.8762 0.8605 -1.79 27470 Stillwater County, Montana 99927 0.8762 0.8605 -1.79 27480 Sweet Grass County, Montana 99927 0.8762 0.8605 -1.79 27490 Teton County, Montana 99927 0.8762 0.8605 -1.79 27500 Toole County, Montana 99927 0.8762 0.8605 -1.79 27510 Treasure County, Montana 99927 0.8762 0.8605 -1.79 27520 Valley County, Montana 99927 0.8762 0.8605 -1.79 27530 Wheatland County, Montana 99927 0.8762 0.8605 -1.79 27540 Wibaux County, Montana 99927 0.8762 0.8605 -1.79 27550 Yellowstone County, Montana 13740 0.8834 0.8728 -1.20 28000 Adams County, Nebraska 99928 0.8657 0.8693 0.42 28010 Antelope County, Nebraska 99928 0.8657 0.8693 0.42 28020 Arthur County, Nebraska 99928 0.8657 0.8693 0.42 28030 Banner County, Nebraska 99928 0.8657 0.8693 0.42 28040 Blaine County, Nebraska 99928 0.8657 0.8693 0.42 28050 Boone County, Nebraska 99928 0.8657 0.8693 0.42 28060 Box Butte County, Nebraska 99928 0.8657 0.8693 0.42 28070 Boyd County, Nebraska 99928 0.8657 0.8693 0.42 28080 Brown County, Nebraska 99928 0.8657 0.8693 0.42 28090 Buffalo County, Nebraska 99928 0.8657 0.8693 0.42 28100 Burt County, Nebraska 99928 0.8657 0.8693 0.42 28110 Butler County, Nebraska 99928 0.8657 0.8693 0.42 28120 Cass County, Nebraska 36540 0.9560 0.9467 -0.97 28130 Cedar County, Nebraska 99928 0.8657 0.8693 0.42 28140 Chase County, Nebraska 99928 0.8657 0.8693 0.42 28150 Cherry County, Nebraska 99928 0.8657 0.8693 0.42 28160 Cheyenne County, Nebraska 99928 0.8657 0.8693 0.42 28170 Clay County, Nebraska 99928 0.8657 0.8693 0.42 28180 Colfax County, Nebraska 99928 0.8657 0.8693 0.42 28190 Cuming County, Nebraska 99928 0.8657 0.8693 0.42 28200 Custer County, Nebraska 99928 0.8657 0.8693 0.42 28210 Dakota County, Nebraska 43580 0.9399 0.9217 -1.94 28220 Dawes County, Nebraska 99928 0.8657 0.8693 0.42 28230 Dawson County, Nebraska 99928 0.8657 0.8693 0.42 28240 Deuel County, Nebraska 99928 0.8657 0.8693 0.42 28250 Dixon County, Nebraska 43580 0.9019 0.9217 2.20 Start Printed Page 44157 28260 Dodge County, Nebraska 99928 0.8657 0.8693 0.42 28270 Douglas County, Nebraska 36540 0.9560 0.9467 -0.97 28280 Dundy County, Nebraska 99928 0.8657 0.8693 0.42 28290 Fillmore County, Nebraska 99928 0.8657 0.8693 0.42 28300 Franklin County, Nebraska 99928 0.8657 0.8693 0.42 28310 Frontier County, Nebraska 99928 0.8657 0.8693 0.42 28320 Furnas County, Nebraska 99928 0.8657 0.8693 0.42 28330 Gage County, Nebraska 99928 0.8657 0.8693 0.42 28340 Garden County, Nebraska 99928 0.8657 0.8693 0.42 28350 Garfield County, Nebraska 99928 0.8657 0.8693 0.42 28360 Gosper County, Nebraska 99928 0.8657 0.8693 0.42 28370 Grant County, Nebraska 99928 0.8657 0.8693 0.42 28380 Greeley County, Nebraska 99928 0.8657 0.8693 0.42 28390 Hall County, Nebraska 99928 0.8657 0.8693 0.42 28400 Hamilton County, Nebraska 99928 0.8657 0.8693 0.42 28410 Harlan County, Nebraska 99928 0.8657 0.8693 0.42 28420 Hayes County, Nebraska 99928 0.8657 0.8693 0.42 28430 Hitchcock County, Nebraska 99928 0.8657 0.8693 0.42 28440 Holt County, Nebraska 99928 0.8657 0.8693 0.42 28450 Hooker County, Nebraska 99928 0.8657 0.8693 0.42 28460 Howard County, Nebraska 99928 0.8657 0.8693 0.42 28470 Jefferson County, Nebraska 99928 0.8657 0.8693 0.42 28480 Johnson County, Nebraska 99928 0.8657 0.8693 0.42 28490 Kearney County, Nebraska 99928 0.8657 0.8693 0.42 28500 Keith County, Nebraska 99928 0.8657 0.8693 0.42 28510 Keya Paha County, Nebraska 99928 0.8657 0.8693 0.42 28520 Kimball County, Nebraska 99928 0.8657 0.8693 0.42 28530 Knox County, Nebraska 99928 0.8657 0.8693 0.42 28540 Lancaster County, Nebraska 30700 1.0214 1.0110 -1.02 28550 Lincoln County, Nebraska 99928 0.8657 0.8693 0.42 28560 Logan County, Nebraska 99928 0.8657 0.8693 0.42 28570 Loup County, Nebraska 99928 0.8657 0.8693 0.42 28580 Mc Pherson County, Nebraska 99928 0.8657 0.8693 0.42 28590 Madison County, Nebraska 99928 0.8657 0.8693 0.42 28600 Merrick County, Nebraska 99928 0.8657 0.8693 0.42 28610 Morrill County, Nebraska 99928 0.8657 0.8693 0.42 28620 Nance County, Nebraska 99928 0.8657 0.8693 0.42 28630 Nemaha County, Nebraska 99928 0.8657 0.8693 0.42 28640 Nuckolls County, Nebraska 99928 0.8657 0.8693 0.42 28650 Otoe County, Nebraska 99928 0.8657 0.8693 0.42 28660 Pawnee County, Nebraska 99928 0.8657 0.8693 0.42 28670 Perkins County, Nebraska 99928 0.8657 0.8693 0.42 28680 Phelps County, Nebraska 99928 0.8657 0.8693 0.42 28690 Pierce County, Nebraska 99928 0.8657 0.8693 0.42 28700 Platte County, Nebraska 99928 0.8657 0.8693 0.42 28710 Polk County, Nebraska 99928 0.8657 0.8693 0.42 28720 Redwillow County, Nebraska 99928 0.8657 0.8693 0.42 28730 Richardson County, Nebraska 99928 0.8657 0.8693 0.42 28740 Rock County, Nebraska 99928 0.8657 0.8693 0.42 28750 Saline County, Nebraska 99928 0.8657 0.8693 0.42 28760 Sarpy County, Nebraska 36540 0.9560 0.9467 -0.97 28770 Saunders County, Nebraska 36540 0.9109 0.9467 3.93 28780 Scotts Bluff County, Nebraska 99928 0.8657 0.8693 0.42 28790 Seward County, Nebraska 30700 0.9436 1.0110 7.14 28800 Sheridan County, Nebraska 99928 0.8657 0.8693 0.42 28810 Sherman County, Nebraska 99928 0.8657 0.8693 0.42 28820 Sioux County, Nebraska 99928 0.8657 0.8693 0.42 28830 Stanton County, Nebraska 99928 0.8657 0.8693 0.42 28840 Thayer County, Nebraska 99928 0.8657 0.8693 0.42 28850 Thomas County, Nebraska 99928 0.8657 0.8693 0.42 28860 Thurston County, Nebraska 99928 0.8657 0.8693 0.42 28870 Valley County, Nebraska 99928 0.8657 0.8693 0.42 28880 Washington County, Nebraska 36540 0.9560 0.9467 -0.97 28890 Wayne County, Nebraska 99928 0.8657 0.8693 0.42 28900 Webster County, Nebraska 99928 0.8657 0.8693 0.42 28910 Wheeler County, Nebraska 99928 0.8657 0.8693 0.42 28920 York County, Nebraska 99928 0.8657 0.8693 0.42 Start Printed Page 44158 29000 Churchill County, Nevada 99929 0.9376 0.8960 -4.44 29010 Clark County, Nevada 29820 1.1296 1.1450 1.36 29020 Douglas County, Nevada 99929 0.9376 0.8960 -4.44 29030 Elko County, Nevada 99929 0.9376 0.8960 -4.44 29040 Esmeralda County, Nevada 99929 0.9376 0.8960 -4.44 29050 Eureka County, Nevada 99929 0.9376 0.8960 -4.44 29060 Humboldt County, Nevada 99929 0.9376 0.8960 -4.44 29070 Lander County, Nevada 99929 0.9376 0.8960 -4.44 29080 Lincoln County, Nevada 99929 0.9376 0.8960 -4.44 29090 Lyon County, Nevada 99929 0.9376 0.8960 -4.44 29100 Mineral County, Nevada 99929 0.9376 0.8960 -4.44 29110 Nye County, Nevada 99929 1.0110 0.8960 -11.37 29120 Carson City County, Nevada 16180 0.9961 1.0043 0.82 29130 Pershing County, Nevada 99929 0.9376 0.8960 -4.44 29140 Storey County, Nevada 39900 1.0335 1.1984 15.96 29150 Washoe County, Nevada 39900 1.0982 1.1984 9.12 29160 White Pine County, Nevada 99929 0.9376 0.8960 -4.44 30000 Belknap County, New Hampshire 99930 1.0817 1.0800 -0.16 30010 Carroll County, New Hampshire 99930 1.0817 1.0800 -0.16 30020 Cheshire County, New Hampshire 99930 1.0817 1.0800 -0.16 30030 Coos County, New Hampshire 99930 1.0817 1.0800 -0.16 30040 Grafton County, New Hampshire 99930 1.0817 1.0800 -0.16 30050 Hillsboro County, New Hampshire 31700 1.0766 1.0261 -4.69 30060 Merrimack County, New Hampshire 31700 1.0766 1.0261 -4.69 30070 Rockingham County, New Hampshire 40484 1.0776 1.0177 -5.56 30080 Strafford County, New Hampshire 40484 1.0776 1.0177 -5.56 30090 Sullivan County, New Hampshire 99930 1.0817 1.0800 -0.16 31000 Atlantic County, New Jersey 12100 1.1556 1.1751 1.69 31100 Bergen County, New Jersey 35644 1.2420 1.3208 6.34 31150 Burlington County, New Jersey 15804 1.0720 1.0411 -2.88 31160 Camden County, New Jersey 15804 1.0720 1.0411 -2.88 31180 Cape May County, New Jersey 36140 1.1254 1.0490 -6.79 31190 Cumberland County, New Jersey 47220 0.9827 0.9849 0.22 31200 Essex County, New Jersey 35084 1.1859 1.1890 0.26 31220 Gloucester County, New Jersey 15804 1.0720 1.0411 -2.88 31230 Hudson County, New Jersey 35644 1.2263 1.3208 7.71 31250 Hunterdon County, New Jersey 35084 1.1525 1.1890 3.17 31260 Mercer County, New Jersey 45940 1.0834 1.0877 0.40 31270 Middlesex County, New Jersey 20764 1.1208 1.1207 -0.01 31290 Monmouth County, New Jersey 20764 1.1255 1.1207 -0.43 31300 Morris County, New Jersey 35084 1.1859 1.1890 0.26 31310 Ocean County, New Jersey 20764 1.1255 1.1207 -0.43 31320 Passaic County, New Jersey 35644 1.2420 1.3208 6.34 31340 Salem County, New Jersey 48864 1.0697 1.0703 0.06 31350 Somerset County, New Jersey 20764 1.1208 1.1207 -0.01 31360 Sussex County, New Jersey 35084 1.1859 1.1890 0.26 31370 Union County, New Jersey 35084 1.1859 1.1890 0.26 31390 Warren County, New Jersey 10900 1.0826 0.9910 -8.46 32000 Bernalillo County, New Mexico 10740 0.9684 0.9474 -2.17 32010 Catron County, New Mexico 99932 0.8599 0.8347 -2.93 32020 Chaves County, New Mexico 99932 0.8599 0.8347 -2.93 32025 Cibola County, New Mexico 99932 0.8599 0.8347 -2.93 32030 Colfax County, New Mexico 99932 0.8599 0.8347 -2.93 32040 Curry County, New Mexico 99932 0.8599 0.8347 -2.93 32050 De Baca County, New Mexico 99932 0.8599 0.8347 -2.93 32060 Dona Ana County, New Mexico 29740 0.8467 0.9290 9.72 32070 Eddy County, New Mexico 99932 0.8599 0.8347 -2.93 32080 Grant County, New Mexico 99932 0.8599 0.8347 -2.93 32090 Guadalupe County, New Mexico 99932 0.8599 0.8347 -2.93 32100 Harding County, New Mexico 99932 0.8599 0.8347 -2.93 32110 Hidalgo County, New Mexico 99932 0.8599 0.8347 -2.93 32120 Lea County, New Mexico 99932 0.8599 0.8347 -2.93 32130 Lincoln County, New Mexico 99932 0.8599 0.8347 -2.93 32131 Los Alamos County, New Mexico 99932 0.9692 0.8347 -13.88 32140 Luna County, New Mexico 99932 0.8599 0.8347 -2.93 32150 Mc Kinley County, New Mexico 99932 0.8599 0.8347 -2.93 32160 Mora County, New Mexico 99932 0.8599 0.8347 -2.93 Start Printed Page 44159 32170 Otero County, New Mexico 99932 0.8599 0.8347 -2.93 32180 Quay County, New Mexico 99932 0.8599 0.8347 -2.93 32190 Rio Arriba County, New Mexico 99932 0.8599 0.8347 -2.93 32200 Roosevelt County, New Mexico 99932 0.8599 0.8347 -2.93 32210 Sandoval County, New Mexico 10740 0.9684 0.9474 -2.17 32220 San Juan County, New Mexico 22140 0.8536 0.8604 0.80 32230 San Miguel County, New Mexico 99932 0.8599 0.8347 -2.93 32240 Santa Fe County, New Mexico 42140 1.0834 1.0843 0.08 32250 Sierra County, New Mexico 99932 0.8599 0.8347 -2.93 32260 Socorro County, New Mexico 99932 0.8599 0.8347 -2.93 32270 Taos County, New Mexico 99932 0.8599 0.8347 -2.93 32280 Torrance County, New Mexico 10740 0.9124 0.9474 3.84 32290 Union County, New Mexico 99932 0.8599 0.8347 -2.93 32300 Valencia County, New Mexico 10740 0.9684 0.9474 -2.17 33000 Albany County, New York 10580 0.8574 0.8735 1.88 33010 Allegany County, New York 99933 0.8275 0.8250 -0.30 33020 Bronx County, New York 35644 1.3326 1.3208 -0.89 33030 Broome County, New York 13780 0.8562 0.8798 2.76 33040 Cattaraugus County, New York 99933 0.8275 0.8250 -0.30 33050 Cayuga County, New York 99933 0.8823 0.8250 -6.49 33060 Chautauqua County, New York 99933 0.7849 0.8250 5.11 33070 Chemung County, New York 21300 0.8250 0.8213 -0.45 33080 Chenango County, New York 99933 0.8275 0.8250 -0.30 33090 Clinton County, New York 99933 0.8275 0.8250 -0.30 33200 Columbia County, New York 99933 0.8275 0.8250 -0.30 33210 Cortland County, New York 99933 0.8275 0.8250 -0.30 33220 Delaware County, New York 99933 0.8275 0.8250 -0.30 33230 Dutchess County, New York 39100 1.0683 1.0913 2.15 33240 Erie County, New York 15380 0.9511 0.9483 -0.29 33260 Essex County, New York 99933 0.8275 0.8250 -0.30 33270 Franklin County, New York 99933 0.8275 0.8250 -0.30 33280 Fulton County, New York 99933 0.8275 0.8250 -0.30 33290 