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Start Preamble
Start Printed Page 60072
AGENCY:
Health Care Financing Administration (HCFA), HHS.
ACTION:
Notice.
SUMMARY:
This notice announces the annual update to the hospice wage index as required by statute. This update is effective October 1, 2000 through September 30, 2001. 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.
EFFECTIVE DATE:
This notice is effective on October 1, 2000.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Carol Blackford, (410) 786-5909.
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY 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 § 418.306(c), which require the rates to be adjusted by a wage index, were revised in the August 8, 1997 final rule (62 FR 42860). This rule implemented a new methodology for calculating the hospice wage index based on the recommendations of a negotiated rulemaking committee. The committee reached consensus on the methodology. We included the resulting committee statement, describing that consensus, as an appendix to the August 8, 1997 final rule (62 FR 42883). The provisions of the final hospice wage index rule are as follows:
- The revised hospice wage index will be calculated using the most current available hospital wage data.
- The revised hospice wage index was phased in over a 3-year transition period. For the first year of the transition period, October 1, 1997 through September 30, 1998, 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, October 1, 1998 through September 30, 1999, the calculation was similar, except that the blend was one-third of the 1983 index value and two-thirds of the revised wage index value for that area. We fully implemented the revised wage index during the third transition period, October 1, 1999 through September 30, 2000.
- All hospice wage index values of 0.8 or greater are subject to a budget-neutrality adjustment to ensure that we do not pay more in the aggregate than we would have paid under the original 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. These data will include any changes to the definitions of Metropolitan Statistical Areas (MSA).
Section 4441(a) of the Balanced Budget Act of 1997 (BBA) amended section 1814(i)(1)(C)(ii) of the Act to establish updates to hospice rates for fiscal years (FYs) 1998 through 2002. Hospice rates were to be updated by a factor equal to the market basket index, minus 1 percentage point. However, section 131(a) of the Balanced Budget Refinement Act of 1999 (BBRA) changed the payment rates for FYs 2001 and 2002 by increasing the FY 2001 rate by 0.5 percent and the FY 2002 rate by 0.75 percent. Section 131(b) of the BBRA states that any additional payments made under section 131(a) of the BBRA shall not be included in updating the hospice rates after those 2 years.
B. Update to the Hospice Wage Index
This annual update is effective October 1, 2000 through September 30, 2001. In accordance with the agreement signed by the Health Care Financing Administration (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. The FY 2000 hospital wage index was the most current hospital wage data available when the FY 2001 wage index values were calculated. We used the pre-reclassified and pre-floor hospital area wage index data.
All wage index values are adjusted by a budget-neutrality factor of 1.065425 and are subject to the wage index floor adjustment, if applicable. We have completed all of the calculations described above and included them in the wage index values reflected in both Tables A and B below. A detailed description of the method used to compute the hospice wage index is contained in both the September 4, 1996 proposed rule (61 FR 46579) and the August 8, 1997 final rule (62 FR 42860).
After the publication of the FY 2000 hospice wage index updates, we received a number of questions about the methodology used to calculate the hospice wage indices. We would like to take this opportunity to further explain the methodology used in determining the hospice wage indices. Start Printed Page 60073
1. Metropolitan Statistical Areas
As explained in the September 4, 1996 hospice wage index proposed rule, each hospice=s labor market area would be established by the MSA definitions issued by the Office of Management and Budget (OMB) on December 28, 1992 based on the 1990 census, and updated periodically by OMB. Any changes to the MSA definitions would be effective annually and announced in the final rule updating the hospice wage index.
2. MSA Wage Index Values Lower Than Rural Values
As explained above, any area not included in an MSA is considered to be nonurban and receives the statewide rural rate. We are aware that in the past, a number of MSAs have had wage index values that were lower than their rural statewide value. This difference is due to variations in local wage data as compared to national wage data. The hospice wage index is computed by dividing the hourly wage rate for an MSA or nonurban area by a national hourly wage rate. Nonurban areas could receive a higher wage index value than urban areas in the same state if the hourly wage rate in the nonurban area increased at a greater rate.
