06-8471. Medicare Program; Hospital Inpatient Prospective Payment Systems and Fiscal Year 2007 Rates: Final Fiscal Year 2007 Wage Indices and Payment Rates After Application of Revised Occupational Mix Adjustment to Wage Index  

  • Start Preamble Start Printed Page 59886

    AGENCY:

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

    ACTION:

    Notice.

    SUMMARY:

    This notice contains tables listing the final occupational mix adjusted wage indices, hospital reclassifications, payment rates, impacts, and other related tables as a result of the application of the occupational mix adjustment to 100 percent of the wage index effective for fiscal year (FY) 2007.

    DATES:

    Effective Date: This notice is effective on October 1, 2006.

    Start Further Info

    FOR FURTHER INFORMATION CONTACT:

    Valerie Miller, (410) 786-4535, Wage Index Issues. Brian Slater, (410) 786-5229, Geographic Reclassification Issues. Marc Hartstein, (410) 786-4548, All Other Issues.

    End Further Info End Preamble Start Supplemental Information

    SUPPLEMENTARY INFORMATION:

    I. Background

    In the August 18, 2006 Federal Register (71 FR 47870) (hereinafter referred to as the FY 2007 IPPS final rule), we set forth our final rule for the Medicare inpatient prospective payment system (IPPS). Due to the decision in the case Bellevue Hosp. Center v. Leavitt, 443 F. 3d 163 (2nd Cir. 2006), we stated that we would publish the FY 2007 occupational mix adjusted wage index tables, rates, and impacts on our Web site and in a Federal Register document subsequent to the FY 2007 IPPS final rule. (See the FY 2007 IPPS final rule for a full explanation of the reasons for such subsequent publication.) This notice includes such wage index tables, rates, and impacts.

    II. Final FY 2007 Occupational Mix Adjusted Wage Indices, Rates, and Impacts

    A. Wage Index and Occupational Mix Adjustment

    1. Implementation of the New Occupational Mix Adjustment for the FY 2007 Wage Index

    The final wage index values for FY 2007 (except those for hospitals receiving wage index adjustments under section 505 of Pub. L. 108-173) are included in Tables 4A-1, 4A-2, 4B, 4C-1, 4C-2, and 4F of the Addendum to this notice and are posted on our Web site at http://www.cms.hhs.gov/​AcuteInpatientPPS/​. For hospitals that are receiving a wage index adjustment under section 505 of Pub. L. 108-173, the hospital's final wage index will reflect the adjustment shown in Table 4J of the Addendum to this notice. Tables 3A and 3B of the Addendum to this notice and on our Web site reflect the 3-year average of the average hourly wage for each labor market area before the redesignation of hospitals, used for FYs 2005, 2006, and 2007. Table 3A lists average hourly wages for urban areas and Table 3B lists these data for rural areas. In addition, Table 2 in the Addendum to this notice includes the occupational mix adjusted average hourly wage for each hospital from the FYs 2001, 2002, and 2003 cost reporting periods. The average hourly wages for FYs 2001 and 2002 reflect a 10 percent occupational mix adjustment using the survey data used to develop the FYs 2005 and 2006 wage indices, respectively. The FY 2003 average hourly wages reflect a 100 percent occupational mix adjustment using the recently collected survey data and were used to calculate the FY 2007 wage index.

    2. Proxy Occupational Mix Adjustment for Hospitals With No Survey Data

    As stated in the FY 2007 IPPS final rule (71 FR 48014), we have applied the average occupational mix adjustment for a hospital's labor market area to the wage data of hospitals that did not submit occupational mix survey data or that submitted survey data that could not be used because we determined it to be aberrant. For example, a hospital's individual nurse category average hourly wages were out of range (that is, unusually high or low), and the hospital did not provide sufficient documentation to explain the aberrancy, or the hospital did not submit any registered nurse staff salaries or hours data.

    In calculating the average occupational mix adjustment factor for an area, we replicated Steps 1 through 6 of the calculation for the occupational mix adjustment (see 71 FR 48009). However, instead of performing these steps at the hospital level, we aggregated the data at the labor market area level. In following these steps, for example, for Core-Based Statistical Areas (CBSAs) that contain providers that did not submit occupational mix survey data, the occupational mix adjustment factor ranged from a low of 0.8944 (CBSA 39820, Redding, CA), to a high of 1.0924 (CBSA 38220, Pine Bluff, AR). Also, in computing a hospital's occupational mix adjusted salaries and wage-related costs for nursing employees (Step 7 of the calculation (see 71 FR 48010)) in the absence of occupational mix survey data, we multiplied the hospital's total salaries and wage-related costs by the percentage of the area's total workers attributable to the area's total nursing category. There were also two CBSAs in which none of the providers submitted the occupational mix survey (CBSA 49740, Yuma, AZ, and CBSA 25020, Guayama, P.R.). In the absence of any data in these labor market areas, we applied an occupational mix adjustment factor of 1.0 to all providers.

    3. Analysis of the Final FY 2007 Wage Index

    Using the new occupational mix survey data and applying the occupational mix adjustment to 100 percent of the FY 2007 wage index results in a national average hourly wage of $29.6529 and a Puerto-Rico specific average hourly wage of $13.0943. We calculated the FY 2007 wage index using the Worksheet S-3 cost report data of 3,570 hospitals and occupational mix survey data from 3,239 hospitals (90.7 percent response rate). Although more than 3,239 hospitals submitted occupational mix survey data for the January through March 2006 collection period, we excluded the data for 37 hospitals that did not have FY 2003 Worksheet S-3 cost report data for use in calculating the FY 2007 wage index. Also, we excluded the occupational mix survey data of another 30 hospitals because their data was incomplete or aberrant. Using the occupational mix data of 3,239 hospitals, the FY 2007 national average hourly wages for each occupational mix nursing subcategory as calculated in Step 2 of the occupational mix calculation are as follows: Start Printed Page 59887

    Occupational mix nursing subcategoryAverage hourly wage
    National RN Management$38.5908
    National RN Staff33.3739
    National LPN19.2721
    National Nurse Aides, Orderlies, and Attendants13.6906
    National Medical Assistants15.6304
    National Nurse Category28.7431

    The national average hourly wage for the entire nurse category as computed in Step 5 of the occupational mix calculation is $28.7431. Hospitals with a nurse category average hourly wage (as calculated in Step 4) of greater than national nurse category average hourly wage receive an occupational mix adjustment factor (as calculated in Step 6) of less than 1.0. Hospitals with a nurse category average hourly wage (as calculated in Step 4) of less than national nurse category average hourly wage receive an occupational mix adjustment factor (as calculated in Step 6) of greater than 1.0.

    Based on the January through March 2006 occupational mix survey data, we determined (in Step 7 of the occupational mix calculation) that the national percentage of hospital employees in the Nurse category is 42.9 percent, and the national percentage of hospital employees in the All Other Occupations category is 57.1 percent. At the CBSA level, the percentage of hospital employees in the Nurse category ranged from a low of 23.0 percent in one CBSA, to a high of 85.5 percent in another CBSA.

    After adjusting the FY 2007 wage indices by 100 percent for occupational mix, the wage index values for a total of 250 hospitals in 73 labor market areas are assigned a statewide rural wage index value (“the rural floor”) according to section 4410 of Pub. L. 105-33, or an imputed floor, for hospitals located in all-urban States, according to § 412.64(h).

    a. Effect of the 2006 Occupational Data on the FY 2007 Wage Index (Unadjusted Relative to Adjusted Wage Index). We compared the FY 2007 unadjusted wage indices for each CBSA to the FY 2007 wage indices adjusted for occupational mix. In implementing an occupational mix adjusted wage index based on the above calculation, the final wage index values for 14 rural areas (29.8 percent) and 201 urban areas (52.1 percent) would decrease as a result of the adjustment. Six rural areas (12.8 percent) and 108 urban areas (28.0 percent) would experience a decrease of 1 percent or greater in their wage index values. The largest negative impacts would be 2.7 percent and 6.0 percent. In addition, 33 rural areas (70.2 percent) and 181 urban areas (46.9 percent) would experience an increase in their wage index values. The largest increase for a rural area would be 3.16 percent and the largest increase for an urban area would be 8.39 percent. Four urban areas would be unaffected. These results indicate that a larger percentage of rural areas benefit from an occupational mix adjustment than do urban areas. However, as was the case with the previous occupational mix data, close to a third of rural CBSAs (29.8 percent) continue to experience a decrease in their wage indices as a result of the occupational mix adjustment.

    b. Effect of the 2006 Occupational Mix Survey Data Relative to the 2003 Survey Data. We also analyzed the effect on the FY 2007 wage index of applying the January through March 2006 occupational mix survey data, relative to applying the 2003 occupational mix survey data. In this analysis, we compared the FY 2007 wage index adjusted 100 percent using 2003 and 2006 survey data. By controlling for changes in hospitals' wage data and geographic reclassification, we determined that the wage index values for 27 rural areas (57.4 percent) and 183 urban areas (47.4 percent) would decrease as a result of applying the 2006 survey data instead of the 2003 survey data. Ten rural areas (21.3 percent) and 96 urban areas (24.9 percent) would experience a decrease of 1 percent or greater in their wage index values. The largest negative impact for a rural area would be 3.6 percent. Six urban areas (1.2 percent) would be decreasing by greater than 5 percent; the largest urban decrease would be 20.9 percent, and the second largest decrease for an urban area would be 7.7 percent. One rural and one urban area would be unaffected by the change in the occupational mix data. In addition, 19 rural areas (40.4 percent) and 202 urban areas (52.3 percent) would experience an increase in their wage index values. The largest increase for a rural area would be 2.6 percent and the largest increase for an urban area would be 7.15 percent.

    B. Final FY 2007 Hospital Reclassifications/Redesignations

    1. Withdrawals and Terminations

    As we stated in the FY 2007 IPPS final rule (71 FR 48020), for FY 2007, rather than hospitals withdrawing or terminating their 3-year reclassifications within 45 days of the publication of the IPPS proposed rule, hospitals would be subject to special procedures unique to FY 2007.

    These procedures are as follows:

    • Hospitals had 15 days from the display date of the FY 2007 IPPS final rule to notify us of whether, in the absence of viewing the final 100 percent occupational mix-adjusted wage index data, they wish to choose a particular wage index for which they are eligible (such as to definitively maintain, terminate, or withdraw from a reclassification that they received ).
    • If we did not receive notice from the hospital within the 15-day timeframe, we made our best efforts to give the hospital the highest wage index among its available options. We made reclassification withdrawal and termination decisions based on what we perceived would be most advantageous to the hospital. (See 71 FR 48020 for an explanation of the reclassifications and adjustment we chose among.) Please note that in some cases we terminated a hospital's Lugar reclassification under section 1886(d)(8)(B) of the Act in order to receive the out-migration adjustment. Because this termination would result in the hospital losing urban status, we published a separate table (Table 9D) identifying these hospitals that move from Lugar/urban status to rural status with the out-migration adjustment. Also, in some cases, we may have made half-year terminations/withdrawals on behalf of section 508 hospitals (or groups containing section 508 hospitals) using the procedures identified in the FY 2007 IPPS final rule. (See 71 FR 48021 for an explanation of the half-year reclassifications that could occur for section 508 hospitals and groups containing section 508 hospitals.
    • We have posted the final occupational mix-adjusted wage indices, out-migration adjustments, and our decisions on hospital reclassification on the CMS Web site at http://www.cms.hhs.gov/​AcuteInpatientPPS/​WIFN/​list.asp. We have posted the same table on the CMS Web site that appeared in the Federal Register final notice of the occupational mix-adjusted wage indices.
    • In the FY 2007 IPPS final rule, we acknowledged that hospitals may base termination/withdrawal decisions on factors other than simply what results in the highest wage index for the upcoming fiscal year. For this reason, we allowed a hospital to change a decision that is made by CMS on its behalf. Hospitals now have a 30-day period from the date these final data and our final decisions appear on the CMS Web site to notify CMS in writing, with a copy to the MGCRB, of whether they wish to reverse the reclassification decision made by CMS or to choose another reclassification for which they are eligible. Hospitals are able to Start Printed Page 59888determine the reclassification decision applied on their behalf by reviewing Tables 9A through 9C for hospitals that are reclassified under section 1886(d)(8)(B) of the Act, section 508 of Pub. L. 108-173, or section 1886(d)(10) of the Act. The applicable wage index for these hospitals will be found on Table 2. If a hospital is not listed in Tables 9A through 9C, CMS has made a decision not to reclassify the hospital and its home wage index will apply, including the effect of any out-migration adjustment (if applicable). Again, the wage index that will apply to the hospital is found in Table 2. Any applicable out-migration adjustment for the hospital is found in Table 4J. As indicated above in this section, we are publishing a separate table identifying hospitals that we move from Lugar/urban status to rural status with the out-migration adjustment in Table 9D.
    • Requests to reverse a decision made on behalf of a hospital by CMS and to choose another reclassification or adjustment for which the hospital is otherwise eligible must be received by CMS no later than 5 p.m., e.s.t., with a copy sent to the MGCRB by October 30, 2006 (or within 30 days from the date the information appears on the CMS Web site at http://www.cms.hhs.gov/​AcuteInpatientPPS/​WIFN/​list.asp at the following addresses: Division of Acute Care, C4-08-06, 7500 Security Boulevard, Baltimore, MD 21244, Attn: Marianne Myers; and a copy to Medicare Geographic Classification Review Board, 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670.

    As required under § 412.273(c), requests by groups of hospitals must be made by all hospitals that are a party to the application or reclassification. The reclassification or adjustment chosen by the hospital must be one for which the hospital would otherwise be eligible had CMS not made the withdrawal or termination decision on the hospital's behalf.

    • If a hospital (or group of hospitals) fails to notify CMS that it is revising a determination made on its behalf within 30 days from the date the information appears on the CMS Web site, the decision made by CMS on the hospital's behalf will be final for FY 2007. Therefore, if CMS made a decision on a hospital's (or group of hospitals) behalf to terminate or withdraw a reclassification and the hospital does not reverse or modify CMS's decision within 30 days of posting the decision on the CMS Web site, we will deem the hospital's reclassification is withdrawn or terminated. If the hospital does not reverse or modify CMS's decision within 30 days of posting of the decision on the CMS Web site, once CMS's decision on the hospital's behalf is in effect, it will be treated in the same manner as if the hospital(s) had made the reclassification decision on its own. Thus, for example, because a hospital cannot have overlapping reclassifications, if we decide a hospital should accept a FY 2007 through 2009 reclassification and the hospital does not modify or reverse CMS's decision within 30 days of posting the decision on the CMS Web site, any reclassification the hospital previously had for FY 2006 through 2008 would be permanently terminated.

    Hospitals should note that we will not recalculate the wage indices or budget neutrality factors now that CMS has made their decisions regarding what is most advantageous to each hospital using the 100 percent occupational mix-adjusted wage data. That is, we will not further recalculate the wage indices (including any rural floors or imputed rural floors) or standardized amounts based on hospital decisions that further revise decisions made by CMS on the hospitals' behalf.

    In addition, we note that rural areas that include a section 508 hospital (specifically a hospital with wages relatively higher than the wages of other hospitals) may experience a decrease in their wage index for the second half of FY 2007. This is because section 508 hospitals are not considered reclassified under section 1886(d)(10) of the Act, and therefore, are not subject to the rule in section 1886(d)(8)(C)(ii) of the Act requiring rural area wage indices to be calculated exclusive of hospitals reclassified under section 1886(d)(10) of the Act, if doing so would increase the rural wage index. Thus, for the first half of the year, a section 508 hospital may be included in the home wage index of a rural area, while the hospitals reclassified under section 1886(d)(10) of the Act are excluded, since such exclusion increases the wage index of the rural area. However, for the second half of the year, the hospital is no longer a section 508 hospital. If the former section 508 hospital is reclassified under section 1886(d)(10) of the Act, it is grouped with other hospitals so reclassified. The high wages of the section 508 hospital may operate such that, for the second half of the year, it is more advantageous for all of the reclassified hospitals to be included in the wage index of the rural area (rather than excluded as they were in the first half of the year). However, because the other reclassified hospitals are now included in the wage index, and not just the sole section 508 hospital with high wages, the area may see a decline in the wage index. We view this scenario as arising due to the rural area's higher than expected wage index during the first half of the year from including only the section 508 hospital and not any reclassified hospitals. If we did not establish special rules that allowed for one-half year reclassifications, the section 508 hospital likely would have reclassified for the entire year under section 1886(d)(10) of the Act. In that case, the wage index for the second-half of FY 2007 would have applied for the entire year.

    2. MGCRB Applications for FY 2008

    Section 1886(d)(10)(C)(ii) of the Act indicates that a hospital requesting a change in geographic classification for a fiscal year must submit its application to the MGCRB no later than the first day of the 13-month period ending on September 30 of the preceding fiscal year. Thus, the statute requires that FY 2008 reclassification applications be submitted to the MGCRB no later than September 1, 2006. For this reason, hospitals must have filed a FY 2008 reclassification application by the September 1, 2006 deadline even though the average hourly wage data used to develop the final FY 2007 wage indices was not available.

    The MGCRB, in evaluating a hospital's request for reclassification for FY 2008 for the wage index, must utilize the official data used to develop the FY 2007 wage index. The wage data used to support the hospital's wage comparisons must be from the CMS hospital wage survey. Generally, the source for these data is the IPPS final rule. However, the wage tables identifying the 3-year average hourly wages of hospitals were not available in time to include them in the FY 2007 IPPS final rule and by the September 1, 2006 deadline for submitting FY 2008 geographic reclassification applications.

    As outlined in § 412.256(c)(2), hospitals with incomplete applications have the opportunity to request that the MGCRB grant a hospital that has submitted an application by September 1, 2006, an extension beyond September 1, 2006, to complete its application. Thus, while hospitals must file an application for reclassification to the MGCRB by September 1, 2006, they are able to supplement the reclassification application with official data used to develop the FY 2007 wage index after filing their initial application.

    Therefore, as we stated in the FY 2007 IPPS final rule (71 FR 48022 through 48023), we are allowing hospitals 30 days after the final wage data is posted on the CMS Web site or by October 30, Start Printed Page 598892006 to file a supplement to the reclassification application they filed by September 1, 2006. The supplement would include the official data (Attachment H in the MGCRB Application) used to develop the FY 2007 wage index. Supplements must be received within 30 days this final data is posted on the CMS Web site or by October 30, 2006. The 3-year average hourly wage information necessary for FY 2008 reclassification applications appears in Tables 2, 3A, and 3B of the Addendum to this notice. The information also is available on the CMS Web site at: http://www.cms.hhs.gov/​AcuteInpatientPPS/​WIFN/​list.asp and then by accessing the page titled “MGCRB Reclassification Data for FY 2008 Applications.” Applications and other information about MGCRB reclassifications may be obtained via the CMS Internet Web site at: http://www.cms.hhs.gov/​mgcrb/​,, or by calling the MGCRB at (410) 786-1174. The mailing address of the MGCRB is: 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670.

    3. Cancellations of Previous Withdrawals or Terminations for FY 2008 and Subsequent Fiscal Years

    We are also allowing a 30-day period from the date the final wage data is posted on the CMS Web site to cancel a previous withdrawal or termination in order for a hospital to reinstate its reclassification for FY 2008 (for a FY 2006-2008 reclassification) or FY 2008 and FY 2009 (for a FY 2007-2009 reclassification). Because we have made termination or withdrawal decisions on behalf of hospitals, hospitals should look carefully at these decisions and determine whether they want to cancel such withdrawals or terminations for FY 2008 or FY 2009 if the reclassification time period includes these years. Hospitals must request to reinstate a reclassification that includes FY 2008 within 30 days of posting the Web site data for the reclassification to continue in that year even if they agree with the decision we made on their behalf for FY 2007.

    Hospitals must request to reinstate a reclassification that includes FY 2008 within 30 days of when the data are posted to the CMS Web site or by October 30, 2006.

    Requests to cancel a withdrawal or termination in order to reinstate a hospital's reclassification for FY 2008 or FY 2009, or both fiscal years, should be forwarded to the following addresses: Medicare Geographic Classification Review Board, 2520 Lord Baltimore Drive, Suite L, Baltimore, MD 21244-2670; and a copy to Division of Acute Care, C4-08-06, 7500 Security Boulevard, Baltimore, MD 21244, Attn: Marianne Myers.

    All requests must be received within 30 days of this posting of CMS final wage data and final reclassification decisions on the CMS Web site or by October 30, 2006.

    C. Final FY 2007 Prospective Payment Systems Payment Rates for Hospital Operating and Capital Related Costs

    As discussed in the FY 2007 IPPS final rule, due to the unusual circumstances imposed by the order of the Court of Appeals for the Second Circuit in the decision in Bellevue Hospital Center v. Leavitt, we did not publish the final FY 2007 budget neutrality factors, standardized amounts, fixed-loss cost threshold, outlier offset factor, DRG weights, or wage indices in the FY 2007 IPPS final rule. Because the occupational mix adjustment affects the calculation of the outlier threshold as well as the outlier offset and budget neutrality factors that are applied to the standardized amounts, we were only able to provide tentative figures in that final rule. As discussed above in this notice, we are publishing final occupation mix-adjusted wage indices. Accordingly, in this section of this notice, we are discussing the final FY 2007 prospective payment rates for Medicare hospital inpatient operating costs and Medicare hospital inpatient capital-related costs. We calculated these final rates using the methodology we adopted in the FY 2007 IPPS final rule.

    We note that, because hospitals excluded from the IPPS are paid on a cost basis (and not by the IPPS), these hospitals were not affected by the tentative figures for standardized amounts, offsets, and budget neutrality factors. Therefore, the rate-of-increase percentages for updating the target amounts for hospitals and hospital units excluded from the IPPS that are effective October 1, 2006 were finalized in the FY 2007 IPPS final rule (71 FR 48164) and are not included in this notice.

    1. Final FY 2007 Prospective Payment Rates for Hospital Inpatient Operating Costs

    a. Final FY 2007 Standardized Amount. We calculated the final FY 2007 standardized amounts using the methodology we adopted in the FY 2007 IPPS final rule. For a complete description of this methodology, please see the FY 2007 IPPS final rule (71 FR 48145 through 48155). Tables 1A and 1B in the Addendum to this notice contain the final national standardized amount that we are applying to all hospitals, except hospitals in Puerto Rico. The final Puerto Rico-specific amounts are shown in Table 1C. The final amounts shown in Tables 1A and 1B differ only in that the labor-related share applied to the final standardized amounts in Table 1A is 69.7 percent, and the labor-related share applied to the final standardized amounts in Table 1B is 62 percent. (The labor-related share is 62 percent for all hospitals (other than those in Puerto Rico) whose wage indices are less than or equal to 1.0000.)

    In addition, Tables 1A and 1B include final standardized amounts reflecting the full 3.4 percent update for FY 2007, and final standardized amounts reflecting the 2.0 percentage point reduction to the update (a 1.4 percent update) applicable for hospitals that fail to submit quality data consistent with section 1886(b)(3)(B)(viii) of the Act.

    In the FY 2007 IPPS final rule, we did not supply a table that illustrated the changes from the FY 2006 national average standardized amount because we were only setting the standardized amounts tentatively, but we stated that we would provide the table in the subsequent Federal Register notice. Therefore, in this notice, we include below a table that details the calculation of the final standardized amounts.

    Comparison of FY 2006 Standardized Amounts to Final FY 2007 Single Standardized Amount With Full Update and Reduced Update

    Full update (3.4 percent)Reduced update (1.4 percent)
    FY 2006 Base Rate, after removing reclassification budget neutrality, demonstration budget neutrality, wage index transition budget neutrality factors and outlier offset (based on the proposed labor and nonlabor market share percentage for FY 2007)Labor: $3,505.76 Nonlabor: $1,524.03Labor: $3,505.76. Nonlabor: $1,524.03.
    Final FY 2007 Update Factor1.034.1.014.
    Start Printed Page 59890
    Final FY 2007 DRG Recalibrations and Wage Index Budget Neutrality Factor0.995662.0.995662.
    Final FY 2007 Reclassification Budget Neutrality Factor0.992355.0.992355.
    Adjusted for Blend of FY 2006 DRG Recalibration and Wage Index Budget Neutrality FactorsLabor: $3,581.64 Nonlabor: $1,557.01Labor: $3,512.37. Nonlabor: $1,526.90.
    Final FY 2007 Outlier Factor0.948968.0.948968.
    Final FY 2007 Labor Market Wage Index Transition Budget Neutrality Factor0.999700.0.999700.
    Final Rural Demonstration Budget Neutrality Factor0.999905.0.999905.
    Final Rate for FY 2007 (after multiplying FY 2006 base rate by above factors) where the wage index is less than or equal to 1.0000Labor: $3,022.18 Nonlabor: $1,852.31Labor: $2,963.73. Nonlabor: $1,816.48.
    Final Rate for FY 2007 (after multiplying FY 2006 base rate by above factors) where the wage index is greater than 1.0000Labor: $3,397.52 Nonlabor: $1,476.97Labor: $3,331.80. Nonlabor: $1,448.40.

    The final labor-related and nonlabor-related portions of the national average standardized amounts for Puerto Rico hospitals for FY 2007 are set forth in Table 1C in the Addendum to this notice. (The labor-related share applied to the Puerto Rico-specific standardized amount is 58.7 percent, or 62 percent, depending on which is more advantageous to the hospital.

    b. Final Adjustments for Area Wage Levels. The final occupational mix adjusted wage indices by geographic area are listed in Tables 4A-1, 4A-2, 4B, 4C-1, 4C-2, and 4F in the Addendum to this notice. (These tables are also available on the CMS Web site.)

    c. FY 2007 Final Outlier Fixed-Loss Cost Threshold. Using the methodology we adopted in the FY 2007 IPPS final rule, we are establishing a final outlier fixed-loss cost threshold for FY 2007 equal to the prospective payment rate for the DRG, plus any IME and DSH payments, and any add-on payments for new technology, plus $24,485.

    d. DRG Weights. Because we rely on the wage index data as one of the standardizing factors that we use in calculating both the charge-based and the cost-based relative weights that we are blending to set the FY 2007 transitional relative weights, we have recalculated the FY 2007 relative weights. We list the final DRG weights in Table 5 of the Addendum to this notice.

    2. Final FY 2007 Prospective Payment Rates for Acute Care Hospital Inpatient Capital-Related Costs

    We have calculated the final FY 2007 capital Federal rates, offsets, and budget neutrality factors using the methodology we adopted in the FY 2007 IPPS final rule. For a complete description of this methodology, please see the FY 2007 IPPS final rule (71 FR 48155 through 48156).

    a. Inpatient Hospital Capital-Related Prospective Payment Rate Update. The factors used in the update framework are not affected by the occupational mix information used to adjust the wage index. Therefore, the update factor for FY 2007 was not revised from the capital PPS standard Federal rate update factor published in the FY 2007 IPPS final rule and remains at 1.10 percent for FY 2007. A full discussion of the update framework is provided in the FY 2007 IPPS final rule (71 FR 48156 through 48158).

    b. Outlier Payment Adjustment Factor. Based on the final thresholds as set forth in section II.C. of this notice, we estimate that final outlier payments for capital-related costs will equal 4.32 percent for inpatient capital-related payments based on the final Federal rate in FY 2007. Therefore, we are applying a final outlier adjustment factor of 0.9568 to the final capital Federal rate. Thus, we estimate that the percentage of capital outlier payments to total capital standard payments for FY 2007 will be slightly lower than the percentages for FY 2006.

    The outlier thresholds for FY 2007 are in section II.C.1. of this notice. For FY 2007, a case qualifies as a cost outlier if the cost for the case plus the IME and DSH payments are greater than the prospective payment rate for the DRG plus $24,485.

    c. Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the GAF. Using the methodology discussed in the FY 2007 IPPS final rule (71 FR 48158 through 48161), for FY 2007, we are establishing a final GAF/DRG budget neutrality factor of 0.9986. The GAF/DRG budget neutrality factors are built permanently into the capital rates; that is, they are applied cumulatively in determining the capital Federal rate. This follows from the requirement that estimated aggregate payments each year be no more or less than they would have been in the absence of the annual DRG reclassification and recalibration and changes in the GAF. The final incremental change in the adjustment from FY 2006 to FY 2007 is 0.9986. The final cumulative change in the capital Federal rate due to this adjustment is 0.9906 (the product of the incremental factors for FYs 1993 though 2006 and the final incremental factor of 0.9986 for FY 2007). (We note that averages of the incremental factors that were in effect during FYs 2005 and 2006, respectively, were used in the calculation of the final cumulative adjustment of 0.9986 for FY 2007.)

    This factor accounts for DRG reclassifications and recalibration and for changes in the GAF as well as the revised wage index as adjusted by occupational mix data. It also incorporates the effects on the final GAF of FY 2007 geographic reclassification decisions made by the MGCRB compared to FY 2006 decisions. However, it does not account for changes in payments due to changes in the DSH and IME adjustment factors or in the large urban add-on.

    d. Exceptions Payment Adjustment Factor. The adjustments made to the wage index as a result of the application of occupational mix data had no effect on capital exceptions payments. Therefore, the special exceptions adjustment factor remains at 0.9997 as discussed in section III.A.4. of FY 2007 IPPS final rule (71 FR 48161). We also explained that the adjustments for regular exception payments are no longer necessary as they were only applicable during the capital transition period (cost reporting periods beginning on or after October 1, 1991 and before October 1, 2001).

    e. Capital Standard Federal Rate for FY 2007. We are providing a chart that shows how each of the factors and adjustments for FY 2007 affected the computation of the final FY 2007 capital Federal rate in comparison to the FY Start Printed Page 598912006 capital Federal rate. The FY 2007 update factor has the effect of increasing the final capital Federal rate by 1.1 percent compared to the average FY 2006 Federal rate. The final GAF/DRG budget neutrality factor has the effect of decreasing the final capital Federal rate by 0.14 percent. The final FY 2007 outlier adjustment factor has the effect of increasing the final capital Federal rate by 0.56 percent compared to the average FY 2006 capital Federal rate. The FY 2007 exceptions payment adjustment factor remains unchanged from the FY 2006 exceptions payment adjustment factor, and therefore, has a 0.0 percent net effect on the final FY 2007 capital Federal rate. The combined effect of all the changes is to increase the capital Federal rate by 1.52 percent compared to the average FY 2006 capital Federal rate.

    Comparison of Factors and Adjustments: FY 2006 Capital Federal Rate and FY 2007 Capital Federal Rate

    FY 2006FY 2007ChangePercent change
    Update Factor 11.00801.01101.01101.10
    GAF/DRG Adjustment Factor 11.00083 0.99860.9986−0.14
    Outlier Adjustment Factor 20.95153 0.95681.00560.56
    Exceptions Adjustment Factor 20.99970.99970.00000.00
    Capital Federal Rate$420.653 $427. 031.01521.52
    1 The update factor and the GAF/DRG budget neutrality factors are built permanently into the capital rates. Thus, for example, the incremental change from FY 2006 to FY 2007 resulting from the application of the final GAF/DRG budget neutrality factor for FY 2007 is 0.9986.
    2 The outlier reduction factor and the exceptions adjustment factor are not built permanently into the capital rates; that is, these factors are not applied cumulatively in determining the capital rates. Thus, for example, the net change resulting from the application of the final FY 2007 outlier adjustment factor would be 0.9568/0.9515, or 1.0056.
    3 Final factors for FY 2007, as discussed in section II.E. of this notice.

    We provided a chart in the FY 2007 IPPS final rule (71 FR 48162) that compared the tentative FY 2007 capital Federal rate to the proposed FY 2007 capital Federal rate (71 FR 24158 through 24159). We are now providing a chart that shows how the final FY 2007 capital Federal rate differs from the tentative FY 2007 capital Federal rate as presented in the FY 2007 IPPS final rule.

    Comparison of Factors and Adjustments: FY 2007 Tentative Capital Federal Rate and FY 2007 Final Capital Federal Rate

    Tentative FY 2007 1Final FY 2007 2ChangePercent change
    Update Factor 11.01101.011000
    GAF/DRG Adjustment Factor 10.99940.99860.0008−0.08
    Outlier Adjustment Factor 20.95680.956800
    Exceptions Adjustment Factor 20.99970.99970.00000.00
    Capital Federal Rate$427.38$427.030.00080.08
    1 As published in the FY 2007 IPPS final rule without the application of occupational mix data to the wage index.
    2 Final capital inpatient factors and rates after occupational mix adjustment to wage index in accordance with the order of the Second Circuit Court.

    As a final comparison, we are providing a chart that shows how the final FY 2007 capital Federal rate differs from the proposed FY 2007 capital Federal rate presented in the FY 2007 IPPS proposed rule (71 FR 24158 through 24159).

    Comparison of Factors and Adjustments: Proposed FY 2007 Capital Federal Rate and Final FY 2007 Capital Federal Rate

    Proposed FY 2007Final FY 2007ChangePercent change
    Update Factor1.00801.01101.00300.30
    GAF/DRG Adjustment Factor1.0012* 0.99860.9974−0.26
    Outlier Adjustment Factor0.9513* 0.95681.00580.58
    Exceptions Adjustment Factor0.99970.99970.00000.00
    Capital Federal Rate$424.42* $427.031.00610.61
    * Final factors for FY 2007, as discussed in section II.C.2 of this notice.
    Start Printed Page 59892

    g. Special Capital Rate for Puerto Rico Hospitals. Using the methodology discussed in the FY 2007 IPPS final rule (71 FR 48104), the final FY 2007 special capital rate for Puerto Rico is $203.06. (See the FY 2007 IPPS final rule (71 FR 48163) for additional information on the calculation of FY 2007 capital PPS payments.)

    D. Final FY 2007 Inpatient Operating and Capital-Related Impacts

    1. Final FY 2007 Inpatient Operating Impacts (Quantitative Effects of the Final Occupational Mix Adjusted Wage Indices)

    The impact analysis for policy changes under the IPPS for operating costs was included in the FY 2007 IPPS final rule. As stated in that impact section (71 FR 48332), we were unable to provide final occupational mix adjusted wage indices because of our obligation to collect new occupational mix survey data consistent with the order of the Court of Appeals in the Second Circuit. We were also unable to provide final relative weights, budget neutrality calculations, the outlier threshold and outlier offsets to the standardized amounts because these figures are all dependent on final wage indices. However, we also indicated that when 100 percent occupational mix adjusted wage data were available, we would recalculate the impacts and provide them in a subsequent Federal Register notice prior to October 1, 2006. Now that the new occupational mix survey data are available and the final 100 percent occupational mix adjusted wage data have been prepared, we are providing the final impacts for FY 2007 including the effect of the occupational mix adjusted wage data. Since there are statutory budget neutrality requirements applied to changes in DRGs and recalibration, wage index and geographic reclassifications, our payment estimates for hospitals overall are consistent with our estimate from the FY 2007 IPPS final rule (71 FR 48331). That is, the revisions to these figures do not increase or decrease aggregate total IPPS payments relative to those we earlier calculated. We continue to estimate that the changes in the FY 2007 IPPS final rule, in conjunction with the final IPPS rates included in this notice, will result in an approximate $3.4 billion increase in operating and capital payments. (See the FY 2007 IPPS final rule (71 FR 48331) for a more detailed explanation of how we estimated this $3.4 billion increase).

    a. Analysis of Impact Table I. Table I displays the results of our analysis of the payment changes for FY 2007 that are affected by use of the 100 percent occupational-mix adjusted wage data using occupational-mix survey data from January through March. These impacts update the tentative ones that were shown in the FY 2007 IPPS final rule. As explained in the FY 2007 IPPS final rule and this notice, the FY 2006 occupational-mix survey data were unavailable in time for the completion of the IPPS final rule that was made available to the public on August 1. In this notice, we are only displaying the columns that were affected by the change to the 100 percent occupational-mix adjusted wage data and therefore we are not reprinting the impacts to the quality data rate difference or the MDH changes from section 5003 of the Deficit Reduction Act that were published in the FY 2007 IPPS final rule. (See the FY 2007 IPPS final rule (71 FR 48333 through 48341) for a full discussion of the FY 2007 regulatory impact analysis.)

    Table I categorizes hospitals by various geographic and special payment consideration groups to illustrate the varying impacts on different types of hospitals. The top row of the table shows the overall impact on the 3,595 hospitals included in the analysis. The next four rows of Table I contain hospitals categorized according to their geographic location: all urban, which is further divided into large urban and other urban; and rural. There are 2,590 hospitals located in urban areas included in our analysis. Among these, there are 1,441 hospitals located in large urban areas (populations over 1 million), and 1,149 hospitals in other urban areas (populations of 1 million or fewer). In addition, there are 1,005 hospitals in rural areas. The next two groupings are by bed-size categories, shown separately for urban and rural hospitals. The final groupings by geographic location are by census divisions, also shown separately for urban and rural hospitals.

    The second part of Table I shows hospital groups based on hospitals' FY 2007 payment classifications, including any reclassifications under section 1886(d)(10) of the Act. For example, the rows labeled urban, large urban, other urban, and rural show that the number of hospitals paid based on these categorizations after consideration of geographic reclassifications (including reclassifications under sections 1886(d)(8)(B) and 1886(d)(8)(E) of the Act, which have implications for capital payments) are 2,607, 1,448, 1,159, and 988, respectively.

    The next three groupings examine the impacts of the changes on hospitals grouped by whether or not they have GME residency programs (teaching hospitals that receive an IME adjustment) or receive DSH payments, or some combination of these two adjustments. There are 2,511 non-teaching hospitals in our analysis, 843 teaching hospitals with fewer than 100 residents, and 241 teaching hospitals with 100 or more residents.

    In the DSH categories, hospitals are grouped according to their DSH payment status, and whether they are considered urban or rural for DSH purposes. The next category groups hospitals considered urban after geographic reclassification, in terms of whether they receive the IME adjustment, the DSH adjustment, both, or neither.

    The next five rows examine the impacts of the changes on rural hospitals by special payment groups (sole community hospitals (SCHs), rural referral centers (RRCs), and Medicare dependent hospitals (MDHs)), as well as rural hospitals not receiving a special payment designation. There were 187 RRCs, 376 SCHs, 146 MDHs, 98 hospitals that are both SCHs and RRCs, and 8 hospitals that are both MDHs and RRCs.

    The next two groupings are based on type of ownership and the hospital's Medicare utilization expressed as a percent of total patient days. These data are taken primarily from the FY 2004 Medicare cost reports, if available, (otherwise FY 2003 data are used).

    The next series of groupings concern the geographic reclassification status of hospitals. The first grouping displays all urban hospitals that were reclassified by the MGCRB for FY 2007. The next grouping shows the MGCRB rural reclassifications. The final three rows in Table I contain hospitals located in urban counties, but deemed to be rural under section 1886(d)(8)(E) of the Act, hospitals located in rural counties but deemed to be urban under section 1886(d)(8)(B) of the Act, and hospitals currently reclassified under section 508 of Pub. L. 108-173, which expires on March 31, 2007. Start Printed Page 59893

    Table I.—Impact Analysis of Changes for FY 2007

    Number of hospitals 1 (1)FY 2007 Transitional1/3 Cost2/3 charge weights & DRG changes 2 (2)FY 2007 wage data 3 (3)FY 2007 DRG, Rel. Wts. and Wage index changes 4 (4)FY 2007 wage index transition for hospitals moving from urban to rural 5 (5)FY 2007 MGCRB reclassifications 6 (6)FY 2007 out-migration adjustment 7 (7)All FY 2007 changes 8 (8)
    All Hospitals3,5950.30.20.00.00.00.13.5
    By Geographic Location:
    Urban hospitals2,5900.20.10.00.0−0.30.13.4
    Large urban areas (populations over 1 million)1,4410.40.0−0.10.0−0.40.03.5
    Other urban areas (populations of 1 million or fewer)1,1490.10.30.00.0−0.10.23.4
    Rural hospitals1,0050.30.30.40.32.10.13.9
    Bed Size (Urban):
    0-99 beds6510.40.10.00.0−0.50.13.5
    100-199 beds8670.60.20.30.0−0.10.13.8
    200-299 beds4920.30.10.00.0−0.30.13.6
    300-499 beds4130.10.2−0.20.0−0.30.13.3
    500 or more beds1670.00.1−0.30.0−0.30.03.2
    Bed Size (Rural):
    0-49 beds3480.50.20.60.10.80.24.7
    50-99 beds3700.50.20.40.21.10.24.9
    100-149 beds1740.40.40.50.52.50.13.6
    150-199 beds680.30.40.30.43.40.13.3
    200 or more beds450.00.3−0.10.03.10.03.0
    Urban by Region:
    New England1280.41.11.00.00.30.13.5
    Middle Atlantic3570.50.60.70.0−0.10.23.9
    South Atlantic3880.1−0.2−0.50.0−0.40.03.2
    East North Central3950.20.30.10.0−0.30.03.4
    East South Central165−0.1−0.6−1.00.0−0.40.12.7
    West North Central1570.0−0.4−0.80.0−0.60.02.8
    West South Central3740.2−0.1−0.30.0−0.50.03.4
    Mountain1490.20.20.00.0−0.20.03.7
    Pacific4240.40.10.10.0−0.30.13.7
    Puerto Rico530.3−1.4−1.50.0−0.60.02.0
    Rural by Region:
    New England190.5−0.20.10.02.00.16.0
    Middle Atlantic720.50.20.50.12.30.05.2
    South Atlantic1760.40.40.50.22.20.23.8
    East North Central1250.2−0.2−0.10.11.60.03.8
    East South Central1800.30.60.50.22.50.13.5
    West North Central1160.20.20.20.02.00.14.3
    West South Central1930.40.90.90.52.80.24.1
    Mountain810.3−0.2−0.12.10.80.12.7
    Pacific430.3−0.3−0.20.01.80.13.2
    By Payment Classification:
    Urban hospitals2,6070.20.10.00.0−0.30.13.4
    Large urban areas (populations over 1 million)1,4480.40.0−0.10.0−0.40.03.5
    Other urban areas (populations of 1 million or fewer)1,1590.10.30.00.0−0.10.23.4
    Rural areas9880.30.30.40.32.00.14.0
    Teaching Status:
    Nonteaching2,5110.40.10.10.00.20.13.8
    Fewer than 100 residents8430.20.1−0.10.0−0.20.13.4
    100 or more residents2410.10.3−0.10.0−0.30.03.1
    Urban DSH:
    Non−DSH9060.20.1−0.10.0−0.10.13.6
    100 or more beds1,5200.20.10.00.0−0.30.13.4
    Less than 100 beds3460.60.00.20.0−0.30.13.6
    Rural DSH:
    SCH3860.30.20.40.20.60.14.6
    Start Printed Page 59894
    RRC1990.20.40.30.23.40.03.5
    Other Rural:
    100 or more beds550.60.70.90.90.70.23.5
    Less than 100 beds1830.60.50.70.40.90.43.8
    Urban teaching and DSH:
    Both teaching and DSH8150.20.1−0.10.0−0.30.03.3
    Teaching and no DSH2010.10.30.00.0−0.10.23.3
    No teaching and DSH1,0510.50.10.10.0−0.10.13.7
    No teaching and no DSH5400.30.0−0.20.0−0.30.03.5
    Special Hospital Types:
    RRC1870.20.50.30.23.10.13.5
    SCH3760.30.10.30.20.40.13.6
    MDH1460.50.20.50.00.70.19.0
    SCH and RRC980.1−0.1−0.10.01.90.03.1
    MDH and RRC80.3−0.10.30.01.00.014.0
    Type of Ownership:
    Voluntary2,1020.20.20.10.00.00.13.5
    Proprietary8800.4−0.1−0.20.1−0.10.03.5
    Government6030.30.0−0.20.00.10.13.4
    Unknown102.20.11.70.0−0.30.27.6
    Medicare Utilization as a Percent of Inpatient Days:
    0-252430.6−0.10.10.0−0.30.03.6
    25-501,3280.20.0−0.20.0−0.40.03.3
    50-651,4780.30.30.20.00.40.13.7
    Over 654620.20.30.10.00.50.13.8
    Unknown841.0−0.40.10.0−0.50.14.4
    Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications2810.30.30.10.02.40.03.7
    Urban Nonreclassified, First Half FY 2007:2,2840.20.1−0.10.0−0.60.13.4
    All Urban Hospitals Reclassified Second Half FY 2007:3410.30.40.20.01.80.03.5
    Urban Nonreclassified Hospitals Second Half FY 2007:2,2240.20.1−0.10.0−0.60.13.4
    All Rural Hospitals Reclassified Full Year FY 2007:3690.20.30.20.13.60.03.6
    Rural Nonreclassified Hospitals Full Year FY 2007:5780.50.30.50.6−0.30.34.4
    All Section 401 Reclassified Hospitals:300.20.80.80.0−0.10.05.4
    Other Reclassified Hospitals (Section 1886(d)(8)(B))570.60.30.60.03.60.04.4
    Section 508 Hospitals1080.20.60.40.0−0.20.01.9
    Specialty Hospitals
    Cardiac Specialty Hospitals21−2.00.0−2.40.0−0.60.01.2
    1 Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2005, and hospital cost report data are from reporting periods beginning in FY 2004 and FY 2003.
    2 This column displays the final payment impact of the changes to the V24 GROUPER and the recalibration of the DRG cost weights based on FY 2005 MedPAR data in accordance with section 1886(d)(4)(C)(iii) of the Act.
    3 This column displays the final payment impact of updating the wage index data with the 100 percent occupational mix adjustment applied to the FY 2003 cost report data. Start Printed Page 59895
    4 This column displays the final payment impact of the 0.995662 budget neutrality factor for DRG and wage index changes (with a 100 percent occupational mix adjustment applied to the wage index) data in accordance with section 1886(d)(4)(C)(iii) of the Act and section 1886(d)(3)(E) of the Act.
    5 Shown here are the final effects of providing rural hospitals formerly located in urban areas with urban wage index values in FY 2007. The effects reflected here are budget neutral: this column therefore includes the effect of the 0.999700 adjustment that we have applied to the rates to ensure budget neutrality.
    6 Shown here are the final effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) and CMS decisions made on behalf of the hospital for FY 2007. The effects demonstrate the FY 2007 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2007. Reclassification for prior years has no bearing on the payment impacts shown here. This column reflects the geographic budget neutrality factor of 0.992355.
    7 This column displays the final impact of the FY 2007 implementation of section 505 of Pub. L. 108-173, which provides for an increase in a hospital's wage index if the hospital qualifies by meeting a threshold percentage of residents of the county where the hospital is located who commute to work at hospitals in counties with higher wage indices.
    8 This column shows final changes in payments from FY 2006 to FY 2007. It incorporates all of the changes displayed in Columns 2, 3, 4,5, and 6 (the changes displayed in Columns 2 and 3 are included in Column 4), as well as those displayed in columns 2 and 3 (related to the quality data differential in the IPPS update and implementation of the MDH DRA provisions) of the FY 2007 IPPS final rule. It also reflects the impact of the FY 2007 update, changes in hospitals' reclassification status in FY 2007 compared to FY 2006, and the changes in payments as a result of continuing the reclassifications under section 508 of Pub. L. 108-173. The product of these impacts may be different from the percentage changes shown here due to rounding and interactive effects.

    (1) Effects of the Changes to the DRG Reclassifications and Relative Cost-Based Weights (Column 2). In Column 2 of Table I, we present the combined effects of the DRG reclassifications and recalibration, as discussed in section II. of the preamble to the FY 2007 IPPS final rule (71 FR 47879 through 47979). Section 1886(d)(4)(C)(i) of the Act requires us annually to make appropriate classification changes in order to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources.

    As discussed in the preamble of the FY 2007 IPPS final rule (71 FR 47882 through 47898), we are changing the relative weight calculation methodology from a charge-based to a cost-based method. Further, we are implementing the new methodology under a 3-year transition such that weights in FY 2007 are 1/3 cost-based and 2/3 charge-based. As part of the methodology for determining cost weights, we standardize hospital charges by the wage index to remove the effect of area wage differences. Since the wage index data has been updated to reflect a 100 percent occupational mix adjustment based on the latest survey data available, we recalculated the relative weights for the FY 2007 by standardizing charges using the 100 percent occupational mix adjusted wage indices. The use of occupational mix adjusted wage indices to standardize hospital charges resulted in very small changes to the DRG relative weights. No DRG weight changed by greater or less than 1 percent from those shown in Table 5 of the FY 2007 IPPS final rule. The revised and final FY 2007 DRG relative weights are shown in Table 5 of the Addendum to this notice.

    In column 2, we compare aggregate payments using the FY 2007 blended relative weights (GROUPER Version 24) to the FY 2006 DRG relative charge weights (GROUPER Version 23.0) so the percentages shown here illustrate the effect of changes to the DRGs and relative weights. The method of calculating the relative weights and the reclassification changes to the GROUPER are described in more detail in section II. of the preamble to the FY 2007 IPPS final rule. The impacts shown in this column are generally very consistent by hospital category with those shown in column 4 of Table I of the FY 2007 IPPS final rule (71 FR 48335). With the exception of using occupational mix adjusted wage indices to standardize hospital charges, the data and methodology that we modeled in this column are identical to the FY 2007 IPPS final rule. Therefore, any differences in the impacts shown in this column from column 6 of Table I of the FY 2007 IPPS final rule and column 4 of the table above are due to the use of occupational mix adjusted wage data. We note that this column reflects the impact of changes to the DRG classifications and relative weights only and is not budget neutral. Consistent with section 1886(d)(4)(C)(iii) of the Act, we apply a single budget neutrality factor to ensure that the combined overall payment impact of changes to the DRG classification, relative weights, and wage index is budget neutral. The budget neutrality factor for the combined changes to the DRGs, relative weights, and wage index are shown in the table above entitled, “Comparison of FY 2006 Standardized Amounts to Final FY 2007 Single Standardized Amount with Full Update and Reduced Update.”

    (2) Effects of Wage Index Changes (Column 3). Section 1886(d)(3)(E) of the Act requires that, beginning October 1, 1993, we annually update the wage data used to calculate the wage index. In accordance with this requirement, the wage index for FY 2007 is based on data submitted for hospital cost reporting periods beginning on or after October 1, 2002 and before October 1, 2003. In the IPPS FY 2007 IPPS final rule, due to the decision in Bellevue Hosp. Center v. Leavitt, in which the Court of Appeals for the Second Circuit ordered CMS to apply the occupational mix adjustment to 100 percent of the wage index effective for FY 2007 (see section III.C. of the FY 2007 IPPS final rule for more details of this Court decision (71 FR 48006)), we were unable to show the impact of the 100 percent occupational mix adjustment as the necessary data were unavailable in time for making the final IPPS rule available to the public on August 1. This column now shows the final estimated effect of updating the wage index with wage data from FY 2003 hospital cost reports and moving to a 100 percent occupational mix adjusted wage index using occupational mix survey data for January through March of this year.

    The estimated impact on hospital payments of the new wage data with the 100 percent occupational mix adjustment applied using the new survey data is isolated in Column 3 by holding the other payment parameters constant. That is, Column 3 shows the percentage changes in payments when going from a model using the FY 2006 wage index, based on FY 2002 wage data and having a 10-percent occupational mix adjustment applied, to a model using the FY 2007 pre-reclassification wage index, based on FY 2003 wage data with a 100 percent occupational mix adjustment based on the latest occupational mix survey data. The wage data collected on the FY 2003 cost report are the same as the FY 2002 wage data that were used to calculate the FY 2006 wage index.

    Hospitals located in urban New England are estimated to receive the greatest benefit from the new wage and occupational mix data. Payments to hospitals in urban New England are estimated to increase 1.1 percent while rural hospitals located in the West South Central region experience an increase of 0.9 percent from these data. Start Printed Page 59896Puerto Rico hospitals see the least benefit from the change to the wage and occupational mix data with a 1.4 percent estimated decrease in payments.

    The national average hourly wage increased 5.9 percent compared to FY 2006 from the new wage data. Therefore, the only manner in which to maintain or exceed the previous year's wage index was to match the national 5.9 increase in average hourly wage. Of the 3,491 hospitals with wage data for both FYs 2006 and 2007, 1,706, or 48.9 percent, also experienced an average hourly wage increase of 5.9 percent or more.

    The following chart compares the shifts in wage index values for hospitals for FY 2007 relative to FY 2006. Among urban hospitals, 40 will experience an increase of between 5 percent and 10 percent and 15 will experience an increase of more than 10 percent. No rural hospitals will experience an increase greater than 5 percent, but 790 will experience increases between 0 and 5 percent. On the negative side, 79 urban hospitals will experience decreases in their wage index values of at least 5 percent, but less than 10 percent. Eight urban hospitals will experience decreases in their wage index values greater than 10 percent.

    The following chart shows the projected impact for urban and rural hospitals:

    Percentage change in area wage index valuesNumber of hospitals
    UrbanRural
    Increase more than 10 percent150
    Increase more than 5 percent and less than 10 percent400
    Increase or decrease less than 5 percent2,354986
    Decrease more than 5 percent and less than 10 percent795
    Decrease more than 10 percent84

    (3) Combined Effects of DRG and Wage Index Changes, Including Budget Neutrality Adjustment (Column 4). Section 1886(d)(4)(C)(iii) of the Act requires that changes to DRG reclassifications and the relative weights cannot increase or decrease aggregate payments. In addition, section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. As noted in the Addendum to this final rule, in determining the budget neutrality factor, we equated simulated aggregate payments for FY 2006 and FY 2007 using the FY 2005 Medicare utilization data after applying the changes to the DRG relative weights and the wage index.

    We computed a wage and DRG recalibration budget neutrality factor of 0.995662. The 0.0 percent impact for all hospitals demonstrates that these changes, in combination with the budget neutrality factor, are budget neutral. In Table I, the combined overall impacts of the effects of both the DRG reclassifications and the updated wage index are shown in Column 4. The changes in this column are the sum of the changes in Columns 2 and 3, combined with the budget neutrality factor for the wage index, including the wage index floor for urban areas required by section 4410 of Pub. L. 105-33. There also may be some variation of plus or minus 0.1 percentage point due to rounding. As indicated above, the changes in the relative weights are generally consistent with those we showed in Table I of the FY 2007 IPPS final rule while the impacts due to the wage data may be somewhat different than those shown there because of the new occupational mix survey and a 100 percent adjustment to the wage index. Any changes between column 6 of Table I of the FY 2007 IPPS final rule and column 4 of Table I of this notice are due to use of a 100 percent adjustment for occupational mix and the new survey data.

    (4) Effects of the 3-Year Provision Allowing Urban Hospitals that Were Converted to Rural as a Result of the FY 2005 Labor Market Area Changes to Maintain the Wage Index of the Urban Labor Market Area in Which They Were Formerly Located (Column 5). To help alleviate the decreased payments for urban hospitals that became rural under the new labor market area definitions, for purposes of the wage index, we adopted a policy in FY 2005 to allow them to maintain the wage index assignment of the MSA where they were located for the 3-year period FY 2005, FY 2006, and FY 2007. Column 5 shows the impact of the remaining labor market area transition, for those hospitals that were urban under the old labor market area designations and are now considered rural hospitals. Section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. Therefore, we applied a adjustment of 0.999700 to ensure that the effects of reclassification are budget neutral as indicated by the zero effect on payments to hospitals overall. The rural hospital row shows a 0.3 percent benefit from this provision as these hold-harmless hospitals are now classified as geographically rural.

    (5) Effects of MGCRB Reclassifications (Column 6). Our impact analysis up to this point has assumed hospitals are paid on the basis of their actual geographic location (with the exception of ongoing policies that provide that certain hospitals receive payments on other bases than where they are geographically located, such as hospitals in rural counties that are deemed urban under section 1886(d)(8)(B) of the Act). The changes in Column 6 reflect the per case payment impact of moving from this baseline to a simulation incorporating the MGCRB decisions for FY 2007 which affect hospitals' wage index area assignments.

    By February 28 of each year, the MGCRB makes reclassification determinations that will be effective for the next fiscal year, which begins on October 1. The MGCRB may approve a hospital's reclassification request for the purpose of using another area's wage index value. The FY 2007 wage index values incorporate all of the MGCRB's reclassification decisions for FY 2007 as well as any decisions made by the CMS Administrator through the appeals and review process.

    For FY 2007, as stated in the FY 2006 IPPS final rule (70 FR 47382, August 12, 2005), we established procedural rules under section 1886(d)(10)(D)(v) of the Act to address specific circumstances where individual and group reclassifications involve a section 508 hospital. The rules were designed to recognize the special circumstances of section 508 hospital reclassifications ending midyear during FY 2007 and were intended to allow previously approved reclassifications to continue through March 31, 2007, and new section 1886(d)(10) reclassifications to begin April 1, 2007, upon the conclusion of the section 508 reclassifications. Under these procedural rules, some section 1886(d)(10) hospital reclassifications are only in effect for the second half of the fiscal year.

    The first and second half fiscal year section 1886(d)(10) reclassifications permitted under these procedural rules have implications for the calculation of the reclassified wage indices and the reclassification budget neutrality factor. Section 1886(d)(8)(c) of the Act provides requirements for determining the wage index values for hospitals that were reclassified as a result of the MGCRB decisions under 1886(d)(10) of the Act. As provided in the statute, we are required to calculate a separate wage index for hospitals reclassified to an area if including the wage data for the reclassified hospitals would reduce the area wage index by more than 1 percent. Start Printed Page 59897

    Because of the half-year reclassifications permitted under the procedural rules, in this final rule, we are issuing two separate wage indices for affected areas (one effective from October 1, 2006, through March 31, 2007 and a second reclassified wage index effective April 1, 2007, through September 30, 2007). The FY 2007 wage index values are calculated based on the wage data for hospitals reclassified to the area in the respective half of the fiscal year. The impact of this policy is modeled in Column 6 of Table I of this notice.

    The overall effect of geographic reclassification is required by section 1886(d)(8)(D) of the Act to be budget neutral. In this final rule, we are calculating one budget neutrality adjustment that reflects the average of the adjustments required for first and second half fiscal year reclassifications, respectively. Therefore, we applied an adjustment of 0.992355 to ensure that the effects of the section 1886(d)(10) reclassifications are budget neutral. (See section II.A. of the Addendum to FY 2007 IPPS final rule (71 48146).) As noted in section II.B. of this notice, CMS applied reclassification decisions for FY 2007 on behalf of hospitals to give them the highest wage index. Hospitals have 30 days from the date of the posting of these data on the CMS Web site to revise the decision that CMS made on their behalf.

    The impacts shown in Column 6 of Table 1 above reflect the CMS reclassification decisions on behalf of hospitals, which reflect the area that would give the hospital the highest wage index using a 100 percent occupational-mix adjustment and the most recent survey data. As a group, rural hospitals benefit most from reclassification. We estimate that their payments will rise 2.1 percent in FY 2007. Payments to urban hospitals will decline by 0.3 percent. Hospitals in other urban areas will experience an overall decrease in payments of 0.1 percent, while hospitals in large urban areas will lose 0.4 percent. Among urban hospital groups (that is, bed size, census division and IME/DSH status), payments generally would decline.

    A positive impact is evident among all of the rural hospital groups. The smallest increase among rural census divisions is 0.8 percent for the Mountain region. The largest increases are in the rural West South Central and rural East South Central regions with 2.8 and 2.5 percent, respectively. Urban hospitals reclassified for FY 2007 are expected to receive an increase of 2.4 percent, while rural reclassified hospitals are expected to benefit from the MGCRB changes with a 3.6 percent increase in payments. Payments to urban and rural hospitals that did not reclassify are expected to decrease slightly due to the MGCRB changes, decreasing by 0.6 percent for urban hospitals and 0.3 percent for rural hospitals.

    (6) Effects of the Wage Index Adjustment for Out-Migration (Column 7). Section 1886(d)(13) of the Act, as added by section 505 of Pub. L. 108-173, provides for an increase in the wage index for hospitals located in certain counties that have a relatively high percentage of hospital employees who reside in the county, but work in a different area with a higher wage index. Hospitals located in counties that qualify for the payment adjustment are to receive an increase in the wage index that is equal to a weighted average of the difference between the wage index of the resident county and the higher wage index work area(s), weighted by the overall percentage of workers who are employed in an area with a higher wage index.

    Using our established criteria, 583 providers in 282 counties are eligible for this adjustment. Due to the statutory formula to calculate the adjustment and the small number of counties that qualify, the impact on hospitals is minimal, with an overall impact on all hospitals of 0.1 percent.

    (7) Effects of All Changes (Column 8). Column 8 compares our estimate of payments per case between FY 2006 and FY 2007, incorporating all changes reflected in the FY 2007 IPPS final rule and in this notice (including statutory changes). This column reflects the impact of all FY 2007 changes relative to FY 2006, including the impact of the quality data changes and the MDH changes from section 5003 of the DRA (see 70 FR 48335) and the impacts shown in Columns 2 through 8 as well as other factors that are not applied until the final rates are calculated. The average increase for all hospitals is approximately 3.5 percent. This increase includes the effects of the 3.4 percent market basket update. It also reflects the 0.5 percentage point difference between the projected outlier payments in FY 2006 (5.1 percent of total DRG payments) and the current estimate of the percentage of actual outlier payments in FY 2006 (4.6 percent), as described in the introduction to this Appendix and the Addendum to this final rule. As a result, payments are projected to be 0.5 percentage points lower in FY 2006 than originally estimated, resulting in a 0.5 percentage point greater increase for FY 2007 than would otherwise occur. In addition, the impact of section 505 adjustments accounted for a 0.1 percent increase. Indirect medical education formula changes for teaching hospitals under section 502 of Pub. L. 108-173, changes in payments due to the difference between the FY 2006 and FY 2007 wage index values assigned to providers reclassified under section 508 of Pub. L. 108-173, and changes in the incremental increase in payments from section 505 of Pub. L. 108-173 out-migration adjustments account for the remaining −0.6 percent.

    There might also be interactive effects among the various factors comprising the payment system that we are not able to isolate. For these reasons, the values in Column 8 may not equal the product of the percentage changes described above. We estimate that payments will increase across all hospitals in each category shown in column 8.

    We estimate that the average payment per case will increase in FY 2007 by 3.5 percent across all hospitals, 3.4 percent for hospitals in urban areas, 3.5 percent for hospitals in large urban areas, 3.4 percent for hospitals in other urban areas and 3.9 percent for hospitals in rural areas.

    Among urban census divisions, we estimate the largest payment increases would be 3.9 percent in the Mid Atlantic region and 3.7 percent in the Pacific and Mountain regions. We estimate that the smallest urban increase will be 2.0 percent in Puerto Rico.

    Among rural areas, the New England and Middle Atlantic regions would benefit the most from changes in the FY 2007 IPPS final rule, with 6.0 and 5.2 percent increases, respectively. The smallest increase would occur in the Mountain region, with a 2.7 percent increase in payments.

    Among special categories of rural hospitals in Column 8, MDH/RRC providers receive an increase in payments of 14.0 percent and MDH providers receive an increase of 9.0 percent, primarily due to the changes to MDH payments set forth in section 5003 of Pub. L. 109-171 (see 70 FR 48062).

    Urban hospitals reclassified for the first half of FY 2007 are anticipated to receive an increase of 3.7 percent, while urban hospitals that reclassified for the second half of FY 2007 are expected to receive an increase of 3.5 percent. The same set of rural hospitals is reclassified for the first and second half of FY 2007. Rural hospitals reclassifying for the entire year of FY 2007 are anticipated to receive a 3.6 percent payment increase. Those hospitals located in rural counties, but deemed to be urban under section 1886(d)(8)(B) of the Act are expected to receive an increase in Start Printed Page 59898payments of 4.4 percent. Hospitals that were reclassified under section 508 of Pub. L. 108-173, which is only effective through March 31, 2007, are expected to receive an increase of 1.9 percent. This lower estimated increase in payment than the average for all hospitals is due to the expiration of the higher section 508 wage indices in effect for 6 months of FY 2007.

    b. Analysis of Impact Table II. Table II presents the projected impact of the changes for FY 2007 for urban and rural hospitals and for the different categories of hospitals shown in Table I. It compares the estimated payments per case for FY 2006 with the average estimated per case payments for FY 2007, as calculated under our models. Thus, this table presents, in terms of the average dollar amounts paid per discharge, the combined effects of the changes presented in Table I. The percentage changes shown in the last column of Table II equal the percentage changes in average payments from Column 8 of Table I.

    TABLE II.—Impact Analysis of Changes for FY 2007 Operating Prospective Payment System

    [Payments per case]

    Number of hospitals (1)Average FY 2006 payment per case 1 (2)Average FY 2007 payment per case 1 (3)All FY 2007 changes (4)
    All hospitals3,5958,5408,8383.5
    By Geographic Location:
    Urban hospitals2,5908,9519,2583.4
    Large urban areas (populations over 1 million)1,4419,3689,6923.5
    Other urban areas (populations of 1 million or fewer)1,1498,4468,7313.4
    Rural hospitals1,0056,2286,4743.9
    Bed Size (Urban):
    0-99 beds6516,7306,9643.5
    100-199 beds8677,4907,7723.8
    200-299 beds4928,4038,7023.6
    300-499 beds4139,4059,7193.3
    500 or more beds16711,38811,7483.2
    Bed Size (Rural):
    0-49 beds3485,2225,4664.7
    50-99 beds3705,6225,8974.9
    100-149 beds1746,1996,4253.6
    150-199 beds686,9337,1633.3
    200 or more beds457,8988,1343.0
    Urban by Region:
    New England1289,3919,7173.5
    Middle Atlantic3579,83310,2173.9
    South Atlantic3888,4768,7473.2
    East North Central3958,5618,8543.4
    East South Central1658,2098,4332.7
    West North Central1578,6898,9292.8
    West South Central3748,4478,7373.4
    Mountain1498,8129,1403.7
    Pacific42410,74211,1443.7
    Puerto Rico534,1904,2722.0
    Rural by Region:
    New England198,1378,6276.0
    Middle Atlantic726,2916,6165.2
    South Atlantic1766,0336,2643.8
    East North Central1256,4576,7003.8
    East South Central1805,9736,1813.5
    West North Central1166,4226,6964.3
    West South Central1935,6695,9024.1
    Mountain816,5896,7682.7
    Pacific437,6087,8503.2
    By Payment Classification:
    Urban hospitals2,6078,9399,2453.4
    Large urban areas (populations over 1 million)1,4489,3579,6823.5
    Other urban areas (populations of 1 million or fewer)1,1598,4318,7143.4
    Rural areas9886,2786,5304.0
    Teaching Status:
    Non-teaching2,5117,1247,3933.8
    Fewer than 100 Residents8438,6408,9323.4
    100 or more Residents24112,60513,0013.1
    Urban DSH:
    Non-DSH9067,7258,0013.6
    100 or more beds1,5209,4249,7463.4
    Less than 100 beds3466,1596,3833.6
    Rural DSH:
    SCH3865,8166,0804.6
    RRC1996,9467,1863.5
    Start Printed Page 59899
    Other Rural:
    100 or more beds555,7375,9363.5
    Less than 100 beds1835,1045,3013.8
    Urban teaching and DSH:
    Both teaching and DSH81510,36710,7073.3
    Teaching and no DSH2018,6018,8893.3
    No teaching and DSH1,0517,6177,8993.7
    No teaching and no DSH5407,2837,5393.5
    Rural Hospital Types:
    RRC1877,2777,5293.5
    SCH3766,2166,4393.6
    MDH1465,1905,6579.0
    SCH and RRC987,4087,6373.1
    MDH and RRC86,4397,34114.0
    Unknown
    Type of Ownership:
    Voluntary2,1028,6808,9843.5
    Proprietary8807,7147,9843.5
    Government6038,7799,0783.4
    Unknown1013,19614,1947.6
    Medicare Utilization as a Percent of Inpatient Days:
    0-2524312,18212,6203.6
    25-501,3289,73910,0573.3
    50-651,4787,4387,7143.7
    Over 654626,6626,9153.8
    Unknown849,92010,3544.4
    Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2005 Reclassifications:
    Urban Hospitals Reclassified by the Medicare Geographic Classification Review Board: First Half FY 2007 Reclassifications:2818,7789,0993.7
    Urban Nonreclassified, First Half FY 2007:2,2848,9839,2883.4
    All Urban Hospitals Reclassified Second Half FY 2007:3419,0389,3513.5
    Urban Nonreclassified Hospitals Second Half FY 2007:2,2248,9479,2533.4
    All Rural Hospitals Reclassified Second Half FY 2007:3696,7597,0043.6
    Rural Nonreclassified Hospitals Second Half FY 2007:5785,5595,8064.4
    All Section 401 Reclassified Hospitals:307,0307,4085.4
    Other Reclassified Hospitals (Section 1886(d)(8)(B))575,8396,0974.4
    Section 508 Hospitals1089,2689,4461.9
    Specialty Hospitals
    Cardiac Specialty Hospitals2111,36311,4971.2
    1 These payment amounts per case do not reflect any estimates of annual case-mix increase.

    2. Final FY 2007 Capital-Related Impacts (Quantitative Effects of the Final Occupational Mix Adjusted Wage Indices)

    (a) General Considerations. In accordance with § 412.312, the basic methodology for determining a capital PPS payment is:

    (Standard Federal Rate) × (DRG weight) × (Geographic Adjustment Factor (GAF)) × (Large Urban Add-on, if applicable) × (COLA for hospitals located in Alaska and Hawaii) × (1 + Disproportionate Share (DSH) Adjustment Factor + Indirect Medical Education (IME) Adjustment Factor, if applicable).

    In addition, hospitals may also receive outlier payments for those cases that qualify under the threshold established for each fiscal year.

    The data used in developing the impact analysis presented below are taken from the March 2006 update of the FY 2005 MedPAR file and the March 2006 update of the Provider-Specific File that is used for payment purposes. Although the analyses of the changes to the capital prospective payment system do not incorporate cost data, we used the March 2006 update of the most recently available hospital cost report data (FYs 2003 and 2004) to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to policy changes. Second, due to the interdependent nature of the IPPS, it is very difficult to precisely quantify the impact associated with each change. Third, we draw upon various sources for the data used to categorize hospitals in the tables. In some cases (for instance, the number of beds), there is a fair degree of variation in the data from different sources. We have attempted to construct these variables with the best available sources overall. However, for individual hospitals, some miscategorizations are possible.

    Using cases from the March 2006 update of the FY 2005 MedPAR file, we simulated payments under the capital PPS for FY 2006 and FY 2007 for a comparison of total payments per case. Any short-term, acute care hospitals not paid under the general IPPS (Indian Health Service hospitals and hospitals in Maryland) are excluded from the simulations. Start Printed Page 59900

    We modeled payments for each hospital by multiplying the capital Federal rate by the GAF and the hospital's case-mix. We then added estimated payments for indirect medical education, disproportionate share, large urban add-on, and outliers, if applicable. For purposes of this impact analysis, the model includes the following assumptions:

    • We estimate that the Medicare case-mix index will increase by 1.0 percent in both FYs 2006 and 2007.
    • We estimate that the Medicare discharges will be 13.5 million in FY 2006 and 13.1 million in FY 2007 for a 3.0 percent decrease from FY 2006 to FY 2007.
    • The capital Federal rate was updated beginning in FY 1996 by an analytical framework that considers changes in the prices associated with capital-related costs and adjustments to account for forecast error, changes in the case-mix index, allowable changes in intensity, and other factors. The FY 2007 update is 1.1 percent (see section II.E.2. of this notice).
    • In addition to the FY 2007 update factor, the FY 2007 capital Federal rate was calculated based on a GAF/DRG budget neutrality factor of 0.9986, an outlier adjustment factor of 0.9568, and an exceptions adjustment factor of 0.9997.

    (b) Results. We used the actuarial model described above to estimate the potential impact of our changes for FY 2007 on total capital payments per case, using a universe of 3,595 hospitals. As described above, the individual hospital payment parameters are taken from the best available data, including the March 2006 update of the FY 2005 MedPAR file, the March 2006 update to the Provider-Specific File, and the most recent cost report data from the March 2006 update of HCRIS. In Table III, we present a comparison of total payments per case for FY 2006 compared to FY 2007 based on the FY 2007 payment policies. Column 2 shows estimates of payments per case under our model for FY 2006. Column 3 shows estimates of payments per case under our model for FY 2007. Column 4 shows the total percentage change in payments from FY 2006 to FY 2007. The change represented in Column 4 includes the 1.1 percent update to the capital Federal rate, a 0.0 percent increase in case-mix, changes in the adjustments to the capital Federal rate (for example, the effect of the hospital wage index on the GAF), and reclassifications by the MGCRB. The comparisons are provided by: (1) Geographic location; (2) region; and (3) payment classification.

    The simulation results show that, on average, capital payments per case can be expected to increase 2.4 percent in FY 2007. In addition to the 1.1 percent increase due to the capital market basket update, this projected increase in capital payments per case is largely attributable to the change in the DRG recalibration process methodology for FY 2007 as discussed in section II.C. of the preamble of the FY 2007 IPPS final rule (71 FR 48006). To a lesser extent, the final outlier factor also contributes to the increase in capital payments per case, while the final GAF has the opposite effect on capital payments (0.2 percent and −0.1 percent, respectively).

    The results of our comparisons by geographic location and by region are consistent with the results we expected after applying the changes to the DRG recalibration methodology. The geographic comparison shows that urban hospitals are expected to experience a 2.3 percent increase in IPPS capital payments per case, while rural hospitals are expected to experience a 2.4 percent increase in capital payments per case. This difference is mostly due to the changes to the methodology used to recalibrate DRGs discussed in the FY 2007 IPPS final rule (71 FR 47882). The capital impact is largely consistent with the impacts in the FY 2007 IPPS final rule (71 FR 48348). However the capital GAF is somewhat affected by the wage index changes resulting from using the revised occupational mix survey data and applying a 100 percent occupational mix adjustment. Any changes from the impact presented in the FY 2007 IPPS final rule would be due to the revised wage indices and the new occupational mix adjustment. Due to circumstances described in the FY 2007 IPPS final rule (71 FR 48005), the wage index used in these calculations is final.

    All regions are estimated to receive an increase in total capital payments per case from FY 2006 to FY 2007. Changes vary by region from a minimum increase of 0.14 percent in Puerto Rico for (urban) to a maximum increase of 3.1 percent in the West South Central rural region and the Middle Atlantic rural region. The change in payments per case for all hospitals is 2.4 percent and is the same as indicated in the FY 2007 IPPS final rule.

    Section 1886(d)(10) of the Act established the MGCRB. Before FY 2005, hospitals could apply to the MGCRB for reclassification for purposes of the standardized amount, wage index, or both. Section 401(c) of Pub. L. 108-173 equalized the standardized amounts under the operating IPPS. Therefore, beginning in FY 2005, there is no longer reclassification for the purposes of the standardized amounts; however, hospitals still may apply for reclassification for purposes of the wage index for FY 2007. Reclassification for wage index purposes also affects the GAF because that factor is constructed from the hospital wage index.

    As discussed in the FY 2007 IPPS final rule (71 FR 48067), procedural rules were established in the FY 2006 IPPS final rule (70 FR 47382) to recognize the special circumstances of section 508 hospital reclassifications ending midyear during FY 2007. Under these procedural rules, some section 1886(d)(10) hospital reclassifications are only in effect for the second half of the fiscal year. These half fiscal year reclassifications have implications for the calculation of reclassified wage indices and therefore, affect capital payments because GAF values are calculated from the hospital wage index.

    To present the effects of the hospitals being reclassified for FY 2007, we show the average payments per case for reclassified hospitals for each half of FY 2007 compared to the average payments per case for the same time period in FY 2006. The reclassified groups are compared to all other nonreclassified hospitals for the same time period. These categories are further identified by urban and rural designation. In general, the average payments per case in the first half of FY 2007 is the same or 0.1 percent less as the average payments per case in the second half of FY 2007 for each category of reclassified hospitals shown in Table III . The exception to that generalization is rural nonreclassified hospitals, which are expected to have the largest increases in payments, as well as the largest increase from the first half to the second half of FY 2007, that is, 2.7 percent in the first half of FY 2007, and 3.0 percent in the second half of FY 2007. Urban reclassified hospitals are expected to increase 2.6 percent and 2.5 percent in the first and second halves of FY 2007, respectively. Reclassified rural hospitals and nonreclassified urban hospitals are projected to have the same increase of 2.3 percent in the first half, while in the second half, the increase in payments per discharge to urban nonreclassified hospitals will remain at 2.3 percent but payments per discharge to rural reclassified hospitals are expected to decrease by 0.1 percent to 2.2 percent from the first half of FY 2007 to the second half of FY 2007. Start Printed Page 59901

    Table III.—Comparison of Total Payments Per Case

    [FY 2006 payments compared to FY 2007 payments]

    Number of hospitalsAverage FY 2006 payments/ caseAverage FY 2007 payments/ caseChange
    By Geographic Location:
    All hospitals3,5957537712.4
    Large urban areas (populations over 1 million)1,4418498692.4
    Other urban areas (populations of 1 million or fewer)1,1497317472.3
    Rural areas1,0055135262.4
    Urban hospitals2,5907968142.3
    0-99 beds6516176312.3
    100-199 beds8676736902.6
    200-299 beds4927517692.4
    300-499 beds4138278452.2
    500 or more beds1671,0051,0272.2
    Rural hospitals1,0055135262.4
    0-49 beds3484224353.1
    50-99 beds3704694822.8
    100-149 beds1745165282.3
    150-199 beds685645762.2
    200 or more beds456426541.9
    By Region:
    Urban by Region2,5907968142.3
    New England1288538742.5
    Middle Atlantic3578738982.9
    South Atlantic3887557712.0
    East North Central3957828012.5
    East South Central1657207311.6
    West North Central1577837951.6
    West South Central3747407582.4
    Mountain1497878082.6
    Pacific4249209422.4
    Puerto Rico533473480.1
    Rural by Region1,0055135262.4
    New England196866961.5
    Middle Atlantic725185343.1
    South Atlantic1764975112.7
    East North Central1255475602.2
    East South Central1804764872.3
    West North Central1165405512.2
    West South Central1934644793.1
    Mountain815355421.3
    Pacific436166271.7
    By Payment Classification:
    All hospitals3,5957537712.4
    Large urban areas (populations over 1 million)1,4488488692.4
    Other urban areas (populations of 1 million or fewer)1,1597307462.3
    Rural areas9885155272.4
    Teaching Status:
    Non-teaching2,5116306452.5
    Fewer than 100 Residents8437657822.2
    100 or more Residents2411,1001,1252.3
    Urban DSH:
    100 or more beds1,5208218402.4
    Less than 100 beds3465435572.5
    Rural DSH:
    Sole Community (SCH/EACH)3864644772.7
    Referral Center (RRC/EACH)1995705822.1
    Other Rural:
    100 or more beds554754862.3
    Less than 100 beds1834234353.0
    Urban teaching and DSH:
    Both teaching and DSH8159029222.3
    Teaching and no DSH2018168352.3
    No teaching and DSH1,0516676832.5
    No teaching and no DSH5407007162.3
    Rural Hospital Types:
    Non special status hospitals2,4907998182.3
    RRC/EACH447077222.2
    SCH/EACH396276402.1
    Medicare-dependent hospitals (MDH)184214332.8
    SCH, RRC and EACH167367562.7
    Start Printed Page 59902
    Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY2007 Reclassifications:
    All Urban Reclassified 1st Half2817777972.6
    All Urban Non-Reclassified 1st Half2,2847998182.3
    All Rural Reclassified 1st Half3585555682.3
    All Rural Non-Reclassified 1st Half5894604732.7
    All Urban Reclassified 2nd Half3418078262.5
    All Urban Non-Reclassified 2nd Half2,2247958142.3
    ALL Rural Reclassified 2nd Half3695595712.2
    All Rural Non-Reclassified 2nd Half5784514643.0
    All Section 401 Reclassified Hospitals305535652.3
    Other Reclassified Hospitals (Section 1886(d)(8)(B))535165282.2
    Type of Ownership:
    Voluntary2,1027717902.4
    Proprietary8806796952.3
    Government6037407572.3
    Medicare Utilization as a Percent of Inpatient Days:
    0-252439991,0262.7
    25-501,3288558742.2
    50-651,4786636802.5
    Over 654625976112.4

    III. Collection of Information Requirements

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

    Start Authority

    Authority: Program; No. 93.773 Medicare—Hospital Insurance Program; and No. 93.774, Medicare—Supplementary Medical Insurance Program)

    End Authority Start Signature

    Dated: September 21, 2006.

    Mark B. McClellan,

    Administrator, , Centers for Medicare & Medicaid Services.

    Approved: September 27, 2006.

    Michael O. Leavitt,

    Secretary.

    End Signature

    Addendum

    This addendum includes tables referred to throughout the notice which contain data relating to the FY 2007 wage indices and the hospital reclassifications and payment amounts for operating and capital-related costs that are affected by the new occupational mix survey data discussed in section II. of this notice.

    Table 1A—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Is Greater Than 1)

    Table 1B—National Adjusted Operating Standardized Amounts, Labor/Nonlabor (62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Is Less Than or Equal To 1)

    Table 1C—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor

    Table 1D—Capital Standard Federal Payment Rate

    Table 2—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wage for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages

    Table 3A—FY 2007 and 3-Year Average Hourly Wage for Urban Areas by CBSA

    Table 3B—FY 2007 and 3-Year Average Hourly Wage for Rural Areas by CBSA

    Table 4A—1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA—FY 2007

    Table 4A—2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period April 1 through September 30, 2007

    Table 4B—1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas by CBSA—FY 2007

    Table 4B—2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Rural Areas by CBSA for the Period April 1 through September 30, 2007*

    Table 4C—1—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified by CBSA—FY 2007

    Table 4C—2—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by CBSA for the Period April 1 through September 30, 2007

    Table 4F—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA—FY 2007

    Table 4J—Out-Migration Adjustment—FY 2007

    Table 5—List of Diagnosis-Related Groups (DRGs), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS)

    Table 9A—Hospital Reclassifications and Redesignations by Individual Hospitals and CBSA for FY 2007

    Table 9B—Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Pub. L. 108-173 for FY 2007

    Table 9C—Hospitals Redesignated as Rural under Section 1886(d)(8)(E) of the Act for FY 2007

    Table 9D—Hospitals who waived Lugar status to receive Out-migration Adjustment

    Table 10—Geometric Mean Plus the Lesser of 0.75 of the National Adjusted Operating Standardized Payment Amount (Increased to Reflect the Difference Between Costs and Charges) or 0.75 of One Standard Deviation of Mean Charges by Diagnosis-Related Group (DRG)—September 2006

    Start Printed Page 59903

    Table 1A.—National Adjusted Operating Standardized; Labor/Nonlabor

    [69.7 Percent Labor Share/30.3 Percent Nonlabor Share If Wage Index Greater Than 1]

    Full Update (3.4 Percent)Reduced Update (1.4 Percent)
    Labor-relatedNonlabor-relatedLabor-relatedNonlabor-related
    $3,397.52$1,476.97$3,331.80$1,448.40

    Table 1B.—National Adjusted Operating Standardized Amounts, Labor/Nonlabor

    [62 Percent Labor Share/38 Percent Nonlabor Share If Wage Index Less Than or Equal to 1]

    Full Update (3.4 Percent)Reduced Update (1.4 Percent)
    Labor-relatedNonlabor-relatedLabor-relatedNonlabor-related
    $3,022.18$1,852.31$2,963.73$1,816.48

    Table 1C.—Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor

    Rates If Wage Index Greater Than 1Rates If Wage Index Less Than or Equal to 1
    LaborNonlaborLaborNonlabor
    National$3,397.52$1,476.97$3,022.18$1,852.31
    Puerto Rico1,436.12880.201,359.68956.64

    Table 1D.—Capital Standard Federal Payment Rate

    Rate
    National$427.03
    Puerto Rico203.03

    Table 2.—Hospital Case-Mix Indexes for Discharges Occurring in Federal Fiscal Year 2005; Hospital Wage Indexes for Federal Fiscal Year 2007; Hospital Average Hourly Wages for Federal Fiscal Years 2005 (2001 Wage Data), 2006 (2002 Wage Data), and 2007 (2003 Wage Data); Wage Indexes and 3-Year Average of Hospital Average Hourly Wages

    Provider No.Case-mix index 2FY 2007 wage indexAverage hourly wage FY 2005Average hourly wage FY 2006Average hourly wage FY 2007 1Average hourly wage** (3 years)
    0100011.49130.766420.656321.654622.198921.5314
    010004****22.7585**22.7585
    010005 h1.12620.888920.493722.490623.602222.2289
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    5200111.32870.960723.778525.274726.626825.2916
    5200131.44180.961324.476626.622529.001826.7305
    520014****22.1064**22.1064
    520015****23.0403**23.0403
    5200171.17530.961323.404424.667628.469925.4918
    5200191.30920.960724.987126.743328.697126.8067
    5200211.33691.065125.487226.693528.418226.9688
    Start Printed Page 59967
    5200241.0406*18.5072**18.5072
    520026****26.1056**26.1056
    5200271.26501.032426.251627.677131.428428.5997
    5200281.29391.062125.777825.416426.726025.9761
    5200301.75570.994725.380727.018529.467827.3375
    5200321.0976*25.3059**25.3059
    5200331.23390.960723.979125.085428.066225.8012
    5200341.20250.960723.656323.985026.109424.6150
    5200351.32380.968423.262524.776727.327625.1707
    5200371.83070.994728.698429.723430.179929.5214
    5200381.23931.032424.665026.647029.313326.9164
    5200401.47791.032423.850127.232529.126226.6542
    5200411.08931.084122.823622.759623.549523.0632
    5200421.0028*24.0788**24.0788
    5200441.33960.968424.938726.019127.368526.1391
    5200451.59960.960724.584426.003027.333625.9816
    520047****25.5346**25.5346
    5200481.62660.960723.165325.172426.808024.9984
    5200492.10360.960724.108325.925626.985125.5981
    5200511.67961.032428.824928.488031.994929.9332
    5200571.20340.972523.320525.374527.752825.5398
    5200591.25611.065126.559628.090629.580128.0985
    5200601.27380.960722.013223.881724.863823.5830
    5200621.26701.032424.998828.221528.851027.3750
    5200631.14011.032425.367427.410129.099327.2991
    5200641.51461.032427.112028.610130.322528.6401
    5200661.48861.062125.881227.165729.208827.4160
    5200680.9089*23.474624.8184*24.1554
    5200701.72140.961323.990824.893527.677125.5786
    5200711.19601.020926.315427.620230.026327.9425
    5200751.46800.960726.060027.169929.292027.4700
    5200761.23641.062124.087926.169827.333525.8642
    5200781.53101.032425.766227.598929.983727.8237
    5200831.72001.084127.001228.840730.882628.9925
    520084****25.5777**25.5777
    5200871.72290.960724.528027.337428.581026.7699
    5200881.28921.036826.088226.993630.745028.0398
    5200891.51791.084126.601330.044833.879330.2306
    5200911.28390.960724.826924.632025.459324.9881
    520092****23.4043**23.4043
    520094****25.316625.7567*25.5399
    5200951.23431.062128.637626.786330.421628.6080
    5200961.35221.020922.992924.575827.889625.3901
    5200971.39440.960725.113526.332129.147926.8851
    5200981.97861.084128.073030.615032.578530.4882
    5201001.27550.986824.591426.216129.324326.7266
    5201021.11721.020925.614626.823429.168027.2579
    5201031.56321.032425.536127.914730.316528.0905
    5201071.24850.960727.741328.343128.987828.3702
    5201091.05730.960722.404823.327124.722823.4867
    520111****26.3095**26.3095
    520112****20.4034**20.4034
    5201131.28420.960726.792627.413531.470728.5985
    520114****22.0536**22.0536
    5201161.27961.020926.305726.990227.968827.1297
    520117****22.0023**22.0023
    520123****22.2430**22.2430
    5201320.96070.968421.602523.194125.000623.2907
    520135****18.5618**18.5618
    5201361.66731.032425.514527.770330.652227.9536
    5201381.86791.032426.904728.439430.801628.7391
    5201391.28071.032425.442426.511028.887027.0173
    5201401.65301.032426.161628.443331.004328.5899
    5201481.3198*26.2258**26.2258
    520151****22.9592**22.9592
    5201521.08040.960723.249324.939229.730826.1195
    Start Printed Page 59968
    520154****23.7160**23.7160
    520156****24.9258**24.9258
    5201601.82190.960724.352825.758827.954826.0586
    520161****24.0673**24.0673
    5201701.40531.032425.612427.222130.430927.8135
    5201731.12451.028526.222428.099529.242927.8645
    5201771.64301.032428.466330.731731.455530.2920
    5201780.9946*23.041920.2666*21.6760
    5201891.16081.065126.317228.472028.001427.7043
    5201931.65040.9607*26.088527.811327.0087
    5201941.32721.0324*24.940830.166827.5109
    520195*****36.697336.311636.5038
    5201961.65000.9613*35.104336.926635.9808
    5201972.61901.0324****
    5201981.35460.9607****
    5201992.35921.0324****
    5202001.3175*****
    5300021.08170.912425.298326.835628.306326.8117
    5300061.16090.912422.834424.931827.242224.9156
    530007****19.347620.4391*19.9218
    5300081.11120.914523.827123.858924.009023.8983
    5300090.93480.912424.242626.831624.671925.2403
    5300101.22780.914523.925525.848225.985225.2473
    5300111.10810.912424.139624.824527.877225.6665
    5300121.69610.914524.345425.252626.958225.5096
    5300141.53370.912423.690724.594726.715625.0071
    5300151.20550.963926.310727.687629.831027.9484
    530016****21.6575**21.6575
    5300170.99350.912423.541525.336229.850426.3807
    530023****24.149321.3813*22.6795
    5300251.23930.923327.798828.693824.439226.8843
    530031****16.3472**16.3472
    5300321.06430.912422.658425.772823.900524.0558
    1 Based on salaries adjusted for occupational mix, according to the calculation specified in FY 2007 IPPS final rule (71 FR 48006).
    2 The transfer-adjusted case-mix index is based on the billed DRG on the FY 2005 MedPAR.
    h These hospitals are assigned a wage index value according to the FY 2007 final rule (71 FR 48005).
    * Denotes wage data not available for the provider for that year.
    ** Based on the sum of the salaries and hours computed for Federal FYs 2005, 2006, and 2007.
    *** Denotes MedPAR data not available for the provider for FY 2005.

    Table 3A.—FY 2007 and 3-Year Average Hourly Wage For Urban Areas By CBSA

    [*Based on the salaries and hours computed for Federal FYs 2005, 2006, and 2007.]

    CBSA codeUrban areaFY 2007 average hourly wage3-year average hourly wage
    10180Abilene, TX24.735422.5497
    10380Aguadilla-Isabela-San Sebastian, PR11.312711.8798
    10420Akron, OH25.474724.8266
    10500Albany, GA26.853726.6477
    10580Albany-Schenectady-Troy, NY26.238924.4301
    10740Albuquerque, NM28.360827.7551
    10780Alexandria, LA23.479522.5264
    10900Allentown-Bethlehem-Easton, PA-NJ29.928627.6856
    11020Altoona, PA25.316724.1524
    11100Amarillo, TX27.421725.7741
    11180Ames, IA28.778626.8184
    11260Anchorage, AK35.299933.6081
    11300Anderson, IN26.155324.4794
    11340Anderson, SC26.447324.8695
    11460Ann Arbor, MI31.663930.4582
    11500Anniston-Oxford, AL23.477721.9712
    11540Appleton, WI27.742425.9029
    11700Asheville, NC27.469725.9704
    Start Printed Page 59969
    12020Athens-Clarke County, GA28.039427.4814
    12060Atlanta-Sandy Springs-Marietta, GA29.039827.5973
    12100Atlantic City, NJ34.669132.0567
    12220Auburn-Opelika, AL23.900722.7914
    12260Augusta-Richmond County, GA-SC28.586226.6851
    12420Austin-Round Rock, TX27.659226.5039
    12540Bakersfield, CA32.376229.5765
    12580Baltimore-Towson, MD29.422527.7580
    12620Bangor, ME28.503227.5520
    12700Barnstable Town, MA37.330035.1183
    12940Baton Rouge, LA23.974923.3468
    12980Battle Creek, MI28.661026.6466
    13020Bay City, MI27.885326.4751
    13140Beaumont-Port Arthur, TX25.826624.0155
    13380Bellingham, WA32.442631.9484
    13460Bend, OR31.083729.7964
    13644Bethesda-Gaithersburg-Frederick, MD32.168531.0437
    13740Billings, MT26.556425.0079
    13780Binghamton, NY26.577324.3089
    13820Birmingham-Hoover, AL26.357925.2037
    13900Bismarck, ND21.665420.9327
    13980Blacksburg-Christiansburg-Radford, VA24.355622.6230
    14020Bloomington, IN26.565524.3118
    14060Bloomington-Normal, IL27.101625.5125
    14260Boise City-Nampa, ID28.008126.0160
    14484Boston-Quincy, MA34.887132.7850
    14500Boulder, CO29.891927.9634
    14540Bowling Green, KY23.966322.8146
    14740Bremerton-Silverdale, WA32.224530.0885
    14860Bridgeport-Stamford-Norwalk, CT37.796735.6899
    15180Harlingen, TX28.855127.7588
    15260Brunswick, GA31.070329.3670
    15380Buffalo-Niagara Falls, NY28.096526.4178
    15500Burlington, NC25.322624.6210
    15540Burlington-South Burlington, VT27.979426.2852
    15764Cambridge-Newton-Framingham, MA32.627031.1502
    15804Camden, NJ31.154929.6108
    15940Canton-Massillon, OH26.831125.1139
    15980Cape Coral-Fort Myers, FL28.052726.3302
    16180Carson City, NV29.365028.4400
    16220Casper, WY26.958225.5096
    16300Cedar Rapids, IA25.822424.7388
    16580Champaign-Urbana, IL28.414126.7812
    16620Charleston, WV25.758924.2660
    16700Charleston-North Charleston, SC27.156825.9700
    16740Charlotte-Gastonia-Concord, NC-SC27.912226.9168
    16820Charlottesville, VA29.768828.4674
    16860Chattanooga, TN-GA26.532725.4481
    16940Cheyenne, WY26.715625.0071
    16974Chicago-Naperville-Joliet, IL31.640430.1812
    17020Chico, CA32.787529.9713
    17140Cincinnati-Middletown, OH-KY-IN28.234026.7214
    17300Clarksville, TN-KY24.969023.0942
    17420Cleveland, TN24.380822.6533
    17460Cleveland-Elyria-Mentor, OH27.861726.3788
    17660Coeur d'Alene, ID27.359726.3413
    17780College Station-Bryan, TX26.400625.2360
    17820Colorado Springs, CO28.097326.7757
    17860Columbia, MO25.057923.4777
    17900Columbia, SC26.516025.5945
    17980Columbus, GA-AL25.294824.0613
    18020Columbus, IN28.006826.5764
    18140Columbus, OH29.878027.7524
    18580Corpus Christi, TX25.020523.9295
    18700Corvallis, OR33.607830.4640
    19060Cumberland, MD-WV24.169524.2795
    19124Dallas-Plano-Irving, TX29.584128.2768
    19140Dalton, GA26.554825.7096
    19180Danville, IL28.329924.9634
    Start Printed Page 59970
    19260Danville, VA25.202223.9494
    19340Davenport-Moline-Rock Island, IA-IL26.200524.5540
    19380Dayton, OH27.236425.7362
    19460Decatur, AL23.915023.6883
    19500Decatur, IL24.355022.8257
    19660Deltona-Daytona Beach-Ormond Beach, FL27.290125.6532
    19740Denver-Aurora, CO31.783630.1612
    19780Des Moines-West Des Moines, IA27.192226.2387
    19804Detroit-Livonia-Dearborn, MI30.781229.0851
    20020Dothan, AL22.278321.3349
    20100Dover, DE30.109427.9303
    20220Dubuque, IA26.670424.9867
    20260Duluth, MN-WI30.221428.6977
    20500Durham, NC28.694128.1744
    20740Eau Claire, WI28.505626.1726
    20764Edison, NJ33.019931.3235
    20940El Centro, CA26.695025.1556
    21060Elizabethtown, KY25.600024.4113
    21140Elkhart-Goshen, IN27.801226.4097
    21300Elmira, NY24.762023.3890
    21340El Paso, TX27.394725.6383
    21500Erie, PA26.190224.4869
    21604Essex County, MA30.881129.5200
    21660Eugene-Springfield, OR32.516330.5454
    21780Evansville, IN-KY26.386224.2557
    21820Fairbanks, AK32.597531.2913
    21940Fajardo, PR11.978711.2316
    22020Fargo, ND-MN24.196423.9807
    22140Farmington, NM24.754323.2955
    22180Fayetteville, NC28.032326.3806
    22220Fayetteville-Springdale-Rogers, AR-MO26.768724.6433
    22380Flagstaff, AZ34.214232.1557
    22420Flint, MI32.020330.4255
    22500Florence, SC25.807024.8022
    22520Florence-Muscle Shoals, AL23.302122.4484
    22540Fond du Lac, WI30.745028.0398
    22660Fort Collins-Loveland, CO27.377427.5172
    22744Fort Lauderdale-Pompano Beach-Deerfield Beach, FL29.637228.5403
    22900Fort Smith, AR-OK23.276522.7417
    23020Fort Walton Beach-Crestview-Destin, FL25.436824.4697
    23060Fort Wayne, IN27.526326.9363
    23104Fort Worth-Arlington, TX28.336326.7137
    23420Fresno, CA32.770230.1663
    23460Gadsden, AL23.900022.4775
    23540Gainesville, FL27.933926.4188
    23580Gainesville, GA27.361825.9487
    23844Gary, IN27.863426.2470
    24020Glens Falls, NY25.565624.0003
    24140Goldsboro, NC27.210524.9866
    24220Grand Forks, ND-MN23.201823.1061
    24300Grand Junction, CO28.631327.2192
    24340Grand Rapids-Wyoming, MI28.329226.5178
    24500Great Falls, MT25.179624.5500
    24540Greeley, CO29.619127.1542
    24580Green Bay, WI28.385526.7916
    24660Greensboro-High Point, NC26.635125.4930
    24780Greenville, NC27.662626.0809
    24860Greenville, SC28.366927.1599
    25020Guayama, PR09.593009.6934
    25060Gulfport-Biloxi, MS25.941024.7777
    25180Hagerstown-Martinsburg, MD-WV27.618026.6584
    25260Hanford-Corcoran, CA31.098528.1098
    25420Harrisburg-Carlisle, PA27.793426.1846
    25500Harrisonburg, VA27.167625.7382
    25540Hartford-West Hartford-East Hartford, CT32.530630.9139
    25620Hattiesburg, MS22.564121.0861
    25860Hickory-Lenoir-Morganton, NC26.659625.5863
    259801 Hinesville-Fort Stewart, GA
    26100Holland-Grand Haven, MI27.329925.9201
    Start Printed Page 59971
    26180Honolulu, HI32.351230.9292
    26300Hot Springs, AR26.180225.3280
    26380Houma-Bayou Cane-Thibodaux, A24.269922.1607
    26420Houston-Sugar Land-Baytown, TX29.931128.1062
    26580Huntington-Ashland, WV-KY-OH26.176225.9741
    26620Huntsville, AL26.588625.1724
    26820Idaho Falls, ID26.793625.7310
    26900Indianapolis-Carmel, IN28.967827.7854
    26980Iowa City, IA28.461527.0882
    27060Ithaca, NY29.252927.4683
    27100Jackson, MI28.814826.2508
    27140Jackson, MS24.358323.1899
    27180Jackson, TN26.082824.8971
    27260Jacksonville, FL27.522126.2665
    27340Jacksonville, NC25.011023.3845
    27500Janesville, WI29.261427.1061
    27620Jefferson City, MO25.540623.6903
    27740Johnson City, TN23.956922.6132
    27780Johnstown, PA25.389623.5735
    27860Jonesboro, AR23.266922.3980
    27900Joplin, MO26.076724.3379
    28020Kalamazoo-Portage, MI32.017329.7247
    28100Kankakee-Bradley, IL29.714229.3063
    28140Kansas City, MO-KS27.710526.5218
    28420Kennewick-Richland-Pasco, WA29.925229.0588
    28660Killeen-Temple-Fort Hood, TX26.666924.9921
    28700Kingsport-Bristol-Bristol, TN-VA24.055022.7725
    28740Kingston, NY27.997125.8916
    28940Knoxville, TN24.387523.5673
    29020Kokomo, IN28.635226.4213
    29100La Crosse, WI-MN28.292826.4773
    29140Lafayette, IN26.027424.7635
    29180Lafayette, LA24.859523.4330
    29340Lake Charles, LA23.491922.1092
    29404Lake County-Kenosha County, IL-WI31.583129.4832
    29460Lakeland, FL26.853925.1966
    29540Lancaster, PA29.370327.6048
    29620Lansing-East Lansing, MI29.854727.5157
    29700Laredo, TX24.395023.4077
    29740Las Cruces, NM27.027124.5756
    29820Las Vegas-Paradise, NV33.056731.6630
    29940Lawrence, KS24.709623.8060
    30020Lawton, OK25.159823.0756
    30140Lebanon, PA25.964524.4260
    30300Lewiston, ID-WA28.615826.7504
    30340Lewiston-Auburn, ME27.383126.2777
    30460Lexington-Fayette, KY26.582825.5280
    30620Lima, OH26.373625.5860
    30700Lincoln, NE29.552928.3730
    30780Little Rock-North Little Rock, AR28.776025.6122
    30860Logan, UT-ID26.821925.5447
    30980Longview, TX26.213324.6592
    31020Longview, WA30.362727.9557
    31084Los Angeles-Long Beach-Glendale, CA34.653432.9160
    31140Louisville-Jefferson County, KY-IN27.146825.7437
    31180Lubbock, TX25.311424.3391
    31340Lynchburg, VA25.500524.5752
    31420Macon, GA29.054427.2917
    31460Madera, CA25.233724.0664
    31540Madison, WI32.147929.7320
    31700Manchester-Nashua, NH30.302129.0984
    31900Mansfield, OH27.388426.5027
    32420Mayaguez, PR11.288911.4438
    32580McAllen-Edinburg-Mission, TX26.076924.4574
    32780Medford, OR31.895829.4566
    32820Memphis, TN-MS-AR27.596826.0783
    32900Merced, CA33.835230.8333
    33124Miami-Miami Beach-Kendall, FL29.120827.5124
    33140Michigan City-La Porte, IN26.798325.9329
    Start Printed Page 59972
    33260Midland, TX28.283726.5950
    33340Milwaukee-Waukesha-West Allis, WI30.613928.5884
    33460Minneapolis-St. Paul-Bloomington, MN-WI31.972330.6935
    33540Missoula, MT25.718225.7998
    33660Mobile, AL23.268122.1095
    33700Modesto, CA34.797933.3338
    33740Monroe, LA23.941222.3954
    33780Monroe, MI29.022126.8789
    33860Montgomery, AL23.523423.1670
    34060Morgantown, WV25.367124.0418
    34100Morristown, TN23.670722.2354
    34580Mount Vernon-Anacortes, WA30.308029.1509
    34620Muncie, IN24.723324.0903
    34740Muskegon-Norton Shores, MI29.963827.6896
    34820Myrtle Beach-Conway-North Myrtle Beach, SC26.338825.0344
    34900Napa, CA38.350135.6146
    34940Naples-Marco Island, FL29.969028.7171
    34980Nashville-Davidson—Murfreesboro, TN29.090627.7029
    35004Nassau-Suffolk, NY38.462036.1106
    35084Newark-Union, NJ-PA34.861032.9825
    35300New Haven-Milford, CT35.784133.4729
    35380New Orleans-Metairie-Kenner, LA25.646624.9412
    35644New York-White Plains-Wayne, NY-NJ39.568837.2163
    35660Niles-Benton Harbor, MI26.473924.9201
    35980Norwich-New London, CT35.650532.7603
    36084Oakland-Fremont-Hayward, CA45.737343.0139
    36100Ocala, FL25.529224.9445
    36140Ocean City, NJ31.290730.2391
    36220Odessa, TX29.764727.8892
    36260Ogden-Clearfield, UT26.897025.5070
    36420Oklahoma City, OK26.114625.0678
    36500Olympia, WA32.505130.7166
    36540Omaha-Council Bluffs, NE-IA27.870226.7732
    36740Orlando-Kissimmee, FL28.393426.8763
    36780Oshkosh-Neenah, WI27.095025.5269
    36980Owensboro, KY26.044024.2668
    37100Oxnard-Thousand Oaks-Ventura, CA32.994931.6529
    37340Palm Bay-Melbourne-Titusville, FL28.308727.1499
    37460Panama City-Lynn Haven, FL24.200622.7018
    37620Parkersburg-Marietta-Vienna, WV-OH24.059223.0883
    37700Pascagoula, MS24.148922.7120
    37860Pensacola-Ferry Pass-Brent, FL23.330522.6237
    37900Peoria, IL27.060025.0857
    37964Philadelphia, PA32.606830.7383
    38060Phoenix-Mesa-Scottsdale, AZ30.086928.3131
    38220Pine Bluff, AR25.849124.4087
    38300Pittsburgh, PA25.407724.3788
    38340Pittsfield, MA30.407128.8423
    38540Pocatello, ID27.219526.2270
    38660Ponce, PR13.971413.6681
    38860Portland-South Portland-Biddeford, ME29.244928.2990
    38900Portland-Vancouver-Beaverton, OR-WA33.241631.5854
    38940Port St. Lucie-Fort Pierce, FL29.255428.0826
    39100Poughkeepsie-Newburgh-Middletown, NY32.517231.0301
    39140Prescott, AZ28.905127.6147
    39300Providence-New Bedford-Fall River, RI-MA31.859530.4800
    39340Provo-Orem, UT28.106926.6360
    39380Pueblo, CO25.745424.3382
    39460Punta Gorda, FL28.812826.5824
    39540Racine, WI28.112925.7619
    39580Raleigh-Cary, NC28.827227.4767
    39660Rapid City, SD25.823024.8711
    39740Reading, PA28.789226.7877
    39820Redding, CA36.917933.9636
    39900Reno-Sparks, NV35.958531.3496
    40060Richmond, VA26.679725.8302
    40140Riverside-San Bernardino-Ontario, CA31.797730.5874
    40220Roanoke, VA26.104823.9632
    40340Rochester, MN33.325831.5976
    Start Printed Page 59973
    40380Rochester, NY26.994425.6945
    40420Rockford, IL29.796227.7018
    40484Rockingham County-Strafford County, NH30.012128.7106
    40580Rocky Mount, NC26.390725.0513
    40660Rome, GA28.761426.1851
    40900Sacramento—Arden-Arcade—Roseville, CA38.506935.3185
    40980Saginaw-Saginaw Township North, MI27.312526.3003
    41060St. Cloud, MN32.702829.2101
    41100St. George, UT28.029126.5758
    41140St. Joseph, MO-KS30.344028.0336
    41180St. Louis, MO-IL26.681225.2397
    41420Salem, OR30.490629.2331
    41500Salinas, CA42.165539.2218
    41540Salisbury, MD26.284225.2167
    41620Salt Lake City, UT28.098626.6060
    41660San Angelo, TX25.154023.3032
    41700San Antonio, TX26.524025.1675
    41740San Diego-Carlsbad-San Marcos, CA32.913031.5806
    41780Sandusky, OH27.453325.4522
    41884San Francisco-San Mateo-Redwood City, CA45.722442.2326
    41900San German-Cabo Rojo, PR14.399513.6919
    41940San Jose-Sunnyvale-Santa Clara, CA45.440942.2101
    41980San Juan-Caguas-Guaynabo, PR13.193312.8054
    42020San Luis Obispo-Paso Robles, CA33.089631.3414
    42044Santa Ana-Anaheim-Irvine, CA33.656532.2329
    42060Santa Barbara-Santa Maria, CA32.199531.1050
    42100Santa Cruz-Watsonville, CA44.645542.0789
    42140Santa Fe, NM32.047730.4670
    42220Santa Rosa-Petaluma, CA42.468938.0360
    42260Sarasota-Bradenton-Venice, FL28.891827.0657
    42340Savannah, GA27.100326.2037
    42540Scranton—Wilkes-Barre, PA24.521623.6058
    42644Seattle-Bellevue-Everett, WA33.391532.0468
    42680Sebastian-Vero Beach, FL29.316226.9491
    43100Sheboygan, WI27.094425.2780
    43300Sherman-Denison, TX25.651825.8894
    43340Shreveport-Bossier City, LA26.237024.9393
    43580Sioux City, IA-NE-SD26.871625.6458
    43620Sioux Falls, SD27.727126.5164
    43780South Bend-Mishawaka, IN-MI29.397327.1692
    43900Spartanburg, SC26.792325.8987
    44060Spokane, WA30.903429.8263
    44100Springfield, IL26.542524.6316
    44140Springfield, MA30.129128.5979
    44180Springfield, MO25.411123.7305
    44220Springfield, OH25.168623.9321
    44300State College, PA25.664323.7164
    44700Stockton, CA34.023331.2391
    44940Sumter, SC24.789923.6087
    45060Syracuse, NY28.987626.9574
    45104Tacoma, WA31.759630.3791
    45220Tallahassee, FL26.566324.5843
    45300Tampa-St. Petersburg-Clearwater, FL27.277225.7846
    45460Terre Haute, IN26.113723.7180
    45500Texarkana, TX-Texarkana, AR24.023723.1611
    45780Toledo, OH28.035926.6301
    45820Topeka, KS25.983624.8278
    45940Trenton-Ewing, NJ32.322029.9814
    46060Tucson, AZ27.844125.6497
    46140Tulsa, OK24.640423.8913
    46220Tuscaloosa, AL25.977724.0371
    46340Tyler, TX26.431825.7626
    46540Utica-Rome, NY25.956423.7574
    46660Valdosta, GA25.193424.0205
    46700Vallejo-Fairfield, CA43.867441.4044
    47020Victoria, TX24.984523.3071
    47220Vineland-Millville-Bridgeton, NJ30.786528.7657
    47260Virginia Beach-Norfolk-Newport News, VA-NC26.016024.7890
    47300Visalia-Porterville, CA29.915828.2959
    Start Printed Page 59974
    47380Waco, TX25.939423.7524
    47580Warner Robins, GA26.128824.3113
    47644Warren-Troy-Farmington Hills, MI29.972428.0999
    47894Washington-Arlington-Alexandria, DC-VA-MD-WV32.548930.7238
    47940Waterloo-Cedar Falls, IA25.483624.1398
    48140Wausau, WI29.467827.3375
    48260Weirton-Steubenville, WV-OH23.892822.5021
    48300Wenatchee, WA30.195627.5727
    48424West Palm Beach-Boca Raton-Boynton Beach, FL28.275427.8801
    48540Wheeling, WV-OH21.001220.2153
    48620Wichita, KS26.736125.7825
    48660Wichita Falls, TX25.387823.5588
    48700Williamsport, PA23.934323.1797
    48864Wilmington, DE-MD-NJ31.344530.0596
    48900Wilmington, NC28.972526.7451
    49020Winchester, VA-WV29.821528.6809
    49180Winston-Salem, NC27.418125.7927
    49340Worcester, MA32.014730.6187
    49420Yakima, WA29.130928.2366
    49500Yauco, PR11.181211.8242
    49620York-Hanover, PA28.158626.1713
    49660Youngstown-Warren-Boardman, OH-PA26.091324.8348
    49700Yuba City, CA31.217429.7427
    49740Yuma, AZ27.011125.4677
    1 This area has no average hourly wage because there are no short-term, acute care hospitals in the area.

    Table 3B.—FY 2007 and 3-Year* Average Hourly Wage for Rural Areas by CBSA

    [*Based on the sum of the salaries and hours computed for federal FYs 2005, 2006, and 2007.]

    CBSA codeNonurban areaFY 2007 average hourly wage3-Year average hourly wage
    01Alabama22.726621.2362
    02Alaska31.734932.0692
    03Arizona26.892425.0201
    04Arkansas22.132220.8590
    05California33.216530.4210
    06Colorado26.956625.9101
    07Connecticut35.547133.2841
    08Delaware29.214127.0822
    10Florida25.895724.2399
    11Georgia23.204021.7117
    12Hawaii31.512229.7080
    13Idaho23.776122.5379
    14Illinois24.783323.2471
    15Indiana25.396224.0538
    16Iowa25.546223.7246
    17Kansas23.757622.4610
    18Kentucky23.143321.7879
    19Louisiana22.715220.9287
    20Maine24.887524.4422
    21Maryland26.335825.6324
    22Massachusetts 1
    23Michigan26.770724.8965
    24Minnesota27.266425.6919
    25Mississippi23.117321.5916
    26Missouri24.081422.2178
    27Montana25.664924.3121
    28Nebraska25.608624.5327
    29Nevada27.222925.6122
    30New Hampshire32.375429.3617
    31New Jersey 1
    32New Mexico24.833024.0136
    33New York24.741723.0382
    34North Carolina25.587024.0377
    35North Dakota21.847820.8336
    36Ohio25.748624.4334
    Start Printed Page 59975
    37Oklahoma23.269821.6211
    38Oregon28.831627.3621
    39Pennsylvania24.614623.2486
    40Puerto Rico 1
    41Rhode Island 1
    42South Carolina25.774424.3480
    43South Dakota24.605223.4919
    44Tennessee23.869922.2751
    45Texas24.388922.6173
    46Utah24.468922.9744
    47Vermont28.531526.6381
    49Virginia24.021622.5475
    50Washington30.263428.7978
    51West Virginia22.991621.8032
    52Wisconsin28.488026.5687
    53Wyoming26.829425.5743
    1 All counties in the State or Territory are classified as urban, with the exception of Massachusetts. Massachusetts has area(s) designated as rural. However, no short-term, acute care hospitals are located in the area(s) for FY 2007.

    Table 4A-1.—Wage Index And Capital Geographic Adjustment Factor (GAF) for Urban Areas by CBSA

    CBSA codeUrban area (constituent counties)Wage indexGAF
    10180Abilene, TX0.83800.8860
     Callahan County, TX
     Jones County, TX
     Taylor County, TX
    10380Aguadilla-Isabela-San Sebastián, PR0.38150.5169
     Aguada Municipio, PR
     Aguadilla Municipio, PR
     Añasco Municipio, PR
     Isabela Municipio, PR
     Lares Municipio, PR
     Moca Municipio, PR
     Rinc≤n Municipio, PR
     San Sebastián Municipio
    104202 Akron, OH0.86830.9078
     Portage County, OH
     Summit County, OH
    10500Albany, GA0.90560.9344
     Baker County, GA
     Dougherty County, GA
     Lee County, GA
     Terrell County, GA
     Worth County, GA
    10580Albany-Schenectady-Troy, NY0.88490.9197
     Albany County, NY
     Rensselaer County, NY
     Saratoga County, NY
     Schenectady County, NY
     Schoharie County, NY
    10740Albuquerque, NM0.95640.9699
     Bernalillo County, NM
     Sandoval County, NM
     Torrance County, NM
     Valencia County, NM
    10780Alexandria, LA0.79610.8554
     Grant Parish, LA
     Rapides Parish, LA
    10900Allentown-Bethlehem-Easton, PA-NJ (PA Hospitals)1.00931.0064
     Warren County, NJ
     Carbon County, PA
     Lehigh County, PA
     Northampton County, PA
    109002 Allentown-Bethlehem-Easton, PA-NJ (NJ Hospitals)1.14021.0940
     Warren County, NJ
     Carbon County, PA
    Start Printed Page 59976
     Lehigh County, PA
     Northampton County, PA
    11020Altoona, PA0.85380.8974
     Blair County, PA
    11100Amarillo, TX0.92480.9479
     Armstrong County, TX
     Carson County, TX
     Potter County, TX
     Randall County, TX
    11180Ames, IA0.97050.9797
     Story County, IA
    112603 Anchorage, AK1.19041.1268
     Anchorage Municipality, AK
     Matanuska-Susitna Borough, AK
    11300Anderson, IN0.88200.9176
     Madison County, IN
    11340Anderson, SC0.89190.9246
     Anderson County, SC
    114603 Ann Arbor, MI1.06781.0459
     Washtenaw County, MI
    11500Anniston-Oxford, AL0.79970.8581
     Calhoun County, AL
    115402 Appleton, WI0.96070.9729
     Calumet County, WI
     Outagamie County, WI
    11700Asheville, NC0.92640.9490
     Buncombe County, NC
     Haywood County, NC
     Henderson County, NC
     Madison County, NC
    12020Athens-Clarke County, GA0.94560.9624
     Clarke County, GA
     Madison County, GA
     Oconee County, GA
     Oglethorpe County, GA
    120601 Atlanta-Sandy Springs-Marietta, GA0.97930.9858
     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
    12100Atlantic City, NJ1.16921.1130
     Atlantic County, NJ
    12220Auburn-Opelika, AL0.80600.8627
     Lee County, AL
    12260Augusta-Richmond County, GA-SC0.96400.9752
     Burke County, GA
    Start Printed Page 59977
     Columbia County, GA
     McDuffie County, GA
     Richmond County, GA
     Aiken County, SC
     Edgefield County, SC
    124201 Austin-Round Rock, TX0.93280.9535
     Bastrop County, TX
     Caldwell County, TX
     Hays County, TX
     Travis County, TX
     Williamson County, TX
    125402 Bakersfield, CA1.12021.0808
     Kern County, CA
    125801 Baltimore-Towson, MD0.99220.9947
     Anne Arundel County, MD
     Baltimore County, MD
     Carroll County, MD
     Harford County, MD
     Howard County, MD
     Queen Anne's County, MD
     Baltimore City, MD
    12620Bangor, ME0.96120.9733
     Penobscot County, ME
    12700Barnstable Town, MA1.25891.1708
     Barnstable County, MA
    12940Baton Rouge, LA0.80850.8645
     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
    12980Battle Creek, MI0.96660.9770
     Calhoun County, MI
    130203 Bay City, MI1.00801.0055
     Bay County, MI
    13140Beaumont-Port Arthur, TX0.87100.9098
     Hardin County, TX
     Jefferson County, TX
     Orange County, TX
    13380Bellingham, WA1.09411.0635
     Whatcom County, WA
    13460Bend, OR1.04831.0328
     Deschutes County, OR
    136441 Bethesda-Gaithersburg-Frederick, MD1.08481.0573
     Frederick County, MD
     Montgomery County, MD
    13740Billings, MT0.89560.9273
     Carbon County, MT
     Yellowstone County, MT
    13780Binghamton, NY0.89630.9278
     Broome County, NY
     Tioga County, NY
    138201 Birmingham-Hoover, AL0.88890.9225
     Bibb County, AL
     Blount County, AL
     Chilton County, AL
     Jefferson County, AL
     St. Clair County, AL
     Shelby County, AL
     Walker County, AL
    139002,3 Bismarck, ND0.73680.8113
     Burleigh County, ND
     Morton County, ND
    13980Blacksburg-Christiansburg-Radford, VA0.82140.8740
     Giles County, VA
     Montgomery County, VA
    Start Printed Page 59978
     Pulaski County, VA
     Radford City, VA
    14020Bloomington, IN0.89590.9275
     Greene County, IN
     Monroe County, IN
     Owen County, IN
    14060Bloomington-Normal, IL0.91400.9403
     McLean County, IL
    14260Boise City-Nampa, ID0.94450.9617
     Ada County, ID
     Boise County, ID
     Canyon County, ID
     Gem County, ID
     Owyhee County, ID
    144841 Boston-Quincy, MA1.17651.1177
     Norfolk County, MA
     Plymouth County, MA
     Suffolk County, MA
    14500Boulder, CO1.00811.0055
     Boulder County, CO
    14540Bowling Green, KY0.80820.8643
     Edmonson County, KY
     Warren County, KY
    14740Bremerton-Silverdale, WA1.08671.0586
     Kitsap County, WA
    14860Bridgeport-Stamford-Norwalk, CT1.27461.1808
     Fairfield County, CT
    15180Brownsville-Harlingen, TX0.97310.9815
     Cameron County, TX
    15260Brunswick, GA1.04781.0325
     Brantley County, GA
     Glynn County, GA
     McIntosh County, GA
    153801 Buffalo-Niagara Falls, NY0.94750.9637
     Erie County, NY
     Niagara County, NY
    155002 Burlington, NC0.86290.9040
     Alamance County, NC
    155402 Burlington-South Burlington, VT0.96220.9740
     Chittenden County, VT
     Franklin County, VT
     Grand Isle County, VT
    157641 Cambridge-Newton-Framingham, MA1.10031.0676
     Middlesex County, MA
    158041,2 Camden, NJ1.14021.0940
     Burlington County, NJ
     Camden County, NJ
     Gloucester County, NJ
    15940Canton-Massillon, OH0.90480.9338
     Carroll County, OH
     Stark County, OH
    15980Cape Coral-Fort Myers, FL0.94600.9627
     Lee County, FL
    16180Carson City, NV0.99030.9933
     Carson City, NV
    162202,3 Casper, WY0.91990.9444
     Natrona County, WY
    163002,3 Cedar Rapids, IA0.88030.9164
     Benton County, IA
     Jones County, IA
     Linn County, IA
    16580Champaign-Urbana, IL0.95820.9712
     Champaign County, IL
     Ford County, IL
     Piatt County, IL
    16620Charleston, WV0.86870.9081
     Boone County, WV
     Clay County, WV
     Kanawha County, WV
     Lincoln County, WV
    Start Printed Page 59979
     Putnam County, WV
    16700Charleston-North Charleston, SC0.91970.9443
     Berkeley County, SC
     Charleston County, SC
     Dorchester County, SC
    167401 Charlotte-Gastonia-Concord, NC-SC0.94130.9594
     Anson County, NC
     Cabarrus County, NC
     Gaston County, NC
     Mecklenburg County, NC
     Union County, NC
     York County, SC
    16820Charlottesville, VA1.00391.0027
     Albemarle County, VA
     Fluvanna County, VA
     Greene County, VA
     Nelson County, VA
     Charlottesville City, VA
    16860Chattanooga, TN-GA0.89480.9267
     Catoosa County, GA
     Dade County, GA
     Walker County, GA
     Hamilton County, TN
     Marion County, TN
     Sequatchie County, TN
    169402,3 Cheyenne, WY0.91990.9444
     Laramie County, WY
    169741 Chicago-Naperville-Joliet, IL1.06701.0454
     Cook County, IL
     DeKalb County, IL
     DuPage County, IL
     Grundy County, IL
     Kane County, IL
     Kendall County, IL
     McHenry County, IL
     Will County, IL
    170202 Chico, CA1.12021.0808
     Butte County, CA
    171401 Cincinnati-Middletown, OH-KY-IN0.95220.9670
     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
    17300Clarksville, TN-KY0.84200.8889
     Christian County, KY
     Trigg County, KY
     Montgomery County, TN
     Stewart County, TN
    17420Cleveland, TN0.82220.8745
     Bradley County, TN
     Polk County, TN
    174601 Cleveland-Elyria-Mentor, OH0.93960.9582
     Cuyahoga County, OH
     Geauga County, OH
     Lake County, OH
     Lorain County, OH
     Medina County, OH
    17660Coeur d'Alene, ID0.92270.9464
     Kootenai County, ID
    Start Printed Page 59980
    17780College Station-Bryan, TX0.89030.9235
     Brazos County, TX
     Burleson County, TX
     Robertson County, TX
    17820Colorado Springs, CO0.94750.9637
     El Paso County, CO
     Teller County, CO
    17860Columbia, MO0.84560.8915
     Boone County, MO
     Howard County, MO
    17900Columbia, SC0.89420.9263
     Calhoun County, SC
     Fairfield County, SC
     Kershaw County, SC
     Lexington County, SC
     Richland County, SC
     Saluda County, SC
    17980Columbus, GA-AL0.85300.8968
     Russell County, AL
     Chattahoochee County, GA
     Harris County, GA
     Marion County, GA
     Muscogee County, GA
    18020Columbus, IN0.94450.9617
     Bartholomew County, IN
    181401 Columbus, OH1.00761.0052
     Delaware County, OH
     Fairfield County, OH
     Franklin County, OH
     Licking County, OH
     Madison County, OH
     Morrow County, OH
     Pickaway County, OH
     Union County, OH
    18580Corpus Christi, TX0.84380.8902
     Aransas County, TX
     Nueces County, TX
     San Patricio County, TX
    18700Corvallis, OR1.13341.0895
     Benton County, OR
    190602 Cumberland, MD-WV (MD Hospitals)0.88810.9219
     Allegany County, MD
     Mineral County, WV
    19060Cumberland, MD-WV (WV Hospitals)0.81510.8694
     Allegany County, MD
     Mineral County, WV
    191241 Dallas-Plano-Irving, TX0.99770.9984
     Collin County, TX
     Dallas County, TX
     Delta County, TX
     Denton County, TX
     Ellis County, TX
     Hunt County, TX
     Kaufman County, TX
     Rockwall County, TX
    19140Dalton, GA0.89550.9272
     Murray County, GA
     Whitfield County, GA
    19180Danville, IL0.95540.9692
     Vermilion County, IL
    19260Danville, VA0.84990.8946
     Pittsylvania County, VA
     Danville City, VA
    19340Davenport-Moline-Rock Island, IA-IL0.88360.9187
     Henry County, IL
     Mercer County, IL
     Rock Island County, IL
     Scott County, IA
    19380Dayton, OH0.91850.9434
     Greene County, OH
    Start Printed Page 59981
     Miami County, OH
     Montgomery County, OH
     Preble County, OH
    19460Decatur, AL0.80650.8631
     Lawrence County, AL
     Morgan County, AL
    195002 Decatur, IL0.83580.8844
     Macon County, IL
    19660Deltona-Daytona Beach-Ormond Beach, FL0.92030.9447
     Volusia County, FL
    197401 Denver-Aurora, CO1.07191.0487
     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
    19780Des Moines-West Des Moines, IA0.91700.9424
     Dallas County, IA
     Guthrie County, IA
     Madison County, IA
     Polk County, IA
     Warren County, IA
    198041,3 Detroit-Livonia-Dearborn, MI1.03811.0259
     Wayne County, MI
    20020Dothan, AL0.76640.8334
     Geneva County, AL
     Henry County, AL
     Houston County, AL
    20100Dover, DE1.01541.0105
     Kent County, DE
    20220Dubuque, IA0.89940.9300
     Dubuque County, IA
    20260Duluth, MN-WI1.02851.0194
     Carlton County, MN
     St. Louis County, MN
     Douglas County, WI
    20500Durham, NC0.96770.9778
     Chatham County, NC
     Durham County, NC
     Orange County, NC
     Person County, NC
    20740Eau Claire, WI0.96130.9733
     Chippewa County, WI
     Eau Claire County, WI
    207641,2 Edison, NJ1.14021.0940
     Middlesex County, NJ
     Monmouth County, NJ
     Ocean County, NJ
     Somerset County, NJ
    209402 El Centro, CA1.12021.0808
     Imperial County, CA
    21060Elizabethtown, KY0.86330.9042
     Hardin County, KY
     Larue County, KY
    21140Elkhart-Goshen, IN0.93760.9568
     Elkhart County, IN
    213002 Elmira, NY0.84300.8896
     Chemung County, NY
    21340El Paso, TX0.92380.9472
     El Paso County, TX
    21500Erie, PA0.88320.9185
     Erie County, PA
    216042 Essex County, MA1.07571.0512
     Essex County, MA
    216603 Eugene-Springfield, OR1.09661.0652
    Start Printed Page 59982
     Lane County, OR
    21780Evansville, IN-KY0.88980.9232
     Gibson County, IN
     Posey County, IN
     Vanderburgh County, IN
     Warrick County, IN
     Henderson County, KY
     Webster County, KY
    21820Fairbanks, AK1.09931.0670
     Fairbanks North Star Borough, AK
    21940Fajardo, PR0.40400.5376
     Ceiba Municipio, PR
     Fajardo Municipio, PR
     Luquillo Municipio, PR
    220203 Fargo, ND-MN (ND Hospitals)0.83670.8851
     Clay County, MN
     Cass County, ND
    220202,3 Fargo, ND-MN (MN Hospitals)0.91950.9441
     Clay County, MN
     Cass County, ND
    221402 Farmington, NM0.83750.8856
     San Juan County, NM
    22180Fayetteville, NC0.94530.9622
     Cumberland County, NC
     Hoke County, NC
    22220Fayetteville-Springdale-Rogers, AR-MO0.90270.9323
     Benton County, AR
     Madison County, AR
     Washington County, AR
     McDonald County, MO
    22380Flagstaff, AZ1.15381.1029
     Coconino County, AZ
    22420Flint, MI1.07981.0540
     Genesee County, MI
    22500Florence, SC0.87030.9093
     Darlington County, SC
     Florence County, SC
    22520Florence-Muscle Shoals, AL0.78760.8492
     Colbert County, AL
     Lauderdale County, AL
    22540Fond du Lac, WI1.03681.0251
     Fond du Lac County, WI
    22660Fort Collins-Loveland, CO0.92330.9468
     Larimer County, CO
    227441 Fort Lauderdale-Pompano Beach-Deerfield Beach, FL1.03201.0218
     Broward County, FL
    22900Fort Smith, AR-OK0.78500.8472
     Crawford County, AR
     Franklin County, AR
     Sebastian County, AR
     Le Flore County, OK
     Sequoyah County, OK
    230202 Fort Walton Beach-Crestview-Destin, FL0.87330.9114
     Okaloosa County, FL
    23060Fort Wayne, IN0.92830.9503
     Allen County, IN
     Wells County, IN
     Whitley County, IN
    231041 Fort Worth-Arlington, TX0.95560.9694
     Johnson County, TX
     Parker County, TX
     Tarrant County, TX
     Wise County, TX
    234202 Fresno, CA1.12021.0808
     Fresno County, CA
    23460Gadsden, AL0.80600.8627
     Etowah County, AL
    23540Gainesville, FL0.94200.9599
     Alachua County, FL
     Gilchrist County, FL
    Start Printed Page 59983
    23580Gainesville, GA0.92270.9464
     Hall County, GA
    23844Gary, IN0.93970.9583
     Jasper County, IN
     Lake County, IN
     Newton County, IN
     Porter County, IN
    24020Glens Falls, NY0.86220.9035
     Warren County, NY
     Washington County, NY
    24140Goldsboro, NC0.91760.9428
     Wayne County, NC
    242203 Grand Forks, ND-MN (ND Hospitals)0.78240.8453
     Polk County, MN
     Grand Forks County, ND
    242202,3 Grand Forks, ND-MN (MN Hospitals)0.91950.9441
     Polk County, MN
     Grand Forks County, ND
    243003 Grand Junction, CO0.96550.9762
     Mesa County, CO
    24340Grand Rapids-Wyoming, MI0.95540.9692
     Barry County, MI
     Ionia County, MI
     Kent County, MI
     Newaygo County, MI
    24500Great Falls, MT0.87470.9124
     Cascade County, MT
    24540Greeley, CO0.99890.9992
     Weld County, CO
    245802 Green Bay, WI0.96070.9729
     Brown County, WI
     Kewaunee County, WI
     Oconto County, WI
    24660Greensboro-High Point, NC0.89820.9291
     Guilford County, NC
     Randolph County, NC
     Rockingham County, NC
    24780Greenville, NC0.93290.9535
     Greene County, NC
     Pitt County, NC
    24860Greenville, SC0.95660.9701
     Greenville County, SC
     Laurens County, SC
     Pickens County, SC
    25020Guayama, PR0.32350.4617
     Arroyo Municipio, PR
     Guayama Municipio, PR
     Patillas Municipio, PR
    25060Gulfport-Biloxi, MS0.87480.9125
     Hancock County, MS
     Harrison County, MS
     Stone County, MS
    25180Hagerstown-Martinsburg, MD-WV0.93140.9525
     Washington County, MD
     Berkeley County, WV
     Morgan County, WV
    252602 Hanford-Corcoran, CA1.12021.0808
     Kings County, CA
    25420Harrisburg-Carlisle, PA0.93730.9566
     Cumberland County, PA
     Dauphin County, PA
     Perry County, PA
    25500Harrisonburg, VA0.91620.9418
     Rockingham County, VA
     Harrisonburg City, VA
    255401,2 Hartford-West Hartford-East Hartford, CT1.19881.1322
     Hartford County, CT
     Litchfield County, CT
     Middlesex County, CT
     Tolland County, CT
    Start Printed Page 59984
    256202 Hattiesburg, MS0.77960.8432
     Forrest County, MS
     Lamar County, MS
     Perry County, MS
    25860Hickory-Lenoir-Morganton, NC0.89910.9298
     Alexander County, NC
     Burke County, NC
     Caldwell County, NC
     Catawba County, NC
    25980Hinesville-Fort Stewart, GA0.78250.8454
     Liberty County, GA
     Long County, GA
    26100Holland-Grand Haven, MI0.92170.9457
     Ottawa County, MI
    26180Honolulu, HI1.09111.0615
     Honolulu County, HI
    26300Hot Springs, AR0.88290.9182
     Garland County, AR
    26380Houma-Bayou Cane-Thibodaux, LA0.81850.8718
     Lafourche Parish, LA
     Terrebonne Parish, LA
    264201 Houston-Sugar Land-Baytown, TX1.00941.0064
     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
    26580Huntington-Ashland, WV-KY-OH0.88280.9182
     Boyd County, KY
     Greenup County, KY
     Lawrence County, OH
     Cabell County, WV
     Wayne County, WV
    26620Huntsville, AL0.89670.9281
     Limestone County, AL
     Madison County, AL
    268203 Idaho Falls, ID0.90360.9329
     Bonneville County, ID
     Jefferson County, ID
    269001 Indianapolis-Carmel, IN0.97690.9841
     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
    26980Iowa City, IA0.95980.9723
     Johnson County, IA
     Washington County, IA
    27060Ithaca, NY0.98650.9907
     Tompkins County, NY
    27100Jackson, MI0.97170.9805
     Jackson County, MI
    27140Jackson, MS0.82140.8740
     Copiah County, MS
     Hinds County, MS
     Madison County, MS
     Rankin County, MS
     Simpson County, MS
    27180Jackson, TN0.87960.9159
     Chester County, TN
    Start Printed Page 59985
     Madison County, TN
    272601 Jacksonville, FL0.92810.9502
     Baker County, FL
     Clay County, FL
     Duval County, FL
     Nassau County, FL
     St. Johns County, FL
    273402 Jacksonville, NC0.86290.9040
     Onslow County, NC
    27500Janesville, WI0.98680.9909
     Rock County, WI
    27620Jefferson City, MO0.86130.9028
     Callaway County, MO
     Cole County, MO
     Moniteau County, MO
     Osage County, MO
    277402 Johnson City, TN0.81220.8672
     Carter County, TN
     Unicoi County, TN
     Washington County, TN
    27780Johnstown, PA0.85620.8991
     Cambria County, PA
    27860Jonesboro, AR0.83450.8835
     Craighead County, AR
     Poinsett County, AR
    27900Joplin, MO0.87940.9158
     Jasper County, MO
     Newton County, MO
    28020Kalamazoo-Portage, MI1.07971.0539
     Kalamazoo County, MI
     Van Buren County, MI
    28100Kankakee-Bradley, IL1.00211.0014
     Kankakee County, IL
    281401 Kansas City, MO-KS0.93450.9547
     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
    284202 Kennewick-Richland-Pasco, WA1.02061.0141
     Benton County, WA
     Franklin County, WA
    28660Killeen-Temple-Fort Hood, TX0.89930.9299
     Bell County, TX
     Coryell County, TX
     Lampasas County, TX
    28700Kingsport-Bristol-Bristol, TN-VA0.82150.8740
     Hawkins County, TN
     Sullivan County, TN
     Bristol City, VA
     Scott County, VA
     Washington County, VA
    28740Kingston, NY0.94420.9614
     Ulster County, NY
    28940Knoxville, TN0.82270.8749
     Anderson County, TN
     Blount County, TN
     Knox County, TN
     Loudon County, TN
     Union County, TN
    Start Printed Page 59986
    29020Kokomo, IN0.96570.9764
     Howard County, IN
     Tipton County, IN
    291002 La Crosse, WI-MN (WI Hospitals)0.96070.9683
     Houston County, MN
     La Crosse County, WI
    29100La Crosse, WI-MN (MN Hospitals)0.95410.9729
     Houston County, MN
     La Crosse County, WI
    29140Lafayette, IN0.87770.9145
     Benton County, IN
     Carroll County, IN
     Tippecanoe County, IN
    29180Lafayette, LA0.84080.8880
     Lafayette Parish, LA
     St. Martin Parish, LA
    29340Lake Charles, LA0.79220.8526
     Calcasieu Parish, LA
     Cameron Parish, LA
    29404Lake County-Kenosha County, IL-WI1.06511.0441
     Lake County, IL
     Kenosha County, WI
    29460Lakeland, FL0.90560.9344
     Polk County, FL
    29540Lancaster, PA0.99420.9960
     Lancaster County, PA
    29620Lansing-East Lansing, MI1.00681.0047
     Clinton County, MI
     Eaton County, MI
     Ingham County, MI
    29700Laredo, TX0.82270.8749
     Webb County, TX
    29740Las Cruces, NM0.91240.9391
     Dona Ana County, NM
    298201 Las Vegas-Paradise, NV1.11481.0773
     Clark County, NV
    29940Lawrence, KS0.83330.8826
     Douglas County, KS
    30020Lawton, OK84850.8936
     Comanche County, OK 0.
    30140Lebanon, PA0.87560.9130
     Lebanon County, PA
    30300Lewiston, ID-WA (ID Hospitals)0.96500.9759
     Nez Perce County, ID
     Asotin County, WA
    303002 Lewiston, ID-WA (WA Hospitals)1.02061.0141
     Nez Perce County, ID
     Asotin County, WA
    30340Lewiston-Auburn, ME0.92350.9470
     Androscoggin County, ME
    30460Lexington-Fayette, KY0.89650.9279
     Bourbon County, KY
     Clark County, KY
     Fayette County, KY
     Jessamine County, KY
     Scott County, KY
     Woodford County, KY
    30620Lima, OH0.89250.9251
     Allen County, OH
    30700Lincoln, NE0.99660.9977
     Lancaster County, NE
     Seward County, NE
    30780Little Rock-North Little Rock, AR0.97040.9796
     Faulkner County, AR
     Grant County, AR
     Lonoke County, AR
     Perry County, AR
     Pulaski County, AR
     Saline County, AR
    30860Logan, UT-ID0.90450.9336
    Start Printed Page 59987
     Franklin County, ID
     Cache County, UT
    30980Longview, TX0.89460.9266
     Gregg County, TX
     Rusk County, TX
     Upshur County, TX
    31020Longview, WA1.02391.0163
     Cowlitz County, WA
    310841,3 Los Angeles-Long Beach-Glendale, CA1.16861.1126
     Los Angeles County, CA
    311401 Louisville-Jefferson County, KY-IN0.91550.9413
     Clark County, IN
     Floyd County, IN
     Harrison County, IN
     Washington County, IN
     Bullitt County, KY
     Henry County, KY
     Jefferson County, KY
     Meade County, KY
     Nelson County, KY
     Oldham County, KY
     Shelby County, KY
     Spencer County, KY
     Trimble County, KY
    31180Lubbock, TX0.85360.8973
     Crosby County, TX
     Lubbock County, TX
    31340Lynchburg, VA0.86000.9019
     Amherst County, VA
     Appomattox County, VA
     Bedford County, VA
     Campbell County, VA
     Bedford City, VA
     Lynchburg City, VA
    31420Macon, GA0.97980.9861
     Bibb County, GA
     Crawford County, GA
     Jones County, GA
     Monroe County, GA
     Twiggs County, GA
    314602 Madera, CA1.12021.0808
     Madera County, CA
    31540Madison, WI1.08411.0569
     Columbia County, WI
     Dane County, WI
     Iowa County, WI
    317002 Manchester-Nashua, NH1.17321.1156
     Hillsborough County, NH
     Merrimack County, NH
    31900Mansfield, OH0.92360.9470
     Richland County, OH
    32420Mayagüez, PR0.38070.5162
     Hormigueros Municipio, PR
     Mayagüez Municipio, PR
    32580McAllen-Edinburg-Mission, TX0.87940.9158
     Hidalgo County, TX
    32780Medford, OR1.07561.0512
     Jackson County, OR
    328201 Memphis, TN-MS-AR0.93070.9520
     Crittenden County, AR
     DeSoto County, MS
     Marshall County, MS
     Tate County, MS
     Tunica County, MS
     Fayette County, TN
     Shelby County, TN
     Tipton County, TN
    32900Merced, CA1.14101.0945
     Merced County, CA
    331241 Miami-Miami Beach-Kendall, FL0.98210.9877
    Start Printed Page 59988
     Miami-Dade County, FL
    33140Michigan City-La Porte, IN0.90370.9330
     LaPorte County, IN
    33260Midland, TX0.95380.9681
     Midland County, TX
    333401 Milwaukee-Waukesha-West Allis, WI1.03241.0221
     Milwaukee County, WI
     Ozaukee County, WI
     Washington County, WI
     Waukesha County, WI
    334601 Minneapolis-St. Paul-Bloomington, MN-WI1.07821.0529
     Anoka County, MN
     Carver County, MN
     Chisago County, MN
     Dakota County, MN
     Hennepin County, MN
     Isanti County, MN
     Ramsey County, MN
     Scott County, MN
     Sherburne County, MN
     Washington County, MN
     Wright County, MN
     Pierce County, WI
     St. Croix County, WI
    33540Missoula, MT0.87830.9150
     Missoula County, MT
    33660Mobile, AL0.78470.8470
     Mobile County, AL
    33700Modesto, CA1.17351.1158
     Stanislaus County, CA
    33740Monroe, LA0.80740.8637
     Ouachita Parish, LA
     Union Parish, LA
    33780Monroe, MI0.97870.9854
     Monroe County, MI
    33860Montgomery, AL0.79330.8534
     Autauga County, AL
     Elmore County, AL
     Lowndes County, AL
     Montgomery County, AL
    34060Morgantown, WV0.85550.8986
     Monongalia County, WV
     Preston County, WV
    341002 Morristown, TN0.81220.8672
     Grainger County, TN
     Hamblen County, TN
     Jefferson County, TN
    34580Mount Vernon-Anacortes, WA1.02211.0151
     Skagit County, WA
    346202 Muncie, IN0.85640.8993
     Delaware County, IN
    347403 Muskegon-Norton Shores, MI1.01051.0072
     Muskegon County, MI
    34820Myrtle Beach-Conway-North Myrtle Beach, SC0.88820.9220
     Horry County, SC
    34900Napa, CA1.29331.1926
     Napa County, CA
    34940Naples-Marco Island, FL1.01071.0073
     Collier County, FL
    349801 Nashville-Davidson—Murfreesboro, TN0.98100.9869
     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
    Start Printed Page 59989
     Trousdale County, TN
     Williamson County, TN
     Wilson County, TN
    350041,3 Nassau-Suffolk, NY1.29711.1950
     Nassau County, NY
     Suffolk County, NY
    350841 Newark-Union, NJ-PA1.17561.1172
     Essex County, NJ
     Hunterdon County, NJ
     Morris County, NJ
     Sussex County, NJ
     Union County, NJ
     Pike County, PA
    353003 New Haven-Milford, CT1.20681.1374
     New Haven County, CT
    353801 New Orleans-Metairie-Kenner, LA0.86490.9054
     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
    356441,3 New York-White Plains-Wayne, NY-NJ1.33441.2184
     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
    356602 Niles-Benton Harbor, MI0.90280.9324
     Berrien County, MI
    35980Norwich-New London, CT1.20311.1350
     New London County, CT
    360841 Oakland-Fremont-Hayward, CA1.56171.3570
     Alameda County, CA
     Contra Costa County, CA
    361002 Ocala, FL0.87330.9114
     Marion County, FL
    361402 Ocean City, NJ1.14021.0940
     Cape May County, NJ
    36220Odessa, TX1.00381.0026
     Ector County, TX
    36260Ogden-Clearfield, UT0.90800.9360
     Davis County, UT
     Morgan County, UT
     Weber County, UT
    364201 Oklahoma City, OK0.88070.9167
     Canadian County, OK
     Cleveland County, OK
     Grady County, OK
     Lincoln County, OK
     Logan County, OK
     McClain County, OK
     Oklahoma County, OK
    36500Olympia, WA1.09621.0649
     Thurston County, WA
    36540Omaha-Council Bluffs, NE-IA0.93990.9584
     Harrison County, IA
     Mills County, IA
     Pottawattamie County, IA
     Cass County, NE
     Douglas County, NE
     Sarpy County, NE
     Saunders County, NE
    Start Printed Page 59990
     Washington County, NE
    367401 Orlando-Kissimmee, FL0.95750.9707
     Lake County, FL
     Orange County, FL
     Osceola County, FL
     Seminole County, FL
    367802 Oshkosh-Neenah, WI0.96070.9729
     Winnebago County, WI
    36980Owensboro, KY0.87830.9150
     Daviess County, KY
     Hancock County, KY
     McLean County, KY
    371002 Oxnard-Thousand Oaks-Ventura, CA1.12021.0808
     Ventura County, CA
    37340Palm Bay-Melbourne-Titusville, FL0.95470.9688
     Brevard County, FL
    374602 Panama City-Lynn Haven, FL0.87330.9114
     Bay County, FL
    37620Parkersburg-Marietta-Vienna, WV-OH (WV Hospitals)0.81140.8667
     Washington County, OH
     Pleasants County, WV
     Wirt County, WV
     Wood County, WV
    376202 Parkersburg-Marietta-Vienna, WV-OH (OH Hospitals)0.86830.9078
     Washington County, OH
     Pleasants County, WV
     Wirt County, WV
     Wood County, WV
    37700Pascagoula, MS0.81440.8688
     George County, MS
     Jackson County, MS
    378602 Pensacola-Ferry Pass-Brent, FL0.87330.9114
     Escambia County, FL
     Santa Rosa County, FL
    37900Peoria, IL0.91260.9393
     Marshall County, IL
     Peoria County, IL
     Stark County, IL
     Tazewell County, IL
     Woodford County, IL
    379641 Philadelphia, PA1.09961.0672
     Bucks County, PA
     Chester County, PA
     Delaware County, PA
     Montgomery County, PA
     Philadelphia County, PA
    380601 Phoenix-Mesa-Scottsdale, AZ1.01461.0100
     Maricopa County, AZ
     Pinal County, AZ
    38220Pine Bluff, AR0.87170.9103
     Cleveland County, AR
     Jefferson County, AR
     Lincoln County, AR
    383001 Pittsburgh, PA0.85680.8996
     Allegheny County, PA
     Armstrong County, PA
     Beaver County, PA
     Butler County, PA
     Fayette County, PA
     Washington County, PA
     Westmoreland County, PA
    383402 Pittsfield, MA1.07571.0512
     Berkshire County, MA
    38540Pocatello, ID0.92040.9448
     Bannock County, ID
     Power County, ID
    38660Ponce, PR0.47120.5973
     Juana Díaz Municipio, PR
     Ponce Municipio, PR
     Villalba Municipio, PR
    Start Printed Page 59991
    38860Portland-South Portland-Biddeford, ME0.98620.9905
     Cumberland County, ME
     Sagadahoc County, ME
     York County, ME
    389001 Portland-Vancouver-Beaverton, OR-WA1.12101.0814
     Clackamas County, OR
     Columbia County, OR
     Multnomah County, OR
     Washington County, OR
     Yamhill County, OR
     Clark County, WA
     Skamania County, WA
    38940Port St. Lucie-Fort Pierce, FL0.99060.9936
     Martin County, FL
     St. Lucie County, FL
    39100Poughkeepsie-Newburgh-Middletown, NY1.09661.0652
     Dutchess County, NY
     Orange County, NY
    39140Prescott, AZ0.97480.9827
     Yavapai County, AZ
    393001,2 Providence-New Bedford-Fall River, RI-MA (RI Hospitals)1.07441.0504
     Bristol County, MA
     Bristol County, RI
     Kent County, RI
     Newport County, RI
     Providence County, RI
     Washington County, RI
    393001,2 Providence-New Bedford-Fall River, RI-MA (MA Hospitals)1.07571.0512
     Bristol County, MA
     Bristol County, RI
     Kent County, RI
     Newport County, RI
     Providence County, RI
     Washington County, RI
    39340Provo-Orem, UT0.94790.9640
     Juab County, UT
     Utah County, UT
    393802 Pueblo, CO0.90910.9368
     Pueblo County, CO
    39460Punta Gorda, FL0.97170.9805
     Charlotte County, FL
    395402 Racine, WI0.96070.9729
     Racine County, WI
    39580Raleigh-Cary, NC0.97220.9809
     Franklin County, NC
     Johnston County, NC
     Wake County, NC
    39660Rapid City, SD0.87080.9096
     Meade County, SD
     Pennington County, SD
    39740Reading, PA0.97090.9800
     Berks County, PA
    39820Redding, CA1.24501.1619
     Shasta County, CA
    39900Reno-Sparks, NV1.21261.1411
     Storey County, NV
     Washoe County, NV
    400601 Richmond, VA0.89970.9302
     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
    Start Printed Page 59992
     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
    401401,2 Riverside-San Bernardino-Ontario, CA1.12021.0808
     Riverside County, CA
     San Bernardino County, CA
    40220Roanoke, VA0.88030.9164
     Botetourt County, VA
     Craig County, VA
     Franklin County, VA
     Roanoke County, VA
     Roanoke City, VA
     Salem City, VA
    40340Rochester, MN1.12391.0833
     Dodge County, MN
     Olmsted County, MN
     Wabasha County, MN
    403801 Rochester, NY0.91030.9377
     Livingston County, NY
     Monroe County, NY
     Ontario County, NY
     Orleans County, NY
     Wayne County, NY
    40420Rockford, IL1.00481.0033
     Boone County, IL
     Winnebago County, IL
    404842 Rockingham County-Strafford County, NH1.17321.1156
     Rockingham County, NH
     Strafford County, NH
    40580Rocky Mount, NC0.89000.9233
     Edgecombe County, NC
     Nash County, NC
    40660Rome, GA0.96990.9793
     Floyd County, GA
    409001 Sacramento—Arden-Arcade—Roseville, CA1.29861.1959
     El Dorado County, CA
     Placer County, CA
     Sacramento County, CA
     Yolo County, CA
    40980Saginaw-Saginaw Township North, MI0.92110.9453
     Saginaw County, MI
    41060St. Cloud, MN1.10291.0694
     Benton County, MN
     Stearns County, MN
    41100St. George, UT0.94520.9621
     Washington County, UT
    41140St. Joseph, MO-KS1.02331.0159
     Doniphan County, KS
     Andrew County, MO
     Buchanan County, MO
     DeKalb County, MO
    41180St. Louis, MO-IL0.89980.9302
     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
    Start Printed Page 59993
     St. Louis County, MO
     Warren County, MO
     Washington County, MO
     St. Louis City, MO
    41420Salem, OR1.02831.0193
     Marion County, OR
     Polk County, OR
    41500Salinas, CA1.42201.2726
     Monterey County, CA
    415402 Salisbury, MD0.88810.9219
     Somerset County, MD
     Wicomico County, MD
    41620Salt Lake City, UT0.94760.9638
     Salt Lake County, UT
     Summit County, UT
     Tooele County, UT
    41660San Angelo, TX0.84830.8935
     Irion County, TX
     Tom Green County, TX
    417001 San Antonio, TX0.89450.9265
     Atascosa County, TX
     Bandera County, TX
     Bexar County, TX
     Comal County, TX
     Guadalupe County, TX
     Kendall County, TX
     Medina County, TX
     Wilson County, TX
    417401,2 San Diego-Carlsbad-San Marcos, CA1.12021.0808
     San Diego County, CA
    41780Sandusky, OH0.92580.9486
     Erie County, OH
    418841 San Francisco-San Mateo-Redwood City, CA1.54191.3452
     Marin County, CA
     San Francisco County, CA
     San Mateo County, CA
    41900San Germán-Cabo Rojo, PR0.48560.6098
     Cabo Rojo Municipio, PR
     Lajas Municipio, PR
     Sabana Grande Municipio, PR
     San Germán Municipio, PR
    419401 San Jose-Sunnyvale-Santa Clara, CA1.53241.3395
     San Benito County, CA
     Santa Clara County, CA
    419801 San Juan-Caguas-Guaynabo, PR0.44490.5743
     Aguas Buenas Municipio, PR
     Aibonito Municipio, PR
     Arecibo Municipio, PR
     Barceloneta Municipio, PR
     Barranquitas Municipio, PR
     Bayamón Municipio, PR
     Caguas Municipio, PR
     Camuy Municipio, PR
     Canóvanas Municipio, PR
     Carolina Municipio, PR
     Cataño Municipio, PR
     Cayey Municipio, PR
     Ciales Municipio, PR
     Cidra Municipio, PR
     Comerío 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
     Loíza Municipio, PR
    Start Printed Page 59994
     Manatí Municipio, PR
     Maunabo Municipio, PR
     Morovis Municipio, PR
     Naguabo Municipio, PR
     Naranjito Municipio, PR
     Orocovis Municipio, PR
     Quebradillas Municipio, PR
     Río 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
    420202 San Luis Obispo-Paso Robles, CA1.12021.0808
     San Luis Obispo County, CA
    420441 Santa Ana-Anaheim-Irvine, CA1.13501.0906
     Orange County, CA
    420602 Santa Barbara-Santa Maria, CA1.12021.0808
     Santa Barbara County, CA
    42100Santa Cruz-Watsonville, CA1.50561.3234
     Santa Cruz County, CA
    42140Santa Fe, NM1.08081.0547
     Santa Fe County, NM
    42220Santa Rosa-Petaluma, CA1.43221.2789
     Sonoma County, CA
    42260Sarasota-Bradenton-Venice, FL0.97430.9823
     Manatee County, FL
     Sarasota County, FL
    42340Savannah, GA0.91390.9402
     Bryan County, GA
     Chatham County, GA
     Effingham County, GA
    425402 Scranton—Wilkes-Barre, PA0.83010.8803
     Lackawanna County, PA
     Luzerne County, PA
     Wyoming County, PA
    426441 Seattle-Bellevue-Everett, WA1.12611.0847
     King County, WA
     Snohomish County, WA
    42680Sebastian-Vero Beach, FL0.98860.9922
     Indian River County, FL
    431002 Sheboygan, WI0.96070.9729
     Sheboygan County, WI
    43300Sherman-Denison, TX0.86510.9055
     Grayson County, TX
    43340Shreveport-Bossier City, LA0.88480.9196
     Bossier Parish, LA
     Caddo Parish, LA
     De Soto Parish, LA
    43580Sioux City, IA-NE-SD0.90620.9348
     Woodbury County, IA
     Dakota County, NE
     Dixon County, NE
     Union County, SD
    43620Sioux Falls, SD0.93510.9551
     Lincoln County, SD
     McCook County, SD
     Minnehaha County, SD
     Turner County, SD
    43780South Bend-Mishawaka, IN-MI0.99140.9941
     St. Joseph County, IN
     Cass County, MI
    43900Spartanburg, SC0.90720.9355
     Spartanburg County, SC
    44060Spokane, WA1.04221.0287
     Spokane County, WA
    44100Springfield, IL0.89510.9269
    Start Printed Page 59995
     Menard County, IL
     Sangamon County, IL
    441402 Springfield, MA1.07571.0512
     Franklin County, MA
     Hampden County, MA
     Hampshire County, MA
    44180Springfield, MO0.85700.8997
     Christian County, MO
     Dallas County, MO
     Greene County, MO
     Polk County, MO
     Webster County, MO
    442202 Springfield, OH0.86830.9078
     Clark County, OH
    44300State College, PA0.86550.9058
     Centre County, PA
    44700Stockton, CA1.14741.0987
     San Joaquin County, CA
    449402 Sumter, SC0.86920.9085
     Sumter County, SC
    45060Syracuse, NY0.97760.9846
     Madison County, NY
     Onondaga County, NY
     Oswego County, NY
    45104Tacoma, WA1.07101.0481
     Pierce County, WA
    45220Tallahassee, FL0.89590.9275
     Gadsden County, FL
     Jefferson County, FL
     Leon County, FL
     Wakulla County, FL
    453001 Tampa-St. Petersburg-Clearwater, FL0.92650.9491
     Hernando County, FL
     Hillsborough County, FL
     Pasco County, FL
     Pinellas County, FL
    45460Terre Haute, IN0.88060.9166
     Clay County, IN
     Sullivan County, IN
     Vermillion County, IN
     Vigo County, IN
    455002 Texarkana, TX-Texarkana, AR (TX Hospitals)0.82250.8748
     Miller County, AR
     Bowie County, TX
    45500Texarkana, TX-Texarkana, AR (AR Hospitals)0.81070.8661
     Miller County, AR
     Bowie County, TX
    45780Toledo, OH0.94550.9623
     Fulton County, OH
     Lucas County, OH
     Ottawa County, OH
     Wood County, OH
    45820Topeka, KS0.87630.9135
     Jackson County, KS
     Jefferson County, KS
     Osage County, KS
     Shawnee County, KS
     Wabaunsee County, KS
    459402 Trenton-Ewing, NJ1.14021.0940
     Mercer County, NJ
    46060Tucson, AZ0.93900.9578
     Pima County, AZ
    46140Tulsa, OK0.83100.8809
     Creek County, OK
     Okmulgee County, OK
     Osage County, OK
     Pawnee County, OK
     Rogers County, OK
     Tulsa County, OK
     Wagoner County, OK
    Start Printed Page 59996
    46220Tuscaloosa, AL0.87610.9134
     Greene County, AL
     Hale County, AL
     Tuscaloosa County, AL
    46340Tyler, TX0.89630.9278
     Smith County, TX
    46540Utica-Rome, NY0.87530.9128
     Herkimer County, NY
     Oneida County, NY
    46660Valdosta, GA0.86320.9042
     Brooks County, GA
     Echols County, GA
     Lanier County, GA
     Lowndes County, GA
    46700Vallejo-Fairfield, CA1.47941.3076
     Solano County, CA
    47020Victoria, TX0.84260.8893
     Calhoun County, TX
     Goliad County, TX
     Victoria County, TX
    472202 Vineland-Millville-Bridgeton, NJ1.14021.0940
     Cumberland County, NJ
    472601 Virginia Beach-Norfolk-Newport News, VA-NC0.87740.9143
     Currituck County, NC
     Gloucester County, VA
     Isle of Wight County, VA
     James City County, VA
     Mathews County, VA
     Surry County, VA
     York County, VA
     Chesapeake City, VA
     Hampton City, VA
     Newport News City, VA
     Norfolk City, VA
     Poquoson City, VA
     Portsmouth City, VA
     Suffolk City, VA
     Virginia Beach City, VA
     Williamsburg City, VA
    473002 Visalia-Porterville, CA1.12021.0808
     Tulare County, CA
    47380Waco, TX0.87480.9125
     McLennan County, TX
    47580Warner Robins, GA0.88120.9170
     Houston County, GA
    476441 Warren-Troy-Farmington Hills, MI1.01081.0074
     Lapeer County, MI
     Livingston County, MI
     Macomb County, MI
     Oakland County, MI
     St. Clair County, MI
    478941 Washington-Arlington-Alexandria, DC-VA-MD-WV1.09771.0659
     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
    Start Printed Page 59997
     Manassas Park City, VA
     Jefferson County, WV
    479402,3 Waterloo-Cedar Falls, IA0.88030.9164
     Black Hawk County, IA
     Bremer County, IA
     Grundy County, IA
    48140Wausau, WI0.99470.9964
     Marathon County, WI
    48260Weirton-Steubenville, WV-OH (WV Hospitals)0.80570.8625
     Jefferson County, OH
     Brooke County, WV
     Hancock County, WV
    482602 Weirton-Steubenville, WV-OH (OH Hospitals)0.86830.9078
     Jefferson County, OH
     Brooke County, WV
     Hancock County, WV
    483002 Wenatchee, WA1.02061.0141
     Chelan County, WA
     Douglas County, WA
    484241 West Palm Beach-Boca Raton-Boynton Beach, FL0.95350.9679
     Palm Beach County, FL
    485402 Wheeling, WV-OH (WV Hospitals)0.77540.8401
     Belmont County, OH
     Marshall County, WV
     Ohio County, WV
    485402 Wheeling, WV-OH (OH Hospitals)0.86830.9078
     Belmont County, OH
     Marshall County, WV
     Ohio County, WV
    48620Wichita, KS0.90160.9315
     Butler County, KS
     Harvey County, KS
     Sedgwick County, KS
     Sumner County, KS
    48660Wichita Falls, TX0.85620.8991
     Archer County, TX
     Clay County, TX
     Wichita County, TX
    487002 Williamsport, PA0.83010.8803
     Lycoming County, PA
    48864Wilmington, DE-MD-NJ (DE, MD Hospitals)1.05701.0387
     New Castle County, DE
     Cecil County, MD
     Salem County, NJ
    488642 Wilmington, DE-MD-NJ (NJ Hospitals)1.14021.0940
     New Castle County, DE
     Cecil County, MD
     Salem County, NJ
    48900Wilmington, NC0.97710.9843
     Brunswick County, NC
     New Hanover County, NC
     Pender County, NC
    49020Winchester, VA-WV1.00571.0039
     Frederick County, VA
     Winchester City, VA
     Hampshire County, WV
    49180Winston-Salem, NC0.92460.9477
     Davie County, NC
     Forsyth County, NC
     Stokes County, NC
     Yadkin County, NC
    49340Worcester, MA1.07961.0538
     Worcester County, MA
    494202 Yakima, WA1.02061.0141
     Yakima County, WA
    49500Yauco, PR0.37710.5128
     Guánica Municipio, PR
     Guayanilla Municipio, PR
     Peñuelas Municipio, PR
     Yauco Municipio, PR
    Start Printed Page 59998
    49620York-Hanover, PA0.94960.9652
     York County, PA
    49660Youngstown-Warren-Boardman, OH-PA0.87990.9161
     Mahoning County, OH
     Trumbull County, OH
     Mercer County, PA
    497002 Yuba City, CA1.12021.0808
     Sutter County, CA
     Yuba County, CA
    497402 Yuma, AZ0.92690.9493
     Yuma County, AZ
    1 Large urban area.
    2 Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2007.
    3 For this area, the wage index and GAF on this table are only effective from October 1, 2006 through March 31, 2007. See Table 4A-2 for the values that are effective from April 1 through September 30, 2007.

    Table 4A-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Urban Areas by CBSA for the Period April 1 Through September 30, 2007 *

    CBSA codeUrban area (constituent counties)Wage indexGAF
    11260Anchorage, AK1.19271.1283
    11460Ann Arbor, MI1.06781.0459
    13020Bay City, MI1.00441.0030
    13900Bismarck, ND0.73680.8113
    16220Casper, WY0.90910.9368
    16300Cedar Rapids, IA0.87080.9096
    16940Cheyenne, WY0.90480.9338
    19804Detroit-Livonia-Dearborn, MI1.03811.0259
    21660Eugene-Springfield, OR1.09661.0652
    22020Fargo, ND-MN (ND Hospitals)0.83670.8851
    22020Fargo, ND-MN (MN Hospitals)0.92800.9501
    24220Grand Forks, ND-MN (ND Hospitals)0.78240.8453
    24220Grand Forks, ND-MN (MN Hospitals)0.92800.9501
    24300Grand Junction, CO0.98790.9917
    26820Idaho Falls, ID0.92170.9457
    31084Los Angeles-Long Beach-Santa Ana, CA1.16861.1126
    34740Muskegon-Norton Shores, MI1.01051.0072
    35004Nassau-Suffolk, NY1.29711.1950
    35300New Haven-Milford, CT1.21421.1421
    35644New York-White Plains-Wayne, NY-NJ1.33441.2184
    47940Waterloo-Cedar Falls, IA0.86150.9029
    * See Table 4A-1 for the wage index and GAF that are effective from October 1, 2006 through March 31, 2007. For areas that are not listed on this table, the wage index and GAF on Table 4A-1 are effective for the entire FY 2007.

    Table 4B-1.—Wage Index and Capital Geographic Adjustment (GAF) for Rural Areas by CBSA—FY 2007

    CBSA codeNonurban areaWage indexGAF
    01Alabama0.76640.8334
    02Alaska1.07021.0476
    03Arizona0.92690.9493
    04Arkansas0.74750.8193
    05California1.12021.0808
    06Colorado0.90910.9368
    07Connecticut1.19881.1322
    08Delaware1.00091.0006
    10Florida0.87330.9114
    11Georgia0.78250.8454
    12Hawaii1.06271.0425
    13Idaho0.85680.8996
    14Illinois0.83580.8844
    15Indiana0.85640.8993
    16Iowa20.88030.9164
    17Kansas0.80180.8596
    18Kentucky0.78050.8439
    Start Printed Page 59999
    19Louisiana0.76600.8331
    20Maine0.83930.8869
    21Maryland0.88810.9219
    22Massachusetts11.07571.0512
    23Michigan0.90280.9324
    24Minnesota20.91950.9441
    25Mississippi0.77960.8432
    26Missouri0.83530.8841
    27Montana0.86550.9058
    28Nebraska0.86360.9045
    29Nevada0.91810.9432
    30New Hampshire1.17321.1156
    31New Jersey11.14021.0940
    32New Mexico0.83750.8856
    33New York0.84300.8896
    34North Carolina0.86290.9040
    35North Dakota0.73680.8113
    36Ohio0.86830.9078
    37Oklahoma0.78470.8470
    38Oregon21.01941.0132
    39Pennsylvania0.83010.8803
    40Puerto Rico1
    41Rhode Island11.07441.0504
    42South Carolina0.86920.9085
    43South Dakota0.82980.8801
    44Tennessee0.81220.8672
    45Texas0.82250.8748
    46Utah0.82520.8767
    47Vermont0.96220.9740
    49Virginia0.81010.8657
    50Washington1.02061.0141
    51West Virginia0.77540.8401
    52Wisconsin0.96070.9729
    53Wyoming20.91990.9444
    1 All counties in the State or Territory are classified as urban, with the exception of Massachusetts. Massachusetts has area(s) designated as rural. However, no short-term, acute care hospitals are located in the area(s) for FY 2007.
    Massachusetts, New Jersey, and Rhode Island rural floors are imputed as discussed in the FY 2005 IPPS final rule, (69 FR 49109).
    2 For this area, the wage index and GAF on this table are only effective from October 1, 2006 through March 31, 2007. See Table 4C-2 for the values that are effective from April 1 through September 30, 2007.

    Table 4B-2.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Certain Rural Areas by CBSA for the Period April 1 Through September 30, 2007 *

    CBSA codeNonurban areaWage indexGAF
    16Iowa0.86150.9029
    24Minnesota0.92800.9501
    38Oregon0.97640.9838
    53Wyoming0.90480.9338
    * See Table 4B-1 for the wage index and GAF that are effective from October 1, 2006 through March 31, 2007. For areas that are not listed on this table, the wage index and GAF on Table 4B-1 are effective for the entire FY 2007.

    Table 4C-1.—Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals that are Reclassified by CBSA

    CBSA codeAreaWage indexGAF
    10180Abilene, TX0.83800.8860
    10420Akron, OH0.86830.9078
    10580Albany-Schenectady-Troy, NY0.88490.9197
    10740Albuquerque, NM0.94440.9616
    10780Alexandria, LA0.79610.8554
    10900Allentown-Bethlehem-Easton, PA-NJ0.99900.9993
    11020Altoona, PA0.85380.8974
    11100Amarillo, TX0.92480.9479
    11180Ames, IA0.92190.9458
    Start Printed Page 60000
    114601 Ann Arbor, MI1.05631.0382
    11500Anniston-Oxford, AL0.79970.8581
    11700Asheville, NC0.92640.9490
    12020Athens-Clarke County, GA0.94560.9624
    12060Atlanta-Sandy Springs-Marietta, GA0.97930.9858
    12260Augusta-Richmond County, GA-SC0.95310.9676
    12420Austin-Round Rock, TX0.93280.9535
    12620Bangor, ME0.96120.9733
    12700Barnstable Town, MA1.21561.1430
    12940Baton Rouge, LA0.80850.8645
    130201 Bay City, MI1.00801.0055
    13644Bethesda-Gaithersburg-Frederick, MD1.08481.0573
    13780Binghamton, NY0.86260.9037
    13820Birmingham-Hoover, AL0.88890.9225
    14260Boise City-Nampa, ID0.93130.9524
    14484Boston-Quincy, MA1.13431.0901
    14540Bowling Green, KY0.80820.8643
    15380Buffalo-Niagara Falls, NY0.94750.9637
    15540Burlington-South Burlington, VT0.94360.9610
    15764Cambridge-Newton-Framingham, MA1.10031.0676
    16180Carson City, NV0.94680.9633
    16580Champaign-Urbana, IL0.90960.9372
    16620Charleston, WV0.84150.8885
    16700Charleston-North Charleston, SC0.91970.9443
    16740Charlotte-Gastonia-Concord, NC-SC0.94130.9594
    16820Charlottesville, VA0.97090.9800
    16860Chattanooga, TN-GA0.88220.9177
    16974Chicago-Naperville-Joliet, IL1.05641.0383
    17140Cincinnati-Middletown, OH-KY-IN0.95220.9670
    17300Clarksville, TN-KY0.80140.8593
    17460Cleveland-Elyria-Mentor, OH0.92290.9465
    17780College Station-Bryan, TX0.89030.9235
    17860Columbia, MO0.84560.8915
    17900Columbia, SC0.89420.9263
    17980Columbus, GA-AL0.83710.8854
    18140Columbus, OH0.98910.9925
    18700Corvallis, OR1.09561.0645
    19124Dallas-Plano-Irving, TX0.97430.9823
    19340Davenport-Moline-Rock Island, IA-IL0.88360.9187
    19380Dayton, OH0.91850.9434
    19460Decatur, AL0.80650.8631
    19740Denver-Aurora, CO1.05551.0377
    19780Des Moines-West Des Moines,IA0.90090.9310
    198041 Detroit-Livonia-Dearborn, MI1.03811.0259
    20100Dover, DE1.00091.0006
    20260Duluth, MN-WI1.02851.0194
    20500Durham, NC0.96770.9778
    20764Edison, NJ1.14021.0940
    21060Elizabethtown, KY0.81440.8688
    21500Erie, PA0.84510.8911
    216601 Eugene-Springfield, OR1.04941.0336
    21780Evansville, IN-KY0.85530.8985
    220201 Fargo, ND-MN0.83670.8851
    22180Fayetteville, NC0.92450.9477
    22220Fayetteville-Springdale-Rogers, AR-MO0.88160.9173
    22380Flagstaff, AZ1.10731.0723
    22420Flint, MI1.06021.0408
    22520Florence-Muscle Shoals, AL0.78760.8492
    22660Fort Collins-Loveland, CO0.92330.9468
    22744Fort Lauderdale-Pompano Beach-Deerfield Beach, FL1.03201.0218
    22900Fort Smith, AR-OK0.78470.8470
    23020Fort Walton Beach-Crestview-Destin, FL0.87330.9114
    23060Fort Wayne, IN0.92830.9503
    23104Fort Worth-Arlington, TX0.95560.9694
    23540Gainesville, FL0.94200.9599
    23844Gary, IN0.93970.9583
    24340Grand Rapids-Wyoming, MI0.95540.9692
    24500Great Falls, MT0.87470.9124
    24540Greeley, CO0.98570.9902
    24580Green Bay, WI (WI Hospitals)0.96070.9729
    Start Printed Page 60001
    24580Green Bay, WI (MI Hospitals)0.95730.9706
    24780Greenville, NC0.92230.9461
    24860Greenville, SC0.92080.9451
    25060Gulfport-Biloxi, MS0.84610.8919
    25420Harrisburg-Carlisle, PA0.92300.9466
    25540Hartford-West Hartford-East Hartford, CT (CT Hospitals)1.19881.1322
    25540Hartford-West Hartford-East Hartford, CT (MA Hospitals)1.09701.0655
    25860Hickory-Lenoir-Morganton, NC0.88600.9205
    26100Holland-Grand Haven, MI0.92170.9457
    26180Honolulu, HI1.09111.0615
    26420Houston-Sugar Land-Baytown, TX1.00941.0064
    26580Huntington-Ashland, WV-KY-OH (WV, KY Hospitals)0.86810.9077
    26580Huntington-Ashland, WV-KY-OH (OH Hospitals)0.86830.9078
    26620Huntsville, AL0.87560.9130
    268201 Idaho Falls, ID0.90360.9329
    26900Indianapolis-Carmel, IN0.96190.9737
    26980Iowa City, IA0.94540.9623
    27060Ithaca, NY0.94070.9590
    27140Jackson, MS0.82140.8740
    27180Jackson, TN0.86430.9050
    27260Jacksonville, FL0.92810.9502
    27860Jonesboro, AR (AR Hospitals)0.83450.8835
    27860Jonesboro, AR (MO Hospitals)0.83530.8841
    27900Joplin, MO0.86260.9037
    28020Kalamazoo-Portage, MI1.07971.0539
    28100Kankakee-Bradley, IL1.00211.0014
    28140Kansas City, MO-KS0.93450.9547
    28420Kennewick-Richland-Pasco, WA1.02061.0141
    28700Kingsport-Bristol-Bristol, TN-VA0.82150.8740
    28740Kingston, NY0.91950.9441
    28940Knoxville, TN0.82270.8749
    29180Lafayette, LA0.84080.8880
    29404Lake County-Kenosha County, IL-WI1.06511.0441
    29460Lakeland, FL0.90560.9344
    29540Lancaster, PA0.99420.9960
    29620Lansing-East Lansing, MI0.98960.9929
    29740Las Cruces, NM0.91240.9391
    29820Las Vegas-Paradise, NV1.10061.0678
    30020Lawton, OK0.84850.8936
    30460Lexington-Fayette, KY0.86430.9050
    30620Lima, OH0.89250.9251
    30700Lincoln, NE0.96170.9736
    30780Little Rock-North Little Rock, AR0.92650.9491
    30980Longview, TX0.89460.9266
    310841 Los Angeles-Long Beach-Santa Ana, CA1.15301.1024
    31140Louisville-Jefferson County, KY-IN0.91550.9413
    31340Lynchburg, VA0.86000.9019
    31420Macon, GA0.94430.9615
    31540Madison, WI1.06211.0421
    31700Manchester-Nashua, NH1.17321.1156
    32780Medford, OR1.04041.0275
    32820Memphis, TN-MS-AR0.89840.9293
    33124Miami-Miami Beach-Kendall, FL0.98210.9877
    33260Midland, TX0.93870.9576
    33340Milwaukee-Waukesha-West Allis, WI1.02091.0143
    33460Minneapolis-St. Paul-Bloomington, MN-WI1.07821.0529
    33540Missoula, MT0.87830.9150
    33740Monroe, LA0.80740.8637
    33860Montgomery, AL0.79330.8534
    34060Morgantown, WV0.85550.8986
    34980Nashville-Davidson—Murfreesboro, TN0.95500.9690
    35084Newark-Union, NJ-PA1.17561.1172
    35380New Orleans-Metairie-Kenner, LA0.86490.9054
    356441 New York-White Plains-Wayne, NY-NJ1.31341.2053
    35980Norwich-New London, CT1.20311.1350
    36084Oakland-Fremont-Hayward, CA1.56171.3570
    36140Ocean City, NJ1.03361.0229
    36220Odessa, TX0.97140.9803
    36260Ogden-Clearfield, UT0.90800.9360
    36420Oklahoma City, OK0.88070.9167
    Start Printed Page 60002
    36540Omaha-Council Bluffs, NE-IA0.93990.9584
    36740Orlando-Kissimmee, FL0.95750.9707
    37860Pensacola-Ferry Pass-Brent, FL0.78710.8488
    37900Peoria, IL0.89660.9280
    37964Philadelphia, PA (PA Hospitals)1.09961.0672
    37964Philadelphia, PA (NJ Hospitals)1.14021.0940
    38220Pine Bluff, AR0.83970.8872
    38300Pittsburgh, PA (PA, WV Hospitals)0.85680.8996
    38300Pittsburgh, PA (OH Hospitals)0.86830.9078
    38340Pittsfield, MA0.98870.9922
    38540Pocatello, ID0.92040.9448
    38860Portland-South Portland-Biddeford, ME0.94720.9635
    38900Portland-Vancouver-Beaverton, OR-WA1.12101.0814
    38940Port St. Lucie-Fort Pierce, FL0.99060.9936
    39100Poughkeepsie-Newburgh-Middletown, NY1.06601.0447
    39340Provo-Orem, UT0.94790.9640
    39580Raleigh-Cary, NC0.94920.9649
    39740Reading, PA0.97090.9800
    39820Redding, CA1.22031.1461
    39900Reno-Sparks, NV1.17131.1144
    40060Richmond, VA0.89970.9302
    40220Roanoke, VA0.87000.9090
    40340Rochester, MN1.12391.0833
    40380Rochester, NY0.91030.9377
    40420Rockford, IL0.98280.9882
    40484Rockingham County, NH1.02371.0162
    40660Rome, GA0.96990.9793
    40900Sacramento—Arden-Arcade—Roseville, CA1.29861.1959
    40980Saginaw-Saginaw Township North, MI0.90280.9324
    41060St. Cloud, MN1.03021.0206
    41100St. George, UT0.94520.9621
    41140St. Joseph, MO-KS1.00451.0031
    41180St. Louis, MO-IL0.88890.9225
    41620Salt Lake City, UT0.94760.9638
    41700San Antonio, TX0.89450.9265
    41884San Francisco-San Mateo-Redwood City, CA1.52601.3357
    41980San Juan-Caguas-Guaynabo, PR0.44490.5743
    42044Santa Ana-Anaheim-Irvine, CA1.12021.0808
    42140Santa Fe, NM0.98080.9868
    42220Santa Rosa-Petaluma, CA1.41161.2663
    42260Sarasota-Bradenton-Venice, FL0.97430.9823
    42340Savannah, GA0.90230.9320
    42644Seattle-Bellevue-Everett, WA1.10961.0738
    43300Sherman-Denison, TX0.85260.8965
    43340Shreveport-Bossier City, LA0.86880.9082
    43580Sioux City, IA-NE-SD0.86930.9085
    43620Sioux Falls, SD0.92380.9472
    43780South Bend-Mishawaka, IN-MI0.97210.9808
    43900Spartanburg, SC0.90720.9355
    44060Spokane, WA1.02441.0166
    44180Springfield, MO0.84120.8883
    44300State College, PA0.83010.8803
    44940Sumter, SC0.86920.9085
    45060Syracuse, NY0.94980.9653
    45220Tallahassee, FL0.88020.9163
    45300Tampa-St. Petersburg-Clearwater, FL0.92650.9491
    45500Texarkana, TX-Texarkana, AR0.81070.8661
    45780Toledo, OH0.94550.9623
    45820Topeka, KS0.86390.9047
    46140Tulsa, OK0.83100.8809
    46220Tuscaloosa, AL0.83620.8847
    46340Tyler, TX0.89630.9278
    46660Valdosta, GA0.86320.9042
    46700Vallejo-Fairfield, CA1.40951.2650
    47260Virginia Beach-Norfolk-Newport News, VA0.87740.9143
    47380Waco, TX0.87480.9125
    47894Washington-Arlington-Alexandria, DC-VA-MD-WV1.08771.0593
    48140Wausau, WI0.99470.9964
    48620Wichita, KS0.87760.9145
    48700Williamsport, PA0.83010.8803
    Start Printed Page 60003
    48864Wilmington, DE-MD-NJ1.05701.0387
    48900Wilmington, NC0.94730.9636
    49180Winston-Salem, NC0.92460.9477
    49340Worcester, MA1.17321.1156
    49660Youngstown-Warren-Boardman, OH-PA0.86900.9083
    04Arkansas0.76600.8331
    05California1.12021.0808
    07Connecticut1.19881.1322
    10Florida (FL Hospitals)0.87330.9114
    10Florida (GA Hospitals)0.84890.8939
    14Illinois (IL Hospitals)0.83580.8844
    14Illinois (KY Hospitals)0.82480.8764
    14Illinois (MO Hospitals)0.83530.8841
    161 Iowa0.87000.9090
    17Kansas0.80180.8596
    23Michigan0.90280.9324
    26Missouri0.83530.8841
    30New Hampshire1.13941.0935
    33New York0.84300.8896
    34North Carolina0.86290.9040
    36Ohio0.86830.9078
    37Oklahoma0.78470.8470
    381 Oregon1.01941.0132
    39Pennsylvania0.84300.8896
    44Tennessee0.81220.8672
    45Texas0.82250.8748
    47Vermont0.93800.9571
    50Washington (WA Hospitals)1.02061.0141
    50Washington (ID Hospitals)0.99780.9985
    52Wisconsin0.96070.9729
    531 Wyoming0.90660.9351
    1 For this area, the wage index and GAF on this table are only effective from October 1, 2006 through March 31, 2007. See Table 4C-2 for the values that are effective from April 1 through September 30, 2007.

    Table 4C2.—Wage Index and capital Geographic Adjustment Factor (GAF) for Certain Hospitals That Are Reclassified by CBSA for the Period April 1 Trhough September 30, 2007*

    CBSA codeAreaWage indexGAF
    11260Anchorage, AK1.19271.1283
    11460Ann Arbor, MI1.04401.0299
    13020Bay City, MI1.00441.0030
    13900Bismarck, ND0.736800.8113
    19804Detroit-Livonia-Dearborn, MI1.02811.0192
    21660Eugene-Springfield, OR1.05981.0406
    22020Fargo, ND-MN0.83670.8851
    24300Grand Junction, CO0.98790.9917
    26820Idaho Falls, ID0.92170.9457
    31084Los Angeles-Long Beach-Santa Ana, CA1.15201.1017
    34740Muskegon-Norton Shores, MI0.97620.9836
    35004Nassau-Suffolk, NY1.27301.1797
    35300New Haven-Milford, CT1.21421.1421
    35644New York-White Plains-Wayne, NY-NJ1.31131.2039
    16Iowa0.86150.9029
    24Minnesota0.92800.9501
    38Oregon0.976400.9838
    53Wyoming0.90480.9338
    ** See Table 4C-1 for the wage index and GAF that are effective from October 1, 2006 through March 31, 2007. For areas that are not listed on this table, the wage index and GAF on Table 4C-1 are effective for the entire FY 2007.

    Table 4F.—Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) by CBSA

    CBSA codeAreaWage IndexGAFWage Index—reclassified rospitalsGAF— Reclassified hospitals
    10380Aguadilla-Isabela-San Sebastián, PR0.87360.9116
    Start Printed Page 60004
    21940Fajardo, PR0.91680.9422
    25020Guayama, PR0.73260.8081;
    32420Mayagüez, PR0.87390.9118;
    38660Ponce, PR1.07811.0528
    41900San Germán-Cabo Rojo, PR1.10521.0709
    41980San Juan-Caguas-Guaynabo, PR1.01191.00811.01191.0081
    49500Yauco, PR0.86680.9067

    The following list represents all hospitals located in counties that became newly eligible in FY 2005, FY 2006 or FY 2007 to have their wage index increased by the out-migration adjustment listed in this table. This table now reflects any additional hospitals located in counties that may newly qualify for the adjustment in FY 2007 based on the 100 percent occupational mix adjusted wage index data. Hospitals cannot receive the out-migration adjustment if they are reclassified under section 1886(d)(10) of the Act, reclassified under section 508 of Pub. L. 108-173, or redesignated under section 1886(d)(8) of the Act. If a hospital has a half fiscal year reclassification, the hospital will be eligible for the out-migration adjustment for the portion of the fiscal year that it is not reclassified. Hospitals that have been reclassified under section 1886(d)(10) of the Act, reclassified under section 508 of Pub. L. 108-173, or redesignated under section 1886(d)(8) of the Act for any portion of the fiscal year are designated with an asterisk. It is important to note that the asterisked information in Table 4J may reflect withdrawal/termination decisions CMS has made on behalf of hospitals. For example, in some cases, CMS may have withdrawn or terminated a reclassification under section 1886(d)(10) of the Act in order for a hospital to receive its home wage index plus an out-migration adjustment. Hospitals have 30 days from this publication of the final occupation mix-adjusted data and other tables on the CMS Web site to reverse a decision CMS has made on its behalf and choose a wage index, adjustment, or reclassification for which they are otherwise eligible.

    Table 4J.—Out-Migration Adjustment —FY 2007

    Provider No.Reclassified between 10/1/06 and 3/31/07Reclassified between 4/1/07 and 9/30/07Out-migration adjustmentQualifying county name
    010005**0.0259MARSHALL
    010008**0.0212CRENSHAW
    010009**0.0259MARSHALL
    010012**0.0205DE KALB
    010022**0.0714CHEROKEE
    010025**0.0235CHAMBERS
    010029**0.0107LEE
    010035**0.0375CULLMAN
    0100380.0062CALHOUN
    010045**0.0160FAYETTE
    0100470.0155BUTLER
    0100520.0103TALLAPOOSA
    010054**0.0092MORGAN
    0100610.0506JACKSON
    010065**0.0103TALLAPOOSA
    0100780.0062CALHOUN
    010083**0.0121BALDWIN
    010085**0.0092MORGAN
    010100**0.0121BALDWIN
    010101**0.0310TALLADEGA
    0101090.0451PICKENS
    0101290.0121BALDWIN
    010143**0.0375CULLMAN
    0101460.0062CALHOUN
    010150**0.0155BUTLER
    010158**0.0093FRANKLIN
    010164**0.0310TALLADEGA
    040014**0.0159WHITE
    040019**0.0697ST. FRANCIS
    040047**0.0090RANDOLPH
    040069**0.0140MISSISSIPPI
    040071**0.0026JEFFERSON
    040076**0.1075HOT SPRING
    040100**0.0159WHITE
    0500080.0026SAN FRANCISCO
    Start Printed Page 60005
    050009**0.0478NAPA
    050013**0.0478NAPA
    050014**0.0131AMADOR
    0500160.0103SAN LUIS OBISPO
    050042**0.0219TEHAMA
    050046**0.0156VENTURA
    0500470.0026SAN FRANCISCO
    0500550.0026SAN FRANCISCO
    050065**0.0029ORANGE
    050069**0.0029ORANGE
    050073**0.0269SOLANO
    050076**0.0026SAN FRANCISCO
    050082*0.0156VENTURA
    0500840.0555SAN JOAQUIN
    050089**0.0152SAN BERNARDINO
    050090**0.0308SONOMA
    050099**0.0152SAN BERNARDINO
    050101**0.0269SOLANO
    0501170.0463MERCED
    0501180.0555SAN JOAQUIN
    0501220.0555SAN JOAQUIN
    050129**0.0152SAN BERNARDINO
    0501330.0170YUBA
    050136**0.0308SONOMA
    050140**0.0152SAN BERNARDINO
    050150**0.0316NEVADA
    0501520.0026SAN FRANCISCO
    050159*0.0156VENTURA
    0501670.0555SAN JOAQUIN
    050168**0.0029ORANGE
    050173**0.0029ORANGE
    050174**0.0308SONOMA
    050193**0.0029ORANGE
    0501940.0052SANTA CRUZ
    050224**0.0029ORANGE
    050226**0.0029ORANGE
    050228**0.0026SAN FRANCISCO
    050230**0.0029ORANGE
    0502320.0103SAN LUIS OBISPO
    050236*0.0156VENTURA
    0502420.0052SANTA CRUZ
    050245**0.0152SAN BERNARDINO
    050272**0.0152SAN BERNARDINO
    050279**0.0152SAN BERNARDINO
    050291**0.0308SONOMA
    050298**0.0152SAN BERNARDINO
    050300**0.0152SAN BERNARDINO
    0503130.0555SAN JOAQUIN
    0503250.0176TUOLUMNE
    050327**0.0152SAN BERNARDINO
    0503350.0176TUOLUMNE
    0503360.0555SAN JOAQUIN
    050348**0.0029ORANGE
    050367**0.0269SOLANO
    050385**0.0308SONOMA
    050394*0.0156VENTURA
    0504070.0026SAN FRANCISCO
    050426**0.0029ORANGE
    0504440.0463MERCED
    0504540.0026SAN FRANCISCO
    0504570.0026SAN FRANCISCO
    050469**0.0152SAN BERNARDINO
    0504760.0257LAKE
    050494*0.0316NEVADA
    0505060.0103SAN LUIS OBISPO
    050517**0.0152SAN BERNARDINO
    050526**0.0029ORANGE
    050528**0.0463MERCED
    050535**0.0029ORANGE
    Start Printed Page 60006
    050543**0.0029ORANGE
    050547**0.0308SONOMA
    050548**0.0029ORANGE
    050549**0.0156VENTURA
    050550**0.0029ORANGE
    050551**0.0029ORANGE
    050567**0.0029ORANGE
    0505680.0062MADERA
    050570**0.0029ORANGE
    050580**0.0029ORANGE
    050584**0.0152SAN BERNARDINO
    050585**0.0029ORANGE
    050586**0.0152SAN BERNARDINO
    050589**0.0029ORANGE
    050592**0.0029ORANGE
    050594**0.0029ORANGE
    050603**0.0029ORANGE
    050609**0.0029ORANGE
    050616*0.0156VENTURA
    050618**0.0152SAN BERNARDINO
    0506330.0103SAN LUIS OBISPO
    050667**0.0478NAPA
    0506680.0026SAN FRANCISCO
    050678**0.0029ORANGE
    050680**0.0269SOLANO
    050690**0.0308SONOMA
    050693**0.0029ORANGE
    0506950.0555SAN JOAQUIN
    0507140.0052SANTA CRUZ
    050720**0.0029ORANGE
    050728**0.0308SONOMA
    0507440.0029ORANGE
    0507450.0029ORANGE
    0507460.0029ORANGE
    0507470.0029ORANGE
    050749*0.0156VENTURA
    060001**0.0294WELD
    060003**0.0203BOULDER
    0600100.0153LARIMER
    060027**0.0203BOULDER
    0600300.0153LARIMER
    060103**0.0203BOULDER
    0601160.0203BOULDER
    070003**0.0009WINDHAM
    070006**0.0047FAIRFIELD
    070010**0.0047FAIRFIELD
    070018**0.0047FAIRFIELD
    0700200.0073MIDDLESEX
    0700210.0009WINDHAM
    070028**0.0047FAIRFIELD
    070033**0.0047FAIRFIELD
    070034**0.0047FAIRFIELD
    0800010.0063NEW CASTLE
    0800030.0063NEW CASTLE
    1000140.0118VOLUSIA
    1000170.0118VOLUSIA
    100045**0.0118VOLUSIA
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    Start Printed Page 60007
    100252**0.0233OKEECHOBEE
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    Start Printed Page 60008
    1901440.0705WEBSTER
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    Start Printed Page 60009
    230130**0.0091OAKLAND
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    230207**0.0091OAKLAND
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    230264**0.0082MACOMB
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    230277**0.0091OAKLAND
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    240018**0.1196GOODHUE
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    240064**0.0138ITASCA
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    240071**0.0454RICE
    240187**0.0506MC LEOD
    240211**0.0705PINE
    250040**0.0294JACKSON
    2600110.0007COLE
    260047**0.0007COLE
    2600740.0158RANDOLPH
    2600970.0425JOHNSON
    280077**0.0089DODGE
    2801230.0137GAGE
    290019**0.0026CARSON CITY
    2900490.0026CARSON CITY
    2900510.0026CARSON CITY
    3000110.0069HILLSBOROUGH
    3000120.0069HILLSBOROUGH
    3000170.0361ROCKINGHAM
    3000200.0069HILLSBOROUGH
    3000230.0361ROCKINGHAM
    3000290.0361ROCKINGHAM
    3000340.0069HILLSBOROUGH
    310002**0.0351ESSEX
    310009**0.0351ESSEX
    3100100.0092MERCER
    3100110.0115CAPE MAY
    310013**0.0351ESSEX
    310018**0.0351ESSEX
    310021**0.0092MERCER
    310038**0.0350MIDDLESEX
    310039**0.0350MIDDLESEX
    3100440.0092MERCER
    310054**0.0351ESSEX
    310070**0.0350MIDDLESEX
    310076**0.0351ESSEX
    310083**0.0351ESSEX
    3100920.0092MERCER
    310093**0.0351ESSEX
    310096**0.0351ESSEX
    310108**0.0350MIDDLESEX
    3101100.0092MERCER
    310119**0.0351ESSEX
    3101230.0351ESSEX
    3101240.0350MIDDLESEX
    3200030.0629SAN MIGUEL
    3200110.0442RIO ARRIBA
    3200180.0063DONA ANA
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    330004**0.0959ULSTER
    330008**0.0470WYOMING
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    Start Printed Page 60010
    330094**0.0778COLUMBIA
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    330225*0.0137NASSAU
    330235**0.0270CAYUGA
    330259*0.0137NASSAU
    330264*0.0560ORANGE
    3302760.0063FULTON
    330331*0.0137NASSAU
    330332*0.0137NASSAU
    330372*0.0137NASSAU
    330386**0.1139SULLIVAN
    3400150.0267ROWAN
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    340021**0.0216CLEVELAND
    3400370.0216CLEVELAND
    340039**0.0144IREDELL
    3400690.0053WAKE
    3400700.0448ALAMANCE
    340073*0.0053WAKE
    3400850.0377DAVIDSON
    3400960.0377DAVIDSON
    3401040.0216CLEVELAND
    3401140.0053WAKE
    340126**0.0161WILSON
    340127**0.0961GRANVILLE
    340129**0.0144IREDELL
    3401330.0308MARTIN
    3401380.0053WAKE
    340144**0.0144IREDELL
    340145**0.0563LINCOLN
    3401730.0053WAKE
    360013**0.0166SHELBY
    3600250.0087ERIE
    360036**0.0263WAYNE
    360065**0.0141HURON
    3600700.0028STARK
    360078**0.0159PORTAGE
    3600840.0028STARK
    360086**0.0168CLARK
    360095**0.0087HANCOCK
    3601000.0028STARK
    360107**0.0213SANDUSKY
    3601310.0028STARK
    3601510.0028STARK
    3601560.0213SANDUSKY
    360175**0.0159CLINTON
    360187**0.0168CLARK
    360197**0.0092LOGAN
    3602700.0120DEFIANCE
    370004**0.0193OTTAWA
    3700140.0831BRYAN
    370015**0.0463MAYES
    3700230.0084STEPHENS
    3700650.0121CRAIG
    370113**0.0205DELAWARE
    3701490.0356POTTAWATOMIE
    3702190.0356POTTAWATOMIE
    3800020.0130JOSEPHINE
    380022**0.0201LINN
    3800290.0075MARION
    Start Printed Page 60011
    3800510.0075MARION
    3800560.0075MARION
    3900110.0012CAMBRIA
    390030**0.0284SCHUYLKILL
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    390044**0.0200BERKS
    390046**0.0098YORK
    3900560.0042HUNTINGDON
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    390066**0.0259LEBANON
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    3901300.0012CAMBRIA
    390138**0.0325FRANKLIN
    3901460.0053WARREN
    3901500.0206GREENE
    390151**0.0325FRANKLIN
    3901620.0200NORTHAMPTON
    3901810.0284SCHUYLKILL
    3901830.0284SCHUYLKILL
    3902010.1127MONROE
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    420009**0.0113OCONEE
    420020**0.0035GEORGETOWN
    420027**0.0210ANDERSON
    420030**0.0103COLLETON
    420039**0.0153UNION
    4200430.0177CHEROKEE
    4200620.0109CHESTERFIELD
    420068**0.0097ORANGEBURG
    420070**0.0101SUMTER
    420083**0.0001SPARTANBURG
    4200980.0035GEORGETOWN
    4400080.0663HENDERSON
    440024**0.0387BRADLEY
    4400300.0056HAMBLEN
    440035**0.0441MONTGOMERY
    4400470.0499GIBSON
    4400560.0321JEFFERSON
    4400600.0499GIBSON
    4400630.0011WASHINGTON
    440067**0.0056HAMBLEN
    440073**0.0513MAURY
    4401050.0011WASHINGTON
    4401150.0499GIBSON
    440148**0.0568DE KALB
    4401530.0007COCKE
    4401740.0372HAYWOOD
    4401810.0407HARDEMAN
    4401840.0011WASHINGTON
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    450032**0.0416HARRISON
    450039**0.0097TARRANT
    450059**0.0073COMAL
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    450087**0.0097TARRANT
    450099**0.0180GRAY
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    450135**0.0097TARRANT
    450137**0.0097TARRANT
    450144**0.0573ANDREWS
    4501630.0134KLEBERG
    450187**0.0264WASHINGTON
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    450214**0.0368WHARTON
    450224**0.0411WOOD
    450324**0.0132GRAYSON
    Start Printed Page 60012
    450347**0.0427WALKER
    4503700.0258COLORADO
    450389**0.0881HENDERSON
    450393**0.0132GRAYSON
    450395**0.0484POLK
    450419**0.0097TARRANT
    450438**0.0258COLORADO
    450447**0.0358NAVARRO
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    4504650.0435MATAGORDA
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    450547**0.0411WOOD
    450563**0.0097TARRANT
    4505650.0486PALO PINTO
    4505960.0808HOOD
    4505970.0077DE WITT
    450639**0.0097TARRANT
    450672**0.0097TARRANT
    450675**0.0097TARRANT
    450677**0.0097TARRANT
    450694**0.0368WHARTON
    450747**0.0195ANDERSON
    4507550.0484HOCKLEY
    450779**0.0097TARRANT
    450813**0.0195ANDERSON
    450872**0.0097TARRANT
    450880**0.0097TARRANT
    4508860.0097TARRANT
    4508880.0097TARRANT
    4600170.0392BOX ELDER
    460039**0.0392BOX ELDER
    4900190.1240CULPEPER
    4900380.0022SMYTH
    4900840.0167ESSEX
    490105**0.0022SMYTH
    4901100.0082MONTGOMERY
    500003**0.0208SKAGIT
    5000070.0208SKAGIT
    5000190.0213LEWIS
    500021**0.0055PIERCE
    5000240.0023THURSTON
    500039**0.0174KITSAP
    500041**0.0118COWLITZ
    500079**0.0055PIERCE
    500108**0.0055PIERCE
    500129**0.0055PIERCE
    5001390.0023THURSTON
    5001430.0023THURSTON
    510018**0.0209JACKSON
    5100390.0112OHIO
    510047**0.0275MARION
    5100500.0112OHIO
    510077**0.0021MINGO
    520028**0.0157GREEN
    5200350.0077SHEBOYGAN
    5200440.0077SHEBOYGAN
    5200570.0118SAUK
    520059**0.0200RACINE
    520071**0.0239JEFFERSON
    520095**0.0118SAUK
    520096**0.0200RACINE
    520102**0.0298WALWORTH
    520116**0.0239JEFFERSON
    5201320.0077SHEBOYGAN
    Start Printed Page 60013

    Table 5.— List of Diagnosis-Related Groups (DRGS), Relative Weighting Factors, and Geometric and Arithmetic Mean Length of Stay (LOS)

    DRGFY 07 final rule post-acute care DRGFY 07 final rule special pay DRGMDCTYPEDRG titleWeightsGeometric mean LOSArithmetic mean LOS
    1YesNo01SURGCraniotomy Age >17 W CC3.46517.39.8
    2YesNo01SURGCraniotomy Age >17 W/O CC1.95253.44.4
    3NoNo01SURG *Craniotomy Age 0-172.011312.712.7
    4NoNo01SURGNo Longer Valid0.00000.00.0
    5NoNo01SURGNo Longer Valid0.00000.00.0
    6NoNo01SURGCarpal Tunnel Release0.79102.13.1
    7YesYes01SURGPeriph & Cranial Nerve & Other Nerv Syst Proc W CC2.66096.59.4
    8YesYes01SURGPeriph & Cranial Nerve & Other Nerv Syst Proc W/O CC1.59532.02.8
    9NoNo01MEDSpinal Disorders & Injuries1.36474.46.2
    10YesNo01MEDNervous System Neoplasms W CC1.25564.66.0
    11YesNo01MEDNervous System Neoplasms W/O CC0.85922.73.6
    12YesNo01MEDDegenerative Nervous System Disorders0.93224.35.5
    13YesNo01MEDMultiple Sclerosis & Cerebellar Ataxia0.85414.04.9
    14YesNo01MEDIntracranial Hemorrhage or Cerebral Infarction1.21184.35.5
    15YesNo01MEDNonspecific CVA & Precerebral Occlusion w/o Infarct0.94423.14.0
    16YesNo01MEDNonspecific Cerebrovascular Disorders w CC1.35795.06.5
    17YesNo01MEDNonspecific Cerebrovascular Disorders w/o CC0.71412.43.0
    18YesNo01MEDCranial & Peripheral Nerve Disorders w CC1.00384.15.2
    19YesNo01MEDCranial & Peripheral Nerve Disorders w/o CC0.71942.73.4
    20NoNo01MEDNo Longer Valid0.00000.00.0
    21NoNo01MEDViral Meningitis1.41304.76.2
    22NoNo01MEDHypertensive Encephalopathy1.16523.95.0
    23NoNo01MEDNontraumatic Stupor & Coma0.80153.03.9
    24NoNo01MEDNo Longer Valid0.00000.00.0
    25NoNo01MEDNo Longer Valid0.00000.00.0
    26NoNo01MEDSeizure & Headache Age 0-171.00762.73.8
    27NoNo01MEDTraumatic Stupor & Coma, Coma >1 Hr1.34993.14.7
    28YesNo01MEDTraumatic Stupor & Coma, Coma <1 Hr Age >17 w CC1.33574.25.7
    29YesNo01MEDTraumatic Stupor & Coma, Coma <1 Hr Age >17 w/o CC0.74012.63.2
    30NoNo01MED *Traumatic Stupor & Coma, Coma <1 Hr Age 0-170.3402
    31NoNo01MEDConcussion Age >17 w CC0.97963.03.9
    32NoNo01MEDConcussion Age >17 w/o CC0.64081.92.3
    33NoNo01MED *Concussion Age 0-170.2136
    34YesNo01MEDOther Disorders Of Nervous System w CC1.01753.64.8
    35YesNo01MEDOther Disorders Of Nervous System w/o CC0.65872.53.1
    36NoNo02SURGRetinal Procedures0.80561.41.9
    37NoNo02SURGOrbital Procedures1.20642.74.1
    38NoNo02SURGPrimary Iris Procedures0.61952.22.8
    39NoNo02SURGLens Procedures With Or Without Vitrectomy0.64611.62.1
    40NoNo02SURGExtraocular Procedures Except Orbit Age >171.03093.14.2
    41NoNo02SURG *Extraocular Procedures Except Orbit Age 0-170.3462
    42NoNo02SURGIntraocular Procedures Except Retina, Iris & Lens0.77171.72.5
    43NoNo02MEDHyphema0.61922.43.0
    44NoNo02MEDAcute Major Eye Infections0.71863.84.8
    45NoNo02MEDNeurological Eye Disorders0.74342.53.0
    46NoNo02MEDOther Disorders Of The Eye Age >17 w CC0.79153.24.2
    47NoNo02MEDOther Disorders Of The Eye Age >17 w/o CC0.55202.43.0
    48NoNo02MED *Other Disorders Of The Eye Age 0-170.3050
    49NoNo03SURGMajor Head & Neck Procedures1.66843.24.5
    Start Printed Page 60014
    50NoNo03SURGSialoadenectomy0.88001.51.9
    51NoNo03SURGSalivary Gland Procedures Except Sialoadenectomy0.87881.92.7
    52NoNo03SURGCleft Lip & Palate Repair0.64981.31.5
    53NoNo03SURGSinus & Mastoid Procedures Age >171.35402.54.0
    54NoNo03SURG *Sinus & Mastoid Procedures Age 0-170.4944
    55NoNo03SURGMiscellaneous Ear, Nose, Mouth & Throat Procedures0.96521.92.9
    56NoNo03SURGRhinoplasty0.89361.92.7
    57NoNo03SURGT&A Proc, Except Tonsillectomy &/Or Adenoidectomy Only, Age >170.99752.13.3
    58NoNo03SURG *T&A Proc, Except Tonsillectomy &/Or Adenoidectomy Only, Age 0-170.2807
    59NoNo03SURGTonsillectomy &/Or Adenoidectomy Only, Age >170.68121.82.4
    60NoNo03SURG *Tonsillectomy &/Or Adenoidectomy Only, Age 0-170.21371.51.5
    61NoNo03SURGMyringotomy W Tube Insertion Age >171.59873.76.1
    62NoNo03SURG *Myringotomy W Tube Insertion Age 0-170.30271.31.3
    63NoNo03SURGOther Ear, Nose, Mouth & Throat O.R. Procedures1.39593.04.5
    64NoNo03MEDEar, Nose, Mouth & Throat Malignancy1.24984.26.2
    65NoNo03MEDDysequilibrium0.61592.32.8
    66NoNo03MEDEpistaxis0.62802.43.1
    67NoNo03MEDEpiglottitis0.82422.83.7
    68NoNo03MEDOtitis Media & Uri Age &>17 w CC0.66053.23.9
    69NoNo03MEDOtitis Media & Uri Age &>17 w/o CC0.49102.53.0
    70NoNo03MEDOtitis Media & Uri Age 0-170.35792.12.4
    71NoNo03MEDLaryngotracheitis0.77583.44.4
    72NoNo03MEDNasal Trauma & Deformity0.77842.63.3
    73YesNo03MEDOther Ear, Nose, Mouth & Throat Diagnoses Age >170.85003.34.3
    74NoNo03MED *Other Ear, Nose, Mouth & Throat Diagnoses Age 0-170.34412.12.1
    75YesNo04SURGMajor Chest Procedures3.03507.49.7
    76YesNo04SURGOther Resp System O.R. Procedures w CC2.83868.210.7
    77YesNo04SURGOther Resp System O.R. Procedures w/o CC1.18863.34.5
    78YesNo04MEDPulmonary Embolism1.23575.36.2
    79YesNo04MEDRespiratory Infections & Inflammations Age >17 w CC1.62686.78.3
    80YesNo04MEDRespiratory Infections & Inflammations Age >17 w/o CC0.89434.35.3
    81NoNo04MED *Respiratory Infections & Inflammations Age 0-171.55796.16.1
    82YesNo04MEDRespiratory Neoplasms1.41215.16.8
    83YesNo04MEDMajor Chest Trauma w CC1.03084.25.3
    84YesNo04MEDMajor Chest Trauma w/o CCc0.60282.63.1
    85YesNo04MEDPleural Effusion w CC1.24594.76.2
    86YesNo04MEDPleural Effusion w/o CC0.71322.73.5
    87NoNo04MEDPulmonary Edema & Respiratory Failure1.38384.96.4
    88NoNo04MEDChronic Obstructive Pulmonary Disease0.88784.04.9
    89YesNo04MEDSimple Pneumonia & Pleurisy Age >17 w CC1.03764.65.6
    90YesNo04MEDSimple Pneumonia & Pleurisy Age >17 w/o CCc0.61483.23.7
    91NoNo04MEDSimple Pneumonia & Pleurisy Age 0-170.55982.53.4
    92YesNo04MEDInterstitial Lung Disease w CC1.19794.86.0
    93YesNo04MEDInterstitial Lung Disease w/o CC0.74373.03.8
    94NoNo04MEDPneumothorax w CC1.14744.55.9
    95NoNo04MEDPneumothorax w/o CC0.58712.73.4
    96NoNo04MEDBronchitis & Asthma Age >17 w CC0.73503.54.3
    97NoNo04MEDBronchitis & Asthma Age >17 w/o CC0.54292.83.4
    98NoNo04MEDBronchitis & Asthma Age 0-170.58702.83.1
    99NoNo04MEDRespiratory Signs & Symptoms w CC0.71552.43.1
    100NoNo04MEDRespiratory Signs & Symptoms w/o CC0.54111.72.1
    Start Printed Page 60015
    101YesNo04MEDOther Respiratory System Diagnoses w CC0.86143.24.2
    102YesNo04MEDOther Respiratory System Diagnoses w/o CC0.56222.02.5
    103NoNoPRESURGHeart Transplant Or Implant Of Heart Assist System18.865322.235.4
    104YesNo05SURGCardiac Valve & Oth Major Cardiothoracic Proc w Card Cath8.290312.815.1
    105YesNo05SURGCardiac Valve & Oth Major Cardiothoracic Proc w/o Card Cath6.05678.410.2
    106NoNo05SURGCoronary Bypass w Ptca6.73839.310.9
    107NoNo05SURGNo Longer Valid0.00000.00.0
    108YesNo05SURGOther Cardiothoracic Procedures5.75448.810.9
    109NoNo05SURGNo Longer Valid0.00000.00.0
    110NoNo05SURGMajor Cardiovascular Procedures w CC3.80645.48.1
    111NoNo05SURGMajor Cardiovascular Procedures w/o CC2.48792.33.1
    112NoNo05SURGNo Longer Valid0.00000.00.0
    113YesNo05SURGAmputation For Circ System Disorders Except Upper Limb & Toe3.264610.813.7
    114YesNo05SURGUpper Limb & Toe Amputation For Circ System Disorders1.75276.68.7
    115NoNo05SURGNo Longer Valid0.00000.00.0
    116NoNo05SURGNo Longer Valid0.00000.00.0
    117NoNo05SURGCardiac Pacemaker Revision Except Device Replacement1.37132.64.3
    118NoNo05SURGCardiac Pacemaker Device Replacement1.66872.03.0
    119NoNo05SURGVein Ligation & Stripping1.45543.35.4
    120YesNo05SURGOther Circulatory System O.R. Procedures2.41736.09.2
    121YesNo05MEDCirculatory Disorders w AMI & Major Comp, Discharged Alive1.61665.26.5
    122NoNo05MEDCirculatory Disorders w AMI w/o Major Comp, Discharged Alive0.96212.73.4
    123NoNo05MEDCirculatory Disorders w AMI, Expired1.49022.94.7
    124NoNo05MEDCirculatory Disorders Except AMI, w Card Cath & Complex Diag1.40993.34.4
    125NoNo05MEDCirculatory Disorders Except Ami, w Card Cath w/o Complex Diag1.05302.12.7
    126YesNo05MEDAcute & Subacute Endocarditis2.66539.011.2
    127YesNo05MEDHeart Failure & Shock1.04904.15.2
    128NoNo05MEDDeep Vein Thrombophlebitis0.74994.45.2
    129NoNo05MEDCardiac Arrest, Unexplained1.01181.62.5
    130YesNo05MEDPeripheral Vascular Disorders w CC0.97124.35.5
    131YesNo05MEDPeripheral Vascular Disorders w/o CC0.57553.13.7
    132NoNo05MEDAtherosclerosis w CC0.63182.22.8
    133NoNo05MEDAtherosclerosis w/o CC0.54941.82.1
    134NoNo05MEDHypertension0.61892.53.1
    135NoNo05MEDCardiac Congenital & Valvular Disorders Age >17w CC0.94053.34.3
    136NoNo05MEDCardiac Congenital & Valvular Disorders Age >17 w/o CC0.65802.12.7
    137NoNo05MED *Cardiac Congenital & Valvular Disorders Age 0-170.8393
    138NoNo05MEDCardiac Arrhythmia & Conduction Disorders w CC0.83653.03.9
    139NoNo05MEDCardiac Arrhythmia & Conduction Disorders w/o CC0.52972.02.4
    140NoNo05MEDAngina Pectoris0.50411.92.4
    141NoNo05MEDSyncope & Collapse w CC0.76332.73.4
    142NoNo05MEDSyncope & Collapse w/o CC0.60122.12.5
    143NoNo05MEDChest Pain0.56371.72.1
    144YesNo05MEDOther Circulatory System Diagnoses w CC1.33814.35.9
    145YesNo05MEDOther Circulatory System Diagnoses w/o CC0.58342.02.6
    146YesNo06SURGRectal Resection w CC2.74318.49.9
    147YesNo06SURGRectal Resection w/o CC1.51244.95.6
    Start Printed Page 60016
    148NoNo06SURGNo Longer Valid0.00000.00.0
    149YesNo06SURGMajor Small & Large Bowel Procedures w/o CC1.43575.15.7
    150YesNo06SURGPeritoneal Adhesiolysis w CC2.78718.710.8
    151YesNo06SURGPeritoneal Adhesiolysis w/o CC1.28634.05.0
    152NoNo06SURGMinor Small & Large Bowel Procedures w CC1.88596.57.9
    153NoNo06SURGMinor Small & Large Bowel Procedures w/o CC1.09834.44.9
    154NoNo06SURGNo Longer Valid0.00000.00.0
    155YesNo06SURGStomach, Esophageal & Duodenal Procedures Age >17 w/o CC1.29483.04.0
    156NoNo06SURG *Stomach, Esophageal & Duodenal Procedures Age 0-170.86446.06.0
    157YesNo06SURGAnal & Stomal Procedures w CC1.34304.15.8
    158YesNo06SURGAnal & Stomal Procedures w/o CC0.65772.12.7
    159NoNo06SURGHernia Procedures Except Inguinal & Femoral Age >17 w CC1.43163.75.1
    160NoNo06SURGHernia Procedures Except Inguinal & Femoral Age >17 w/o CC0.86752.22.7
    161NoNo06SURGInguinal & Femoral Hernia Procedures Age >17 w CC1.24033.24.5
    162NoNo06SURGInguinal & Femoral Hernia Procedures Age >17 w/o CCc0.69161.72.1
    163NoNo06SURG *Hernia Procedures Age 0-170.68092.12.1
    164NoNo06SURGAppendectomy w Complicated Principal Diag w CC2.14746.47.7
    165NoNo06SURGAppendectomy w Complicated Principal Diag w/o CC1.18433.44.0
    166NoNo06SURGAppendectomy w/o Complicated Principal Diag w CC1.40353.24.3
    167NoNo06SURGAppendectomy w/o Complicated Principal Diag w/o CC0.90011.82.1
    168NoNo03SURGMouth Procedures w CC1.28273.34.8
    169NoNo03SURGMouth Procedures w/o CC0.76791.82.3
    170YesNo06SURGOther Digestive System O.R. Procedures w CC2.99217.810.9
    171YesNo06SURGOther Digestive System O.R. Procedures w/o CC1.22423.14.2
    172YesNo06MEDDigestive Malignancy w CC1.42935.16.9
    173YesNo06MEDDigestive Malignancy w/o CC0.76452.73.6
    174NoNo06MEDG.I. Hemorrhage w CC1.02963.84.7
    175NoNo06MEDG.I. Hemorrhage w/o CC0.58082.42.9
    176YesNo06MEDComplicated Peptic Ulcer1.12754.05.1
    177NoNo06MEDUncomplicated Peptic Ulcer w CC0.93333.64.4
    178NoNo06MEDUncomplicated Peptic Ulcer w/o CCc0.69002.63.1
    179NoNo06MEDInflammatory Bowel Disease1.08044.55.8
    180YesNo06MEDG.I. Obstruction w CC0.99304.15.3
    181YesNo06MEDG.I. Obstruction w/o CC0.57842.83.3
    182NoNo06MEDEsophagitis, Gastroent & Misc Digest Disorders Age >17 w CC0.78533.24.1
    183NoNo06MEDEsophagitis, Gastroent & Misc Digest Disorders Age >17 w/o CC0.58412.32.8
    184NoNo06MEDEsophagitis, Gastroent & Misc Digest Disorders Age 0-170.61922.53.7
    185NoNo03MEDDental & Oral Dis Except Extractions & Restorations, Age >170.88863.34.5
    186NoNo03MED *Dental & Oral Dis Except Extractions & Restorations, Age 0-170.32942.92.9
    187NoNo03MEDDental Extractions & Restorations0.84213.14.2
    188YesNo06MEDOther Digestive System Diagnoses Age >17w CC1.09314.05.4
    189YesNo06MEDOther Digestive System Diagnoses Age >17 w/o CC0.59162.43.0
    190NoNo06MEDOther Digestive System Diagnoses Age 0-170.63512.33.0
    191YesNo07SURGPancreas, Liver & Shunt Procedures w CC3.93848.812.5
    Start Printed Page 60017
    192YesNo07SURGPancreas, Liver & Shunt Procedures w/o CC1.67404.25.5
    193NoNo07SURGBiliary Tract Proc Except Only Cholecyst w or w/o C.D.E. w CC3.383110.112.6
    194NoNo07SURGBiliary Tract Proc Except Only Cholecyst w or w/o C.D.E. w/o CC1.58795.46.3
    195NoNo07SURGCholecystectomy w C.D.E. w CC3.05018.810.6
    196NoNo07SURGCholecystectomy w C.D.E. w/o CC1.54124.55.3
    197YesNo07SURGCholecystectomy Except By Laparoscope w/o C.D.E. w CC2.55187.49.1
    198YesNo07SURGCholecystectomy Except By Laparoscope w/o C.D.E. w/o CC1.17813.74.3
    199NoNo07SURGHepatobiliary Diagnostic Procedure For Malignancy2.23506.49.0
    200NoNo07SURGHepatobiliary Diagnostic Procedure For Non-Malignancy2.84026.510.4
    201NoNo07SURGOther Hepatobiliary or Pancreas O.R. Procedures3.790510.013.6
    202NoNo07MEDCirrhosis & Alcoholic Hepatitis1.33964.66.2
    203NoNo07MEDMalignancy of Hepatobiliary System or Pancreas1.36724.86.5
    204NoNo07MEDDisorders of Pancreas Except Malignancy1.09894.15.4
    205YesNo07MEDDisorders of Liver Except Malig,Cirr,Alc Hepa w CC1.20134.45.9
    206YesNo07MEDDisorders of Liver Except Malig,Cirr,Alc Hepa w/o CC0.72873.03.8
    207NoNo07MEDDisorders of The Biliary Tract w CC1.18394.15.3
    208NoNo07MEDDisorders of The Biliary Tract w/o CC0.68902.43.0
    209NoNo08SURGNo Longer Valid0.00000.00.0
    210YesYes08SURGHip & Femur Procedures Except Major Joint Age >17 w CC1.90225.96.7
    211YesYes08SURGHip & Femur Procedures Except Major Joint Age >17 w/o CC1.29394.34.6
    212NoNo08SURGHip & Femur Procedures Except Major Joint Age 0-170.91642.22.5
    213YesNo08SURGAmputation for Musculoskeletal System & Conn Tissue Disorders2.11747.19.5
    214NoNo08SURGNo Longer Valid0.00000.00.0
    215NoNo08SURGNo Longer Valid0.00000.00.0
    216YesNo08SURGBiopsies of Musculoskeletal System & Connective Tissue1.87443.15.4
    217YesNo08SURGWnd Debrid & Skn Grft Except Hand,for Muscskelet & Conn Tiss Dis3.04999.012.9
    218YesNo08SURGLower Extrem & Humer Proc Except Hip,Foot,Femur Age >17 w CC1.70534.45.5
    219YesNo08SURGLower Extrem & Humer Proc Except Hip,Foot,Femur Age >17 w/o CC1.10332.73.2
    220NoNo08SURG *Lower Extrem & Humer Proc Except Hip,Foot,Femur Age 0-170.59885.35.3
    221NoNo08SURGNo Longer Valid0.00000.00.0
    222NoNo08SURGNo Longer Valid0.00000.00.0
    223NoNo08SURGMajor Shoulder/Elbow Proc, or Other Upper Extremity Proc w CC1.17262.43.3
    224NoNo08SURGShoulder,Elbow or Forearm Proc,Exc Major Joint Proc, w/o CC0.85741.61.9
    225YesNo08SURGFoot Procedures1.27753.85.4
    226YesNo08SURGSoft Tissue Procedures w CCc1.63404.66.5
    227YesNo08SURGSoft Tissue Procedures w/o CC0.86182.12.6
    228NoNo08SURGMajor Thumb or Joint Proc,or Oth Hand or Wrist Proc w CC1.15282.94.2
    229NoNo08SURGHand or Wrist Proc, Except Major Joint Proc, w/o CC0.72082.02.5
    230NoNo08SURGLocal Excision & Removal of Int Fix Devices of Hip & Femur1.33853.65.4
    231NoNo08SURGNo Longer Valid0.00000.00.0
    232NoNo08SURGArthroscopy0.97321.92.7
    Start Printed Page 60018
    233YesYes08SURGOther Musculoskelet Sys & Conn Tiss O.R. Proc w CC1.90334.36.4
    234YesYes08SURGOther Musculoskelet Sys & Conn Tiss O.R. Proc w/o CC1.25651.92.7
    235YesNo08MEDFractures of Femur0.82263.84.8
    236YesNo08MEDFractures of Hip & Pelvis0.76883.84.5
    237NoNo08MEDSprains, Strains, & Dislocations of Hip, Pelvis & Thigh0.65733.03.8
    238YesNo08MEDOsteomyelitis1.41006.58.3
    239YesNo08MEDPathological Fractures & Musculoskeletal & Conn Tiss Malignancy1.12034.96.2
    240YesNo08MEDConnective Tissue Disorders w CC1.38074.96.5
    241YesNo08MEDConnective Tissue Disorders w/o CC0.66373.03.7
    242NoNo08MEDSeptic Arthritis1.10455.16.5
    243NoNo08MEDMedical Back Problems0.79703.64.5
    244YesNo08MEDBone Diseases & Specific Arthropathies w CC0.73943.64.5
    245YesNo08MEDBone Diseases & Specific Arthropathies w/o CC0.49432.53.1
    246NoNo08MEDNon-Specific Arthropathies0.63112.83.6
    247NoNo08MEDSigns & Symptoms of Musculoskeletal System & Conn Tissue0.59342.63.3
    248NoNo08MEDTendonitis, Myositis & Bursitis0.88763.84.8
    249NoNo08MEDAftercare, Musculoskeletal System & Connective Tissue0.75062.84.0
    250YesNo08MEDFx, Sprn, Strn & Disl of Forearm, Hand, Foot Age >17 w CC0.72303.23.9
    251YesNo08MEDFx, Sprn, Strn & Disl of Forearm, Hand, Foot Age >17 w/o CC0.51222.32.8
    252NoNo08MED *Fx, Sprn, Strn & Disl of Forearm, Hand, Foot Age 0-170.2600
    253YesNo08MEDFx, Sprn, Strn & Disl of Uparm,Lowleg Ex Foot Age >17 w CC0.81803.84.6
    254YesNo08MEDFx, Sprn, Strn & Disl of Uparm,Lowleg Ex Foot Age >17 w/o CC0.49782.63.1
    255NoNo08MED *Fx, Sprn, Strn & Disl of Uparm,Lowleg Ex Foot Age 0-170.3028
    256YesNo08MEDOther Musculoskeletal System & Connective Tissue Diagnoses0.87143.95.0
    257NoNo09SURGTotal Mastectomy For Malignancy w CC0.91232.02.6
    258NoNo09SURGTotal Mastectomy For Malignancy w/o CC0.71301.51.7
    259NoNo09SURGSubtotal Mastectomy For Malignancy w CC1.00601.82.8
    260NoNo09SURGSubtotal Mastectomy For Malignancy w/o CC0.68191.21.4
    261NoNo09SURGBreast Proc for Non-Malignancy Except Biopsy & Local Excision0.95351.62.2
    262NoNo09SURGBreast Biopsy & Local Excision for Non-Malignancy0.96213.34.7
    263YesNo09SURGSkin Graft &/or Debrid for Skn Ulcer or Cellulitis w CC2.12308.311.1
    264YesNo09SURGSkin Graft &/or Debrid for Skn Ulcer or Cellulitis w/o CC1.09804.96.4
    265YesNo09SURGSkin Graft &/or Debrid Except for Skin Ulcer or Cellulitis w CC1.69514.26.7
    266YesNo09SURGSkin Graft &/or Debrid Except for Skin Ulcer or Cellulitis w/o CC0.91362.33.0
    267NoNo09SURGPerianal & Pilonidal Procedures0.94442.94.2
    268NoNo09SURGSkin, Subcutaneous Tissue & Breast Plastic Procedures1.22192.43.6
    269YesNo09SURGOther Skin, Subcut Tiss & Breast Proc w CC1.79206.08.3
    270YesNo09SURGOther Skin, Subcut Tiss & Breast Proc w/o CCc0.82092.73.6
    271YesNo09MEDSkin Ulcers1.07635.67.1
    272YesNo09MEDMajor Skin Disorders w CC1.03564.55.9
    273YesNo09MEDMajor Skin Disorders w/o CC0.58532.93.7
    Start Printed Page 60019
    274NoNo09MEDMalignant Breast Disorders w CC1.13154.56.2
    275NoNo09MEDMalignant Breast Disorders w/o CC0.59542.43.3
    276NoNo09MEDNon-Maligant Breast Disorders0.74303.64.6
    277YesNo09MEDCellulitis Age >17 w CC0.89584.55.5
    278YesNo09MEDCellulitis Age >17 w/o CC0.56493.44.0
    279NoNo09MED *Cellulitis Age 0-170.79224.24.2
    280YesNo09MEDTrauma to the Skin, Subcut Tiss & Breast Age >17 w CC0.77163.24.0
    281YesNo09MEDTrauma to the Skin, Subcut Tiss & Breast Age >17 w/o CC0.52072.32.8
    282NoNo09MED *Trauma to the Skin, Subcut Tiss & Breast Age 0-170.2633
    283YesNo09MEDMinor Skin Disorders w CCc0.76053.44.6
    284YesNo09MEDMinor Skin Disorders w/o CC0.45842.32.9
    285YesNo10SURGAmputat of Lower Limb For Endocrine,Nutrit,& Metabol Disorders2.17748.110.3
    286NoNo10SURGAdrenal & Pituitary Procedures1.90983.85.2
    287YesNo10SURGSkin Grafts & Wound Debrid for Endoc, Nutrit & Metab Disorders1.95077.69.9
    288NoNo10SURGO.R. Procedures for Obesity1.91302.93.7
    289NoNo10SURGParathyroid Procedures0.92451.62.4
    290NoNo10SURGThyroid Procedures0.88061.52.0
    291NoNo10SURGThyroglossal Procedures0.58491.31.5
    292YesNo10SURGOther Endocrine, Nutrit & Metab O.R. Proc w CC2.69857.310.2
    293YesNo10SURGOther Endocrine, Nutrit & Metab O.R. Proc w/o CC1.39123.54.8
    294YesNo10MEDDiabetes Age >350.78693.34.3
    295NoNo10MEDDiabetes Age 0-350.76552.83.7
    296YesNo10MEDNutritional & Misc Metabolic Disorders Age >17 w CC0.83343.64.7
    297YesNo10MEDNutritional & Misc Metabolic Disorders Age >17 w/o CC0.50902.53.0
    298NoNo10MEDNutritional & Misc Metabolic Disorders Age 0-170.57532.53.5
    299NoNo10MEDInborn Errors of Metabolism1.04903.75.1
    300YesNo10MEDEndocrine Disorders w CC1.11934.65.9
    301YesNo10MEDEndocrine Disorders w/o CC0.62092.73.4
    302NoNo11SURGKidney Transplant3.11526.77.9
    303NoNo11SURGKidney And Ureter Procedures for Neoplasm1.97765.06.3
    304YesNo11SURGKidney And Ureter Procedures for Non-Neoplasm W CC2.34735.88.3
    305YesNo11SURGKidney And Ureter Procedures for Non-Neoplasm W/o CC1.15202.53.0
    306NoNo11SURGProstatectomy w CC1.33903.65.6
    307NoNo11SURGProstatectomy w/o CC0.64111.72.0
    308NoNo11SURGMinor Bladder Procedures w CC1.45943.35.3
    309NoNo11SURGMinor Bladder Procedures w/o CC0.90221.41.7
    310NoNo11SURGTransurethral Procedures w CC1.21313.14.5
    311NoNo11SURGTransurethral Procedures w/o CC0.65521.51.9
    312NoNo11SURGUrethral Procedures, Age >17 w CC1.17673.34.9
    313NoNo11SURGUrethral Procedures, Age >17 w/o CC0.74651.82.4
    314NoNo11SURG *Urethral Procedures, Age 0-170.50762.32.3
    315NoNo11SURGOther Kidney & Urinary Tract O.R. Procedures2.11733.76.8
    316YesNo11MEDRenal Failure1.26024.86.3
    317NoNo11MEDAdmit for Renal Dialysis0.80672.43.5
    318NoNo11MEDKidney & Urinary Tract Neoplasms w CC1.23764.46.0
    319NoNo11MEDKidney & Urinary Tract Neoplasms w/o CC0.60841.92.6
    320YesNo11MEDKidney & Urinary Tract Infections Age >17 w CC0.87694.15.1
    321YesNo11MEDKidney & Urinary Tract Infections Age >17 w/o CC0.57933.03.6
    322NoNo11MEDKidney & Urinary Tract Infections Age 0-170.61603.13.6
    Start Printed Page 60020
    323NoNo11MEDUrinary Stones w CC, &/or ESW Lithotripsy0.82592.33.1
    324NoNo11MEDUrinary Stones w/o CC0.50491.61.8
    325NoNo11MEDKidney & Urinary Tract Signs & Symptoms Age >17 w CC0.69042.93.7
    326NoNo11MEDKidney & Urinary Tract Signs & Symptoms Age >17 w/o CCc0.45442.12.6
    327NoNo11MEDKidney & Urinary Tract Signs & Symptoms Age 0-170.21091.82.0
    328NoNo11MEDUrethral Stricture Age >17 w CC0.72942.63.4
    329NoNo11MEDUrethral Stricture Age >17 w/o CC0.51981.41.7
    330NoNo11MED *Urethral Stricture Age 0-170.3268
    331YesNo11MEDOther Kidney & Urinary Tract Diagnoses Age >17 w CC1.09604.25.5
    332YesNo11MEDOther Kidney & Urinary Tract Diagnoses Age >17 w/o CC0.62552.43.1
    333NoNo11MEDOther Kidney & Urinary Tract Diagnoses Age 0-171.01703.75.4
    334NoNo12SURGMajor Male Pelvic Procedures w CC1.42023.34.0
    335NoNo12SURGMajor Male Pelvic Procedures w/o CC1.11742.22.5
    336NoNo12SURGTransurethral Prostatectomy w CC0.85762.43.2
    337NoNo12SURGTransurethral Prostatectomy w/o CC0.58771.61.8
    338NoNo12SURGTestes Procedures, For Malignancy1.37973.85.8
    339NoNo12SURGTestes Procedures, Non-Malignancy Age >171.25533.35.2
    340NoNo12SURG *Testes Procedures, Non-Malignancy Age 0-170.2904
    341NoNo12SURGPenis Procedures1.34191.93.2
    342NoNo12SURGCircumcision Age >170.81032.33.0
    343NoNo12SURG *Circumcision Age 0-170.1579
    344NoNo12SURGOther Male Reproductive System O.R. Procedures for Malignancy1.21241.72.7
    345NoNo12SURGOther Male Reproductive System O.R. Proc Except for Malignancy1.29873.45.4
    346NoNo12MEDMalignancy, Male Reproductive System, w CC1.07164.55.9
    347NoNo12MEDMalignancy, Male Reproductive System, w/o CC0.53852.02.7
    348NoNo12MEDBenign Prostatic Hypertrophy w CC0.74293.14.0
    349NoNo12MEDBenign Prostatic Hypertrophy w/o CC0.46152.12.6
    350NoNo12MEDInflammation of the Male Reproductive System0.77483.64.5
    351NoNo12MED *Sterilization, Male0.2422
    352NoNo12MEDOther Male Reproductive System Diagnoses0.78193.04.2
    353NoNo13SURGPelvic Evisceration, Radical Hysterectomy & Radical Vulvectomy1.81924.56.0
    354NoNo13SURGUterine,Adnexa Proc for Non-Ovarian/Adnexal Malig w CC1.49664.55.6
    355NoNo13SURGUterine,Adnexa Proc for Non-Ovarian/Adnexal Malig w/o CC0.90742.83.0
    356NoNo13SURGFemale Reproductive System Reconstructive Procedures0.75711.61.9
    357NoNo13SURGUterine & Adnexa Proc for Ovarian Or Adnexal Malignancy2.22506.48.0
    358NoNo13SURGUterine & Adnexa Proc for Non-Malignancy w CC1.14183.13.9
    359NoNo13SURGUterine & Adnexa Proc for Non-Malignancy w/o CC0.80532.12.3
    360NoNo13SURGVagina, Cervix & Vulva Procedures0.88112.02.5
    361NoNo13SURGLaparoscopy & Incisional Tubal Interruption1.06262.12.9
    362NoNo13SURG *Endoscopic Tubal Interruption0.30961.41.4
    363NoNo13SURGD&C, Conization & Radio-Implant, for Malignancy1.10282.94.2
    364NoNo13SURGD&C, Conization Except for Malignancy0.89362.73.8
    365NoNo13SURGOther Female Reproductive System O.R. Procedures2.05085.37.9
    Start Printed Page 60021
    366NoNo13MEDMalignancy, Female Reproductive System w CC1.24664.66.3
    367NoNo13MEDMalignancy, Female Reproductive System w/o CC0.58652.33.0
    368NoNo13MEDInfections, Female Reproductive System1.16975.06.4
    369NoNo13MEDMenstrual & Other Female Reproductive System Disorders0.65982.53.3
    370NoNo14SURGCesarean Section w CC0.90024.15.0
    371NoNo14SURGCesarean Section w/o CC0.65653.13.4
    372NoNo14MEDVaginal Delivery w Complicating Diagnoses0.56602.63.4
    373NoNo14MEDVaginal Delivery w/o Complicating Diagnoses0.39112.12.2
    374NoNo14SURGVaginal Delivery w Sterilization &/or D&C0.65052.43.0
    375NoNo14SURGVaginal Delivery w O.R. Proc Except Steril &/or D&C1.12524.16.5
    376NoNo14MEDPostpartum & Post Abortion Diagnoses w/o O.R. Procedure0.61502.53.3
    377NoNo14SURGPostpartum & Post Abortion Diagnoses w O.R. Procedure1.24573.24.5
    378NoNo14MEDEctopic Pregnancy0.71631.82.2
    379NoNo14MEDThreatened Abortion0.41382.23.3
    380NoNo14MEDAbortion w/o D&C0.44301.52.0
    381NoNo14SURGAbortion w D&C, Aspiration Curettage or Hysterotomy0.70701.72.5
    382NoNo14MEDFalse Labor0.18171.31.5
    383NoNo14MEDOther Antepartum Diagnoses w Medical Complications0.51032.63.7
    384NoNo14MEDOther Antepartum Diagnoses w/o Medical Complications0.37901.72.6
    385NoNo15MED *Neonates, Died or Transferred to Another Acute Care Facility1.4107
    386NoNo15MED *Extreme Immaturity or Respiratory Distress Syndrome, Neonate4.6519
    387NoNo15MED *Prematurity w Major Problems3.1771
    388NoNo15MED *Prematurity w/o Major Problems1.9170
    389NoNo15MED *Full Term Neonate w Major Problems3.26364.74.7
    390NoNo15MED *Neonate w Other Significant Problems1.1551
    391NoNo15MED *Normal Newborn0.1564
    392NoNo16SURGSplenectomy Age >173.02026.38.9
    393NoNo16SURG *Splenectomy Age 0-171.3819
    394NoNo16SURGOther O.R. Procedures of the Blood and Blood Forming Organs1.92994.57.3
    395YesNo16MEDRed Blood Cell Disorders Age >170.79923.14.1
    396NoNo16MEDRed Blood Cell Disorders Age 0-170.66542.63.1
    397NoNo16MEDCoagulation Disorders1.32673.75.1
    398YesNo16MEDReticuloendothelial & Immunity Disorders w CC1.12694.15.5
    399YesNo16MEDReticuloendothelial & Immunity Disorders w/o CC0.67202.63.2
    400NoNo17SURGNo Longer Valid0.00000.00.0
    401YesNo17SURGLymphoma & Non-Acute Leukemia w Other O.R. Proc w CC2.96528.111.3
    402YesNo17SURGLymphoma & Non-Acute Leukemia w Other O.R. Proc w/o CC1.16122.83.9
    403YesNo17MEDLymphoma & Non-Acute Leukemia w CC1.86255.78.0
    404YesNo17MEDLymphoma & Non-Acute Leukemia w/o CC0.92243.04.1
    405NoNo17MED *Acute Leukemia w/o Major O.R. Procedure Age 0-171.9592
    406NoNo17SURGMyeloprolif Disord or Poorly Diff Neopl w Maj O.R.Proc w CC2.72016.79.4
    407NoNo17SURGMyeloprolif Disord or Poorly Diff Neopl w Maj O.R.Proc w/o CC1.15452.83.5
    408NoNo17SURGMyeloprolif Disord or Poorly Diff Neopl w Other O.R.Proc2.16515.18.2
    409NoNo17MEDRadiotherapy1.29484.56.0
    Start Printed Page 60022
    410NoNo17MEDChemotherapy w/o Acute Leukemia as Secondary Diagnosis1.09082.93.8
    411NoNo17MED *History of Malignancy w/o Endoscopy0.36814.74.7
    412NoNo17MED *History of Malignancy w Endoscopy0.85592.02.0
    413NoNo17MEDOther Myeloprolif Dis or Poorly Diff Neopl Diag w CC1.33475.06.7
    414NoNo17MEDOther Myeloprolif Dis or Poorly Diff Neopl Diag w/o CC0.76783.04.1
    415NoNo18SURGNo Longer Valid0.00000.00.0
    416NoNo18MEDNo Longer Valid0.00000.00.0
    417NoNo18MEDSepticemia Age 0-171.88415.26.5
    418YesNo18MEDPostoperative & Post-Traumatic Infections1.09934.76.1
    419NoNo18MEDFever of Unknown Origin Age >17 w CC0.86143.44.4
    420NoNo18MEDFever of Unknown Origin Age >17 w/o CC0.59572.63.2
    421NoNo18MEDViral Illness Age >170.77473.14.0
    422NoNo18MEDViral Illness & Fever of Unknown Origin Age 0-170.61762.63.7
    423YesNo18MEDOther Infectious & Parasitic Diseases Diagnoses1.83796.08.2
    424NoNo19SURGO.R. Procedure w Principal Diagnoses of Mental Illness2.24877.411.5
    425NoNo19MEDAcute Adjustment Reaction & Psychosocial Dysfunction0.62992.63.5
    426NoNo19MEDDepressive Neuroses0.51223.14.3
    427NoNo19MEDNeuroses Except Depressive0.55803.14.6
    428NoNo19MEDDisorders of Personality & Impulse Control0.77974.57.3
    429YesNo19MEDOrganic Disturbances & Mental Retardation0.83884.35.6
    430YesNo19MEDPsychoses0.72615.87.9
    431NoNo19MEDChildhood Mental Disorders0.67294.26.7
    432NoNo19MEDOther Mental Disorder Diagnoses0.66112.74.0
    433NoNo20MEDAlcohol/Drug Abuse or Dependence, Left AMA0.32842.12.8
    434NoNo20MEDNo Longer Valid0.00000.00.0
    435NoNo20MEDNo Longer Valid0.00000.00.0
    436NoNo20MEDNo Longer Valid0.00000.00.0
    437NoNo20MEDNo Longer Valid0.00000.00.0
    438NoNo20MEDNo Longer Valid0.00000.00.0
    439NoNo21SURGSkin Grafts For Injuries1.90715.48.3
    440YesNo21SURGWound Debridements For Injuries1.92915.68.5
    441NoNo21SURGHand Procedures For Injuries0.99202.33.4
    442YesNo21SURGOther O.R. Procedures For Injuries w CC2.55336.08.9
    443YesNo21SURGOther O.R. Procedures For Injuries w/o CC1.04982.73.5
    444YesNo21MEDTraumatic Injury Age >17 w CC0.77953.24.1
    445YesNo21MEDTraumatic Injury Age >17 w/o CC0.53012.32.8
    446NoNo21MED *Traumatic Injury Age 0-170.3037
    447NoNo21MEDAllergic Reactions Age >170.57381.92.6
    448NoNo21MED *Allergic Reactions Age 0-170.1000
    449NoNo21MEDPoisoning & Toxic Effects of Drugs Age >17 w CC0.87322.73.7
    450NoNo21MEDPoisoning & Toxic Effects of Drugs Age >17 w/o CC0.44201.62.0
    451NoNo21MED *Poisoning & Toxic Effects of Drugs Age 0-170.26972.12.1
    452NoNo21MEDComplications of Treatment w CC1.06863.55.0
    453NoNo21MEDComplications of Treatment w/o CC0.52972.22.8
    454NoNo21MEDOther Injury, Poisoning & Toxic Effect Diag w CC0.86163.04.1
    455NoNo21MEDOther Injury, Poisoning & Toxic Effect Diag w/o CC0.48641.82.3
    456NoNo22MEDNo Longer Valid0.00000.00.0
    457NoNo22MEDNo Longer Valid0.00000.00.0
    458NoNo22SURGNo Longer Valid0.00000.00.0
    459NoNo22SURGNo Longer Valid0.00000.00.0
    Start Printed Page 60023
    460NoNo22MEDNo Longer Valid0.00000.00.0
    461NoNo23SURGO.R. Proc w Diagnoses of Other Contact w Health Services1.57073.35.6
    462YesNo23MEDRehabilitation0.94608.410.0
    463YesNo23MEDSigns & Symptoms w CC0.71583.13.9
    464YesNo23MEDSigns & Symptoms w/o CC0.52712.42.9
    465NoNo23MEDAftercare w History Of Malignancy As Secondary Diagnosis0.59542.43.5
    466NoNo23MEDAftercare w/o History of Malignancy as Secondary Diagnosis0.76342.74.9
    467NoNo23MEDOther Factors Influencing Health Status0.47591.92.7
    468YesNoSURGExtensive O.R. Procedure Unrelated to Principal Diagnosis3.99259.613.0
    469NoNo**Principal Diagnosis Invalid as Discharge Diagnosis0.00000.00.0
    470NoNo**Ungroupable0.00000.00.0
    471YesYes08SURGBilateral or Multiple Major Joint Procs of Lower Extremity3.04244.14.6
    472NoNo22SURGNo Longer Valid0.00000.00.0
    473NoNo17MEDAcute Leukemia w/o Major O.R. Procedure Age >173.36237.312.7
    474NoNo04SURGNo Longer Valid0.00000.00.0
    475NoNo04MEDNo Longer Valid0.00000.00.0
    476NoNoSURGProstatic O.R. Procedure Unrelated to Principal Diagnosis2.16546.99.9
    477YesNoSURGNon-Extensive O.R. Procedure Unrelated to Principal Diagnosis2.09105.98.7
    478NoNo05SURGNo Longer Valid0.00000.00.0
    479NoNo05SURGOther Vascular Procedures w/o CC1.44011.92.6
    480NoNoPRESURGLiver Transplant &/or Intestinal Transplant9.409614.019.1
    481NoNoPRESURGBone Marrow Transplant6.392918.722.0
    482YesNoPRESURGTracheostomy for Face, Mouth & Neck Diagnoses3.34909.411.8
    483NoNoPRESURGNo Longer Valid0.00000.00.0
    484NoNo24SURGCraniotomy For Multiple Significant Trauma5.09678.512.8
    485YesNo24SURGLimb Reattachment, Hip And Femur Proc for Multiple Significant Trauma3.50488.110.0
    486NoNo24SURGOther O.R. Procedures for Multiple Significant Trauma4.83468.512.3
    487YesNo24MEDOther Multiple Significant Trauma1.89305.27.0
    488NoNo25SURGHIV w Extensive O.R. Procedure5.129812.217.7
    489NoNo25MEDHIV w Major Related Condition1.79215.88.2
    490NoNo25MEDHIV w or w/o Other Related Condition1.04083.95.3
    491NoNo08SURGMajor Joint & Limb Reattachment Procedures of Upper Extremity1.72032.53.0
    492NoNo17MEDChemotherapy w Acute Leukemia or w Use of Hi Dose Chemoagent3.48928.913.8
    493NoNo07SURGLaparoscopic Cholecystectomy w/o C.D.E. w CC1.82804.66.0
    494NoNo07SURGLaparoscopic Cholecystectomy w/o C.D.E. w/o CC1.03202.12.7
    495NoNoPRESURGLung Transplant8.418214.217.3
    496NoNo08SURGCombined Anterior/Posterior Spinal Fusion6.37826.48.8
    497YesYes08SURGSpinal Fusion Except Cervical w CC3.81924.85.7
    498YesYes08SURGSpinal Fusion Except Cervical w/o CC2.98963.33.7
    499NoNo08SURGBack & Neck Procedures Except Spinal Fusion w CC1.38873.04.2
    500NoNo08SURGBack & Neck Procedures Except Spinal Fusion w/o CC0.92231.82.2
    501YesNo08SURGKnee Procedures w PDX of Infection w CC2.64278.410.4
    502YesNo08SURGKnee Procedures w PDX of Infection w/o CC1.42744.95.8
    503NoNo08SURGKnee Procedures w/o PDX of Infection1.24503.13.9
    Start Printed Page 60024
    504NoNo22SURGExten. Burns or Full Thickness Burn w/MV 96+Hrs w/Skin Gft11.252420.728.0
    505NoNo22MEDExten. Burns Or Full Thickness Burn w/MV 96+Hrs w/o Skin Gft2.63302.86.9
    506NoNo22SURGFull Thickness Burn w Skin Graft or Inhal Inj w CC or Sig Trauma3.785610.815.2
    507NoNo22SURGFull Thickness Burn w Skin Grft or Inhal Inj w/o CC or Sig Trauma1.93285.47.7
    508NoNo22MEDFull Thickness Burn w/o Skin Grft or Inhal Inj w CC or Sig Trauma1.41575.37.4
    509NoNo22MEDFull Thickness Burn w/o Skin Grft Or Inh Inj w/o CC or Sig Trauma0.83473.75.3
    510NoNo22MEDNon-Extensive Burns w CC or Significant Trauma1.24774.16.1
    511NoNo22MEDNon-Extensive Burns w/o CC or Significant Trauma0.68192.63.6
    512NoNoPRESURGSimultaneous Pancreas/Kidney Transplant6.258811.113.6
    513NoNoPRESURGPancreas Transplant3.97718.910.6
    514NoNo05SURGNo Longer Valid0.00000.00.0
    515NoNo05SURGCardiac Defibrillator Implant w/o Cardiac Cath5.22932.23.8
    516NoNo05SURGNo Longer Valid0.00000.00.0
    517NoNo05SURGNo Longer Valid0.00000.00.0
    518NoNo05SURGPerc Cardio Proc w/o Coronary Artery Stent or AMI1.63881.82.5
    519NoNo08SURGCervical Spinal Fusion w CC2.54392.94.7
    520NoNo08SURGCervical Spinal Fusion w/o CC1.75691.61.9
    521YesNo20MEDAlcohol/Drug Abuse or Dependence w CC0.73384.05.3
    522YesNo20MEDAlc/Drug Abuse or Depend w Rehabilitation Therapy w/o CC0.59938.010.4
    523NoNo20MEDAlc/Drug Abuse or Depend w/o Rehabilitation Therapy w/o CC0.41963.13.8
    524NoNo01MEDTransient Ischemia0.73732.63.1
    525NoNo05SURGOther Heart Assist System Implant 12.22687.714.3
    526NoNo05SURGNo Longer Valid0.00000.00.0
    527NoNo05SURGNo Longer Valid0.00000.00.0
    528NoNo01SURGIntracranial Vascular Proc w PDX Hemorrhage7.062613.316.4
    529YesNo01SURGVentricular Shunt Procedures w CC2.17374.67.4
    530YesNo01SURGVentricular Shunt Procedures w/o CC1.21862.32.9
    531YesNo01SURGSpinal Procedures w CC3.11696.49.3
    532YesNo01SURGSpinal Procedures w/o CC1.45772.83.7
    533NoNo01SURGExtracranial Procedures w CC1.54632.43.7
    534NoNo01SURGExtracranial Procedures w/o CC0.99261.41.7
    535NoNo05SURGCardiac Defib Implant w Cardiac Cath w AMI/HF/Shock7.37416.99.3
    536NoNo05SURGCardiac Defib Implant w Cardiac Cath w/o AMI/HF/Shock6.60435.57.3
    537YesNo08SURGLocal Excis & Remov of Int Fix Dev Except Hip & Femur w CC1.83604.76.6
    538YesNo08SURGLocal Excis & Remov of Int Fix Dev Except Hip & Femur w/o CC1.02822.22.9
    539NoNo17SURGLymphoma & Leukemia w Major or Procedure w CC3.19076.810.6
    540NoNo17SURGLymphoma & Leukemia w Major or Procedure w/o CC1.17592.63.5
    541YesNoPRESURGEcmo or Trach w MV 96+Hrs or PDX Exc Face, Mouth & Neck w Maj O.R.19.255137.044.3
    542YesNoPRESURGTrach w MV 96+Hrs or PDX Exc Face, Mouth & Neck w/o Maj O.R.11.644027.232.6
    543YesNo01SURGCraniotomy w Major Device Implant or Acute Complex CNS Principal Diagnosis4.35577.911.6
    544YesNo08SURGMajor Joint Replacement or Reattachment of Lower Extremity1.98784.04.4
    545YesYes08SURGRevision of Hip or Knee Replacement2.53374.45.2
    Start Printed Page 60025
    546NoNo08SURGSpinal Fusion Exc Cerv with Curvature of the Spine or Malig5.38127.08.8
    547YesNo05SURGCoronary Bypass w Cardiac Cath w Major CV Dx6.139010.912.4
    548YesNo05SURGCoronary Bypass w Cardiac Cath w/o Major CV Dx4.64408.18.9
    549YesYes05SURGCoronary Bypass w/o Cardiac Cath w Major CV Dx5.02468.610.2
    550YesYes05SURGCoronary Bypass w/o Cardiac Cath w/o Major CV Dx3.59046.26.8
    551NoNo05SURGPermanent Cardiac Pacemaker Impl w Maj CV Dx or Aicd Lead or Gnrtr3.03644.26.1
    552NoNo05SURGOther Permanent Cardiac Pacemaker Implant w/o Major CV Dx2.08602.53.5
    553YesNo05SURGOther Vascular Procedures w CC w Major CV Dx3.01246.29.2
    554YesNo05SURGOther Vascular Procedures w CC w/o Major CV Dx2.07733.75.6
    555NoNo05SURGPercutaneous Cardiovascular Proc w Major CV Dx2.30663.44.8
    556NoNo05SURGPercutaneous Cardiovasc Proc w Non-Drug-Eluting Stent w/o Maj Cv Dx1.77471.62.0
    557NoNo05SURGPercutaneous Cardiovascular Proc w Drug-Eluting Stent w Major Cv Dx2.76163.04.1
    558NoNo05SURGPercutaneous Cardiovascular Proc w Drug-Eluting Stent w/o Maj Cv Dx2.08141.51.8
    559NoNo01MEDAcute Ischemic Stroke With Use of Thrombolytic Agent2.25245.46.9
    560NoNo01MEDBacterial & Tuberculous Infections of Nervous System2.90668.210.6
    561NoNo01MEDNon-Bacterial Infections of Nervous System Except Viral Meningitis2.21877.49.5
    562YesNo01MEDSeizure Age > 17 w CC1.05863.74.9
    563YesNo01MEDSeizure Age > 17 w/o CC0.64402.63.2
    564NoNo01MEDHeadaches Age >170.69312.63.4
    565YesNo04MEDRespiratory System Diagnosis with Ventilator Support 96+ Hours5.243013.415.8
    566YesNo04MEDRespiratory System Diagnosis with Ventilator Support < 96 Hours2.33555.67.8
    567YesNo06SURGStomach, Esophageal & Duodenal Proc Age > 17 w CC w Major GI Dx5.221012.716.0
    568YesNo06SURGStomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major GI Dx3.36668.311.5
    569YesNo06SURGMajor Small & Large Bowel Procedures w CC w Major GI Dx4.342711.914.6
    570YesNo06SURGMajor Small & Large Bowel Procedures w CC w/o Major GI Dx2.69978.410.1
    571NoNo06MEDMajor Esophageal Disorders1.11093.84.8
    572YesNo08MEDMajor Gastrointestinal Disorders And Peritoneal Infections1.33785.67.1
    573YesNo11SURGMajor Bladder Procedures3.34899.111.1
    574NoNo16MEDMajor Hematologic/Immunologic Diag Exc Sickle Cell Crisis & Coagul1.27034.35.7
    575YesNo18MEDSepticemia w MV96+ Hours Age >175.971413.216.0
    576YesNo18MEDSepticemia w/o MV96+ Hours Age >171.59965.57.3
    577NoNo01SURGCarotid Artery Stent Procedure1.78591.62.3
    578YesNo18SURGInfectious & Parasitic Diseases w O.R. Procedure4.865012.716.6
    579YesNo18SURGPostoperative O.R. Post-Traumatic Infections w O.R. Procedure2.84088.411.5
    DRGs 469 and 470 contain cases which could not be assigned to valid drgs.
    Note: Arithmetic mean is presented for informational purposes only.
    Note: Geometric mean is used only to determine payment for transfer cases.
    Note: Relative weights are based on Medicare patient data and may not be appropriate for other patients.
    Start Printed Page 60026