Genesee County, New York 99933 0.8602 0.8250 -4.09 33300 Greene County, New York 99933 0.8275 0.8250 -0.30 33310 Hamilton County, New York 99933 0.8275 0.8250 -0.30 33320 Herkimer County, New York 46540 0.8358 0.8402 0.53 33330 Jefferson County, New York 99933 0.8275 0.8250 -0.30 33331 Kings County, New York 35644 1.3326 1.3208 -0.89 33340 Lewis County, New York 99933 0.8275 0.8250 -0.30 33350 Livingston County, New York 40380 0.9085 0.9005 -0.88 33360 Madison County, New York 45060 0.9533 0.9709 1.85 33370 Monroe County, New York 40380 0.9085 0.9005 -0.88 33380 Montgomery County, New York 99933 0.8357 0.8250 -1.28 33400 Nassau County, New York 35004 1.2719 1.2681 -0.30 33420 New York County, New York 35644 1.3326 1.3208 -0.89 33500 Niagara County, New York 15380 0.9511 0.9483 -0.29 33510 Oneida County, New York 46540 0.8358 0.8402 0.53 33520 Onondaga County, New York 45060 0.9533 0.9709 1.85 33530 Ontario County, New York 40380 0.9085 0.9005 -0.88 33540 Orange County, New York 39100 1.1049 1.0913 -1.23 33550 Orleans County, New York 40380 0.9085 0.9005 -0.88 33560 Oswego County, New York 45060 0.9533 0.9709 1.85 33570 Otsego County, New York 99933 0.8275 0.8250 -0.30 33580 Putnam County, New York 35644 1.3326 1.3208 -0.89 33590 Queens County, New York 35644 1.3326 1.3208 -0.89 33600 Rensselaer County, New York 10580 0.8574 0.8735 1.88 33610 Richmond County, New York 35644 1.3326 1.3208 -0.89 33620 Rockland County, New York 35644 1.3326 1.3208 -0.89 33630 St Lawrence County, New York 99933 0.8275 0.8250 -0.30 33640 Saratoga County, New York 10580 0.8574 0.8735 1.88 33650 Schenectady County, New York 10580 0.8574 0.8735 1.88 33660 Schoharie County, New York 10580 0.8574 0.8735 1.88 33670 Schuyler County, New York 99933 0.8275 0.8250 -0.30 33680 Seneca County, New York 99933 0.8275 0.8250 -0.30 33690 Steuben County, New York 99933 0.8275 0.8250 -0.30 33700 Suffolk County, New York 35004 1.2719 1.2681 -0.30 33710 Sullivan County, New York 99933 0.8275 0.8250 -0.30 Start Printed Page 44160 33720 Tioga County, New York 13780 0.8562 0.8798 2.76 33730 Tompkins County, New York 27060 0.9094 0.9831 8.10 33740 Ulster County, New York 28740 0.8825 0.9383 6.32 33750 Warren County, New York 24020 0.8559 0.8339 -2.57 33760 Washington County, New York 24020 0.8559 0.8339 -2.57 33770 Wayne County, New York 40380 0.9085 0.9005 -0.88 33800 Westchester County, New York 35644 1.3326 1.3208 -0.89 33900 Wyoming County, New York 99933 0.8275 0.8250 -0.30 33910 Yates County, New York 99933 0.8275 0.8250 -0.30 34000 Alamance County, N Carolina 15500 0.8962 0.8689 -3.05 34010 Alexander County, N Carolina 25860 0.8921 0.9021 1.12 34020 Alleghany County, N Carolina 99934 0.8501 0.8599 1.15 34030 Anson County, N Carolina 16740 0.9106 0.9564 5.03 34040 Ashe County, N Carolina 99934 0.8501 0.8599 1.15 34050 Avery County, N Carolina 99934 0.8501 0.8599 1.15 34060 Beaufort County, N Carolina 99934 0.8501 0.8599 1.15 34070 Bertie County, N Carolina 99934 0.8501 0.8599 1.15 34080 Bladen County, N Carolina 99934 0.8501 0.8599 1.15 34090 Brunswick County, N Carolina 48900 0.9582 0.9853 2.83 34100 Buncombe County, N Carolina 11700 0.9511 0.9093 -4.39 34110 Burke County, N Carolina 25860 0.8921 0.9021 1.12 34120 Cabarrus County, N Carolina 16740 0.9733 0.9564 -1.74 34130 Caldwell County, N Carolina 25860 0.8921 0.9021 1.12 34140 Camden County, N Carolina 99934 0.8501 0.8599 1.15 34150 Carteret County, N Carolina 99934 0.8501 0.8599 1.15 34160 Caswell County, N Carolina 99934 0.8501 0.8599 1.15 34170 Catawba County, N Carolina 25860 0.8921 0.9021 1.12 34180 Chatham County, N Carolina 20500 1.0139 0.9843 -2.92 34190 Cherokee County, N Carolina 99934 0.8501 0.8599 1.15 34200 Chowan County, N Carolina 99934 0.8501 0.8599 1.15 34210 Clay County, N Carolina 99934 0.8501 0.8599 1.15 34220 Cleveland County, N Carolina 99934 0.8501 0.8599 1.15 34230 Columbus County, N Carolina 99934 0.8501 0.8599 1.15 34240 Craven County, N Carolina 99934 0.8501 0.8599 1.15 34250 Cumberland County, N Carolina 22180 0.9416 0.8961 -4.83 34251 Currituck County, N Carolina 47260 0.8799 0.8805 0.07 34270 Dare County, N Carolina 99934 0.8501 0.8599 1.15 34280 Davidson County, N Carolina 99934 0.8779 0.8599 -2.05 34290 Davie County, N Carolina 49180 0.8981 0.9293 3.47 34300 Duplin County, N Carolina 99934 0.8501 0.8599 1.15 34310 Durham County, N Carolina 20500 1.0139 0.9843 -2.92 34320 Edgecombe County, N Carolina 40580 0.8915 0.8869 -0.52 34330 Forsyth County, N Carolina 49180 0.8981 0.9293 3.47 34340 Franklin County, N Carolina 39580 0.9863 0.9879 0.16 34350 Gaston County, N Carolina 16740 0.9733 0.9564 -1.74 34360 Gates County, N Carolina 99934 0.8501 0.8599 1.15 34370 Graham County, N Carolina 99934 0.8501 0.8599 1.15 34380 Granville County, N Carolina 99934 0.8501 0.8599 1.15 34390 Greene County, N Carolina 24780 0.8944 0.9449 5.65 34400 Guilford County, N Carolina 24660 0.9061 0.8735 -3.60 34410 Halifax County, N Carolina 99934 0.8501 0.8599 1.15 34420 Harnett County, N Carolina 99934 0.8501 0.8599 1.15 34430 Haywood County, N Carolina 11700 0.8874 0.9093 2.47 34440 Henderson County, N Carolina 11700 0.8874 0.9093 2.47 34450 Hertford County, N Carolina 99934 0.8501 0.8599 1.15 34460 Hoke County, N Carolina 22180 0.8939 0.8961 0.25 34470 Hyde County, N Carolina 99934 0.8501 0.8599 1.15 34480 Iredell County, N Carolina 99934 0.8501 0.8599 1.15 34490 Jackson County, N Carolina 99934 0.8501 0.8599 1.15 34500 Johnston County, N Carolina 39580 0.9863 0.9879 0.16 34510 Jones County, N Carolina 99934 0.8501 0.8599 1.15 34520 Lee County, N Carolina 99934 0.8501 0.8599 1.15 34530 Lenoir County, N Carolina 99934 0.8501 0.8599 1.15 34540 Lincoln County, N Carolina 99934 0.9128 0.8599 -5.80 34550 Mc Dowell County, N Carolina 99934 0.8501 0.8599 1.15 34560 Macon County, N Carolina 99934 0.8501 0.8599 1.15 34570 Madison County, N Carolina 11700 0.9511 0.9093 -4.39 Start Printed Page 44161 34580 Martin County, N Carolina 99934 0.8501 0.8599 1.15 34590 Mecklenburg County, N Carolina 16740 0.9733 0.9564 -1.74 34600 Mitchell County, N Carolina 99934 0.8501 0.8599 1.15 34610 Montgomery County, N Carolina 99934 0.8501 0.8599 1.15 34620 Moore County, N Carolina 99934 0.8501 0.8599 1.15 34630 Nash County, N Carolina 40580 0.8915 0.8869 -0.52 34640 New Hanover County, N Carolina 48900 0.9582 0.9853 2.83 34650 Northampton County, N Carolina 99934 0.8501 0.8599 1.15 34660 Onslow County, N Carolina 27340 0.8236 0.8245 0.11 34670 Orange County, N Carolina 20500 1.0139 0.9843 -2.92 34680 Pamlico County, N Carolina 99934 0.8501 0.8599 1.15 34690 Pasquotank County, N Carolina 99934 0.8501 0.8599 1.15 34700 Pender County, N Carolina 48900 0.9022 0.9853 9.21 34710 Perquimans County, N Carolina 99934 0.8501 0.8599 1.15 34720 Person County, N Carolina 20500 0.9353 0.9843 5.24 34730 Pitt County, N Carolina 24780 0.9425 0.9449 0.25 34740 Polk County, N Carolina 99934 0.8501 0.8599 1.15 34750 Randolph County, N Carolina 24660 0.9061 0.8735 -3.60 34760 Richmond County, N Carolina 99934 0.8501 0.8599 1.15 34770 Robeson County, N Carolina 99934 0.8501 0.8599 1.15 34780 Rockingham County, N Carolina 24660 0.8783 0.8735 -0.55 34790 Rowan County, N Carolina 99934 0.9128 0.8599 -5.80 34800 Rutherford County, N Carolina 99934 0.8501 0.8599 1.15 34810 Sampson County, N Carolina 99934 0.8501 0.8599 1.15 34820 Scotland County, N Carolina 99934 0.8501 0.8599 1.15 34830 Stanly County, N Carolina 99934 0.8501 0.8599 1.15 34840 Stokes County, N Carolina 49180 0.8981 0.9293 3.47 34850 Surry County, N Carolina 99934 0.8501 0.8599 1.15 34860 Swain County, N Carolina 99934 0.8501 0.8599 1.15 34870 Transylvania County, N Carolina 99934 0.8501 0.8599 1.15 34880 Tyrrell County, N Carolina 99934 0.8501 0.8599 1.15 34890 Union County, N Carolina 16740 0.9733 0.9564 -1.74 34900 Vance County, N Carolina 99934 0.8501 0.8599 1.15 34910 Wake County, N Carolina 39580 0.9863 0.9879 0.16 34920 Warren County, N Carolina 99934 0.8501 0.8599 1.15 34930 Washington County, N Carolina 99934 0.8501 0.8599 1.15 34940 Watauga County, N Carolina 99934 0.8501 0.8599 1.15 34950 Wayne County, N Carolina 24140 0.8775 0.9187 4.70 34960 Wilkes County, N Carolina 99934 0.8501 0.8599 1.15 34970 Wilson County, N Carolina 99934 0.8501 0.8599 1.15 34980 Yadkin County, N Carolina 49180 0.8981 0.9293 3.47 34981 Yancey County, N Carolina 99934 0.8501 0.8599 1.15 35000 Adams County, N Dakota 99935 0.7261 0.7228 -0.45 35010 Barnes County, N Dakota 99935 0.7261 0.7228 -0.45 35020 Benson County, N Dakota 99935 0.7261 0.7228 -0.45 35030 Billings County, N Dakota 99935 0.7261 0.7228 -0.45 35040 Bottineau County, N Dakota 99935 0.7261 0.7228 -0.45 35050 Bowman County, N Dakota 99935 0.7261 0.7228 -0.45 35060 Burke County, N Dakota 99935 0.7261 0.7228 -0.45 35070 Burleigh County, N Dakota 13900 0.7574 0.7253 -4.24 35080 Cass County, N Dakota 22020 0.8486 0.8265 -2.60 35090 Cavalier County, N Dakota 99935 0.7261 0.7228 -0.45 35100 Dickey County, N Dakota 99935 0.7261 0.7228 -0.45 35110 Divide County, N Dakota 99935 0.7261 0.7228 -0.45 35120 Dunn County, N Dakota 99935 0.7261 0.7228 -0.45 35130 Eddy County, N Dakota 99935 0.7261 0.7228 -0.45 35140 Emmons County, N Dakota 99935 0.7261 0.7228 -0.45 35150 Foster County, N Dakota 99935 0.7261 0.7228 -0.45 35160 Golden Valley County, N Dakota 99935 0.7261 0.7228 -0.45 35170 Grand Forks County, N Dakota 24220 0.7901 0.7963 0.78 35180 Grant County, N Dakota 99935 0.7261 0.7228 -0.45 35190 Griggs County, N Dakota 99935 0.7261 0.7228 -0.45 35200 Hettinger County, N Dakota 99935 0.7261 0.7228 -0.45 35210 Kidder County, N Dakota 99935 0.7261 0.7228 -0.45 35220 La Moure County, N Dakota 99935 0.7261 0.7228 -0.45 35230 Logan County, N Dakota 99935 0.7261 0.7228 -0.45 35240 Mc Henry County, N Dakota 99935 0.7261 0.7228 -0.45 Start Printed Page 44162 35250 Mc Intosh County, N Dakota 99935 0.7261 0.7228 -0.45 35260 Mc Kenzie County, N Dakota 99935 0.7261 0.7228 -0.45 35270 Mc Lean County, N Dakota 99935 0.7261 0.7228 -0.45 35280 Mercer County, N Dakota 99935 0.7261 0.7228 -0.45 35290 Morton County, N Dakota 13900 0.7574 0.7253 -4.24 35300 Mountrail County, N Dakota 99935 0.7261 0.7228 -0.45 35310 Nelson County, N Dakota 99935 0.7261 0.7228 -0.45 35320 Oliver County, N Dakota 99935 0.7261 0.7228 -0.45 35330 Pembina County, N Dakota 99935 0.7261 0.7228 -0.45 35340 Pierce County, N Dakota 99935 0.7261 0.7228 -0.45 35350 Ramsey County, N Dakota 99935 0.7261 0.7228 -0.45 35360 Ransom County, N Dakota 99935 0.7261 0.7228 -0.45 35370 Renville County, N Dakota 99935 0.7261 0.7228 -0.45 35380 Richland County, N Dakota 99935 0.7261 0.7228 -0.45 35390 Rolette County, N Dakota 99935 0.7261 0.7228 -0.45 35400 Sargent County, N Dakota 99935 0.7261 0.7228 -0.45 35410 Sheridan County, N Dakota 99935 0.7261 0.7228 -0.45 35420 Sioux County, N Dakota 99935 0.7261 0.7228 -0.45 35430 Slope County, N Dakota 99935 0.7261 0.7228 -0.45 35440 Stark County, N Dakota 99935 0.7261 0.7228 -0.45 35450 Steele County, N Dakota 99935 0.7261 0.7228 -0.45 35460 Stutsman County, N Dakota 99935 0.7261 0.7228 -0.45 35470 Towner County, N Dakota 99935 0.7261 0.7228 -0.45 35480 Traill County, N Dakota 99935 0.7261 0.7228 -0.45 35490 Walsh County, N Dakota 99935 0.7261 0.7228 -0.45 35500 Ward County, N Dakota 99935 0.7261 0.7228 -0.45 35510 Wells County, N Dakota 99935 0.7261 0.7228 -0.45 35520 Williams County, N Dakota 99935 0.7261 0.7228 -0.45 36000 Adams County, Ohio 99936 0.8874 0.8674 -2.25 36010 Allen County, Ohio 30620 0.9172 0.9058 -1.24 36020 Ashland County, Ohio 99936 0.8874 0.8674 -2.25 36030 Ashtabula County, Ohio 99936 0.9005 0.8674 -3.68 36040 Athens County, Ohio 99936 0.8874 0.8674 -2.25 36050 Auglaize County, Ohio 99936 0.8973 0.8674 -3.33 36060 Belmont County, Ohio 48540 0.7161 0.7022 -1.94 36070 Brown County, Ohio 17140 0.9675 0.9617 -0.60 36080 Butler County, Ohio 17140 0.9283 0.9617 3.60 36090 Carroll County, Ohio 15940 0.8935 0.9047 1.25 36100 Champaign County, Ohio 99936 0.8874 0.8674 -2.25 36110 Clark County, Ohio 44220 0.8688 0.8462 -2.60 36120 Clermont County, Ohio 17140 0.9675 0.9617 -0.60 36130 Clinton County, Ohio 99936 0.8874 0.8674 -2.25 36140 Columbiana County, Ohio 99936 0.8837 0.8674 -1.84 36150 Coshocton County, Ohio 99936 0.8874 0.8674 -2.25 36160 Crawford County, Ohio 99936 0.9359 0.8674 -7.32 36170 Cuyahoga County, Ohio 17460 0.9198 0.9385 2.03 36190 Darke County, Ohio 99936 0.8874 0.8674 -2.25 36200 Defiance County, Ohio 99936 0.8874 0.8674 -2.25 36210 Delaware County, Ohio 18140 0.9867 1.0122 2.58 36220 Erie County, Ohio 41780 0.8970 0.9319 3.89 36230 Fairfield County, Ohio 18140 0.9867 1.0122 2.58 36240 Fayette County, Ohio 99936 0.8874 0.8674 -2.25 36250 Franklin County, Ohio 18140 0.9867 1.0122 2.58 36260 Fulton County, Ohio 45780 0.9574 0.9599 0.26 36270 Gallia County, Ohio 99936 0.8874 0.8674 -2.25 36280 Geauga County, Ohio 17460 0.9198 0.9385 2.03 36290 Greene County, Ohio 19380 0.9022 0.9053 0.34 36300 Guernsey County, Ohio 99936 0.8874 0.8674 -2.25 36310 Hamilton County, Ohio 17140 0.9675 0.9617 -0.60 36330 Hancock County, Ohio 99936 0.8874 0.8674 -2.25 36340 Hardin County, Ohio 99936 0.8874 0.8674 -2.25 36350 Harrison County, Ohio 99936 0.8874 0.8674 -2.25 36360 Henry County, Ohio 99936 0.8874 0.8674 -2.25 36370 Highland County, Ohio 99936 0.8874 0.8674 -2.25 36380 Hocking County, Ohio 99936 0.8874 0.8674 -2.25 36390 Holmes County, Ohio 99936 0.8874 0.8674 -2.25 36400 Huron County, Ohio 99936 0.8874 0.8674 -2.25 Start Printed Page 44163 36410 Jackson County, Ohio 99936 0.8874 0.8674 -2.25 36420 Jefferson County, Ohio 48260 0.7819 0.8078 3.31 36430 Knox County, Ohio 99936 0.8874 0.8674 -2.25 36440 Lake County, Ohio 17460 0.9198 0.9385 2.03 36450 Lawrence County, Ohio 26580 0.9477 0.9013 -4.90 36460 Licking County, Ohio 18140 0.9867 1.0122 2.58 36470 Logan County, Ohio 99936 0.8874 0.8674 -2.25 36480 Lorain County, Ohio 17460 0.9198 0.9385 2.03 36490 Lucas County, Ohio 45780 0.9574 0.9599 0.26 36500 Madison County, Ohio 18140 0.9867 1.0122 2.58 36510 Mahoning County, Ohio 49660 0.8726 0.8817 1.04 36520 Marion County, Ohio 99936 0.8874 0.8674 -2.25 36530 Medina County, Ohio 17460 0.9198 0.9385 2.03 36540 Meigs County, Ohio 99936 0.8874 0.8674 -2.25 36550 Mercer County, Ohio 99936 0.8874 0.8674 -2.25 36560 Miami County, Ohio 19380 0.9022 0.9053 0.34 36570 Monroe County, Ohio 99936 0.8874 0.8674 -2.25 36580 Montgomery County, Ohio 19380 0.9022 0.9053 0.34 36590 Morgan County, Ohio 99936 0.8874 0.8674 -2.25 36600 Morrow County, Ohio 18140 0.9391 1.0122 7.78 36610 Muskingum County, Ohio 99936 0.8874 0.8674 -2.25 36620 Noble County, Ohio 99936 0.8874 0.8674 -2.25 36630 Ottawa County, Ohio 45780 0.9248 0.9599 3.80 36640 Paulding County, Ohio 99936 0.8874 0.8674 -2.25 36650 Perry County, Ohio 99936 0.8874 0.8674 -2.25 36660 Pickaway County, Ohio 18140 0.9867 1.0122 2.58 36670 Pike County, Ohio 99936 0.8874 0.8674 -2.25 36680 Portage County, Ohio 10420 0.8982 0.8639 -3.82 36690 Preble County, Ohio 19380 0.8993 0.9053 0.67 36700 Putnam County, Ohio 99936 0.8874 0.8674 -2.25 36710 Richland County, Ohio 31900 0.8902 0.9287 4.32 36720 Ross County, Ohio 99936 0.8874 0.8674 -2.25 36730 Sandusky County, Ohio 99936 0.8874 0.8674 -2.25 36740 Scioto County, Ohio 99936 0.8874 0.8674 -2.25 36750 Seneca County, Ohio 99936 0.8874 0.8674 -2.25 36760 Shelby County, Ohio 99936 0.8874 0.8674 -2.25 36770 Stark County, Ohio 15940 0.8935 0.9047 1.25 36780 Summit County, Ohio 10420 0.8982 0.8639 -3.82 36790 Trumbull County, Ohio 49660 0.8726 0.8817 1.04 36800 Tuscarawas County, Ohio 99936 0.8874 0.8674 -2.25 36810 Union County, Ohio 18140 0.9391 1.0122 7.78 36820 Van Wert County, Ohio 99936 0.8874 0.8674 -2.25 36830 Vinton County, Ohio 99936 0.8874 0.8674 -2.25 36840 Warren County, Ohio 17140 0.9675 0.9617 -0.60 36850 Washington County, Ohio 37620 0.8270 0.7940 -3.99 36860 Wayne County, Ohio 99936 0.8874 0.8674 -2.25 36870 Williams County, Ohio 99936 0.8874 0.8674 -2.25 36880 Wood County, Ohio 45780 0.9574 0.9599 0.26 36890 Wyandot County, Ohio 99936 0.8874 0.8674 -2.25 37000 Adair County, Oklahoma 99937 0.7512 0.7640 1.70 37010 Alfalfa County, Oklahoma 99937 0.7512 0.7640 1.70 37020 Atoka County, Oklahoma 99937 0.7512 0.7640 1.70 37030 Beaver County, Oklahoma 99937 0.7512 0.7640 1.70 37040 Beckham County, Oklahoma 99937 0.7512 0.7640 1.70 37050 Blaine County, Oklahoma 99937 0.7512 0.7640 1.70 37060 Bryan County, Oklahoma 99937 0.7512 0.7640 1.70 37070 Caddo County, Oklahoma 99937 0.7512 0.7640 1.70 37080 Canadian County, Oklahoma 36420 0.9028 0.8853 -1.94 37090 Carter County, Oklahoma 99937 0.7512 0.7640 1.70 37100 Cherokee County, Oklahoma 99937 0.7512 0.7640 1.70 37110 Choctaw County, Oklahoma 99937 0.7512 0.7640 1.70 37120 Cimarron County, Oklahoma 99937 0.7512 0.7640 1.70 37130 Cleveland County, Oklahoma 36420 0.9028 0.8853 -1.94 37140 Coal County, Oklahoma 99937 0.7512 0.7640 1.70 37150 Comanche County, Oklahoma 30020 0.7872 0.8080 2.64 37160 Cotton County, Oklahoma 99937 0.7512 0.7640 1.70 37170 Craig County, Oklahoma 99937 0.7512 0.7640 1.70 Start Printed Page 44164 37180 Creek County, Oklahoma 46140 0.8565 0.8104 -5.38 37190 Custer County, Oklahoma 99937 0.7512 0.7640 1.70 37200 Delaware County, Oklahoma 99937 0.7512 0.7640 1.70 37210 Dewey County, Oklahoma 99937 0.7512 0.7640 1.70 37220 Ellis County, Oklahoma 99937 0.7512 0.7640 1.70 37230 Garfield County, Oklahoma 99937 0.8124 0.7640 -5.96 37240 Garvin County, Oklahoma 99937 0.7512 0.7640 1.70 37250 Grady County, Oklahoma 36420 0.8237 0.8853 7.48 37260 Grant County, Oklahoma 99937 0.7512 0.7640 1.70 37270 Greer County, Oklahoma 99937 0.7512 0.7640 1.70 37280 Harmon County, Oklahoma 99937 0.7512 0.7640 1.70 37290 Harper County, Oklahoma 99937 0.7512 0.7640 1.70 37300 Haskell County, Oklahoma 99937 0.7512 0.7640 1.70 37310 Hughes County, Oklahoma 99937 0.7512 0.7640 1.70 37320 Jackson County, Oklahoma 99937 0.7512 0.7640 1.70 37330 Jefferson County, Oklahoma 99937 0.7512 0.7640 1.70 37340 Johnston County, Oklahoma 99937 0.7512 0.7640 1.70 37350 Kay County, Oklahoma 99937 0.7512 0.7640 1.70 37360 Kingfisher County, Oklahoma 99937 0.7512 0.7640 1.70 37370 Kiowa County, Oklahoma 99937 0.7512 0.7640 1.70 37380 Latimer County, Oklahoma 99937 0.7512 0.7640 1.70 37390 Le Flore County, Oklahoma 22900 0.7836 0.7745 -1.16 37400 Lincoln County, Oklahoma 36420 0.8237 0.8853 7.48 37410 Logan County, Oklahoma 36420 0.9028 0.8853 -1.94 37420 Love County, Oklahoma 99937 0.7512 0.7640 1.70 37430 Mc Clain County, Oklahoma 36420 0.9028 0.8853 -1.94 37440 Mc Curtain County, Oklahoma 99937 0.7512 0.7640 1.70 37450 Mc Intosh County, Oklahoma 99937 0.7512 0.7640 1.70 37460 Major County, Oklahoma 99937 0.7512 0.7640 1.70 37470 Marshall County, Oklahoma 99937 0.7512 0.7640 1.70 37480 Mayes County, Oklahoma 99937 0.7512 0.7640 1.70 37490 Murray County, Oklahoma 99937 0.7512 0.7640 1.70 37500 Muskogee County, Oklahoma 99937 0.7512 0.7640 1.70 37510 Noble County, Oklahoma 99937 0.7512 0.7640 1.70 37520 Nowata County, Oklahoma 99937 0.7512 0.7640 1.70 37530 Okfuskee County, Oklahoma 99937 0.7512 0.7640 1.70 37540 Oklahoma County, Oklahoma 36420 0.9028 0.8853 -1.94 37550 Okmulgee County, Oklahoma 46140 0.7993 0.8104 1.39 37560 Osage County, Oklahoma 46140 0.8565 0.8104 -5.38 37570 Ottawa County, Oklahoma 99937 0.7512 0.7640 1.70 37580 Pawnee County, Oklahoma 46140 0.7993 0.8104 1.39 37590 Payne County, Oklahoma 99937 0.7512 0.7640 1.70 37600 Pittsburg County, Oklahoma 99937 0.7512 0.7640 1.70 37610 Pontotoc County, Oklahoma 99937 0.7512 0.7640 1.70 37620 Pottawatomie County, Oklahoma 99937 0.8303 0.7640 -7.99 37630 Pushmataha County, Oklahoma 99937 0.7512 0.7640 1.70 37640 Roger Mills County, Oklahoma 99937 0.7512 0.7640 1.70 37650 Rogers County, Oklahoma 46140 0.8565 0.8104 -5.38 37660 Seminole County, Oklahoma 99937 0.7512 0.7640 1.70 37670 Sequoyah County, Oklahoma 22900 0.8238 0.7745 -5.98 37680 Stephens County, Oklahoma 99937 0.7512 0.7640 1.70 37690 Texas County, Oklahoma 99937 0.7512 0.7640 1.70 37700 Tillman County, Oklahoma 99937 0.7512 0.7640 1.70 37710 Tulsa County, Oklahoma 46140 0.8565 0.8104 -5.38 37720 Wagoner County, Oklahoma 46140 0.8565 0.8104 -5.38 37730 Washington County, Oklahoma 99937 0.7512 0.7640 1.70 37740 Washita County, Oklahoma 99937 0.7512 0.7640 1.70 37750 Woods County, Oklahoma 99937 0.7512 0.7640 1.70 37760 Woodward County, Oklahoma 99937 0.7512 0.7640 1.70 38000 Baker County, Oregon 99938 0.9939 0.9770 -1.70 38010 Benton County, Oregon 18700 1.0729 1.1566 7.80 38020 Clackamas County, Oregon 38900 1.1266 1.1436 1.51 38030 Clatsop County, Oregon 99938 0.9939 0.9770 -1.70 38040 Columbia County, Oregon 38900 1.1266 1.1436 1.51 38050 Coos County, Oregon 99938 0.9939 0.9770 -1.70 38060 Crook County, Oregon 99938 0.9939 0.9770 -1.70 38070 Curry County, Oregon 99938 0.9939 0.9770 -1.70 Start Printed Page 44165 38080 Deschutes County, Oregon 13460 1.0419 1.0762 3.29 38090 Douglas County, Oregon 99938 0.9939 0.9770 -1.70 38100 Gilliam County, Oregon 99938 0.9939 0.9770 -1.70 38110 Grant County, Oregon 99938 0.9939 0.9770 -1.70 38120 Harney County, Oregon 99938 0.9939 0.9770 -1.70 38130 Hood River County, Oregon 99938 0.9939 0.9770 -1.70 38140 Jackson County, Oregon 32780 1.0225 1.0837 5.99 38150 Jefferson County, Oregon 99938 0.9939 0.9770 -1.70 38160 Josephine County, Oregon 99938 0.9939 0.9770 -1.70 38170 Klamath County, Oregon 99938 0.9939 0.9770 -1.70 38180 Lake County, Oregon 99938 0.9939 0.9770 -1.70 38190 Lane County, Oregon 21660 1.0818 1.0896 0.72 38200 Lincoln County, Oregon 99938 0.9939 0.9770 -1.70 38210 Linn County, Oregon 99938 0.9939 0.9770 -1.70 38220 Malheur County, Oregon 99938 0.9939 0.9770 -1.70 38230 Marion County, Oregon 41420 1.0442 1.0457 0.14 38240 Morrow County, Oregon 99938 0.9939 0.9770 -1.70 38250 Multnomah County, Oregon 38900 1.1266 1.1436 1.51 38260 Polk County, Oregon 41420 1.0442 1.0457 0.14 38270 Sherman County, Oregon 99938 0.9939 0.9770 -1.70 38280 Tillamook County, Oregon 99938 0.9939 0.9770 -1.70 38290 Umatilla County, Oregon 99938 0.9939 0.9770 -1.70 38300 Union County, Oregon 99938 0.9939 0.9770 -1.70 38310 Wallowa County, Oregon 99938 0.9939 0.9770 -1.70 38320 Wasco County, Oregon 99938 0.9939 0.9770 -1.70 38330 Washington County, Oregon 38900 1.1266 1.1436 1.51 38340 Wheeler County, Oregon 99938 0.9939 0.9770 -1.70 38350 Yamhill County, Oregon 38900 1.1266 1.1436 1.51 39000 Adams County, Pennsylvania 99939 0.8305 0.8332 0.33 39010 Allegheny County, Pennsylvania 38300 0.8853 0.8685 -1.90 39070 Armstrong County, Pennsylvania 38300 0.8582 0.8685 1.20 39080 Beaver County, Pennsylvania 38300 0.8853 0.8685 -1.90 39100 Bedford County, Pennsylvania 99939 0.8305 0.8332 0.33 39110 Berks County, Pennsylvania 39740 0.9686 0.9639 -0.49 39120 Blair County, Pennsylvania 11020 0.8944 0.8727 -2.43 39130 Bradford County, Pennsylvania 99939 0.8305 0.8332 0.33 39140 Bucks County, Pennsylvania 37964 1.0980 1.1018 0.35 39150 Butler County, Pennsylvania 38300 0.8853 0.8685 -1.90 39160 Cambria County, Pennsylvania 27780 0.8220 0.8635 5.05 39180 Cameron County, Pennsylvania 99939 0.8305 0.8332 0.33 39190 Carbon County, Pennsylvania 10900 0.9832 0.9910 0.79 39200 Centre County, Pennsylvania 44300 0.8356 0.8799 5.30 39210 Chester County, Pennsylvania 37964 1.0980 1.1018 0.35 39220 Clarion County, Pennsylvania 99939 0.8305 0.8332 0.33 39230 Clearfield County, Pennsylvania 99939 0.8305 0.8332 0.33 39240 Clinton County, Pennsylvania 99939 0.8305 0.8332 0.33 39250 Columbia County, Pennsylvania 99939 0.8408 0.8332 -0.90 39260 Crawford County, Pennsylvania 99939 0.8305 0.8332 0.33 39270 Cumberland County, Pennsylvania 25420 0.9273 0.9419 1.57 39280 Dauphin County, Pennsylvania 25420 0.9273 0.9419 1.57 39290 Delaware County, Pennsylvania 37964 1.0980 1.1018 0.35 39310 Elk County, Pennsylvania 99939 0.8305 0.8332 0.33 39320 Erie County, Pennsylvania 21500 0.8737 0.8704 -0.38 39330 Fayette County, Pennsylvania 38300 0.8853 0.8685 -1.90 39340 Forest County, Pennsylvania 99939 0.8305 0.8332 0.33 39350 Franklin County, Pennsylvania 99939 0.8305 0.8332 0.33 39360 Fulton County, Pennsylvania 99939 0.8305 0.8332 0.33 39370 Greene County, Pennsylvania 99939 0.8305 0.8332 0.33 39380 Huntingdon County, Pennsylvania 99939 0.8305 0.8332 0.33 39390 Indiana County, Pennsylvania 99939 0.8305 0.8332 0.33 39400 Jefferson County, Pennsylvania 99939 0.8305 0.8332 0.33 39410 Juniata County, Pennsylvania 99939 0.8305 0.8332 0.33 39420 Lackawanna County, Pennsylvania 42540 0.8532 0.8521 -0.13 39440 Lancaster County, Pennsylvania 29540 0.9694 0.9644 -0.52 39450 Lawrence County, Pennsylvania 99939 0.8305 0.8332 0.33 39460 Lebanon County, Pennsylvania 30140 0.8846 0.8695 -1.71 39470 Lehigh County, Pennsylvania 10900 0.9832 0.9910 0.79 Start Printed Page 44166 39480 Luzerne County, Pennsylvania 42540 0.8532 0.8521 -0.13 39510 Lycoming County, Pennsylvania 48700 0.8364 0.8126 -2.85 39520 Mc Kean County, Pennsylvania 99939 0.8305 0.8332 0.33 39530 Mercer County, Pennsylvania 49660 0.8198 0.8817 7.55 39540 Mifflin County, Pennsylvania 99939 0.8305 0.8332 0.33 39550 Monroe County, Pennsylvania 99939 0.8305 0.8332 0.33 39560 Montgomery County, Pennsylvania 37964 1.0980 1.1018 0.35 39580 Montour County, Pennsylvania 99939 0.8305 0.8332 0.33 39590 Northampton County, Pennsylvania 10900 0.9832 0.9910 0.79 39600 Northumberland County, Pennsylvania 99939 0.8305 0.8332 0.33 39610 Perry County, Pennsylvania 25420 0.9273 0.9419 1.57 39620 Philadelphia County, Pennsylvania 37964 1.0980 1.1018 0.35 39630 Pike County, Pennsylvania 35084 1.1545 1.1890 2.99 39640 Potter County, Pennsylvania 99939 0.8305 0.8332 0.33 39650 Schuylkill County, Pennsylvania 99939 0.8305 0.8332 0.33 39670 Snyder County, Pennsylvania 99939 0.8305 0.8332 0.33 39680 Somerset County, Pennsylvania 99939 0.8189 0.8332 1.75 39690 Sullivan County, Pennsylvania 99939 0.8305 0.8332 0.33 39700 Susquehanna County, Pennsylvania 99939 0.8305 0.8332 0.33 39710 Tioga County, Pennsylvania 99939 0.8305 0.8332 0.33 39720 Union County, Pennsylvania 99939 0.8305 0.8332 0.33 39730 Venango County, Pennsylvania 99939 0.8305 0.8332 0.33 39740 Warren County, Pennsylvania 99939 0.8305 0.8332 0.33 39750 Washington County, Pennsylvania 38300 0.8853 0.8685 -1.90 39760 Wayne County, Pennsylvania 99939 0.8305 0.8332 0.33 39770 Westmoreland County, Pennsylvania 38300 0.8853 0.8685 -1.90 39790 Wyoming County, Pennsylvania 42540 0.8532 0.8521 -0.13 39800 York County, Pennsylvania 49620 0.9347 0.9414 0.72 40010 Adjuntas County, Puerto Rico 99940 0.3826 0.4047 5.78 40020 Aguada County, Puerto Rico 10380 0.4807 0.3922 -18.41 40030 Aguadilla County, Puerto Rico 10380 0.4807 0.3922 -18.41 40040 Aguas Buenas County, Puerto Rico 41980 0.4687 0.4397 -6.19 40050 Aibonito County, Puerto Rico 41980 0.4113 0.4397 6.90 40060 Anasco County, Puerto Rico 10380 0.4491 0.3922 -12.67 40070 Arecibo County, Puerto Rico 41980 0.4367 0.4397 0.69 40080 Arroyo County, Puerto Rico 25020 0.3393 0.3241 -4.48 40090 Barceloneta County, Puerto Rico 41980 0.4687 0.4397 -6.19 40100 Barranquitas County, Puerto Rico 41980 0.4113 0.4397 6.90 40110 Bayamon County, Puerto Rico 41980 0.4687 0.4397 -6.19 40120 Cabo Rojo County, Puerto Rico 41900 0.4447 0.4893 10.03 40130 Caguas County, Puerto Rico 41980 0.4371 0.4397 0.59 40140 Camuy County, Puerto Rico 41980 0.4367 0.4397 0.69 40145 Canovanas County, Puerto Rico 41980 0.4687 0.4397 -6.19 40150 Carolina County, Puerto Rico 41980 0.4687 0.4397 -6.19 40160 Catano County, Puerto Rico 41980 0.4687 0.4397 -6.19 40170 Cayey County, Puerto Rico 41980 0.4371 0.4397 0.59 40180 Ceiba County, Puerto Rico 21940 0.4453 0.4044 -9.18 40190 Ciales County, Puerto Rico 41980 0.4113 0.4397 6.90 40200 Cidra County, Puerto Rico 41980 0.4371 0.4397 0.59 40210 Coamo County, Puerto Rico 99940 0.3826 0.4047 5.78 40220 Comerio County, Puerto Rico 41980 0.4687 0.4397 -6.19 40230 Corozal County, Puerto Rico 41980 0.4687 0.4397 -6.19 40240 Culebra County, Puerto Rico 99940 0.3826 0.4047 5.78 40250 Dorado County, Puerto Rico 41980 0.4687 0.4397 -6.19 40260 Fajardo County, Puerto Rico 21940 0.4453 0.4044 -9.18 40265 Florida County, Puerto Rico 41980 0.4687 0.4397 -6.19 40270 Guanica County, Puerto Rico 49500 0.4006 0.3861 -3.62 40280 Guayama County, Puerto Rico 25020 0.3393 0.3241 -4.48 40290 Guayanilla County, Puerto Rico 49500 0.4645 0.3861 -16.88 40300 Guaynabo County, Puerto Rico 41980 0.4687 0.4397 -6.19 40310 Gurabo County, Puerto Rico 41980 0.4371 0.4397 0.59 40320 Hatillo County, Puerto Rico 41980 0.4367 0.4397 0.69 40330 Hormigueros County, Puerto Rico 32420 0.4132 0.3857 -6.66 40340 Humacao County, Puerto Rico 41980 0.4687 0.4397 -6.19 40350 Isabela County, Puerto Rico 10380 0.4171 0.3922 -5.97 40360 Jayuya County, Puerto Rico 99940 0.3826 0.4047 5.78 40370 Juana Diaz County, Puerto Rico 38660 0.4910 0.4851 -1.20 Start Printed Page 44167 40380 Juncos County, Puerto Rico 41980 0.4687 0.4397 -6.19 40390 Lajas County, Puerto Rico 41900 0.4127 0.4893 18.56 40400 Lares County, Puerto Rico 10380 0.4171 0.3922 -5.97 40410 Las Marias County, Puerto Rico 99940 0.3826 0.4047 5.78 40420 Las Piedras County, Puerto Rico 41980 0.4687 0.4397 -6.19 40430 Loiza County, Puerto Rico 41980 0.4687 0.4397 -6.19 40440 Luquillo County, Puerto Rico 21940 0.4453 0.4044 -9.18 40450 Manati County, Puerto Rico 41980 0.4687 0.4397 -6.19 40460 Maricao County, Puerto Rico 99940 0.3826 0.4047 5.78 40470 Maunabo County, Puerto Rico 41980 0.4113 0.4397 6.90 40480 Mayaguez County, Puerto Rico 32420 0.4132 0.3857 -6.66 40490 Moca County, Puerto Rico 10380 0.4807 0.3922 -18.41 40500 Morovis County, Puerto Rico 41980 0.4687 0.4397 -6.19 40510 Naguabo County, Puerto Rico 41980 0.4687 0.4397 -6.19 40520 Naranjito County, Puerto Rico 41980 0.4687 0.4397 -6.19 40530 Orocovis County, Puerto Rico 41980 0.4113 0.4397 6.90 40540 Patillas County, Puerto Rico 25020 0.3393 0.3241 -4.48 40550 Penuelas County, Puerto Rico 49500 0.4645 0.3861 -16.88 40560 Ponce County, Puerto Rico 38660 0.4910 0.4851 -1.20 40570 Quebradillas County, Puerto Rico 41980 0.4113 0.4397 6.90 40580 Rincon County, Puerto Rico 10380 0.4171 0.3922 -5.97 40590 Rio Grande County, Puerto Rico 41980 0.4687 0.4397 -6.19 40610 Sabana Grande County, Puerto Rico 41900 0.4447 0.4893 10.03 40620 Salinas County, Puerto Rico 99940 0.3826 0.4047 5.78 40630 San German County, Puerto Rico 41900 0.4447 0.4893 10.03 40640 San Juan County, Puerto Rico 41980 0.4687 0.4397 -6.19 40650 San Lorenzo County, Puerto Rico 41980 0.4371 0.4397 0.59 40660 San Sebastian County, Puerto Rico 10380 0.4171 0.3922 -5.97 40670 Santa Isabel County, Puerto Rico 99940 0.3826 0.4047 5.78 40680 Toa Alta County, Puerto Rico 41980 0.4687 0.4397 -6.19 40690 Toa Baja County, Puerto Rico 41980 0.4687 0.4397 -6.19 40700 Trujillo Alto County, Puerto Rico 41980 0.4687 0.4397 -6.19 40710 Utuado County, Puerto Rico 99940 0.3826 0.4047 5.78 40720 Vega Alta County, Puerto Rico 41980 0.4687 0.4397 -6.19 40730 Vega Baja County, Puerto Rico 41980 0.4687 0.4397 -6.19 40740 Vieques County, Puerto Rico 99940 0.3826 0.4047 5.78 40750 Villalba County, Puerto Rico 38660 0.4910 0.4851 -1.20 40760 Yabucoa County, Puerto Rico 41980 0.4687 0.4397 -6.19 40770 Yauco County, Puerto Rico 49500 0.4645 0.3861 -16.88 41000 Bristol County, Rhode Island 39300 1.1012 1.0804 -1.89 41010 Kent County, Rhode Island 39300 1.1012 1.0804 -1.89 41020 Newport County, Rhode Island 39300 1.1012 1.0804 -1.89 41030 Providence County, Rhode Island 39300 1.1012 1.0804 -1.89 41050 Washington County, Rhode Island 39300 1.1012 1.0804 -1.89 42000 Abbeville County, S Carolina 99942 0.8635 0.8583 -0.60 42010 Aiken County, S Carolina 12260 0.9778 0.9678 -1.02 42020 Allendale County, S Carolina 99942 0.8635 0.8583 -0.60 42030 Anderson County, S Carolina 11340 0.9306 0.8959 -3.73 42040 Bamberg County, S Carolina 99942 0.8635 0.8583 -0.60 42050 Barnwell County, S Carolina 99942 0.8635 0.8583 -0.60 42060 Beaufort County, S Carolina 99942 0.8635 0.8583 -0.60 42070 Berkeley County, S Carolina 16700 0.9245 0.9156 -0.96 42080 Calhoun County, S Carolina 17900 0.8844 0.8028 -9.23 42090 Charleston County, S Carolina 16700 0.9245 0.9156 -0.96 42100 Cherokee County, S Carolina 99942 0.9127 0.8583 -5.96 42110 Chester County, S Carolina 99942 0.8635 0.8583 -0.60 42120 Chesterfield County, S Carolina 99942 0.8635 0.8583 -0.60 42130 Clarendon County, S Carolina 99942 0.8635 0.8583 -0.60 42140 Colleton County, S Carolina 99942 0.8635 0.8583 -0.60 42150 Darlington County, S Carolina 22500 0.8789 0.8421 -4.19 42160 Dillon County, S Carolina 99942 0.8635 0.8583 -0.60 42170 Dorchester County, S Carolina 16700 0.9245 0.9156 -0.96 42180 Edgefield County, S Carolina 12260 0.9778 0.9678 -1.02 42190 Fairfield County, S Carolina 17900 0.8844 0.8028 -9.23 42200 Florence County, S Carolina 22500 0.8995 0.8421 -6.38 42210 Georgetown County, S Carolina 99942 0.8635 0.8583 -0.60 42220 Greenville County, S Carolina 24860 0.9821 0.9733 -0.90 Start Printed Page 44168 42230 Greenwood County, S Carolina 99942 0.8635 0.8583 -0.60 42240 Hampton County, S Carolina 99942 0.8635 0.8583 -0.60 42250 Horry County, S Carolina 34820 0.8934 0.8824 -1.23 42260 Jasper County, S Carolina 99942 0.8635 0.8583 -0.60 42270 Kershaw County, S Carolina 17900 0.8844 0.8028 -9.23 42280 Lancaster County, S Carolina 99942 0.8635 0.8583 -0.60 42290 Laurens County, S Carolina 24860 0.9329 0.9733 4.33 42300 Lee County, S Carolina 99942 0.8635 0.8583 -0.60 42310 Lexington County, S Carolina 17900 0.9070 0.8028 -11.49 42320 Mc Cormick County, S Carolina 99942 0.8635 0.8583 -0.60 42330 Marion County, S Carolina 99942 0.8635 0.8583 -0.60 42340 Marlboro County, S Carolina 99942 0.8635 0.8583 -0.60 42350 Newberry County, S Carolina 99942 0.8635 0.8583 -0.60 42360 Oconee County, S Carolina 99942 0.8635 0.8583 -0.60 42370 Orangeburg County, S Carolina 99942 0.8635 0.8583 -0.60 42380 Pickens County, S Carolina 24860 0.9821 0.9733 -0.90 42390 Richland County, S Carolina 17900 0.9070 0.8028 -11.49 42400 Saluda County, S Carolina 17900 0.8844 0.8028 -9.23 42410 Spartanburg County, S Carolina 43900 0.9394 0.9190 -2.17 42420 Sumter County, S Carolina 44940 0.8377 0.8098 -3.33 42430 Union County, S Carolina 99942 0.8635 0.8583 -0.60 42440 Williamsburg County, S Carolina 99942 0.8635 0.8583 -0.60 42450 York County, S Carolina 16740 0.9733 0.9564 -1.74 43010 Aurora County, S Dakota 99943 0.8556 0.8496 -0.70 43020 Beadle County, S Dakota 99943 0.8556 0.8496 -0.70 43030 Bennett County, S Dakota 99943 0.8556 0.8496 -0.70 43040 Bon Homme County, S Dakota 99943 0.8556 0.8496 -0.70 43050 Brookings County, S Dakota 99943 