C. Tables
Table A.—Hospice Wage Index for Urban Areas
MSA code No. Urban area (constituent counties or county equivalents) 1 Wage index 2 0040 Abilene, TX 0.8715 Taylor, TX 0060 Aguadilla, PR 0.4386 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH 1.0829 Portage, OH Summit, OH 0120 Albany, GA 1.1052 Dougherty, GA Lee, GA 0160 Albany-Schenectady-Troy, NY 0.9328 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM 0.9056 Bernalillo, NM Sandoval, NM Valencia, NM 0220 Alexandria, LA 0.8385 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA 1.0897 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA 0.9954 Blair, PA 0320 Amarillo, TX 0.8929 Potter, TX Randall, TX 0380 Anchorage, AK 1.3701 Anchorage, AK 0440 Ann Arbor, MI 1.2235 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL 0.9017 Calhoun, AL 0460 Appleton-Oshkosh-Neenah, WI 0.9496 Calumet, WI Outagamie, WI Winnebago, WI 0470 Arecibo, PR 0.5537 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC 0.9466 Buncombe, NC Madison, NC 0500 Athens, GA 1.0340 Clarke, GA Madison, GA Oconee, GA 0520 Atlanta, GA 1.0709 Barrow, GA Bartow, GA Carroll, 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 Pickens, GA Rockdale, GA Spalding, GA Walton, GA 0560 Atlantic-Cape May, NJ 1.2051 Atlantic, NJ Cape May, NJ 0580 Aubrn-Opelika, AL 0.8256 Lee, AL 0600 Augusta-Aiken, GA-SC 0.9603 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 Austin-San Marcos, TX 0.9676 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 Bakersfield, CA 1.0248 Kern, CA 0720 Baltimore, MD 1.0539 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME 1.0239 Penobscot, ME 0743 Barnstable-Yarmouth, MA 1.4173 Barnstable, MA 0760 Baton Rouge, LA 0.9278 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX 0.9129 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA 1.2141 Whatcom, WA 0870 Benton Harbor, MI 0.9011 Berrien, MI 0875 Bergen-Passaic, NJ 1.2816 Bergen, NJ Passaic, NJ 0880 Billings, MT 1.0696 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS 0.8383 Hancock, MS Harrison, MS Jackson, MS 0960 Binghamton, NY 0.9324 Broome, NY Tioga, NY 1000 Birmingham, AL 0.9584 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND 0.8267 Burleigh, ND Morton, ND 1020 Bloomington, IN 0.9155 Monroe, IN 1040 Bloomington-Normal, IL 0.9582 McLean, IL 1080 Boise City, ID 0.9654 Ada, ID Canyon, ID 1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.2102 Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Start Printed Page 60074 Strafford, NH 1125 Boulder-Longmont, CO 1.0596 Boulder, CO 1145 Brazoria, TX 0.9074 Brazoria, TX 1150 Bremerton, WA 1.1733 Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX 0.9816 Cameron, TX 1260 Bryan-College Station, TX 0.9057 Brazos, TX 1280 Buffalo-Niagara Falls, NY 1.0233 Erie, NY Niagara, NY 1303 Burlington, VT 1.1250 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR 0.5245 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH 0.9346 Carroll, OH Stark, OH 1350 Casper, WY 0.9802 Natrona, WY 1360 Cedar Rapids, IA 0.9609 Linn, IA 1400 Champaign-Urbana, IL 0.9764 Champaign, IL 1440 Charleston-North Charleston, SC 0.9577 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV 0.9691 Kanawha, WV Putnam, WV 1520 Charlotte-Gastonia-Rock Hill, NC-SC 1.0051 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA 1.1267 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA 1.0369 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 Cheyenne, WY 0.8711 Laramie, WY 1600 Chicago, IL 1.1585 Cook, IL DeKalb, IL Du Page, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA 1.1071 Butte, CA 1640 Cincinnati, OH-KY-IN 1.0035 Brown, OH Clermont, OH Hamilton, OH Warren, OH Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Dearborn, IN Ohio, IN 1660 Clarksville-Hopkinsville, TN-KY 0.8619 Christian, KY Montgomery, TN 1680 Cleveland-Lorain-Elyria, OH 1.0323 Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO 0.9821 El Paso, CO 1740 Columbia, MO 0.9488 Boone, MO 1760 Columbia, SC 0.9970 Lexington, SC Richland, SC 1800 Columbus, GA-AL 0.9068 Chattahochee, GA Harris, GA Muscogee, GA Russell, AL 1840 Columbus, OH 1.0556 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX 0.9271 Nueces, TX San Patricio, TX 1890 Corvallis, Oregon 1.1813 Benton, OR 1900 Cumberland, MD-WV 0.9378 Allegany, MD Mineral, WV 1920 Dallas, TX 1.0236 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA 0.9277 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock