[Federal Register Volume 63, Number 192 (Monday, October 5, 1998)]
[Notices]
[Pages 53446-53456]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 98-26501]
[[Page 53446]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-1039-N]
RIN 0938-AI87
Medicare Program; Hospice Wage Index
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the annual update to the hospice wage
index as required by 42 CFR 418.306(c). This update is effective
October 1, 1998. The wage index is used to reflect local differences in
wage levels. The hospice wage index methodology and values are based on
recommendations of a negotiated rulemaking advisory committee and were
originally published in the Federal Register on August 8, 1997. This
update is the second year of a 3-year transition period. The second
transition year begins October 1, 1998 and ends September 30, 1999.
EFFECTIVE DATE: This notice is effective on October 1, 1998.
FOR FURTHER INFORMATION CONTACT: Carol Blackford, (410) 786-5909.
SUPPLEMENTARY INFORMATION:
I. Background
A. Statute and Regulations
Hospice Care is an approach to treatment that recognizes that the
impending death of an individual warrants a change in the focus from
curative care to palliative care (relief of pain and other
uncomfortable symptoms). The goal of hospice care is to help terminally
ill individuals continue life with minimal disruption to normal
activities while remaining primarily in the home environment. A hospice
uses an interdisciplinary approach to deliver medical, social,
psychological, emotional, and spiritual services through use of a broad
spectrum of professional and other caregivers, with the goal of making
the individual as physically and emotionally comfortable as possible.
Counseling and respite services are available to the family of the
hospice patient. Hospice programs consider both the patient and the
family as a unit of care.
Section 1861(dd) of the Social Security Act (the Act) provides for
coverage of hospice care for terminally ill Medicare beneficiaries who
elect to receive care from a participating hospice. The statutory
authority for payment to hospices participating in the Medicare program
is contained in section 1814(i) of the Act.
Our existing regulations under 42 CFR Part 418 (issued on December
16, 1983, effective for hospice services furnished on or after November
1, 1983) establish eligibility requirements and payment standards and
procedures, define covered services, and delineate the conditions a
hospice must meet to be approved for participation in the Medicare
program. Subpart G of Part 418 provides for payment to hospices based
on one of four prospectively determined rates for each day in which a
qualified Medicare beneficiary is under the care of a hospice. The four
rate categories are routine home care, continuous home care, inpatient
respite care, and general inpatient care. Payment rates are established
for each category.
The regulations at Sec. 418.306(c), which require the rates to be
adjusted by a wage index, were revised on August 8, 1997, through
publication of a final rule in the Federal Register (62 FR 42860). This
rule implemented a new methodology for calculating the hospice wage
index that was based on the recommendations of a negotiated rulemaking
committee. The committee reached consensus on a methodology and the
resulting committee statement, describing that consensus, was included
as an attachment to the August 8, 1997 final hospice wage index rule.
The provisions of the final hospice wage index rule are as follows:
The revised hospice wage index will be phased in over a 3-
year transition period. For the first year of the transition period, a
blended index was calculated by adding two-thirds of the 1983 index
value for an area to one-third of the revised wage index value for that
area. During the second year of the transition period, the calculation
is similar, except that the blend is one-third of the 1983 index value
and two-thirds of the revised wage index value for that area. During
the third transition year the revised wage index will be fully
implemented. The first transition year occurred October 1, 1997 through
September 30, 1998.
All hospice wage index values of 0.8 or greater are
subject to a budget neutrality adjustment to ensure that Medicare does
not pay any more in the aggregate than it would with the previous wage
index. The budget neutrality adjustment is calculated by multiplying
the hospice wage index for a given area by the budget neutrality
adjustment factor. The budget neutrality adjustment is to be applied
annually, both during and after the transition period.
All hospice wage index values below 0.8 receive the
greater of the following adjustments: the wage index floor, a 15
percent increase, subject to a maximum wage index value of 0.8; or, the
budget neutrality adjustment.
The wage index is to be updated annually, in the Federal
Register, based on the most current available hospital wage data.
Because the Virgin Islands is not an area designated under
the Prospective Payment System for hospitals, and does not have a
hospital wage index, the hospice wage index for the Virgin Islands will
be calculated by gathering information from the hospital cost report
and comparing hourly wages of the hospital located in the Virgin
Islands to the national average, as described in step 9 of item III(A)
(computation of the hospice wage index) in the proposed hospice wage
index rule published in the Federal Register on September 4, 1996 (61
FR 46583).
Section 4442 of the Balanced Budget Act of 1997 requires payment
for routine and continuous home care to be made based on the geographic
location at which the service is furnished. The site of service
provision, as it is commonly referred to, was effective October 1, 1997
and was implemented through a Program Memorandum issued in September of
1997. This notice does not address implementation of the site of
service provision but merely takes this change into account when
analyzing the impact of the annual hospice wage index update.
B. Update to the Hospice Wage Index
The second year of the 3-year transition period begins October 1,
1998 and ends September 30, 1999. In accordance with the agreement
signed by HCFA and all other members of the Hospice Wage Index
Negotiated Rulemaking Committee, we are using the most current HCFA
hospital data available, including any changes to the definitions of
MSAs, that allow us to publish this notice at least 4 months in advance
of the October 1, 1998 effective date. We will be using the 1997
hospital area wage index. Updated wage index values have been
calculated by adding one-third of the 1983 index value for each area to
two-thirds of the new wage index value. All wage index values are
adjusted by a budget neutrality factor of 1.04662 and are subject to
the wage index floor adjustment, if applicable. All of the calculations
described above have been completed by HCFA and are built into the wage
index values
[[Page 53447]]
reflected in both Tables A and B below. At this time, there are no
Medicare certified hospices located in the Virgin Islands. Therefore, a
wage index value for the Virgin Islands has not been calculated.
C. Tables
Table A.--Hospice Wage Index for Urban Areas
------------------------------------------------------------------------
Urban area (constituent counties Wage
MSA code number or county equivalents) index
-------------------------------------------------------------------\1\--
0040........................ Abilene, TX..................... 0.9066
Taylor, TX
0060........................ Aguadilla, PR................... 0.5905
Aguada, PR
Aguadilla, PR
Moca, PR
0080........................ Akron, OH....................... 1.0563
Portage, OH
Summit, OH
0120........................ Albany, GA...................... 0.8629
Dougherty, GA
Lee, GA
0160........................ Albany-Schenectady-Troy, NY..... 0.9030
Albany, NY
Montgomery, NY
Rensselaer, NY
Saratoga, NY
Schenectady, NY
Schoharie, NY
01606....................... Albany-Schenectady-Troy, NY..... 0.8958
Schoharie, NY
0200........................ Albuquerque, NM................. 0.9737
Sandoval, NM
Valencia, NM
02006....................... Albuquerque, NM................. 1.0186
Bernalillo, NM
0220........................ Alexandria, LA.................. 0.9091
Rapides, LA
0240........................ Allentown-Bethlehem-Easton, PA.. 1.0707
Carbon, PA
Lehigh, PA
Northampton, PA
0280........................ Altoona, PA..................... 0.9951
Blair, PA
0320........................ Amarillo, TX.................... 0.9959
Potter, TX
Randall, TX
0380........................ Anchorage, AK................... 1.4074
Anchorage, AK
0440........................ Ann Arbor, MI................... 1.1528
Lenawee, MI
04406....................... Ann Arbor, MI................... 1.2441
Washtenaw, MI
04407....................... Ann Arbor, MI................... 1.2406
Livingston, MI
0450........................ Anniston, AL.................... 0.8776
Calhoun, AL
0460........................ Appleton-Oshkosh-Neenah, WI..... 0.9662
Calumet, WI
Outagamie, WI
Winnebago, WI
0470........................ Arecibo, PR..................... 0.5905
Arecibo, PR
Camuy, PR
Hatillo, PR
0480........................ Asheville, NC................... 0.9296
Madison, NC
04806....................... Asheville, NC................... 0.9647
Buncombe, NC
0500........................ Athens, GA...................... 0.9416
Clarke, GA
Madison, GA
Oconee, GA
0520........................ Atlanta, GA..................... 1.0139
Barrow, GA
Cherokee, GA
Clayton, GA
Cobb, GA
Coweta, GA
DeKalb, GA
Douglas, GA
Fayette, GA
Forsyth, GA
Fulton, GA
Gwinnett, GA
Henry, GA
Newton, GA
Paulding, GA
Rockdale, GA
Spalding, GA
Walton, GA
05206....................... Atlanta, GA..................... 0.9820
Bartow, GA
Carroll, GA
Pickens, GA
0560........................ Atlantic-Cape May, NJ........... 1.1498
Atlantic City, NJ
Cape May, NJ
0600........................ Augusta-Aiken, GA-SC............ 0.9866
Columbia, GA
McDuffie, GA
Richmond, GA
Aiken, SC
06006....................... Augusta-Aiken, GA-SC............ 0.9333
Edgefield, SC
0640........................ Austin-San Marcos, TX........... 0.9206
Bastrop, TX
Caldwell, TX
06406....................... Austin-San Marcos, TX........... 1.0067
Hays, TX
Travis, TX
Williamson, TX
0680........................ Bakersfield, CA................. 1.1268
Kern, CA
0720........................ Baltimore, MD................... 1.0549
Anne Arundel, MD
Baltimore, MD
Baltimore City, MD
Carroll, MD
Harford, MD
Howard, MD
Queen Anne's, MD
0733........................ Bangor, ME...................... 0.9847
Penobscot, ME
0743........................ Barnstable-Yarmouth, MA......... 1.3359
Barnstable, MA
0760........................ Baton Rouge, LA................. 0.9398
Ascension, LA
East Baton Rouge, LA
Livingston, LA
West Baton Rouge, LA
0840........................ Beaumont-Port Arthur, TX........ 0.9440
Hardin, TX
Jefferson, TX
Orange, TX
0860........................ Bellingham, WA.................. 1.1508
Whatcom, WA
0870........................ Benton Harbor, MI............... 0.9273
Berrien, NJ
0875........................ Bergen-Passaic, NJ.............. 1.2072
Bergen, NJ
Passaic, NJ
0880........................ Billings, MT.................... 1.0192
Yellowstone, MT
0920........................ Biloxi-Gulfport-Pascagoula, MS.. 0.8910
Hancock, MS
Harrison, MS
09206....................... Biloxi-Gulfport-Pascagoula, MS.. 0.9409
Jackson, MS
0960........................ Binghamton, NY.................. 0.9543
Broome, NY
Tioga, NY
1000........................ Birmingham, AL.................. 0.9788
Blount, AL
Jefferson, AL
St. Clair, AL
Shelby, AL
1010........................ Bismarck, ND.................... 0.8893
Burleigh, ND
Morton, ND
1020........................ Bloomington, IN................. 0.9559
Monroe, IN
1040........................ Bloomington-Normal, IL.......... 0.9630
McLean, IL
1080........................ Boise City, ID.................. 0.9320
Canyon, ID
10806....................... Boise City, ID.................. 0.9931
Ada, ID
1123........................ Boston-Worcester-Lawrence-Lowell- 1.1805
Brockton, MA-NH.
Essex, MA
Middlesex, MA
Norfolk, MA
Plymouth, MA
Suffolk, MA
11236....................... Boston-Worcester-Lawrence-Lowell- 1.1246
Brockton, MA-NH.
Hillsborough, NH
Merrimack, NH
11237....................... Boston-Worcester-Lawrence-Lowell- 1.1356
Brockton, MA-NH.
Bristol, MA
11238....................... Boston-Worcester-Lawrence-Lowell- 1.0935
Brockton, MA-NH.
Rockingham, NH
Strafford, NH
11239....................... Boston-Worcester-Lawrence-Lowell- 1.1394
Brockton, MA-NH.
Worcester, MA
1125........................ Boulder-Longmont, CO............ 1.0470
Boulder, CO
1145........................ Brazoria, TX.................... 0.9451
Brazoria, TX
1150........................ Bremerton, WA................... 1.0810
Kitsap, WA
[[Page 53448]]
1240........................ Brownsville-Harlingen-San 0.9314
Benito, TX.
Cameron, TX
1260........................ Bryan-College Station, TX....... 0.9147
Brazos, TX
1280........................ Buffalo-Niagara Falls, NY....... 0.9884
Erie, NY
12806....................... Buffalo-Niagara Falls, NY....... 0.9519
Niagara, NY
1303........................ Burlington, VT.................. 1.1037
Franklin, VT
13036....................... Burlington, VT.................. 1.0444
Chittenden, VT
Grand Isle, VT
1310........................ Caguas, PR...................... 0.6085
Caguas, PR
Cayey, PR
Cidra, PR
Gurabo, PR
San Lorenzo, PR
1320........................ Canton-Massillon, OH............ 0.9670
Carroll, OH
Stark, OH
1350........................ Casper, WY...................... 0.9866
Natrona, WY
1360........................ Cedar Rapids, IA................ 0.9223
Linn, IA
1400........................ Champaign-Urbana, IL............ 0.9731
Champaign, IL
1440........................ Charleston-North Charleston, SC. 0.9725
Berkeley, SC
Charleston, SC
Dorchester, SC
1480........................ Charleston, WV.................. 1.0228
Kanawha, WV
Putnam, WV
1520........................ Charlotte-Gastonia-Rock Hill, NC- 1.0186
SC.
Cabarrus, NC
Gaston, NC
Lincoln, NC
Mecklenburg, NC
Rowan, NC
Stanly, NC
Union, NC
York, SC
1540........................ Charlottesville, VA............. 1.0824
Albemarle, VA
Charlottesville City, VA
Fluvanna, VA
Greene, VA
1560........................ Chattanooga, TN-GA.............. 0.9415
Catoosa, GA
Dade, GA
Walker, GA
Hamilton, TN
Marion, TN
1580........................ Cheyenne, WY.................... 0.9091
Laramie, WY
1600........................ Chicago, IL..................... 1.0607
DeKalb, IL
16006....................... Chicago, IL..................... 1.1051
Kane, IL
Kendall, IL
16007....................... Chicago, IL..................... 1.1832
Cook, IL
Du Page, IL
McHenry, IL
16008....................... Chicago, IL..................... 1.1378
Grundy, IL
Will, IL
16009....................... Chicago, IL..................... 1.1445
Lake, IL
1620........................ Chico-Paradise, CA.............. 1.0960
Butte, CA
1640........................ Cincinnati, OH-KY-IN............ 0.9617
Ohio, IN
16406....................... Cincinnati, OH-KY-IN............ 0.9455
Gallatin, KY
Grant, KY
Pendleton, KY
16407....................... Cincinnati, OH-KY-IN............ 0.9801
Brown, OH
16408....................... Cincinnati, OH-KY-IN............ 1.0294
Dearborn, IN
Boone, KY
Campbell, KY
Kenton, KY
Clermont, OH
Hamilton, OH
Warren, OH
1660........................ Clarksville-Hopkinsville, TN-KY. 0.8389
Christian, KY
Montgomery, TN
1680........................ Cleveland-Lorain-Elyria, OH..... 1.0031
Ashtabula, OH
16806....................... Cleveland-Lorain-Elyria, OH..... 1.1037
Cuyahoga, OH
Geauga, OH
Lake, OH
Medina, OH
16807....................... Cleveland-Lorain-Elyria, OH..... 1.0521
Lorain, OH
1720........................ Colorado Springs, CO............ 1.0362
El Paso, CO
1740........................ Columbia, MO.................... 1.0242
Boone, MO
1760........................ Columbia, SC.................... 0.9764
Lexington, SC
Richland, SC
1800........................ Harris, GA...................... 0.8749
18006....................... Columbus, GA-AL................. 0.8992
Russell, AL
Chattahoochee, GA
Muscogee, GA
1840........................ Columbus, OH.................... 1.0469
Delaware, OH
Fairfield, OH
Franklin, OH
Licking, OH
Madison, OH
Pickaway, OH
1880........................ Corpus Christi, TX.............. 0.9607
Nueces, TX
San Patricio, TX
1900........................ Cumberland, MD-WV............... 0.9456
Allegany, MD
Mineral, WV
1920........................ Dallas, TX...................... 1.0529
Collin, TX
Dallas, TX
Denton, TX
Ellis, TX
Kaufman, TX
Rockwall, TX
19206....................... Dallas, TX...................... 0.9604
Henderson, TX
Hunt, TX
1950........................ Danville, VA.................... 0.8719
Danville City, VA
Pittsylvania, VA
1960........................ Davenport-Moline-Rock Island, IA- 0.9291
IL.
Scott, IA
Henry, IL
Rock Island, IL
2000........................ Dayton-Springfield, OH.......... 1.0565
Clark, OH
Greene, OH
Miami, OH
Montgomery, OH
2020........................ Daytona Beach, FL............... 0.9209
Flagler, FL
20206....................... Daytona Beach, FL............... 0.9548
Volusia, FL
2030........................ Decatur, AL..................... 0.8572
Lawrence, AL
Morgan, AL
2040........................ Decatur, IL..................... 0.8952
Macon, IL
2080........................ Denver, CO...................... 1.1482
Adams, CO
Arapahoe, CO
Denver, CO
Douglas, CO
Jefferson, CO
2120........................ Des Moines, IA.................. 0.9902
Dallas, IA
Polk, IA
Warren, IA
2160........................ Detroit, MI..................... 1.1737
Lapeer, MI
Macomb, MI
Monroe, MI
Oakland, MI
St. Clair, MI
Wayne, MI
2180........................ Dothan, AL...................... 0.8717
Dale, AL
Houston, AL
2190........................ Dover, DE....................... 0.9636
Kent, DE
2200........................ Dubuque, IA..................... 0.9230
Dubuque, IA
2240........................ Duluth-Superior, MN-WI.......... 1.0017
St. Louis, MN
Douglas, WI
2281........................ Dutchess County, NY............. 1.1228
Dutchess, NY
2290........................ Eau Claire, WI.................. 0.9500
Chippewa, WI
Eau Claire, WI
2320........................ El Paso, TX..................... 1.0200
El Paso, TX
2330........................ Elkhart-Goshen, IN.............. 0.9443
Elkhart, IN
2335........................ Elmira, NY...................... 0.9440
Chemung, NY
2340........................ Enid, OK........................ 0.8701
[[Page 53449]]
Garfield, OK
2360........................ Erie, PA........................ 0.9647
Erie, PA
2400........................ Eugene-Springfield, OR.......... 1.1426
Lane, OR
2440........................ Evansville-Henderson, IN-KY..... 0.9550
Posey, IN
Vanderburgh, IN
Warrick, IN
Henderson, KY
2520........................ Fargo-Moorhead, ND-MN........... 0.9672
Clay, MN
Cass, ND
2560........................ Fayetteville, NC................ 0.9347
Cumberland, NC
2580........................ Fayetteville-Springdale-Rogers, 0.8000
AR.
Benton, AR
2580........................ Fayetteville-Springdale-Rogers, 0.8102
AR.
Washington, AR
2620........................ Flagstaff, AZ-UT................ 0.9482
Coconino, AZ
26206....................... Flagstaff, AZ-UT................ 0.9242
Kane, UT
2640........................ Flint, MI....................... 1.1814
Genesee, MI
2650........................ Florence, AL.................... 0.8029
Colbert, AL
Lauderdale, AL
2655........................ Florence, SC.................... 0.8894
Florence, SC
2670........................ Fort Collins-Loveland, CO....... 1.0387
Larimer, CO
2680........................ Ft. Lauderdale, FL.............. 1.1164
Broward, FL
2700........................ Fort Myers-Cape Coral, FL....... 0.9391
Lee, FL
2710........................ Fort Pierce-Port St. Lucie, FL.. 1.0625
Martin, FL
St. Lucie, FL
2720........................ Fort Smith, AR-OK............... 0.8806
Crawford, AR
Sebastian, AR
Sequoyah, OK
2750........................ Fort Walton Beach, FL........... 0.8958
Okaloosa, FL
2760........................ Fort Wayne, IN.................. 0.9217
Adams, IN
Huntington, IN
Wells, IN
2760........................ Fort Wayne, IN.................. 0.9506
Allen, IN
De Kalb, IN
Whitley, IN
2800........................ Forth Worth-Arlington, TX....... 0.9797
Hood, TX
28006....................... Forth Worth-Arlington, TX....... 1.0201
Johnson, TX
Parker, TX
Tarrant, TX
2840........................ Fresno, CA...................... 1.0927
Madera, CA
28406....................... Fresno, CA...................... 1.1570
Fresno, CA
2880........................ Gadsden, AL..................... 0.9372
Etowah, AL
2900........................ Gainesville, FL................. 1.0097
Alachua, FL
2920........................ Galveston-Texas City, TX........ 1.1495
Galveston, TX
2960........................ Gary, IN........................ 1.0636
Lake, IN
Porter, IN
2975........................ Glens Falls, NY................. 0.8936
Warren, NY
Washington, NY
2980........................ Goldsboro, NC................... 0.8857
Wayne, NC
2985........................ Grand Forks, ND-MN.............. 0.9098
Polk, MN
29856....................... Grand Forks, ND-MN.............. 0.9507
Grand Forks, ND
2995........................ Grand Junction, CO.............. 0.9246
Mesa, CO
3000........................ Grand Rapids-Muskegon-Holland, 1.0385
MI.
Allegan, MI
30006....................... Grand Rapids-Muskegon-Holland, 1.0568
MI.
Kent, MI
Ottawa, MI
30007....................... Grand Rapids-Muskegon-Holland, 1.0333
MI.
Muskegon, MI
3040........................ Great Falls, MT................. 0.9738
Cascade, MT
3060........................ Greeley, CO..................... 1.0823
Weld, CO
3080........................ Green Bay, WI................... 0.9827
Brown, WI
3120........................ Greensboro-Winston-Salem-High 0.9866
Point, NC.
Davidson, NC
Davie, NC
Forsyth, NC
Guilford, NC
Randolph, NC
Stokes, NC
Yadkin, NC
31206....................... Greensboro-Winston-Salem-High 0.9483
Point, NC.
Alamance, NC
3150........................ Greenville, NC.................. 0.9291
Pitt, NC
3160........................ Greenville-Spartanburg-Anderson, 0.9142
SC.
Cherokee, SC
31606....................... Greenville-Spartanburg-Anderson, 0.9372
SC.
Anderson, SC
31607....................... Greenville-Spartanburg-Anderson, 0.9626
SC.
Greenville, SC
Pickens, SC
Spartanburg, SC
3180........................ Hagerstown, MD.................. 1.0275
Washington, MD
3200........................ Hamilton-Middletown, OH......... 0.9757
Butler, OH
3240........................ Harrisburg-Lebanon-Carlisle, PA. 1.0721
Cumberland, PA
Dauphin, PA
Lebanon, PA
Perry, PA
3283........................ Hartford, CT.................... 1.2533
Hartford, CT
Litchfield, CT
Middlesex, CT
Tolland, CT
3285........................ Hattiesburg, MS................. 0.8007
Forrest, MS
Lamar, MS
3290........................ Hickory-Morganton-Lenoir, NC.... 0.9027
Caldwell, NC
32906....................... Hickory-Morganton-Lenoir, NC.... 0.9376
Alexander, NC
Burke, NC
Catawba, NC
3320........................ Honolulu, HI.................... 1.2246
Honolulu, HI
3350........................ Houma, LA....................... 0.8894
Lafourche, LA
Terrebonne, LA
3360........................ Houston, TX..................... 1.0755
Fort Bend, TX
Harris, TX
Liberty, TX
Montgomery, TX
Waller, TX
33606....................... Houston, TX..................... 0.9710
Chambers, TX
3400........................ Huntington-Ashland, WV-KY-OH.... 0.9813
Boyd, KY
Carter, KY
Greenup, KY
Lawrence, OH
Cabell, WV
Wayne, WV
3440........................ Huntsville, AL.................. 0.8711
Limestone, AL
34406....................... Huntsville, AL.................. 0.9057
Madison, AL
3480........................ Indianapolis, IN................ 1.0554
Boone, IN
Hamilton, IN
Hancock, IN
Hendricks, IN
Johnson, IN
Marion, IN
Morgan, IN
Shelby, IN
34806....................... Indianapolis, IN................ 1.0252
Madison, IN
3500........................ Iowa City, IA................... 1.0545
Johnson, IA
3520........................ Jackson, MI..................... 0.9903
Jackson, MI
3560........................ Jackson, MS..................... 0.8593
Hinds, MS
Madison, MS
Rankin, MS
3580........................ Jackson, TN..................... 0.8737
Madison, TN
[[Page 53450]]
Chester, TN
3600........................ Jacksonville, FL................ 0.9717
Clay, FL
Duval, FL
Nassau, FL
St. Johns, FL
3605........................ Jacksonville, NC................ 0.8625
Onslow, NC
3610........................ Jamestown, NY................... 0.8902
Chautauqua, NY
3620........................ Janesville-Beloit, WI........... 0.9264
Rock, WI
3640........................ Jersey City, NJ................. 1.1770
Hudson, NJ
3660........................ Johnson City-Kingsport-Bristol, 0.9583
TN-VA.
Carter, TN
Hawkins, TN
Sullivan, TN
Unicoi, TN
Washington, TN
Bristol City, VA
Scott, VA
Washington, VA
3680........................ Johnstown, PA................... 0.9463
Cambria, PA
Somerset, PA
3700........................ Jonesboro, AR................... 0.8000
Craighead, AR
3710........................ Joplin, MO...................... 0.8526
Jasper, MO
Newton, MO
3720........................ Kalamazoo-Battlecreek, MI....... 1.0749
Van Buren, MI
37206....................... Kalamazoo-Battlecreek, MI....... 1.1141
Calhoun, MI
37207....................... Kalamazoo-Battlecreek, MI....... 1.1724
Kalamazoo, MI
3740........................ Kankakee, IL.................... 0.9227
Kankakee, IL
3760........................ Kansas City, KS-MO.............. 0.9568
Clinton, MO
37606....................... Kansas City, KS-MO.............. 1.0086
Johnson, KS
Leavenworth, KS
Miami, KS
Wyandotte, KS
37607....................... Kansas City, KS-MO.............. 1.0130
Cass, MO
Clay, MO
Jackson, MO
Lafayette, MO
Platte, MO
Ray, MO
3800........................ Kenosha, WI..................... 1.0224
Kenosha, WI
3810........................ Killeen-Temple, TX.............. 1.0433
Bell, TX
Coryell, TX
3840........................ Knoxville, TN................... 0.9366
Anderson, TN
Blount, TN
Knox, TN
Sevier, TN
Union, TN
38406....................... Knoxville, TN................... 0.8953
Loudon, TN
3850........................ Kokomo, IN...................... 0.9225
Howard, IN
Tipton, IN
3870........................ La Crosse, WI-MN................ 0.9101
Houston, MN
La Crosse, WI
38706....................... La Crosse, WI-MN................ 0.9385
La Crosse, WI
3880........................ Lafayette, LA................... 0.8641
Acadia, LA
St. Landry, LA
38806....................... Lafayette, LA................... 0.9271
Lafayette, LA
St. Martin, LA
3920........................ Lafayette, IN................... 0.9407
Clinton, IN
39206....................... Lafayette, IN................... 0.9580
Tippecanoe, IN
3960........................ Lake Charles, LA................ 0.8894
Calcasieu, LA
3980........................ Lakeland-Winter Haven, FL....... 0.9403
Polk, FL
4000........................ Lancaster, PA................... 1.0234
Lancaster, PA
4040........................ Lansing-East Lansing, MI........ 1.0707
Clinton, MI
Eaton, MI
Ingham, MI
4080........................ Laredo, TX...................... 0.8187
Webb, TX
4100........................ Las Cruces, NM.................. 0.8982
Dona Ana, NM
4120........................ Las Vegas, NV-AZ................ 1.0512
Mohave, AZ
41206....................... Las Vegas, NV-AZ................ 1.0941
Nye, NV
41207....................... Las Vegas, NV-AZ................ 1.1643
Clark, NV
4150........................ Lawrence, KS.................... 0.9424
Douglas, KS
4200........................ Lawton, OK...................... 0.9547
Comanche, OK
4243........................ Lewiston-Auburn, ME............. 0.9855
Androscoggin, ME
4280........................ Lexington, KY................... 0.9194
Bourbon, KY
Clark, KY
Fayette, KY
Jessamine, KY
Scott, KY
Woodford, KY
42806....................... Lexington, KY................... 0.8699
Madison, KY
4320........................ Lima, OH........................ 0.9893
Allen, OH
Auglaize, OH
4360........................ Lincoln, NE..................... 0.9465
Lancaster, NE
4400........................ Little Rock-North Little Rock, 0.9476
AR.
Faulkner, AR
Lonoke, AR
Pulaski, AR
Saline, AR
4420........................ Longview-Marshall, TX........... 0.8843
Upshur, TX
44206....................... Longview-Marshall, TX........... 0.8996
Gregg, TX
Harrison, TX
4480........................ Los Angeles-Long Beach, CA...... 1.3083
Los Angeles, CA
4520........................ Louisville, KY-IN............... 1.0420
Clark, IN
Floyd, IN
Harrison, IN
Bullitt, KY
Jefferson, KY
Oldham, KY
45206....................... Louisville, KY-IN............... 0.9640
Scott, IN
4600........................ Lubbock, TX..................... 0.9380
Lubbock, TX
4640........................ Lynchburg, VA................... 0.8713
Bedford, VA
Bedford City, VA
46406....................... Lynchburg, VA................... 0.8964
Amherst, VA
Campbell, VA
Lynchburg City, VA
4680........................ Macon, GA....................... 0.9874
Bibb, GA
Houston, GA
Jones, GA
Peach, GA
46806....................... Macon, GA....................... 0.9404
Twiggs, GA
4720........................ Madison, WI..................... 1.0595
Dane, WI
4800........................ Mansfield, OH................... 0.9218
Crawford, OH
48006....................... Mansfield, OH................... 0.9229
Richland, OH
4840........................ Mayaguez, PR.................... 0.6098
Anasco, PR
Cabo Rojo, PR
Hormigueros, PR
Mayaguez, PR
Sabana Grande, PR
San German, PR
4880........................ McAllen-Edinburg-Mission, TX.... 0.8764
Hidalgo, TX
4890........................ Medford-Ashland, OR............. 1.0662
Jackson, OR
4900........................ Melbourne-Titusville-Palm Bay, 0.9423
FL.
Brevard, Fl
4920........................ Memphis, TN-AR-MS............... 0.9748
Crittenden, AR
DeSoto, MS
Shelby, TN
Tipton, TN
49206....................... Memphis, TN-AR-MS............... 0.8784
Fayette, TN
4940........................ Merced, CA...................... 1.1164
Merced, CA
5000........................ Miami, FL....................... 1.0888
Dade, FL
5015........................ Middlesex-Somerset-Hunterdon, NJ 1.1426
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
[[Page 53451]]
5080........................ Milwaukee-Waukesha, WI.......... 1.0522
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120........................ Minneapolis-St. Paul, MN-WI..... 1.0385
Pierce, WI
51206....................... Minneapolis-St. Paul, MN-WI..... 1.1072
Anoka, MN
Carver, MN
Chisago, MN
Dakota, MN
Hennepin, MN
Isanti, MN
Ramsey, MN
Scott, MN
Washington, MN
Wright, MN
St. Croix, WI
51207....................... Minneapolis-St. Paul, MN-WI..... 1.0561
Sherburne, MN
5160........................ Mobile, AL...................... 0.9154
Baldwin, AL
Mobile, AL
5170........................ Modesto, CA..................... 1.1297
Stanislaus, CA
5190........................ Monmouth-Ocean, NJ.............. 1.1070
Monmouth, NJ
Ocean, NJ
5200........................ Monroe, LA...................... 0.9202
Ouachita, LA
5240........................ Montgomery, AL.................. 0.8745
Autauga, AL
Elmore, AL
Montgomery, AL
5280........................ Muncie, IN...................... 0.9813
Delaware, IN
5330........................ Myrtle Beach, SC................ 0.8453
Horry, SC
5345........................ Naples, FL...................... 1.0096
Collier, FL
5360........................ Nashville, TN................... 1.0693
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
Rutherford, TN
Sumner, TN
Williamson, TN
Wilson, TN
5380........................ Nassau-Suffolk, NY.............. 1.3852
Nassau, NY
Suffolk, NY
5483........................ New Haven-Bridgeport-Stamford- 1.2841
Waterbury-Danbury, CT.
Fairfield, CT
54836....................... New Haven-Bridgeport-Stamford- 1.2525
Waterbury-Danbury, CT.
New Haven, CT
5523........................ New London-Norwich, CT.......... 1.2525
New London, CT
5560........................ New Orleans, LA................. 1.0220
Jefferson, LA
Orleans, LA
St. Bernard, LA
St. Charles, LA
St. John The Baptist, LA
St. Tammany, LA
55606....................... New Orleans, LA................. 0.9590
Plaquemines, LA
St. James, LA
5600........................ New York, NY.................... 1.4545
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
Richmond, NY
Rockland, NY
Westchester, NY
5640........................ Newark, NJ...................... 1.2297
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
5640........................ Newark, NJ...................... 1.2028
Warren, NJ
5660........................ Newburgh, NY-PA................. 1.1476
Pike, PA
56606....................... Newburgh, NY-PA................. 1.1382
Orange, NY
5720........................ Norfolk-Virginia Beach-Newport 0.9215
News, VA-NC.
Chesapeake City, VA
Gloucester, VA
Hampton City, VA
James 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
York, VA
57206....................... Norfolk-Virginia Beach-Newport 0.8774
News, VA-NC.
Isle of Wight, VA
Mathews, VA
57207....................... Norfolk-Virginia Beach-Newport 0.8769
News, VA-NC.
Currituck, NC
5775........................ Oakland, CA..................... 1.4914
Alameda, CA
Contra Costa, CA
5790........................ Ocala, FL....................... 0.9825
Marion, FL
5800........................ Odessa-Midland, TX.............. 0.9804
Midland, TX
58006....................... Odessa-Midland, TX.............. 0.9453
Ector, TX
5880........................ Oklahoma City, OK............... 0.9606
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910........................ Olympia, WA..................... 1.1295
Thurston, WA
5920........................ Omaha, NE-IA.................... 0.9694
Pottawattamie, IA
Douglas, NE
Sarpy, NE
Washington, NE
59206....................... Omaha, NE-IA.................... 0.9364
Cass, NE
5945........................ Orange County, CA............... 1.2439
Orange, CA
5960........................ Orlando, FL..................... 1.0096
Orange, FL
Osceola, FL
Seminole, FL
59606....................... Orlando, FL..................... 0.9599
Lake, FL
5990........................ Owensboro, KY................... 0.8510
Daviess, KY
6015........................ Panama City, FL................. 0.9333
Bay, FL
6020........................ Parkersburg-Marietta, WV-OH..... 0.9357
Washington, OH
Wood, WV
6080........................ Pensacola, FL................... 0.9345
Escambia, FL
Santa Rosa, FL
6120........................ Peoria-Pekin, IL................ 0.9883
Peoria, IL
Tazewell, IL
Woodford, IL
6160........................ Philadelphia, PA-NJ............. 1.2042
Burlington, NJ
Camden, NJ
Gloucester, NJ
Bucks, PA
Chester, PA
Delaware, PA
Montgomery, PA
Philadelphia, PA
61606....................... Philadelphia, PA-NJ............. 1.1740
Salem, NJ
6200........................ Phoenix-Mesa, AZ................ 0.9824
Pinal, AZ
62006....................... Phoenix-Mesa, AZ................ 1.0583
Maricopa, AZ
6240........................ Pine Bluff, AR.................. 0.8521
Jefferson, AR
6280........................ Pittsburgh, PA.................. 1.0758
Allegheny, PA
Fayette, PA
Washington, PA
Westmoreland, PA
62806....................... Pittsburgh, PA.................. 1.0575
Beaver, PA
62807....................... Pittsburgh, PA.................. 1.0389
Butler, PA
6323........................ Pittsfield, MA.................. 1.1071
Berkshire, MA
6340........................ Pocatello, ID................... 0.9829
Bannock, ID
6360........................ Ponce, PR....................... 0.6185
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
[[Page 53452]]
6403........................ Portland, ME.................... 1.0085
Cumberland, ME
Sagadahoc, ME
York, ME
6440........................ Portland-Vancouver, OR-WA....... 1.1251
Columbia, OR
64406....................... Portland-Vancouver, OR-WA....... 1.1820
Clackamas, OR
Multnomah, OR
Washington, OR
Yamhill, OR
64407....................... Portland-Vancouver, OR-WA....... 1.1693
Clark, WA
6483........................ Providence-Warwick-Pawtucket, RI 1.1119
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520........................ Provo-Orem, UT.................. 1.0332
Utah, UT
6560........................ Pueblo, CO...................... 0.9943
Pueblo, CO
6580........................ Punta Gorda, FL................. 0.9209
Charlotte, FL
6600........................ Racine, WI...................... 0.9727
Racine, WI
6640........................ Raleigh-Durham-Chapel Hill, NC.. 0.9817
Chatham, NC
Johnston, NC
66406....................... Raleigh-Durham-Chapel Hill, NC.. 1.0388
Durham, NC
Franklin, NC
Orange, NC
Wake, NC
6660........................ Rapid City, SD.................. 0.8614
Pennington, SD
6680........................ Reading, PA..................... 1.0228
Berks, PA
6690........................ Redding, CA..................... 1.1905
Shasta, CA
6720........................ Reno, NV........................ 1.2044
Washoe, NV
6740........................ Richland-Kennewick-Pasco, WA.... 1.0462
Benton, WA
Franklin, WA
6760........................ Richmond-Petersburg, VA......... 0.9479
Charles City County, VA
Chesterfield, VA
Colonial Heights City, VA
Dinwiddie, VA
Goochland, VA
Hanover, VA
Henrico, VA
Hopewell City, VA
New Kent, VA
Petersburg City, VA
Powhatan, VA
Prince George, VA
Richmond City, VA
6780........................ Riverside-San Bernardino, CA.... 1.1990
Riverside, CA
San Bernardino, CA
6800........................ Roanoke, VA..................... 0.9358
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820........................ Rochester, MN................... 1.0905
Olmsted, MN
6840........................ Rochester, NY................... 1.0266
Livingston, NY
Monroe, NY
Ontario, NY
Orleans, NY
Wayne, NY
68406....................... Rochester, NY................... 0.9686
Genesee, NY
6880........................ Rockford, IL.................... 0.9365
Ogle, IL
68806....................... Rockford, IL.................... 0.9976
Boone, IL
Winnebago, IL
6895........................ Rocky Mount, NC................. 0.9266
Edgecombe, NC
Nash, NC
6920........................ Sacramento, CA.................. 1.2499
El Dorado, CA
Placer, CA
Sacramento, CA
6960........................ Saginaw-Bay City-Midland, MI.... 1.0493
Bay, MI
Midland, MI
Saginaw, MI
6980........................ St. Cloud, MN................... 0.9731
Benton, MN
Stearns, MN
7000........................ St. Joseph, MO.................. 0.8732
Andrew, MO
70006....................... St. Joseph, MO.................. 0.9283
Buchanan, MO
7040........................ St. Louis, MO-IL................ 0.9265
Lincoln, MO
Warren, MO
70406....................... St. Louis, MO-IL................ 0.9715
Jersey, IL
Madison, IL
70407....................... St. Louis, MO-IL................ 0.9760
Clinton, IL
St. Clair, IL
70408....................... St. Louis, MO-IL................ 1.0109
Franklin, MO
Jefferson, MO
Monore, IL
St. Charles, MO
St. Louis City, MO
7080........................ Salem, OR....................... 1.0651
Marion, OR
Polk, OR
7120........................ Salinas, CA..................... 1.4579
Monterey, CA
7160........................ Salt Lake City-Ogden, UT........ 1.0251
Davis, UT
Salt Lake, UT
Weber, UT
7200........................ San Angelo, TX.................. 0.8669
Tom Green, TX
7240........................ San Antonio, TX................. 0.8764
Wilson, TX
72406....................... San Antonio, TX................. 0.9599
Bexar, TX
Comal, TX
Guadalupe, TX
7320........................ San Diego, CA................... 1.2658
San Diego, CA
7360........................ San Francisco, CA............... 1.4769
Marin, CA
San Francisco, CA
San Mateo, CA
7400........................ San Jose, CA.................... 1.4519
Santa Clara, CA
7440........................ San Juan-Bayamon, PR............ 0.6207
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
Fajardo, PR
Florida, PR
Guaynabo, PR
Humacao, PR
Juncos, PR
Los Piedras, PR
Loiza, PR
Luguillo, PR
Manati, PR
Morovis, PR
Naguabo, PR
Naranjito, PR
Rio Grande, PR
San Juan, PR
Toa Alta, PR
Toa Baja, PR
Trujillo Alto, PR
Vega Alta, PR
Vega Baja, PR
Yabucoa, PR
7460........................ San Luis Obispo-Atascadero-Paso 1.1462
Robles, CA.
San Luis Obispo, CA
7480........................ Santa Barbara-Santa Maria- 1.1336
Lompoc, CA.
Santa Barbara, CA
7485........................ Santa Cruz-Watsonville, CA...... 1.3871
Santa Cruz, CA
7490........................ Santa Fe, NM.................... 1.0451
Los Alamos, NM
Santa Fe, NM
7500........................ Santa Rosa, CA.................. 1.3069
Sonoma, CA
7510........................ Sarasota-Bradenton, FL.......... 1.0255
Sarasota, FL
75106....................... Sarasota-Bradenton, FL.......... 1.0017
Manatee, FL
7520........................ Savannah, GA.................... 0.8993
Bryan, GA
75206....................... Savannah, GA.................... 0.9349
Chatham, GA
[[Page 53453]]
Effingham, GA
7560........................ Scranton--Wilkes-Barre-- 0.9364
Hazleton, PA.
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600........................ Seattle-Bellevue-Everett, WA.... 1.1225
Island, WA
76006....................... Seattle-Bellevue-Everett, WA.... 1.1708
King, WA
Snohomish, WA
7610........................ Sharon, PA...................... 0.9498
Mercer, PA
7620........................ Sheboygan, WI................... 0.9000
Sheboygan, WI
7640........................ Sherman-Denison, TX............. 0.9075
Grayson, TX
7680........................ Shreveport-Bossier City, LA..... 0.9461
Webster, LA
76806....................... Shreveport-Bossier City, LA..... 1.0263
Bossier, LA
Caddo, LA
7720........................ Sioux City, IA-NE............... 0.9205
Woodbury, IA
Dakota, NE
7760........................ Sioux Falls, SD................. 0.8870
Lincoln, SD
77606....................... Sioux Falls, SD................. 0.9375
Minnehaha, SD
7800........................ South Bend, IN.................. 1.0021
St. Joseph, IN
7840........................ Spokane, WA..................... 1.1221
Spokane, WA
7880........................ Springfield, IL................. 1.0062
Menard, IL
Sangamon, IL
7920........................ Springfield, MO................. 0.8469
Webster, MO
79206....................... Springfield, MO................. 0.8901
Christian, MO
Greene, MO
8003........................ Springfield, MA................. 1.0923
Hampden, MA
Hampshire, MA
8050........................ State College, PA............... 1.0411
Centre, PA
8080........................ Steubenville-Weirton, OH-WV..... 0.9438
Jefferson, OH
Brooke, WV
Hancock, WV
8120........................ Stockton-Lodi, CA............... 1.2084
San Joaquin, CA
8140........................ Sumter, SC...................... 0.8348
Sumter, SC
8160........................ Syracuse, NY.................... 0.9644
Cayuga, NY
81606....................... Syracuse, NY.................... 1.1682
Madison, NY
Onondaga, NY
Oswego, NY
8200........................ Tacoma, WA...................... 1.1330
Pierce, WA
8240........................ Tallahassee, FL................. 0.9401
Gadsden, FL
Leon, FL
8280........................ Tampa-St. Petersburg-Clearwater, 0.9834
FL.
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320........................ Terre Haute, IN................. 0.9016
Vermillion, IN
83206....................... Terre Haute, IN................. 0.9106
Clay, IN
Vigo, IN
8360........................ Texarkana, AR-Texarkana, TX..... 0.9919
Miller, AR
Bowie, TX
8400........................ Toledo, OH...................... 1.1202
Fulton, OH
Lucas, OH
Wood, OH
8440........................ Topeka, KS...................... 1.0468
Shawnee, KS
8480........................ Trenton, NJ..................... 1.0866
Mercer, NJ
8520........................ Tucson, AZ...................... 0.9950
Pima, AZ
8560........................ Tulsa, OK....................... 0.9259
Creek, OK
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600........................ Tuscaloosa, AL.................. 0.9266
Tuscaloosa, AL
8640........................ Tyler, TX....................... 1.0174
Smith, TX
8680........................ Utica-Rome, NY.................. 0.9124
Herkimer, NY
Oneida, NY
8720........................ Vallejo-Fairfield-Napa, CA...... 1.4234
Napa, CA
Solano, CA
8735........................ Ventura, CA..................... 1.1819
Ventura, CA
8750........................ Victoria, TX.................... 0.8925
Victoria, TX
8760........................ Vineland-Millville-Bridgeton, NJ 1.0368
Cumberland, NJ
8780........................ Visalia-Tulare-Porterville, CA.. 1.0922
Tulare, CA
8800........................ Waco, TX........................ 0.8276
McLennan, TX
8840........................ Washington, DC-MD-VA-WV......... 1.1581
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Fairfax, VA
Fairfax City, VA
Falls Church City, VA
Loudoun, VA
Manassas City, VA
Manassas Park City, VA
Prince William, VA
Stafford, VA
88406....................... Washington, DC-MD-VA-WV......... 1.0725
Berkeley, WV
Jefferson, WV
88407....................... Washington, DC-MD-VA-WV......... 1.0494
Clarke, VA
Culpeper, VA
Fauquier, VA
Fredericksburg City, VA
King George, VA
Spotsylvania, VA
Warren, VA
8920........................ Waterloo-Cedar Falls, IA........ 0.9203
Black Hawk, IA
8940........................ Wausau, WI...................... 1.0607
Marathon, WI
8960........................ West Palm Beach-Boca Raton, FL.. 1.0658
Palm Beach, FL
9000........................ Wheeling, WV-OH................. 0.9314
Belmont, OH
Marshall, WV
Ohio, WV
9040........................ Wichita, KS..................... 0.9399
Harvey, KS
90406....................... Wichita, KS..................... 1.0473
Butler, KS
Sedgwick, KS
9080........................ Wichita Falls, TX............... 0.8169
Archer, TX
90806....................... Wichita Falls, TX............... 0.8376
Wichita, TX
9140........................ Williamsport, PA................ 0.9544
Lycoming, PA
9160........................ Wilmington-Newark, DE-MD........ 1.1851
New Castle, DE
Cecil, MD
9200........................ Wilmington, NC.................. 0.9471
Brunswick, NC
92006....................... Wilmington, NC.................. 0.9649
New Hanover, NC
9260........................ Yakima, WA...................... 1.0634
Yakima, WA
9270........................ Yolo, CA........................ 1.1961
Yolo, CA
9280........................ York, PA........................ 1.0165
York, PA
9320........................ Youngstown-Warren, OH........... 1.0124
Columbiana, OH
93206....................... Youngstown-Warren, OH........... 1.0785
Mahoning, OH
Trumbull, OH
9340........................ Yuba City, CA................... 1.0981
Sutter, CA
Yuba, CA
9360........................ Yuma, AZ........................ 0.9912
[[Page 53454]]
Yuma, AZ
------------------------------------------------------------------------
\1\ Wage index values are based on FY 1997 hospital cost report data
prior to reclassification. This wage index is further adjusted. Wage
index values greater than 0.8 are subject to a budget neutrality
adjustment of 1.04662. Wage index values below 0.8 are adjusted to be
the greater of a 15 percent increase, subject to a maximum wage index
value of 0.8, or an adjustment by multiplying the hospital wage index
value for a given area by the budget neutrality adjustment. All of
these adjustments have been completed by HCFA and are built into the
wage index values reflected in this table.
Table B.--Wage Index for Rural Areas
------------------------------------------------------------------------
Wage
MSA code number Nonurban area index
-------------------------------------------------------------------\2\--
9901........................ Alabama......................... 0.8000
Alabama
99016....................... Walker, AL.................... 0.8682
9902........................ Alaska.......................... 1.3387
9903........................ Arizona......................... 0.8696
9904........................ Arkansas........................ 0.8000
9905........................ California...................... 1.0488
9906........................ Colorado........................ 0.8575
9907........................ Connecticut
Windham, CT................... 1.2283
Delaware
9908........................ Sussex, DE.................... 0.9372
9910........................ Florida......................... 0.9209
Florida
99106....................... Bradford, FL.................. 0.9554
9911........................ Georgia......................... 0.8381
Georgia
99116....................... Butts, GA..................... 0.8700
Georgia
99117....................... Jackson, GA................... 0.8491
9912........................ Hawaii.......................... 1.1244
9913........................ Idaho........................... 0.8877
9914........................ Illinois........................ 0.8363
9915........................ Indiana......................... 0.8700
9916........................ Iowa............................ 0.8058
Iowa
99166....................... Bremer, IA.................... 0.8367
9917........................ Kansas.......................... 0.8045
9918........................ Kentucky........................ 0.8267
Kentucky
99186....................... Shelby, KY.................... 0.9209
9919........................ Louisiana....................... 0.8119
9920........................ Maine........................... 0.8934
9921........................ Maryland........................ 0.9262
9922........................ Massachusetts................... 1.0866
9923........................ Michigan........................ 0.9531
9924........................ Minnesota....................... 0.8703
9925........................ Mississippi..................... 0.7972
9926........................ Missouri........................ 0.8099
9927........................ Montana......................... 0.8828
9928........................ Nebraska........................ 0.8000
9929........................ Nevada.......................... 0.9770
9930........................ New Hampshire................... 1.0380
9931........................ New Jersey \1\.................. ........
9932........................ New Mexico...................... 0.8873
9933........................ New York........................ 0.8902
New York
99336....................... Greene, NY.................... 0.8975
9934........................ North Carolina.................. 0.8504
9935........................ North Dakota.................... 0.8109
9936........................ Ohio............................ 0.9075
Ohio
99366....................... Union, OH....................... 0.9521
9937........................ Oklahoma........................ 0.8197
9938........................ Oregon.......................... 1.0296
9939........................ Pennsylvania.................... 0.9479
Pennsylvania
99396....................... Monroe, PA.................... 0.9281
Pennsylvania
99397....................... Adams, PA..................... 0.9471
9940........................ Puerto Rico..................... 0.5905
9941........................ Rhode Island \1\................ ........
9942........................ South Carolina.................. 0.8348
9943........................ South Dakota.................... 0.8000
9944........................ Tennessee 0.8000
99446....................... Tennessee.......................
Sequatchie, TN................ 0.8557
99447....................... Tennessee....................... 0.8395
Grainger, TN
Jefferson, TN
9945........................ Texas........................... 0.8041
9946........................ Utah............................ 0.9110
9947........................ Vermont......................... 0.9560
9949........................ Virginia........................ 0.8402
9950........................ Washington...................... 1.0445
9951........................ West Virginia................... 0.8742
9952........................ Wisconsin....................... 0.8807
9953........................ Wyoming......................... 0.9091
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.
\2\ Wage index values are based on FY 1997 hospital cost report data
prior to reclassification. This wage index is further adjusted. Wage
index values greater than 0.8 are subject to a budget neutrality
adjustment of 1.04662. Wage index values below 0.8 are adjusted to be
the greater of a 15 percent increase, subject to a maximum wage index
value of 0.8, or an adjustment by multiplying the hospital wage index
value for a given area by the budget neutrality adjustment. All of
these adjustments have been completed by HCFA and are built into the
wage index values reflected in this table.
II. Regulatory Impact Statement
A. Background
We have examined the impacts of this notice as required by
Executive Order 12866, the Unfunded Mandate Reform Act, and the
Regulatory Flexibility Act (RFA) (Public Law 96-354). In this notice,
we identified an impact on hospices as a result of changes in the way
we compute the hospice wage index. The change in the methodology for
computing the wage index was determined through a negotiated rulemaking
committee and implemented in the August 8, 1997 final rule (62 FR
42860). This notice only described the effects of those changes in
conjunction with the annual update to the hospice wage index. Also, we
believe these changes to be insignificant.
1. Executive Order 12866 and RFA
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects; distributive impacts; and equity). We have determined that
this notice is not an economically significant rule under this
Executive Order. The RFA requires agencies to analyze options for
regulatory relief for small businesses. For purposes of the RFA, States
and individuals are not considered small entities. However, most
providers, physicians, and health care suppliers are small entities,
either by nonprofit status or by having revenues of $5 million or less
annually. Approximately 74 percent of Medicare certified hospices are
identified as being voluntary, government, or other agency, and
therefore are considered small entities. Because the National Hospice
Organization estimates that approximately 65 percent of hospice
patients are Medicare beneficiaries, we have not considered other
sources of revenue in this analysis.
As discussed below, payments to urban hospices in Puerto Rico will
experience the most significant decrease (11.6 percent) in payments
under this wage index. Looking at the effects of this rule on Puerto
Rico, we see that 21 of the 29 hospices in urban Puerto Rico can be
considered small entities that will experience an 11.6 percent decrease
in Medicare payments. Therefore, we anticipate this rule will have a
significant impact on a substantial number of small entities. However,
the methodology for the hospice wage index was previously determined by
consensus through a negotiated rulemaking committee that included
representatives of national hospice associations; rural, urban, large
and small hospices; multi-site hospices; and consumer groups. Based on
all of the options considered, the committee determined that the
methodology described in the committee statement, and adopted into
regulation on August 8, 1997 (62 FR 42860), were favorable for the
hospice community as a whole, as well as for the beneficiaries that
they serve. Therefore, we believe that mitigating the effects of small
entities has been taken into consideration.
[[Page 53455]]
2. Congressional Review
Section 804(2) of Title 5, United States Code (as added by section
251 of Public Law 104-121), specifies that a ``major rule'' is any rule
that the Office of Management and Budget finds is likely to result in--
An annual effect on the economy of $100 million or more;
A major increase in costs or prices for consumers,
individual industries, Federal, State, or local government agencies, or
geographic regions; or
Significant adverse effects on competition, employment,
investment, productivity, innovation, or on the ability of United
States-based enterprises to compete with foreign-based enterprises in
domestic and export markets.
We estimate that the impact of this notice will not be $100 million
or more; therefore, this rule is not a major rule as defined in Title
5, United States Code, section 804(2) and is not being forwarded to
Congress for a 60-day review period.
3. Unfunded Mandate
The Unfunded Mandate Reform Act of 1995 also requires (in section
202) that agencies prepare an assessment of anticipated costs and
benefits for any rule that may result in an annual expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more. The notice has no
consequential effect on State, local, or tribal governments. We believe
the private sector costs of this rule fall below the threshold, as
well.
4. Rural Hospital Impact
Section 1102(b) of the Act requires us to prepare a regulatory
impact analysis for any notice that may have a significant impact on
the operations of a substantial number of small rural hospitals. Such
an analysis must conform to the provisions of section 604 of the RFA.
For purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside a Metropolitan
Statistical Area and has fewer than 50 beds.
Because this notice has no direct impact on small hospitals, in
accordance with 5 U.S.C. 604, the Secretary certifies that this notice
will not have a significant impact on the operations of a substantial
number of small rural hospitals.
B. Anticipated Effects
In accordance with the Balanced Budget Act of 1997 (BBA of 1997),
hospices are now paid for home care services based on where the service
is rendered. This change was effective with FY 1998 and was implemented
on October 1, 1997. This impact analysis compares hospice payments
under the FY 1998 wage index (Column 4 of the table) to the second
transition year blend (Column 5). The wage index blend for the second
transition year of the 3-year transition is one-third of the 1983 wage
index added to two-thirds of the new wage index. The data used in
developing the quantitative analysis for this notice were obtained from
the December 1997 update of the national claims history file of all
bills submitted during fiscal year 1997. We deleted bills from hospices
that have since closed.
Table C demonstrates the results of our analysis. In Column 2 of
the table we indicate the number of routine home care days that were
included in our analysis, although the analysis was performed on all
types of hospice care. Column 3 of Table C (below) indicates payments
that were made using the FY 1998 wage index. Column 5 of Table C is
based on FY 1998 claims and estimates payments to be made to hospices
using the FY 1999 wage index. For the purposes of this analysis, the
payments reflected in Column 3 were adjusted to account for the site of
service provision. This adjustment is shown in Column 4 of Table C.
The final column, which compares Columns 4 and 5, shows the percent
change in estimated hospice payments made based on the category of the
hospice. The overall percentage change in hospice payments is 0.2
percent. However, the wage index itself is budget neutral to what would
have been paid using the 1983 wage index. The 0.2 percent is
attributable to the site of service provision, i.e., the effect on
payments resulting from the distribution of beneficiaries residing in
MSAs with different wage index values than the hospice.
Table C categorizes hospices by various geographic and provider
characteristics. The top row of the table demonstrates the neutral
overall payment impact on 2,133 hospices included in the analysis. The
next two rows of the table categorize hospices according to their
geographic location (urban and rural). There are 1,385 hospices located
in urban areas included in our analysis and 748 hospices located in
rural areas. The next two groupings in the table indicate the number of
hospices by census region, also broken down by urban and rural
hospices. The next grouping shows the impact on hospices based on the
size of the hospice's program. We determined that the majority of
hospice payments are made at the routine home care rate. Therefore, we
based the size of each individual hospice's program on the number of
routine home care days provided in 1997. The next grouping shows the
impact on hospices by type of ownership. The final grouping shows the
impact on hospices defined by whether they are provider-based or
freestanding.
The results of our analysis show that the greatest increases are
for urban and rural hospices in the New England region, 4.5 percent and
2.8 percent respectively, and for rural hospices in the Pacific
regions, with 3.8 percent. The greatest decreases, besides Puerto Rico,
are the rural West North Central and rural West South Central regions
with 3.1 percent and 4.0 percent respectively. The most dramatic shift
occurs in Puerto Rico, where urban payments decrease by 11.6 percent
and rural payments decrease by 12.3 percent. Since the wage index
values for the Puerto Rico region are more than 15 percent below the
1983 wage index value of 0.8, this region is most affected by the
revision to the wage index floor.
Small hospice programs show small decreases while larger programs
show slight increases. Proprietary hospices show slight decreases in
payment due to the wage index change while voluntary programs gain
slightly. Finally, freestanding hospices show no percent change in
their wage index values while provider-based hospice programs show
small increases.
[[Page 53456]]
Table C.--Impact of Hospice Wage Index Change
(1) (2) (3) (4) (5) (6)
----------------------------------------------------------------------------------------------------------------
All............................... 2,133 19,944 2,211,336 2,195,009 2,200,107 0.2
Urban Hospices.................... 1,385 16,148 11,868,369 1,849,873 1,855,939 0.3
Rural Hospices.................... 748 3,795 342,967 345,136 344,168 -0.3
Region (Urban):
New England................... 102 568 72,785 72,694 75,979 4.5
Middle Atlantic............... 176 1,849 226,264 225,095 228,443 1.5
South Atlantic................ 182 3,825 445,473 443,033 445,646 0.6
East North Central............ 224 2,599 300,801 297,570 296,812 -0.3
East South Central............ 89 770 83,503 81,985 81,082 -1.1
West North Central............ 99 937 96,630 94,617 94,224 -0.4
West South Central............ 197 2,373 249,586 243,893 240,371 -1.4
Mountain...................... 88 887 114,857 113,848 113,010 -0.7
Pacific....................... 199 2,145 263,250 261,968 266,963 1.9
Puerto Rico................... 29 194 15,221 15,169 13,410 -11.6
Region (Rural):
New England................... 21 63 6,341 6,358 6,536 2.8
Middle Atlantic............... 34 261 25,759 25,838 25,384 -1.8
South Atlantic................ 115 549 49,985 50,658 50,932 0.5
East North Central............ 121 442 40,906 41,264 41,511 0.6
East South Central............ 76 1,452 124,526 124,784 125,167 0.3
West North Central............ 164 399 36,089 36,241 35,127 -3.1
West South Central............ 82 255 22,474 22,926 21,999 -4.0
Mountain...................... 80 175 16,739 16,806 16,831 0.1
Pacific....................... 52 185 19,122 19,229 19,773 2.8
Puerto Rico................... 3 13 1,028 1,034 907 -12.3
Size (Routine Home Care Days):
0-1,752 Days.................. 533 417 48,237 48,051 47,757 -0.6
1,753-4,225 Days.............. 533 1,524 152,653 151,925 151,578 -0.2
4,226-9,422 Days.............. 533 3,420 352,974 351,698 352,436 0.2
9,422+ Days................... 534 14,583 1,657,472 1,643,334 1,648,336 0.3
Type of Ownership:
Voluntary..................... 1,373 13,516 1,492,335 1,483,835 1,492,700 0.6
Proprietary................... 560 5,876 664,169 656,650 653,129 -0.5
Government.................... 172 474 47,067 46,818 46,550 -0.6
Other......................... 28 78 7,766 7,705 7,727 0.3
Hospice Base:
Freestanding.................. 793 11,495 1,272,781 1,263,013 1,263,114 0.0
Home Health Agency............ 788 5,235 581,863 577,857 581,728 0.7
Hospital...................... 533 3,123 344,200 341,727 342,789 0.3
Skilled Nursing Facility...... 19 91 12,492 12,411 12,476 0.5
----------------------------------------------------------------------------------------------------------------
*The FY 1997 data used to construct the FY 1998 wage index was adjusted to account for the site of service
provision that was included in the Balanced Budget Act of 1997.
**Percent change in hospice payments made from 1997, taking into account the site of service change.
Authority: Section 1814(I) of the Social Security Act (42 U.S.C.
1395f(I)(1))
(Catalog of Federal Domestic Assistance Program No. 93.773
Medicare--Hospital Insurance Program; and No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: July 7, 1998.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Dated: August 4, 1998.
Donna E. Shalala,
Secretary.
[FR Doc. 98-26501 Filed 9-30-98; 9:53 am]
BILLING CODE 4120-01-P