0.8556 0.8496 -0.70 43060 Brown County, S Dakota 99943 0.8556 0.8496 -0.70 43070 Brule County, S Dakota 99943 0.8556 0.8496 -0.70 43080 Buffalo County, S Dakota 99943 0.8556 0.8496 -0.70 43090 Butte County, S Dakota 99943 0.8556 0.8496 -0.70 43100 Campbell County, S Dakota 99943 0.8556 0.8496 -0.70 43110 Charles Mix County, S Dakota 99943 0.8556 0.8496 -0.70 43120 Clark County, S Dakota 99943 0.8556 0.8496 -0.70 43130 Clay County, S Dakota 99943 0.8556 0.8496 -0.70 43140 Codington County, S Dakota 99943 0.8556 0.8496 -0.70 43150 Corson County, S Dakota 99943 0.8556 0.8496 -0.70 43160 Custer County, S Dakota 99943 0.8556 0.8496 -0.70 43170 Davison County, S Dakota 99943 0.8556 0.8496 -0.70 43180 Day County, S Dakota 99943 0.8556 0.8496 -0.70 43190 Deuel County, S Dakota 99943 0.8556 0.8496 -0.70 43200 Dewey County, S Dakota 99943 0.8556 0.8496 -0.70 43210 Douglas County, S Dakota 99943 0.8556 0.8496 -0.70 43220 Edmunds County, S Dakota 99943 0.8556 0.8496 -0.70 43230 Fall River County, S Dakota 99943 0.8556 0.8496 -0.70 43240 Faulk County, S Dakota 99943 0.8556 0.8496 -0.70 43250 Grant County, S Dakota 99943 0.8556 0.8496 -0.70 43260 Gregory County, S Dakota 99943 0.8556 0.8496 -0.70 43270 Haakon County, S Dakota 99943 0.8556 0.8496 -0.70 43280 Hamlin County, S Dakota 99943 0.8556 0.8496 -0.70 43290 Hand County, S Dakota 99943 0.8556 0.8496 -0.70 43300 Hanson County, S Dakota 99943 0.8556 0.8496 -0.70 43310 Harding County, S Dakota 99943 0.8556 0.8496 -0.70 43320 Hughes County, S Dakota 99943 0.8556 0.8496 -0.70 43330 Hutchinson County, S Dakota 99943 0.8556 0.8496 -0.70 43340 Hyde County, S Dakota 99943 0.8556 0.8496 -0.70 43350 Jackson County, S Dakota 99943 0.8556 0.8496 -0.70 43360 Jerauld County, S Dakota 99943 0.8556 0.8496 -0.70 43370 Jones County, S Dakota 99943 0.8556 0.8496 -0.70 43380 Kingsbury County, S Dakota 99943 0.8556 0.8496 -0.70 43390 Lake County, S Dakota 99943 0.8556 0.8496 -0.70 43400 Lawrence County, S Dakota 99943 0.8556 0.8496 -0.70 43410 Lincoln County, S Dakota 43620 0.9635 0.9587 -0.50 43420 Lyman County, S Dakota 99943 0.8556 0.8496 -0.70 43430 Mc Cook County, S Dakota 43620 0.9093 0.9587 5.43 43440 Mc Pherson County, S Dakota 99943 0.8556 0.8496 -0.70 Start Printed Page 44169 43450 Marshall County, S Dakota 99943 0.8556 0.8496 -0.70 43460 Meade County, S Dakota 39660 0.8769 1.0351 18.04 43470 Mellette County, S Dakota 99943 0.8556 0.8496 -0.70 43480 Miner County, S Dakota 99943 0.8556 0.8496 -0.70 43490 Minnehaha County, S Dakota 43620 0.9635 0.9587 -0.50 43500 Moody County, S Dakota 99943 0.8556 0.8496 -0.70 43510 Pennington County, S Dakota 39660 0.8987 1.0351 15.18 43520 Perkins County, S Dakota 99943 0.8556 0.8496 -0.70 43530 Potter County, S Dakota 99943 0.8556 0.8496 -0.70 43540 Roberts County, S Dakota 99943 0.8556 0.8496 -0.70 43550 Sanborn County, S Dakota 99943 0.8556 0.8496 -0.70 43560 Shannon County, S Dakota 99943 0.8556 0.8496 -0.70 43570 Spink County, S Dakota 99943 0.8556 0.8496 -0.70 43580 Stanley County, S Dakota 99943 0.8556 0.8496 -0.70 43590 Sully County, S Dakota 99943 0.8556 0.8496 -0.70 43600 Todd County, S Dakota 99943 0.8556 0.8496 -0.70 43610 Tripp County, S Dakota 99943 0.8556 0.8496 -0.70 43620 Turner County, S Dakota 43620 0.9093 0.9587 5.43 43630 Union County, S Dakota 43580 0.8966 0.9217 2.80 43640 Walworth County, S Dakota 99943 0.8556 0.8496 -0.70 43650 Washabaugh County, S Dakota 99943 0.8556 0.8496 -0.70 43670 Yankton County, S Dakota 99943 0.8556 0.8496 -0.70 43680 Ziebach County, S Dakota 99943 0.8556 0.8496 -0.70 44000 Anderson County, Tennessee 28940 0.8419 0.8263 -1.85 44010 Bedford County, Tennessee 99944 0.7915 0.7841 -0.93 44020 Benton County, Tennessee 99944 0.7915 0.7841 -0.93 44030 Bledsoe County, Tennessee 99944 0.7915 0.7841 -0.93 44040 Blount County, Tennessee 28940 0.8419 0.8263 -1.85 44050 Bradley County, Tennessee 17420 0.8037 0.8124 1.08 44060 Campbell County, Tennessee 99944 0.7915 0.7841 -0.93 44070 Cannon County, Tennessee 34980 0.8838 0.9862 11.59 44080 Carroll County, Tennessee 99944 0.7915 0.7841 -0.93 44090 Carter County, Tennessee 27740 0.7972 0.8057 1.07 44100 Cheatham County, Tennessee 34980 0.9751 0.9862 1.14 44110 Chester County, Tennessee 27180 0.8964 0.8869 -1.06 44120 Claiborne County, Tennessee 99944 0.7915 0.7841 -0.93 44130 Clay County, Tennessee 99944 0.7915 0.7841 -0.93 44140 Cocke County, Tennessee 99944 0.7915 0.7841 -0.93 44150 Coffee County, Tennessee 99944 0.7915 0.7841 -0.93 44160 Crockett County, Tennessee 99944 0.7915 0.7841 -0.93 44170 Cumberland County, Tennessee 99944 0.7915 0.7841 -0.93 44180 Davidson County, Tennessee 34980 0.9751 0.9862 1.14 44190 Decatur County, Tennessee 99944 0.7915 0.7841 -0.93 44200 De Kalb County, Tennessee 99944 0.7915 0.7841 -0.93 44210 Dickson County, Tennessee 34980 0.9751 0.9862 1.14 44220 Dyer County, Tennessee 99944 0.7915 0.7841 -0.93 44230 Fayette County, Tennessee 32820 0.9407 0.9361 -0.49 44240 Fentress County, Tennessee 99944 0.7915 0.7841 -0.93 44250 Franklin County, Tennessee 99944 0.7915 0.7841 -0.93 44260 Gibson County, Tennessee 99944 0.7915 0.7841 -0.93 44270 Giles County, Tennessee 99944 0.7915 0.7841 -0.93 44280 Grainger County, Tennessee 34100 0.7948 0.7944 -0.05 44290 Greene County, Tennessee 99944 0.7915 0.7841 -0.93 44300 Grundy County, Tennessee 99944 0.7915 0.7841 -0.93 44310 Hamblen County, Tennessee 34100 0.7948 0.7944 -0.05 44320 Hamilton County, Tennessee 16860 0.9088 0.8963 -1.38 44330 Hancock County, Tennessee 99944 0.7915 0.7841 -0.93 44340 Hardeman County, Tennessee 99944 0.7915 0.7841 -0.93 44350 Hardin County, Tennessee 99944 0.7915 0.7841 -0.93 44360 Hawkins County, Tennessee 28700 0.8031 0.7975 -0.70 44370 Haywood County, Tennessee 99944 0.7915 0.7841 -0.93 44380 Henderson County, Tennessee 99944 0.7915 0.7841 -0.93 44390 Henry County, Tennessee 99944 0.7915 0.7841 -0.93 44400 Hickman County, Tennessee 34980 0.8838 0.9862 11.59 44410 Houston County, Tennessee 99944 0.7915 0.7841 -0.93 44420 Humphreys County, Tennessee 99944 0.7915 0.7841 -0.93 44430 Jackson County, Tennessee 99944 0.7915 0.7841 -0.93 Start Printed Page 44170 44440 Jefferson County, Tennessee 34100 0.7948 0.7944 -0.05 44450 Johnson County, Tennessee 99944 0.7915 0.7841 -0.93 44460 Knox County, Tennessee 28940 0.8419 0.8263 -1.85 44470 Lake County, Tennessee 99944 0.7915 0.7841 -0.93 44480 Lauderdale County, Tennessee 99944 0.7915 0.7841 -0.93 44490 Lawrence County, Tennessee 99944 0.7915 0.7841 -0.93 44500 Lewis County, Tennessee 99944 0.7915 0.7841 -0.93 44510 Lincoln County, Tennessee 99944 0.7915 0.7841 -0.93 44520 Loudon County, Tennessee 28940 0.8419 0.8263 -1.85 44530 Mc Minn County, Tennessee 99944 0.7915 0.7841 -0.93 44540 Mc Nairy County, Tennessee 99944 0.7915 0.7841 -0.93 44550 Macon County, Tennessee 34980 0.8838 0.9862 11.59 44560 Madison County, Tennessee 27180 0.8964 0.8869 -1.06 44570 Marion County, Tennessee 16860 0.9088 0.8963 -1.38 44580 Marshall County, Tennessee 99944 0.7915 0.7841 -0.93 44590 Maury County, Tennessee 99944 0.7915 0.7841 -0.93 44600 Meigs County, Tennessee 99944 0.7915 0.7841 -0.93 44610 Monroe County, Tennessee 99944 0.7915 0.7841 -0.93 44620 Montgomery County, Tennessee 17300 0.8284 0.8451 2.02 44630 Moore County, Tennessee 99944 0.7915 0.7841 -0.93 44640 Morgan County, Tennessee 99944 0.7915 0.7841 -0.93 44650 Obion County, Tennessee 99944 0.7915 0.7841 -0.93 44660 Overton County, Tennessee 99944 0.7915 0.7841 -0.93 44670 Perry County, Tennessee 99944 0.7915 0.7841 -0.93 44680 Pickett County, Tennessee 99944 0.7915 0.7841 -0.93 44690 Polk County, Tennessee 17420 0.8037 0.8124 1.08 44700 Putnam County, Tennessee 99944 0.7915 0.7841 -0.93 44710 Rhea County, Tennessee 99944 0.7915 0.7841 -0.93 44720 Roane County, Tennessee 99944 0.7915 0.7841 -0.93 44730 Robertson County, Tennessee 34980 0.9751 0.9862 1.14 44740 Rutherford County, Tennessee 34980 0.9751 0.9862 1.14 44750 Scott County, Tennessee 99944 0.7915 0.7841 -0.93 44760 Sequatchie County, Tennessee 16860 0.8512 0.8963 5.30 44770 Sevier County, Tennessee 99944 0.8146 0.7841 -3.74 44780 Shelby County, Tennessee 32820 0.9407 0.9361 -0.49 44790 Smith County, Tennessee 34980 0.8838 0.9862 11.59 44800 Stewart County, Tennessee 17300 0.8110 0.8451 4.20 44810 Sullivan County, Tennessee 28700 0.8031 0.7975 -0.70 44820 Sumner County, Tennessee 34980 0.9751 0.9862 1.14 44830 Tipton County, Tennessee 32820 0.9407 0.9361 -0.49 44840 Trousdale County, Tennessee 34980 0.8838 0.9862 11.59 44850 Unicoi County, Tennessee 27740 0.7972 0.8057 1.07 44860 Union County, Tennessee 28940 0.8419 0.8263 -1.85 44870 Van Buren County, Tennessee 99944 0.7915 0.7841 -0.93 44880 Warren County, Tennessee 99944 0.7915 0.7841 -0.93 44890 Washington County, Tennessee 27740 0.7972 0.8057 1.07 44900 Wayne County, Tennessee 99944 0.7915 0.7841 -0.93 44910 Weakley County, Tennessee 99944 0.7915 0.7841 -0.93 44920 White County, Tennessee 99944 0.7915 0.7841 -0.93 44930 Williamson County, Tennessee 34980 0.9751 0.9862 1.14 44940 Wilson County, Tennessee 34980 0.9751 0.9862 1.14 45000 Anderson County, Texas 99945 0.7967 0.7973 0.08 45010 Andrews County, Texas 99945 0.7967 0.7973 0.08 45020 Angelina County, Texas 99945 0.7967 0.7973 0.08 45030 Aransas County, Texas 18580 0.8241 0.8579 4.10 45040 Archer County, Texas 48660 0.8325 0.8326 0.01 45050 Armstrong County, Texas 11100 0.8544 0.9177 7.41 45060 Atascosa County, Texas 41700 0.8456 0.8860 4.78 45070 Austin County, Texas 26420 0.8962 1.0026 11.87 45080 Bailey County, Texas 99945 0.7967 0.7973 0.08 45090 Bandera County, Texas 41700 0.8456 0.8860 4.78 45100 Bastrop County, Texas 12420 0.9437 0.9360 -0.82 45110 Baylor County, Texas 99945 0.7967 0.7973 0.08 45113 Bee County, Texas 99945 0.7967 0.7973 0.08 45120 Bell County, Texas 28660 0.8526 0.9098 6.71 45130 Bexar County, Texas 41700 0.8982 0.8860 -1.36 45140 Blanco County, Texas 99945 0.7967 0.7973 0.08 Start Printed Page 44171 45150 Borden County, Texas 99945 0.7967 0.7973 0.08 45160 Bosque County, Texas 99945 0.7967 0.7973 0.08 45170 Bowie County, Texas 45500 0.8283 0.8118 -1.99 45180 Brazoria County, Texas 26420 0.9278 1.0026 8.06 45190 Brazos County, Texas 17780 0.8900 0.9061 1.81 45200 Brewster County, Texas 99945 0.7967 0.7973 0.08 45201 Briscoe County, Texas 99945 0.7967 0.7973 0.08 45210 Brooks County, Texas 99945 0.7967 0.7973 0.08 45220 Brown County, Texas 99945 0.7967 0.7973 0.08 45221 Burleson County, Texas 17780 0.8416 0.9061 7.66 45222 Burnet County, Texas 99945 0.7967 0.7973 0.08 45223 Caldwell County, Texas 12420 0.9437 0.9360 -0.82 45224 Calhoun County, Texas 47020 0.8046 0.8575 6.57 45230 Callahan County, Texas 10180 0.7914 0.8014 1.26 45240 Cameron County, Texas 15180 0.9804 0.9446 -3.65 45250 Camp County, Texas 99945 0.7967 0.7973 0.08 45251 Carson County, Texas 11100 0.8544 0.9177 7.41 45260 Cass County, Texas 99945 0.7967 0.7973 0.08 45270 Castro County, Texas 99945 0.7967 0.7973 0.08 45280 Chambers County, Texas 26420 1.0040 1.0026 -0.14 45281 Cherokee County, Texas 99945 0.7967 0.7973 0.08 45290 Childress County, Texas 99945 0.7967 0.7973 0.08 45291 Clay County, Texas 48660 0.8108 0.8326 2.69 45292 Cochran County, Texas 99945 0.7967 0.7973 0.08 45300 Coke County, Texas 99945 0.7967 0.7973 0.08 45301 Coleman County, Texas 99945 0.7967 0.7973 0.08 45310 Collin County, Texas 19124 1.0217 1.0093 -1.21 45311 Collingsworth County, Texas 99945 0.7967 0.7973 0.08 45312 Colorado County, Texas 99945 0.7967 0.7973 0.08 45320 Comal County, Texas 41700 0.8982 0.8860 -1.36 45321 Comanche County, Texas 99945 0.7967 0.7973 0.08 45330 Concho County, Texas 99945 0.7967 0.7973 0.08 45340 Cooke County, Texas 99945 0.7967 0.7973 0.08 45341 Coryell County, Texas 28660 0.8526 0.9098 6.71 45350 Cottle County, Texas 99945 0.7967 0.7973 0.08 45360 Crane County, Texas 99945 0.7967 0.7973 0.08 45361 Crockett County, Texas 99945 0.7967 0.7973 0.08 45362 Crosby County, Texas 31180 0.8357 0.8628 3.24 45370 Culberson County, Texas 99945 0.7967 0.7973 0.08 45380 Dallam County, Texas 99945 0.7967 0.7973 0.08 45390 Dallas County, Texas 19124 1.0217 1.0093 -1.21 45391 Dawson County, Texas 99945 0.7967 0.7973 0.08 45392 Deaf Smith County, Texas 99945 0.7967 0.7973 0.08 45400 Delta County, Texas 19124 0.9080 1.0093 11.16 45410 Denton County, Texas 19124 1.0217 1.0093 -1.21 45420 De Witt County, Texas 99945 0.7967 0.7973 0.08 45421 Dickens County, Texas 99945 0.7967 0.7973 0.08 45430 Dimmit County, Texas 99945 0.7967 0.7973 0.08 45431 Donley County, Texas 99945 0.7967 0.7973 0.08 45440 Duval County, Texas 99945 0.7967 0.7973 0.08 45450 Eastland County, Texas 99945 0.7967 0.7973 0.08 45451 Ector County, Texas 36220 0.9813 1.0119 3.12 45460 Edwards County, Texas 99945 0.7967 0.7973 0.08 45470 Ellis County, Texas 19124 1.0217 1.0093 -1.21 45480 El Paso County, Texas 21340 0.8977 0.9069 1.02 45490 Erath County, Texas 99945 0.7967 0.7973 0.08 45500 Falls County, Texas 99945 0.7967 0.7973 0.08 45510 Fannin County, Texas 99945 0.7967 0.7973 0.08 45511 Fayette County, Texas 99945 0.7967 0.7973 0.08 45520 Fisher County, Texas 99945 0.7967 0.7973 0.08 45521 Floyd County, Texas 99945 0.7967 0.7973 0.08 45522 Foard County, Texas 99945 0.7967 0.7973 0.08 45530 Fort Bend County, Texas 26420 1.0040 1.0026 -0.14 45531 Franklin County, Texas 99945 0.7967 0.7973 0.08 45540 Freestone County, Texas 99945 0.7967 0.7973 0.08 45541 Frio County, Texas 99945 0.7967 0.7973 0.08 45542 Gaines County, Texas 99945 0.7967 0.7973 0.08 Start Printed Page 44172 45550 Galveston County, Texas 26420 0.9814 1.0026 2.16 45551 Garza County, Texas 99945 0.7967 0.7973 0.08 45552 Gillespie County, Texas 99945 0.7967 0.7973 0.08 45560 Glasscock County, Texas 99945 0.7967 0.7973 0.08 45561 Goliad County, Texas 47020 0.8046 0.8575 6.57 45562 Gonzales County, Texas 99945 0.7967 0.7973 0.08 45563 Gray County, Texas 99945 0.7967 0.7973 0.08 45564 Grayson County, Texas 43300 0.9507 0.8517 -10.41 45570 Gregg County, Texas 30980 0.8809 0.8803 -0.07 45580 Grimes County, Texas 99945 0.7967 0.7973 0.08 45581 Guadaloupe County, Texas 41700 0.8982 0.8860 -1.36 45582 Hale County, Texas 99945 0.7967 0.7973 0.08 45583 Hall County, Texas 99945 0.7967 0.7973 0.08 45590 Hamilton County, Texas 99945 0.7967 0.7973 0.08 45591 Hansford County, Texas 99945 0.7967 0.7973 0.08 45592 Hardeman County, Texas 99945 0.7967 0.7973 0.08 45600 Hardin County, Texas 13140 0.8412 0.8610 2.35 45610 Harris County, Texas 26420 1.0040 1.0026 -0.14 45620 Harrison County, Texas 99945 0.8446 0.7973 -5.60 45621 Hartley County, Texas 99945 0.7967 0.7973 0.08 45630 Haskell County, Texas 99945 0.7967 0.7973 0.08 45631 Hays County, Texas 12420 0.9437 0.9360 -0.82 45632 Hemphill County, Texas 99945 0.7967 0.7973 0.08 45640 Henderson County, Texas 99945 0.9104 0.7973 -12.42 45650 Hidalgo County, Texas 32580 0.8934 0.8788 -1.63 45651 Hill County, Texas 99945 0.7967 0.7973 0.08 45652 Hockley County, Texas 99945 0.7967 0.7973 0.08 45653 Hood County, Texas 99945 0.8763 0.7973 -9.02 45654 Hopkins County, Texas 99945 0.7967 0.7973 0.08 45660 Houston County, Texas 99945 0.7967 0.7973 0.08 45661 Howard County, Texas 99945 0.7967 0.7973 0.08 45662 Hudspeth County, Texas 99945 0.7967 0.7973 0.08 45670 Hunt County, Texas 19124 1.0217 1.0093 -1.21 45671 Hutchinson County, Texas 99945 0.7967 0.7973 0.08 45672 Irion County, Texas 41660 0.8101 0.8377 3.41 45680 Jack County, Texas 99945 0.7967 0.7973 0.08 45681 Jackson County, Texas 99945 0.7967 0.7973 0.08 45690 Jasper County, Texas 99945 0.7967 0.7973 0.08 45691 Jeff Davis County, Texas 99945 0.7967 0.7973 0.08 45700 Jefferson County, Texas 13140 0.8412 0.8610 2.35 45710 Jim Hogg County, Texas 99945 0.7967 0.7973 0.08 45711 Jim Wells County, Texas 99945 0.7967 0.7973 0.08 45720 Johnson County, Texas 23104 0.9504 0.9587 0.87 45721 Jones County, Texas 10180 0.7914 0.8014 1.26 45722 Karnes County, Texas 99945 0.7967 0.7973 0.08 45730 Kaufman County, Texas 19124 1.0217 1.0093 -1.21 45731 Kendall County, Texas 41700 0.8456 0.8860 4.78 45732 Kenedy County, Texas 99945 0.7967 0.7973 0.08 45733 Kent County, Texas 99945 0.7967 0.7973 0.08 45734 Kerr County, Texas 99945 0.7967 0.7973 0.08 45740 Kimble County, Texas 99945 0.7967 0.7973 0.08 45741 King County, Texas 99945 0.7967 0.7973 0.08 45742 Kinney County, Texas 99945 0.7967 0.7973 0.08 45743 Kleberg County, Texas 99945 0.7967 0.7973 0.08 45744 Knox County, Texas 99945 0.7967 0.7973 0.08 45750 Lamar County, Texas 99945 0.7967 0.7973 0.08 45751 Lamb County, Texas 99945 0.7967 0.7973 0.08 45752 Lampasas County, Texas 28660 0.8229 0.9098 10.56 45753 La Salle County, Texas 99945 0.7967 0.7973 0.08 45754 Lavaca County, Texas 99945 0.7967 0.7973 0.08 45755 Lee County, Texas 99945 0.7967 0.7973 0.08 45756 Leon County, Texas 99945 0.7967 0.7973 0.08 45757 Liberty County, Texas 26420 1.0040 1.0026 -0.14 45758 Limestone County, Texas 99945 0.7967 0.7973 0.08 45759 Lipscomb County, Texas 99945 0.7967 0.7973 0.08 45760 Live Oak County, Texas 99945 0.7967 0.7973 0.08 45761 Llano County, Texas 99945 0.7967 0.7973 0.08 Start Printed Page 44173 45762 Loving County, Texas 99945 0.7967 0.7973 0.08 45770 Lubbock County, Texas 31180 0.8783 0.8628 -1.76 45771 Lynn County, Texas 99945 0.7967 0.7973 0.08 45772 Mc Culloch County, Texas 99945 0.7967 0.7973 0.08 45780 Mc Lennan County, Texas 47380 0.8518 0.8648 1.53 45781 Mc Mullen County, Texas 99945 0.7967 0.7973 0.08 45782 Madison County, Texas 99945 0.7967 0.7973 0.08 45783 Marion County, Texas 99945 0.7967 0.7973 0.08 45784 Martin County, Texas 99945 0.7967 0.7973 0.08 45785 Mason County, Texas 99945 0.7967 0.7973 0.08 45790 Matagorda County, Texas 99945 0.7967 0.7973 0.08 45791 Maverick County, Texas 99945 0.7967 0.7973 0.08 45792 Medina County, Texas 41700 0.8456 0.8860 4.78 45793 Menard County, Texas 99945 0.7967 0.7973 0.08 45794 Midland County, Texas 33260 0.9628 0.9803 1.82 45795 Milam County, Texas 99945 0.7967 0.7973 0.08 45796 Mills County, Texas 99945 0.7967 0.7973 0.08 45797 Mitchell County, Texas 99945 0.7967 0.7973 0.08 45800 Montague County, Texas 99945 0.7967 0.7973 0.08 45801 Montgomery County, Texas 26420 1.0040 1.0026 -0.14 45802 Moore County, Texas 99945 0.7967 0.7973 0.08 45803 Morris County, Texas 99945 0.7967 0.7973 0.08 45804 Motley County, Texas 99945 0.7967 0.7973 0.08 45810 Nacogdoches County, Texas 99945 0.7967 0.7973 0.08 45820 Navarro County, Texas 99945 0.7967 0.7973 0.08 45821 Newton County, Texas 99945 0.7967 0.7973 0.08 45822 Nolan County, Texas 99945 0.7967 0.7973 0.08 45830 Nueces County, Texas 18580 0.8550 0.8579 0.34 45831 Ochiltree County, Texas 99945 0.7967 0.7973 0.08 45832 Oldham County, Texas 99945 0.7967 0.7973 0.08 45840 Orange County, Texas 13140 0.8412 0.8610 2.35 45841 Palo Pinto County, Texas 99945 0.7967 0.7973 0.08 45842 Panola County, Texas 99945 0.7967 0.7973 0.08 45843 Parker County, Texas 23104 0.9504 0.9587 0.87 45844 Parmer County, Texas 99945 0.7967 0.7973 0.08 45845 Pecos County, Texas 99945 0.7967 0.7973 0.08 45850 Polk County, Texas 99945 0.7967 0.7973 0.08 45860 Potter County, Texas 11100 0.9156 0.9177 0.23 45861 Presidio County, Texas 99945 0.7967 0.7973 0.08 45870 Rains County, Texas 99945 0.7967 0.7973 0.08 45871 Randall County, Texas 11100 0.9156 0.9177 0.23 45872 Reagan County, Texas 99945 0.7967 0.7973 0.08 45873 Real County, Texas 99945 0.7967 0.7973 0.08 45874 Red River County, Texas 99945 0.7967 0.7973 0.08 45875 Reeves County, Texas 99945 0.7967 0.7973 0.08 45876 Refugio County, Texas 99945 0.7967 0.7973 0.08 45877 Roberts County, Texas 99945 0.7967 0.7973 0.08 45878 Robertson County, Texas 17780 0.8416 0.9061 7.66 45879 Rockwall County, Texas 19124 1.0217 1.0093 -1.21 45880 Runnels County, Texas 99945 0.7967 0.7973 0.08 45881 Rusk County, Texas 30980 0.8331 0.8803 5.67 45882 Sabine County, Texas 99945 0.7967 0.7973 0.08 45883 San Augustine County, Texas 99945 0.7967 0.7973 0.08 45884 San Jacinto County, Texas 26420 0.8962 1.0026 11.87 45885 San Patricio County, Texas 18580 0.8550 0.8579 0.34 45886 San Saba County, Texas 99945 0.7967 0.7973 0.08 45887 Schleicher County, Texas 99945 0.7967 0.7973 0.08 45888 Scurry County, Texas 99945 0.7967 0.7973 0.08 45889 Shackelford County, Texas 99945 0.7967 0.7973 0.08 45890 Shelby County, Texas 99945 0.7967 0.7973 0.08 45891 Sherman County, Texas 99945 0.7967 0.7973 0.08 45892 Smith County, Texas 46340 0.9168 0.8827 -3.72 45893 Somervell County, Texas 99945 0.7967 0.7973 0.08 45900 Starr County, Texas 99945 0.7967 0.7973 0.08 45901 Stephens County, Texas 99945 0.7967 0.7973 0.08 45902 Sterling County, Texas 99945 0.7967 0.7973 0.08 45903 Stonewall County, Texas 99945 0.7967 0.7973 0.08 Start Printed Page 44174 45904 Sutton County, Texas 99945 0.7967 0.7973 0.08 45905 Swisher County, Texas 99945 0.7967 0.7973 0.08 45910 Tarrant County, Texas 23104 0.9504 0.9587 0.87 45911 Taylor County, Texas 10180 0.7975 0.8014 0.49 45912 Terrell County, Texas 99945 0.7967 0.7973 0.08 45913 Terry County, Texas 99945 0.7967 0.7973 0.08 45920 Throckmorton County, Texas 99945 0.7967 0.7973 0.08 45921 Titus County, Texas 99945 0.7967 0.7973 0.08 45930 Tom Green County, Texas 41660 0.8271 0.8377 1.28 45940 Travis County, Texas 12420 0.9437 0.9360 -0.82 45941 Trinity County, Texas 99945 0.7967 0.7973 0.08 45942 Tyler County, Texas 99945 0.7967 0.7973 0.08 45943 Upshur County, Texas 30980 0.8809 0.8803 -0.07 45944 Upton County, Texas 99945 0.7967 0.7973 0.08 45945 Uvalde County, Texas 99945 0.7967 0.7973 0.08 45946 Val Verde County, Texas 99945 0.7967 0.7973 0.08 45947 Van Zandt County, Texas 99945 0.7967 0.7973 0.08 45948 Victoria County, Texas 47020 0.8160 0.8575 5.09 45949 Walker County, Texas 99945 0.7967 0.7973 0.08 45950 Waller County, Texas 26420 1.0040 1.0026 -0.14 45951 Ward County, Texas 99945 0.7967 0.7973 0.08 45952 Washington County, Texas 99945 0.7967 0.7973 0.08 45953 Webb County, Texas 29700 0.8068 0.7825 -3.01 45954 Wharton County, Texas 99945 0.7967 0.7973 0.08 45955 Wheeler County, Texas 99945 0.7967 0.7973 0.08 45960 Wichita County, Texas 48660 0.8325 0.8326 0.01 45961 Wilbarger County, Texas 99945 0.7967 0.7973 0.08 45962 Willacy County, Texas 99945 0.7967 0.7973 0.08 45970 Williamson County, Texas 12420 0.9437 0.9360 -0.82 45971 Wilson County, Texas 41700 0.8982 0.8860 -1.36 45972 Winkler County, Texas 99945 0.7967 0.7973 0.08 45973 Wise County, Texas 23104 0.8709 0.9587 10.08 45974 Wood County, Texas 99945 0.7967 0.7973 0.08 45980 Yoakum County, Texas 99945 0.7967 0.7973 0.08 45981 Young County, Texas 99945 0.7967 0.7973 0.08 45982 Zapata County, Texas 99945 0.7967 0.7973 0.08 45983 Zavala County, Texas 99945 0.7967 0.7973 0.08 46000 Beaver County, Utah 99946 0.8440 0.8154 -3.39 46010 Box Elder County, Utah 99946 0.8440 0.8154 -3.39 46020 Cache County, Utah 30860 0.8963 0.9038 0.84 46030 Carbon County, Utah 99946 0.8440 0.8154 -3.39 46040 Daggett County, Utah 99946 0.8440 0.8154 -3.39 46050 Davis County, Utah 36260 0.9185 0.9011 -1.89 46060 Duchesne County, Utah 99946 0.8440 0.8154 -3.39 46070 Emery County, Utah 99946 0.8440 0.8154 -3.39 46080 Garfield County, Utah 99946 0.8440 0.8154 -3.39 46090 Grand County, Utah 99946 0.8440 0.8154 -3.39 46100 Iron County, Utah 99946 0.8440 0.8154 -3.39 46110 Juab County, Utah 39340 0.9131 0.9554 4.63 46120 Kane County, Utah 99946 0.9982 0.8154 -18.31 46130 Millard County, Utah 99946 0.8440 0.8154 -3.39 46140 Morgan County, Utah 36260 0.8896 0.9011 1.29 46150 Piute County, Utah 99946 0.8440 0.8154 -3.39 46160 Rich County, Utah 99946 0.8440 0.8154 -3.39 46170 Salt Lake County, Utah 41620 0.9381 0.9418 0.39 46180 San Juan County, Utah 99946 0.8440 0.8154 -3.39 46190 Sanpete County, Utah 99946 0.8440 0.8154 -3.39 46200 Sevier County, Utah 99946 0.8440 0.8154 -3.39 46210 Summit County, Utah 41620 0.9092 0.9418 3.59 46220 Tooele County, Utah 41620 0.9092 0.9418 3.59 46230 Uintah County, Utah 99946 0.8440 0.8154 -3.39 46240 Utah County, Utah 39340 0.9500 0.9554 0.57 46250 Wasatch County, Utah 99946 0.8440 0.8154 -3.39 46260 Washington County, Utah 41100 0.9077 0.9281 2.25 46270 Wayne County, Utah 99946 0.8440 0.8154 -3.39 46280 Weber County, Utah 36260 0.9185 0.9011 -1.89 47000 Addison County, Vermont 99947 0.9830 0.9944 1.16 Start Printed Page 44175 47010 Bennington County, Vermont 99947 0.9830 0.9944 1.16 47020 Caledonia County, Vermont 99947 0.9830 0.9944 1.16 47030 Chittenden County, Vermont 15540 0.9410 0.9491 0.86 47040 Essex County, Vermont 99947 0.9830 0.9944 1.16 47050 Franklin County, Vermont 15540 0.9410 0.9491 0.86 47060 Grand Isle County, Vermont 15540 0.9410 0.9491 0.86 47070 Lamoille County, Vermont 99947 0.9830 0.9944 1.16 47080 Orange County, Vermont 99947 0.9830 0.9944 1.16 47090 Orleans County, Vermont 99947 0.9830 0.9944 1.16 47100 Rutland County, Vermont 99947 0.9830 0.9944 1.16 47110 Washington County, Vermont 99947 0.9830 0.9944 1.16 47120 Windham County, Vermont 99947 0.9830 0.9944 1.16 47130 Windsor County, Vermont 99947 0.9830 0.9944 1.16 48010 St Croix County, Virgin Islands 99948 0.7615 0.7615 0.00 48020 St Thomas-John County, Virgin Islands 99948 0.7615 0.7615 0.00 49000 Accomack County, Virginia 99949 0.8215 0.7954 -3.18 49010 Albemarle County, Virginia 16820 1.0187 1.0143 -0.43 49011 Alexandria City County, Virginia 47894 1.0951 1.1074 1.12 49020 Alleghany County, Virginia 99949 0.8215 0.7954 -3.18 49030 Amelia County, Virginia 40060 0.8873 0.9193 3.61 49040 Amherst County, Virginia 31340 0.8691 0.8710 0.22 49050 Appomattox County, Virginia 31340 0.8554 0.8710 1.82 49060 Arlington County, Virginia 47894 1.0951 1.1074 1.12 49070 Augusta County, Virginia 99949 0.8215 0.7954 -3.18 49080 Bath County, Virginia 99949 0.8215 0.7954 -3.18 49088 Bedford City County, Virginia 31340 0.8691 0.8710 0.22 49090 Bedford County, Virginia 31340 0.8691 0.8710 0.22 49100 Bland County, Virginia 99949 0.8215 0.7954 -3.18 49110 Botetourt County, Virginia 40220 0.8381 0.8662 3.35 49111 Bristol City County, Virginia 28700 0.8031 0.7975 -0.70 49120 Brunswick County, Virginia 99949 0.8215 0.7954 -3.18 49130 Buchanan County, Virginia 99949 0.8215 0.7954 -3.18 49140 Buckingham County, Virginia 99949 0.8215 0.7954 -3.18 49141 Buena Vista City County, Virginia 99949 0.8215 0.7954 -3.18 49150 Campbell County, Virginia 31340 0.8691 0.8710 0.22 49160 Caroline County, Virginia 40060 0.8873 0.9193 3.61 49170 Carroll County, Virginia 99949 0.8215 0.7954 -3.18 49180 Charles City County, Virginia 40060 0.9328 0.9193 -1.45 49190 Charlotte County, Virginia 99949 0.8215 0.7954 -3.18 49191 Charlottesville City County, Virginia 16820 1.0187 1.0143 -0.43 49194 Chesapeake County, Virginia 47260 0.8799 0.8805 0.07 49200 Chesterfield County, Virginia 40060 0.9328 0.9193 -1.45 49210 Clarke County, Virginia 47894 1.0951 1.1074 1.12 49211 Clifton Forge City County, Virginia 99949 0.8215 0.7954 -3.18 49212 Colonial Heights County, Virginia 40060 0.9328 0.9193 -1.45 49213 Covington City County, Virginia 99949 0.8215 0.7954 -3.18 49220 Craig County, Virginia 40220 0.8396 0.8662 3.17 49230 Culpeper County, Virginia 99949 0.9495 0.7954 -16.23 49240 Cumberland County, Virginia 40060 0.8873 0.9193 3.61 49241 Danville City County, Virginia 19260 0.8489 0.8466 -0.27 49250 Dickenson County, Virginia 99949 0.8215 0.7954 -3.18 49260 Dinniddie County, Virginia 40060 0.9328 0.9193 -1.45 49270 Emporia County, Virginia 99949 0.8215 0.7954 -3.18 49280 Essex County, Virginia 99949 0.8215 0.7954 -3.18 49288 Fairfax City County, Virginia 47894 1.0951 1.1074 1.12 49290 Fairfax County, Virginia 47894 1.0951 1.1074 1.12 49291 Falls Church City County, Virginia 47894 1.0951 1.1074 1.12 49300 Fauquier County, Virginia 47894 1.0951 1.1074 1.12 49310 Floyd County, Virginia 99949 0.8215 0.7954 -3.18 49320 Fluvanna County, Virginia 16820 1.0187 1.0143 -0.43 49328 Franklin City County, Virginia 99949 0.8215 0.7954 -3.18 49330 Franklin County, Virginia 40220 0.8396 0.8662 3.17 49340 Frederick County, Virginia 49020 0.9316 1.0109 8.51 49342 Fredericksburg City County, Virginia 47894 1.0951 1.1074 1.12 49343 Galax City County, Virginia 99949 0.8215 0.7954 -3.18 49350 Giles County, Virginia 13980 0.8186 0.8227 0.50 49360 Gloucester County, Virginia 47260 0.8799 0.8805 0.07 Start Printed Page 44176 49370 Goochland County, Virginia 40060 0.9328 0.9193 -1.45 49380 Grayson County, Virginia 99949 0.8215 0.7954 -3.18 49390 Greene County, Virginia 16820 1.0187 1.0143 -0.43 49400 Greensville County, Virginia 99949 0.8215 0.7954 -3.18 49410 Halifax County, Virginia 99949 0.8215 0.7954 -3.18 49411 Hampton City County, Virginia 47260 0.8799 0.8805 0.07 49420 Hanover County, Virginia 40060 0.9328 0.9193 -1.45 49421 Harrisonburg City County, Virginia 25500 0.8753 0.9090 3.85 49430 Henrico County, Virginia 40060 0.9328 0.9193 -1.45 49440 Henry County, Virginia 99949 0.8215 0.7954 -3.18 49450 Highland County, Virginia 99949 0.8215 0.7954 -3.18 49451 Hopewell City County, Virginia 40060 0.9328 0.9193 -1.45 49460 Isle Of Wight County, Virginia 47260 0.8799 0.8805 0.07 49470 James City County, Virginia 47260 0.8799 0.8805 0.07 49480 King And Queen County, Virginia 40060 0.8873 0.9193 3.61 49490 King George County, Virginia 99949 0.9495 0.7954 -16.23 49500 King William County, Virginia 40060 0.8873 0.9193 3.61 49510 Lancaster County, Virginia 99949 0.8215 0.7954 -3.18 49520 Lee County, Virginia 99949 0.8215 0.7954 -3.18 49522 Lexington County, Virginia 99949 0.8215 0.7954 -3.18 49530 Loudoun County, Virginia 47894 1.0951 1.1074 1.12 49540 Louisa County, Virginia 40060 0.8873 0.9193 3.61 49550 Lunenburg County, Virginia 99949 0.8215 0.7954 -3.18 49551 Lynchburg City County, Virginia 31340 0.8691 0.8710 0.22 49560 Madison County, Virginia 99949 0.8215 0.7954 -3.18 49561 Martinsville City County, Virginia 99949 0.8215 0.7954 -3.18 49563 Manassas City County, Virginia 47894 1.0951 1.1074 1.12 49565 Manassas Park City County, Virginia 47894 1.0951 1.1074 1.12 49570 Mathews County, Virginia 47260 0.8799 0.8805 0.07 49580 Mecklenburg County, Virginia 99949 0.8215 0.7954 -3.18 49590 Middlesex County, Virginia 99949 0.8215 0.7954 -3.18 49600 Montgomery County, Virginia 13980 0.8186 0.8227 0.50 49610 Nansemond, Virginia 99949 0.8215 0.7954 -3.18 49620 Nelson County, Virginia 16820 0.9302 1.0143 9.04 49621 New Kent County, Virginia 40060 0.9328 0.9193 -1.45 49622 Newport News City County, Virginia 47260 0.8799 0.8805 0.07 49641 Norfolk City County, Virginia 47260 0.8799 0.8805 0.07 49650 Northampton County, Virginia 99949 0.8215 0.7954 -3.18 49660 Northumberland County, Virginia 99949 0.8215 0.7954 -3.18 49661 Norton City County, Virginia 99949 0.8215 0.7954 -3.18 49670 Nottoway County, Virginia 99949 0.8215 0.7954 -3.18 49680 Orange County, Virginia 99949 0.8215 0.7954 -3.18 49690 Page County, Virginia 99949 0.8215 0.7954 -3.18 49700 Patrick County, Virginia 99949 0.8215 0.7954 -3.18 49701 Petersburg City County, Virginia 40060 0.9328 0.9193 -1.45 49710 Pittsylvania County, Virginia 19260 0.8489 0.8466 -0.27 49711 Portsmouth City County, Virginia 47260 0.8799 0.8805 0.07 49712 Poquoson City County, Virginia 47260 0.8799 0.8805 0.07 49720 Powhatan County, Virginia 40060 0.9328 0.9193 -1.45 49730 Prince Edward County, Virginia 99949 0.8215 0.7954 -3.18 49740 Prince George County, Virginia 40060 0.9328 0.9193 -1.45 49750 Prince William County, Virginia 47894 1.0951 1.1074 1.12 49770 Pulaski County, Virginia 13980 0.8186 0.8227 0.50 49771 Radford City County, Virginia 13980 0.8186 0.8227 0.50 49780 Rappahannock County, Virginia 99949 0.8215 0.7954 -3.18 49790 Richmond County, Virginia 99949 0.8215 0.7954 -3.18 49791 Richmond City County, Virginia 40060 0.9328 0.9193 -1.45 49800 Roanoke County, Virginia 40220 0.8381 0.8662 3.35 49801 Roanoke City County, Virginia 40220 0.8381 0.8662 3.35 49810 Rockbridge County, Virginia 99949 0.8215 0.7954 -3.18 49820 Rockingham County, Virginia 25500 0.8753 0.9090 3.85 49830 Russell County, Virginia 99949 0.8215 0.7954 -3.18 49838 Salem County, Virginia 40220 0.8381 0.8662 3.35 49840 Scott County, Virginia 28700 0.8031 0.7975 -0.70 49850 Shenandoah County, Virginia 99949 0.8215 0.7954 -3.18 49860 Smyth County, Virginia 99949 0.8215 0.7954 -3.18 49867 South Boston City County, Virginia 99949 0.8215 0.7954 -3.18 Start Printed Page 44177 49870 Southampton County, Virginia 99949 0.8215 0.7954 -3.18 49880 Spotsylvania County, Virginia 47894 1.0951 1.1074 1.12 49890 Stafford County, Virginia 47894 1.0951 1.1074 1.12 49891 Staunton City County, Virginia 99949 0.8215 0.7954 -3.18 49892 Suffolk City County, Virginia 47260 0.8799 0.8805 0.07 49900 Surry County, Virginia 47260 0.8608 0.8805 2.29 49910 Sussex County, Virginia 40060 0.8873 0.9193 3.61 49920 Tazewell County, Virginia 99949 0.8215 0.7954 -3.18 49921 Virginia Beach City County, Virginia 47260 0.8799 0.8805 0.07 49930 Warren County, Virginia 47894 1.0951 1.1074 1.12 49950 Washington County, Virginia 28700 0.8031 0.7975 -0.70 49951 Waynesboro City County, Virginia 99949 0.8215 0.7954 -3.18 49960 Westmoreland County, Virginia 99949 0.8215 0.7954 -3.18 49961 Williamsburg City County, Virginia 47260 0.8799 0.8805 0.07 49962 Winchester City County, Virginia 49020 0.9316 1.0109 8.51 49970 Wise County, Virginia 99949 0.8215 0.7954 -3.18 49980 Wythe County, Virginia 99949 0.8215 0.7954 -3.18 49981 York County, Virginia 47260 0.8799 0.8805 0.07 50000 Adams County, Washington 99950 1.0364 1.0281 -0.80 50010 Asotin County, Washington 30300 1.0052 0.9871 -1.80 50020 Benton County, Washington 28420 1.0619 1.0361 -2.43 50030 Chelan County, Washington 48300 1.0144 1.0365 2.18 50040 Clallam County, Washington 99950 1.0364 1.0281 -0.80 50050 Clark County, Washington 38900 1.1266 1.1436 1.51 50060 Columbia County, Washington 99950 1.0364 1.0281 -0.80 50070 Cowlitz County, Washington 31020 0.9898 1.0029 1.32 50080 Douglas County, Washington 48300 1.0144 1.0365 2.18 50090 Ferry County, Washington 99950 1.0364 1.0281 -0.80 50100 Franklin County, Washington 28420 1.0619 1.0361 -2.43 50110 Garfield County, Washington 99950 1.0364 1.0281 -0.80 50120 Grant County, Washington 99950 1.0364 1.0281 -0.80 50130 Grays Harbor County, Washington 99950 1.0364 1.0281 -0.80 50140 Island County, Washington 99950 1.1039 1.0281 -6.87 50150 Jefferson County, Washington 99950 1.0364 1.0281 -0.80 50160 King County, Washington 42644 1.1572 1.1454 -1.02 50170 Kitsap County, Washington 14740 1.0675 1.0932 2.41 50180 Kittitas County, Washington 99950 1.0364 1.0281 -0.80 50190 Klickitat County, Washington 99950 1.0364 1.0281 -0.80 50200 Lewis County, Washington 99950 1.0364 1.0281 -0.80 50210 Lincoln County, Washington 99950 1.0364 1.0281 -0.80 50220 Mason County, Washington 