    It is important to note that in some cases this Table reflects withdrawal or termination decisions CMS has made on a hospital's behalf. For example, if CMS withdrew or terminated a hospital's reclassification(s) or redesignation on the hospital's behalf, such hospital would not be shown on this Table. Requests to reverse a decision made on behalf of a hospital by CMS and to choose another wage index, reclassification, or adjustment for which the hospital is otherwise eligible must be received by CMS no later than 5 p.m., e.s.t., with a copy sent to the MGCRB, by October 30, 2006 (30 days from the date that information appears on the CMS Web site at http://www.cms.hhs.gov/​AcuteInpatientPPS/​WIFN/​list.asp.)

    Table 9A.—Hospital Reclassifications and Redesignations by Individual Hospitals and CBSA for FY 2007

    Provider No.Geographic CBSAReclassified CBSA 10/1/2006- 3/31/2007Reclassified CBSA 4/1/2007- 9/30/2007LUGAR
    010005011382013820
    010008013386033860
    010009194602662026620
    010012011686016860
    010022014066040660LUGAR
    010025011798017980
    010029122201798017980
    010035011382013820
    010044011382013820
    010045011382013820
    010054194602662026620
    010059194602662026620
    010065013386033860
    010072011150011500LUGAR
    010083013786037860
    010085194602662026620
    010100013786037860
    010101011150011500LUGAR
    010118014622046220
    010126013386033860
    010143011382013820
    0101500133860
    010158011946019460
    010164011150011500LUGAR
    0200080211260
    030007032238022380
    030033032238022380
    040014043078030780
    040017042222022220
    040019043282032820
    040020278603282032820
    040027044418044180
    040039042626
    040041043078030780
    040047042626
    040069043282032820
    040071382203078030780
    040076043078030780
    040078263003078030780
    040080042786027860
    040088044334043340
    040091044550045500
    040100043078030780
    040119043078030780
    050006053982039820
    050009349004670046700
    050013349004670046700
    050014054090040900
    050022401404204442044
    050042053982039820
    0500463710031084
    050054401404204442044
    050065420443108431084
    050069420443108431084
    050071419403608436084
    050073467003608436084
    050076418843608436084
    0500823710031084
    050089401403108431084
    050090422204188441884
    050099401403108431084
    Start Printed Page 60027
    050101467003608436084
    050102401404204442044
    050129401403108431084
    050136422204188441884
    050140401403108431084
    050150054090040900
    0501593710031084
    050168420443108431084
    050173420443108431084
    050174422204188441884
    050193420443108431084
    050197418843608436084
    050224420443108431084
    050226420443108431084
    050228418843608436084
    050230420443108431084
    0502363710031084
    050243401404204442044
    050245401403108431084
    050251053990039900
    050272401403108431084
    050279401403108431084
    050291422204188441884
    050292401404204442044
    050298401403108431084
    050300401403108431084
    050327401403108431084
    050329401404204442044
    050348420443108431084
    050367467003608436084
    050385422204188441884
    050390401404204442044
    0503943710031084
    050423401404204442044
    050426420443108431084
    050430053990039900
    050510418843608436084
    050517401403108431084
    050526420443108431084
    050534401404204442044
    050535420443108431084
    050541418843608436084
    050543420443108431084
    050547422204188441884
    050548420443108431084
    0505493710031084
    050550420443108431084
    050551420443108431084
    050567420443108431084
    050569054222042220
    050570420443108431084
    050573401404204442044
    050580420443108431084
    050584401403108431084
    050585420443108431084
    050586401403108431084
    050589420443108431084
    050592420443108431084
    050594420443108431084
    050603420443108431084
    050609420443108431084
    0506163710031084
    050667349004670046700
    050678420443108431084
    050680467003608436084
    050684401404204442044
    050686401404204442044
    050690422204188441884
    Start Printed Page 60028
    050693420443108431084
    050694401404204442044
    050701401404204442044
    050709401403108431084
    050718401404204442044
    050720420443108431084
    050728422204188441884
    0507493710031084
    060001245401974019740
    060003145001974019740
    060023243001974019740
    060027145001974019740
    060044061974019740
    060049062266022660
    0600750624300
    060096061974019740
    060103145001974019740
    0700013530035004
    070003072554025540LUGAR
    0700053530035004
    0700061486035644
    0700101486035644
    0700163530035004
    0700173530035004
    0700181486035644
    0700193530035004
    0700223530035004
    0700281486035644
    0700313530035004
    070033148603564435644
    0700341486035644
    0700362554035300
    0700383530035004
    0700393530035004
    080004201004886448864
    080006082010020100
    080007083614036140
    100022331242274422744
    100023103674036740
    100024103312433124
    100045196603674036740
    100049102946029460
    100081102302023020LUGAR
    100109103674036740
    100118102726027260
    100139102354023540LUGAR
    100150103312433124
    100157294604530045300
    100176484243894038940
    100217426803894038940
    100232102726027260
    100239453004226042260
    100249104530045300
    100252103894038940
    100258484242274422744
    100292102302023020LUGAR
    110001191401206012060
    110002111206012060
    110003112726027260
    110023111206012060
    110029235801206012060
    110038111010
    110040111206012060LUGAR
    110041111202012020
    110052111686016860LUGAR
    110054406601206012060
    110069475803142031420
    110075114234042340
    Start Printed Page 60029
    110088111206012060LUGAR
    110095114666046660
    110117111206012060LUGAR
    110122466604522045220
    110125113142031420
    110128114234042340
    110150111206012060
    110153475803142031420
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    530025532266022660

    It is important to note that in some cases this Table reflects termination decisions CMS has made on a hospital's behalf. For example, if CMS terminated a hospital's section 1886(d)(10) reclassification on the hospital's behalf to allow the hospital to receive a section 508 reclassification, it would be shown on this Table. Requests to reverse a decision made on behalf of a hospital by CMS and to choose another wage index, reclassification, or adjustment for which the hospital is otherwise eligible must be received by CMS no later than 5 p.m., e.s.t, with a copy sent to the MGCRB, by October 30, 2006 (30 days from the date the information appears on the CMS Web site at: http://www.cms.hhs.gov/​AcuteInpatientPPS/​WIFN/​list.asp.)

    TABLE 9B.—Hospital Reclassifications and Redesignations by Individual Hospital Under Section 508 of Pub. L. 108-173—FY 2007

    Provider No.NoteGeographic CBSAWage Index CBSA— 10/1/2006- 3/31/2007Wage Index CBSA— 4/1/2007- 9/30/2007 *Own Wage Index— 10/1/2006- 3/31/2007
    0101500117980
    Start Printed Page 60038
    020008021.2183
    0504940542220
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    060075061.0877
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    070036255401.2930
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    140155*281001697416974
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    1600404794016300
    160064160.9701
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    2200463834014484
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    Start Printed Page 60039
    3100283508435644
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    33010635004-- -- --1.4779
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    3500021390022020
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    3500173522020
    350019*242202202022020
    3500303522020
    380090381.1162
    3900014254010900
    3900033910900
    390044***393796437964
    390045**3910900
    390096***393796437964
    3900544254029540
    3900723910900
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    3901194254010900
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    4300054339660
    430008*434362043620
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    4300604343620
    4300644343620
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    4500104866032580
    4500722642026420
    4505912642026420
    4700031554014484
    4900014931340
    4900244022019260
    530008*531622016220
    530010*531622016220
    530015531.006
    * These hospitals are assigned a wage index value under a special exceptions policy (see the FY 2005 IPPS final rule, 69 FR 49105).
    ** This hospital has been assigned a wage index for the 1st half of FY 2007 under a special exceptions policy (71 FR 48070).
    *** These hospitals are receiving the same wage index for FY 2007 as hospitals reclassified to the wage index CBSA under a special exceptions policy (71 FR 48072).
    Start Printed Page 60040

    Table 9C.—Hospitals Redesignated as Rural Under Section 1886(d)(8)(E) of the Act—FY 2007

    Provider NumberGeographic CBSARedesignated Rural Area
    501922342005
    0504694014005
    0505283290005
    0506184014005
    0700042554007
    1000483786010
    1001342726010
    1401671414
    1701372994017
    2300783566023
    2501263282025
    2600064114026
    2600472762026
    2601954418026
    3300444654033
    3302454654033
    3302681058033
    3601253636
    3700543642037
    3800401346038
    4401353498044
    4401444444
    4500524545
    4500781018045
    4502431018045
    4503484545
    5001484830050
    5200605252

    This Table represents decisions CMS has made on a hospital's behalf to withdraw a redesignation under 1886(d)(8)(B) in order for the hospital to receive an out-migration adjustment. Because such withdrawal removes the hospital's urban status, we have published this separate Table 9D. Requests to reverse a decision made on behalf of a hospital by CMS and to choose another wage index, reclassification, or adjustment for which the hospital is otherwise eligible must be received by CMS from the date the information appears on the CMS Web site at no later than 5 p.m., e.s.t, with a copy sent to the MGCRB, by October 30, 2006 (30 days from the date the information appears on the CMS Web site at: http://www.cms.hhs.gov/​AcuteInpatientPPS/​WIFN/​list.asp.)

    TABLE 9D.—HOSPITALS WHO WAIVED LUGAR STATUS TO RECEIVE OUT-MIGRATION ADJUSTMENT

    Provider No.Lugar CBSAGeographic CBSA
    0700212554007
    3901503830039

    Table 10.—Geometric Mean Plus the Lesser of 0.75 of the National Adjusted Operating Standardized Payment Amount (Increased to Reflect the Difference Between Costs and Charges) or 0.75 of One Standard Deviation of Mean Charges by Diagnosis-Related Group (DRG)—September 2006 1

    DRGNumber of casesThreshold
    124,393$53,936
    210,183$37,116
    33$58,151
    6288$16,761
    715,032$41,305
    83,441$31,218
    91,775$25,448
    1019,625$25,064
    113,083$19,015
    1255,944$18,885
    137,525$17,709
    14278,664$24,949
    1519,988$20,868
    1617,297$26,485
    172,973$15,690
    1833,443$21,281
    198,461$15,797
    212,220$26,882
    223,168$23,893
    2310,670$17,130
    2625$20,794
    275,971$25,133
    2819,908$25,479
    296,522$15,839
    315,039$21,151
    321,903$14,225
    3427,626$21,196
    357,908$14,378
    36307$17,809
    371,219$24,783
    3850$12,362
    39328$14,783
    401,187$22,552
    421,636$17,152
    43125$12,945
    441,290$14,832
    452,770$16,515
    463,929$16,801
    471,309$12,127
    492,415$31,299
    502,024$19,215
    51193$19,093
    52234$14,094
    532,145$26,688
    551,368$20,105
    56451$19,428
    57742$20,317
    59126$14,906
    603$18,895
    61222$28,833
    624$7,231
    632,827$26,807
    643,234$23,214
    6540,485$13,518
    668,195$12,932
    67379$17,209
    6818,913$14,133
    695,146$10,686
    7025$7,496
    7170$15,634
    721,326$16,706
    739,957$18,059
    743$8,077
    7546,852$48,047
    7648,155$43,568
    772,111$25,944
    7849,690$26,250
    79160,357$29,338
    807,158$18,890
    816$26,040
    8263,188$26,606
    837,153$21,619
    841,403$12,794
    8522,222$25,173
    861,717$15,489
    8796,688$26,941
    88427,043$19,079
    89553,977$22,015
    9043,487$13,141
    9153$11,532
    9216,513$24,871
    931,440$16,325
    9413,655$23,739
    951,577$12,582
    9659,616$15,886
    9726,688$11,792
    9813$12,385
    9921,386$15,725
    1006,410$12,207
    10123,368$18,532
    1024,930$12,464
    103886$234,790
    10420,120$123,941
    10532,626$93,509
    1063,440$110,979
    1088,757$89,257
    11057,708$59,154
    11110,783$45,072
    11334,728$45,319
    1147,959$30,164
    1175,349$25,616
    1187,619$33,285
    119963$25,968
    12033,555$36,452
    121150,046$29,680
    12254,522$20,942
    12329,563$25,710
    124120,511$29,663
    12592,405$23,754
    1265,422$40,934
    127667,286$21,971
    1284,210$15,620
    1293,521$21,831
    13087,464$20,073
    13122,952$12,066
    132101,373$13,642
    1335,853$12,329
    13439,815$13,569
    1357,164$19,619
    Start Printed Page 60041
    136943$14,096
    138206,123$17,779
    13974,037$11,515
    14031,103$11,148
    141123,084$16,561
    14249,143$13,263
    143237,810$12,620
    144104,876$24,607
    1455,742$12,887
    14610,269$45,085
    1472,614$31,236
    14919,522$30,220
    15022,971$44,985
    1515,403$27,722
    1525,011$33,345
    1531,951$23,305
    1556,015$27,713
    1564$42,483
    1578,316$25,978
    1583,718$14,380
    15919,222$28,297
    16011,939$18,842
    16110,145$25,543
    1624,950$15,310
    1635$14,037
    1645,996$38,812
    1652,457$25,557
    1665,154$29,283
    1674,909$19,618
    1681,640$25,297
    169895$16,754
    17017,930$44,495
    1711,408$26,705
    17233,048$26,386
    1732,225$17,067
    174253,126$21,935
    17529,235$12,619
    17614,648$23,980
    1777,654$20,567
    1782,557$15,456
    17914,726$22,991
    18091,333$20,898
    18125,350$12,543
    182255,695$17,111
    18379,006$13,062
    18472$12,788
    1856,251$18,891
    1867$5,682
    187646$18,329
    18887,004$22,793
    18912,389$13,014
    19010$13,844
    19110,586$54,763
    1921,379$32,585
    1934,041$51,627
    194461$32,149
    1952,846$50,151
    196594$32,373
    19716,420$41,918
    1984,109$26,007
    1991,481$37,168
    2001,017$39,819
    2012,717$52,822
    20227,495$25,144
    20332,424$26,193
    20469,425$23,001
    20532,781$23,350
    2062,069$16,175
    20738,290$24,723
    2089,444$15,567
    210126,742$36,048
    21125,766$26,709
    21210$18,640
    2139,549$33,765
    21619,882$35,321
    21715,719$41,774
    21830,183$32,723
    21921,169$23,471
    2202$23,950
    22312,680$25,338
    2249,900$18,613
    2256,275$26,106
    2266,770$29,359
    2274,857$18,625
    2282,678$24,536
    2291,121$15,636
    2302,473$26,449
    232570$20,932
    23318,488$34,645
    2349,054$27,557
    2354,763$16,225
    23641,768$15,378
    2371,924$13,851
    2389,693$26,241
    23940,335$23,048
    24012,890$24,453
    2412,848$14,337
    2422,722$22,539
    243100,966$17,005
    24416,921$15,401
    2455,808$10,457
    2461,393$13,422
    24721,347$12,738
    24816,397$18,895
    24913,488$15,481
    2504,164$15,047
    2512,060$10,726
    25324,800$16,488
    25410,027$10,231
    2567,605$17,982
    25713,112$19,590
    25811,382$15,403
    2592,660$21,569
    2602,420$15,136
    2611,569$20,684
    262602$20,906
    26322,523$32,388
    2643,924$22,371
    2654,035$28,311
    2662,229$19,608
    267276$20,117
    2681,007$25,617
    26911,061$30,458
    2702,581$17,775
    27121,574$21,522
    2726,063$20,960
    2731,268$12,686
    2742,214$22,741
    275181$13,452
    2761,611$15,546
    277118,986$18,413
    27833,859$11,767
    2796$9,146
    28019,325$16,074
    2816,587$11,105
    2836,750$15,606
    2841,860$9,719
    2858,075$35,310
    2862,868$34,890
    2875,459$31,321
    28811,449$36,433
    2896,343$19,733
    29011,873$18,847
    29160$12,885
    2927,589$41,617
    293318$27,403
    29496,809$16,328
    2954,384$16,246
    296247,066$17,313
    29742,865$10,814
    298111$11,206
    2991,529$21,388
    30021,667$23,240
    3013,928$13,559
    30210,492$53,338
    30319,976$35,840
    30413,647$37,446
    3052,957$25,330
    3065,818$25,924
    3071,947$13,770
    3085,453$27,143
    3092,963$19,770
    31025,376$25,325
    3115,890$14,282
    3121,328$24,333
    313505$16,723
    3142$63,668
    31534,913$34,744
    316205,564$24,392
    3172,713$17,237
    3185,910$24,034
    319386$13,859
    320224,863$18,222
    32131,969$12,283
    32267$13,256
    32320,412$18,199
    3244,635$11,384
    Start Printed Page 60042
    3259,919$14,511
    3262,592$9,803
    32711$4,287
    328574$15,451
    32954$11,775
    33156,121$22,455
    3323,962$13,809
    333244$18,783
    3349,525$29,895
    33512,194$24,054
    33628,188$18,058
    33721,485$12,514
    338674$26,937
    3391,237$24,400
    3413,131$26,325
    342457$16,760
    3442,341$26,264
    3451,390$24,260
    3463,961$22,442
    347235$12,271
    3484,262$15,658
    349554$10,030
    3507,276$16,403
    3521,177$16,583
    3533,089$31,220
    3547,566$29,704
    3554,987$19,286
    35622,032$16,331
    3575,537$37,764
    35820,928$24,273
    35928,584$17,298
    36013,855$18,950
    361287$23,686
    3622$6,796
    3632,155$23,016
    3641,799$19,267
    3651,617$32,699
    3664,645$23,868
    367446$12,998
    3684,145$23,496
    3693,723$14,363
    3702,249$17,564
    3712,705$12,728
    3721,376$10,829
    3735,273$7,559
    374153$13,086
    37512$22,690
    376476$12,879
    377109$24,191
    378201$16,303
    379499$8,235
    380111$9,375
    381169$15,153
    38248$3,957
    3832,806$10,566
    384151$7,395
    3893$47,550
    3922,139$45,748
    3942,759$31,095
    395101,473$16,889
    39618$13,731
    39716,392$23,042
    3986,706$23,195
    3991,080$14,886
    4016,451$43,898
    4021,356$25,234
    40331,326$29,951
    4043,820$20,323
    4062,303$42,395
    407615$24,808
    4081,948$33,924
    4091,748$25,090
    41029,053$23,878
    4115$9,689
    4129$9,325
    4135,741$25,503
    414487$16,459
    41733$28,277
    41829,977$22,170
    41917,634$18,501
    4203,100$12,987
    42113,255$16,161
    42279$11,719
    4238,962$28,700
    4241,041$36,317
    42513,096$13,579
    4264,235$10,364
    4271,579$11,172
    428845$13,787
    42923,937$16,841
    43075,525$13,560
    431333$12,622
    432402$14,045
    4334,471$6,874
    4391,759$29,662
    4405,216$29,532
    441686$20,412
    44218,596$37,581
    4433,589$22,657
    4446,012$16,341
    4452,242$11,493
    4476,323$11,529
    44940,846$18,259
    4507,445$9,450
    4512$19,075
    45228,815$21,740
    4535,394$11,430
    4544,738$17,873
    455887$10,736
    4612,290$27,973
    4627,863$17,177
    46332,884$15,102
    4647,661$11,329
    465163$12,758
    4661,204$14,616
    4671,026$10,056
    46852,034$57,130
    470128$25,337
    47115,630$55,525
    4738,578$38,344
    4762,850$35,320
    47728,197$34,214
    47927,646$30,661
    480908$128,375
    4811,198$89,005
    4825,081$49,252
    484472$75,143
    4853,713$51,989
    4862,712$69,289
    4875,016$32,012
    488828$63,441
    48913,547$28,616
    4905,252$21,801
    49122,663$35,766
    4923,924$44,487
    49361,082$34,534
    49424,547$22,726
    495342$121,280
    4963,726$96,585
    49731,201$62,709
    49821,280$52,054
    49935,237$28,358
    50046,425$19,847
    5013,200$42,457
    502764$29,384
    5035,910$26,642
    504192$146,686
    505180$28,342
    506963$50,252
    507323$31,921
    508654$23,708
    509155$16,122
    5101,782$21,231
    511627$13,442
    512550$90,296
    513226$67,441
    51558,659$86,726
    51823,762$34,527
    51912,586$44,237
    52016,525$35,867
    52129,364$15,479
    5223,423$12,533
    52314,462$8,530
    524109,013$16,166
    525205$156,390
    5281,845$107,946
    5295,026$36,171
    5303,360$25,619
    5314,993$45,629
    5322,882$28,150
    53343,711$29,870
    53440,201$21,434
    5358,826$119,455
    5368,259$109,010
    5378,983$32,598
    5385,459$22,345
    5394,973$44,611
    Start Printed Page 60043
    5401,504$25,501
    54125,104$251,059
    54223,115$151,522
    5435,718$64,397
    544445,799$39,439
    54544,802$44,851
    5462,360$83,437
    54732,710$97,734
    54832,249$79,397
    54913,141$80,495
    55034,566$63,327
    55153,869$51,351
    55282,058$40,481
    55339,292$46,800
    55477,351$36,871
    55537,378$42,659
    55618,973$37,602
    557124,154$51,160
    558192,637$42,298
    5592,894$40,731
    5603,457$44,405
    5612,952$35,694
    56252,954$22,156
    56321,145$14,021
    56416,327$15,310
    56546,823$78,345
    56673,082$39,133
    56710,363$72,728
    56816,695$48,820
    56960,814$63,237
    57072,247$44,163
    57111,153$23,681
    57248,983$25,165
    5736,683$51,724
    57426,619$24,474
    57510,978$86,104
    576277,472$28,309
    5775,596$35,353
    57835,312$65,007
    57920,665$39,583
    1 Cases taken from the FY 2005 MedPAR file; DRGs are from GROUPER Version 24.0.
    End Supplemental Information

    [FR Doc. 06-8471 Filed 9-29-06; 4:00 pm]

    BILLING CODE 4120-01-P

Document Information

Published:
10/11/2006
Department:
Centers for Medicare & Medicaid Services
Entry Type:
Notice
Action:
Notice.
Document Number:
06-8471
Pages:
59885-60043 (159 pages)
Docket Numbers:
CMS-1488-N
RINs:
0938-AO12
PDF File:
06-8471.pdf