99950 1.0364 1.0281 -0.80 50230 Okanogan County, Washington 99950 1.0364 1.0281 -0.80 50240 Pacific County, Washington 99950 1.0364 1.0281 -0.80 50250 Pend Oreille County, Washington 99950 1.0364 1.0281 -0.80 50260 Pierce County, Washington 45104 1.0742 1.0808 0.61 50270 San Juan County, Washington 99950 1.0364 1.0281 -0.80 50280 Skagit County, Washington 34580 1.0336 1.0536 1.93 50290 Skamania County, Washington 38900 1.0742 1.1436 6.46 50300 Snohomish County, Washington 42644 1.1572 1.1454 -1.02 50310 Spokane County, Washington 44060 1.0905 1.0465 -4.03 50320 Stevens County, Washington 99950 1.0364 1.0281 -0.80 50330 Thurston County, Washington 36500 1.0927 1.1100 1.58 50340 Wahkiakum County, Washington 99950 1.0364 1.0281 -0.80 50350 Walla Walla County, Washington 99950 1.0364 1.0281 -0.80 50360 Whatcom County, Washington 13380 1.1731 1.1124 -5.17 50370 Whitman County, Washington 99950 1.0364 1.0281 -0.80 50380 Yakima County, Washington 49420 1.0155 0.9865 -2.86 51000 Barbour County, W Virginia 99951 0.7809 0.7620 -2.42 51010 Berkeley County, W Virginia 25180 1.0233 0.9054 -11.52 51020 Boone County, W Virginia 16620 0.8173 0.8558 4.71 51030 Braxton County, W Virginia 99951 0.7809 0.7620 -2.42 51040 Brooke County, W Virginia 48260 0.7819 0.8078 3.31 51050 Cabell County, W Virginia 26580 0.9477 0.9013 -4.90 51060 Calhoun County, W Virginia 99951 0.7809 0.7620 -2.42 51070 Clay County, W Virginia 16620 0.8173 0.8558 4.71 51080 Doddridge County, W Virginia 99951 0.7809 0.7620 -2.42 51090 Fayette County, W Virginia 99951 0.7809 0.7620 -2.42 Start Printed Page 44178 51100 Gilmer County, W Virginia 99951 0.7809 0.7620 -2.42 51110 Grant County, W Virginia 99951 0.7809 0.7620 -2.42 51120 Greenbrier County, W Virginia 99951 0.7809 0.7620 -2.42 51130 Hampshire County, W Virginia 49020 0.9057 1.0109 11.62 51140 Hancock County, W Virginia 48260 0.7819 0.8078 3.31 51150 Hardy County, W Virginia 99951 0.7809 0.7620 -2.42 51160 Harrison County, W Virginia 99951 0.7809 0.7620 -2.42 51170 Jackson County, W Virginia 99951 0.7809 0.7620 -2.42 51180 Jefferson County, W Virginia 47894 1.0951 1.1074 1.12 51190 Kanawha County, W Virginia 16620 0.8445 0.8558 1.34 51200 Lewis County, W Virginia 99951 0.7809 0.7620 -2.42 51210 Lincoln County, W Virginia 16620 0.8173 0.8558 4.71 51220 Logan County, W Virginia 99951 0.7809 0.7620 -2.42 51230 Mc Dowell County, W Virginia 99951 0.7809 0.7620 -2.42 51240 Marion County, W Virginia 99951 0.7809 0.7620 -2.42 51250 Marshall County, W Virginia 48540 0.7161 0.7022 -1.94 51260 Mason County, W Virginia 99951 0.7809 0.7620 -2.42 51270 Mercer County, W Virginia 99951 0.7809 0.7620 -2.42 51280 Mineral County, W Virginia 19060 0.9317 0.8859 -4.92 51290 Mingo County, W Virginia 99951 0.7809 0.7620 -2.42 51300 Monongalia County, W Virginia 34060 0.8160 0.8438 3.41 51310 Monroe County, W Virginia 99951 0.7809 0.7620 -2.42 51320 Morgan County, W Virginia 25180 0.8695 0.9054 4.13 51330 Nicholas County, W Virginia 99951 0.7809 0.7620 -2.42 51340 Ohio County, W Virginia 48540 0.7161 0.7022 -1.94 51350 Pendleton County, W Virginia 99951 0.7809 0.7620 -2.42 51360 Pleasants County, W Virginia 37620 0.8085 0.7940 -1.79 51370 Pocahontas County, W Virginia 99951 0.7809 0.7620 -2.42 51380 Preston County, W Virginia 34060 0.8160 0.8438 3.41 51390 Putnam County, W Virginia 16620 0.8445 0.8558 1.34 51400 Raleigh County, W Virginia 99951 0.7809 0.7620 -2.42 51410 Randolph County, W Virginia 99951 0.7809 0.7620 -2.42 51420 Ritchie County, W Virginia 99951 0.7809 0.7620 -2.42 51430 Roane County, W Virginia 99951 0.7809 0.7620 -2.42 51440 Summers County, W Virginia 99951 0.7809 0.7620 -2.42 51450 Taylor County, W Virginia 99951 0.7809 0.7620 -2.42 51460 Tucker County, W Virginia 99951 0.7809 0.7620 -2.42 51470 Tyler County, W Virginia 99951 0.7809 0.7620 -2.42 51480 Upshur County, W Virginia 99951 0.7809 0.7620 -2.42 51490 Wayne County, W Virginia 26580 0.9477 0.9013 -4.90 51500 Webster County, W Virginia 99951 0.7809 0.7620 -2.42 51510 Wetzel County, W Virginia 99951 0.7809 0.7620 -2.42 51520 Wirt County, W Virginia 37620 0.8085 0.7940 -1.79 51530 Wood County, W Virginia 37620 0.8270 0.7940 -3.99 51540 Wyoming County, W Virginia 99951 0.7809 0.7620 -2.42 52000 Adams County, Wisconsin 99952 0.9494 0.9468 -0.27 52010 Ashland County, Wisconsin 99952 0.9494 0.9468 -0.27 52020 Barron County, Wisconsin 99952 0.9494 0.9468 -0.27 52030 Bayfield County, Wisconsin 99952 0.9494 0.9468 -0.27 52040 Brown County, Wisconsin 24580 0.9483 0.9804 3.39 52050 Buffalo County, Wisconsin 99952 0.9494 0.9468 -0.27 52060 Burnett County, Wisconsin 99952 0.9494 0.9468 -0.27 52070 Calumet County, Wisconsin 11540 0.9264 0.9472 2.25 52080 Chippewa County, Wisconsin 20740 0.9201 0.9647 4.85 52090 Clark County, Wisconsin 99952 0.9494 0.9468 -0.27 52100 Columbia County, Wisconsin 31540 1.0069 1.0736 6.62 52110 Crawford County, Wisconsin 99952 0.9494 0.9468 -0.27 52120 Dane County, Wisconsin 31540 1.0707 1.0736 0.27 52130 Dodge County, Wisconsin 99952 0.9494 0.9468 -0.27 52140 Door County, Wisconsin 99952 0.9494 0.9468 -0.27 52150 Douglas County, Wisconsin 20260 1.0213 1.0070 -1.40 52160 Dunn County, Wisconsin 99952 0.9494 0.9468 -0.27 52170 Eau Claire County, Wisconsin 20740 0.9201 0.9647 4.85 52180 Florence County, Wisconsin 99952 0.9494 0.9468 -0.27 52190 Fond Du Lac County, Wisconsin 22540 0.9559 1.0081 5.46 52200 Forest County, Wisconsin 99952 0.9494 0.9468 -0.27 52210 Grant County, Wisconsin 99952 0.9494 0.9468 -0.27 Start Printed Page 44179 52220 Green County, Wisconsin 99952 0.9494 0.9468 -0.27 52230 Green Lake County, Wisconsin 99952 0.9494 0.9468 -0.27 52240 Iowa County, Wisconsin 31540 1.0069 1.0736 6.62 52250 Iron County, Wisconsin 99952 0.9494 0.9468 -0.27 52260 Jackson County, Wisconsin 99952 0.9494 0.9468 -0.27 52270 Jefferson County, Wisconsin 99952 0.9494 0.9468 -0.27 52280 Juneau County, Wisconsin 99952 0.9494 0.9468 -0.27 52290 Kenosha County, Wisconsin 29404 1.0095 1.0406 3.08 52300 Kewaunee County, Wisconsin 24580 0.9481 0.9804 3.41 52310 La Crosse County, Wisconsin 29100 0.9564 0.9442 -1.28 52320 Lafayette County, Wisconsin 99952 0.9494 0.9468 -0.27 52330 Langlade County, Wisconsin 99952 0.9494 0.9468 -0.27 52340 Lincoln County, Wisconsin 99952 0.9494 0.9468 -0.27 52350 Manitowoc County, Wisconsin 99952 0.9494 0.9468 -0.27 52360 Marathon County, Wisconsin 48140 0.9590 0.9740 1.56 52370 Marinette County, Wisconsin 99952 0.9494 0.9468 -0.27 52380 Marquette County, Wisconsin 99952 0.9494 0.9468 -0.27 52381 Menominee County, Wisconsin 99952 0.9494 0.9468 -0.27 52390 Milwaukee County, Wisconsin 33340 1.0146 1.0236 0.89 52400 Monroe County, Wisconsin 99952 0.9494 0.9468 -0.27 52410 Oconto County, Wisconsin 24580 0.9481 0.9804 3.41 52420 Oneida County, Wisconsin 99952 0.9494 0.9468 -0.27 52430 Outagamie County, Wisconsin 11540 0.9264 0.9472 2.25 52440 Ozaukee County, Wisconsin 33340 1.0146 1.0236 0.89 52450 Pepin County, Wisconsin 99952 0.9494 0.9468 -0.27 52460 Pierce County, Wisconsin 33460 1.1075 1.0965 -0.99 52470 Polk County, Wisconsin 99952 0.9494 0.9468 -0.27 52480 Portage County, Wisconsin 99952 0.9494 0.9468 -0.27 52490 Price County, Wisconsin 99952 0.9494 0.9468 -0.27 52500 Racine County, Wisconsin 39540 0.8997 0.9192 2.17 52510 Richland County, Wisconsin 99952 0.9494 0.9468 -0.27 52520 Rock County, Wisconsin 27500 0.9538 0.9672 1.40 52530 Rusk County, Wisconsin 99952 0.9494 0.9468 -0.27 52540 St Croix County, Wisconsin 33460 1.1075 1.0965 -0.99 52550 Sauk County, Wisconsin 99952 0.9494 0.9468 -0.27 52560 Sawyer County, Wisconsin 99952 0.9494 0.9468 -0.27 52570 Shawano County, Wisconsin 99952 0.9494 0.9468 -0.27 52580 Sheboygan County, Wisconsin 43100 0.8911 0.9042 1.47 52590 Taylor County, Wisconsin 99952 0.9494 0.9468 -0.27 52600 Trempealeau County, Wisconsin 99952 0.9494 0.9468 -0.27 52610 Vernon County, Wisconsin 99952 0.9494 0.9468 -0.27 52620 Vilas County, Wisconsin 99952 0.9494 0.9468 -0.27 52630 Walworth County, Wisconsin 99952 0.9494 0.9468 -0.27 52640 Washburn County, Wisconsin 99952 0.9494 0.9468 -0.27 52650 Washington County, Wisconsin 33340 1.0146 1.0236 0.89 52660 Waukesha County, Wisconsin 33340 1.0146 1.0236 0.89 52670 Waupaca County, Wisconsin 99952 0.9494 0.9468 -0.27 52680 Waushara County, Wisconsin 99952 0.9494 0.9468 -0.27 52690 Winnebago County, Wisconsin 36780 0.9211 0.9332 1.31 52700 Wood County, Wisconsin 99952 0.9494 0.9468 -0.27 53000 Albany County, Wyoming 99953 0.9257 0.9311 0.58 53010 Big Horn County, Wyoming 99953 0.9257 0.9311 0.58 53020 Campbell County, Wyoming 99953 0.9257 0.9311 0.58 53030 Carbon County, Wyoming 99953 0.9257 0.9311 0.58 53040 Converse County, Wyoming 99953 0.9257 0.9311 0.58 53050 Crook County, Wyoming 99953 0.9257 0.9311 0.58 53060 Fremont County, Wyoming 99953 0.9257 0.9311 0.58 53070 Goshen County, Wyoming 99953 0.9257 0.9311 0.58 53080 Hot Springs County, Wyoming 99953 0.9257 0.9311 0.58 53090 Johnson County, Wyoming 99953 0.9257 0.9311 0.58 53100 Laramie County, Wyoming 16940 0.8775 0.9076 3.43 53110 Lincoln County, Wyoming 99953 0.9257 0.9311 0.58 53120 Natrona County, Wyoming 16220 0.9026 0.9161 1.50 53130 Niobrara County, Wyoming 99953 0.9257 0.9311 0.58 53140 Park County, Wyoming 99953 0.9257 0.9311 0.58 53150 Platte County, Wyoming 99953 0.9257 0.9311 0.58 53160 Sheridan County, Wyoming 99953 0.9257 0.9311 0.58 Start Printed Page 44180 53170 Sublette County, Wyoming 99953 0.9257 0.9311 0.58 53180 Sweetwater County, Wyoming 99953 0.9257 0.9311 0.58 53190 Teton County, Wyoming 99953 0.9257 0.9311 0.58 53200 Uinta County, Wyoming 99953 0.9257 0.9311 0.58 53210 Washakie County, Wyoming 99953 0.9257 0.9311 0.58 53220 Weston County, Wyoming 99953 0.9257 0.9311 0.58 65010 Agana County, Guam 99965 0.9611 0.9611 0.00 65020 Agana Heights County, Guam 99965 0.9611 0.9611 0.00 65030 Agat County, Guam 99965 0.9611 0.9611 0.00 65040 Asan County, Guam 99965 0.9611 0.9611 0.00 65050 Barrigada County, Guam 99965 0.9611 0.9611 0.00 65060 Chalan Pago County, Guam 99965 0.9611 0.9611 0.00 65070 Dededo County, Guam 99965 0.9611 0.9611 0.00 65080 Inarajan County, Guam 99965 0.9611 0.9611 0.00 65090 Maite County, Guam 99965 0.9611 0.9611 0.00 65100 Mangilao County, Guam 99965 0.9611 0.9611 0.00 65110 Merizo County, Guam 99965 0.9611 0.9611 0.00 65120 Mongmong County, Guam 99965 0.9611 0.9611 0.00 65130 Ordot County, Guam 99965 0.9611 0.9611 0.00 65140 Piti County, Guam 99965 0.9611 0.9611 0.00 65150 Santa Rita County, Guam 99965 0.9611 0.9611 0.00 65160 Sinajana County, Guam 99965 0.9611 0.9611 0.00 65170 Talofofo County, Guam 99965 0.9611 0.9611 0.00 65180 Tamuning County, Guam 99965 0.9611 0.9611 0.00 65190 Toto County, Guam 99965 0.9611 0.9611 0.00 65200 Umatac County, Guam 99965 0.9611 0.9611 0.00 65210 Yigo County, Guam 99965 0.9611 0.9611 0.00 65220 Yona County, Guam 99965 0.9611 0.9611 0.00 [FR Doc. 06-6614 Filed 7-27-06; 4:00 pm]
BILLING CODE 4120-01-P
Document Information
- Published:
- 08/03/2006
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Proposed Rule
- Action:
- Proposed rule.
- Document Number:
- 06-6614
- Dates:
- To be assured consideration, comments must be received at one of
- Pages:
- 44081-44180 (100 pages)
- Docket Numbers:
- CMS-1304-P
- RINs:
- 0938-AN76
- Topics:
- Administrative practice and procedure, Health facilities, Health professions, Kidney diseases, Medicare, Reporting and recordkeeping requirements
- PDF File:
- 06-6614.pdf
- CFR: (5)
- 42 CFR 414.210
- 42 CFR 414.226
- 42 CFR 414.229
- 42 CFR 414.230
- 42 CFR 484.225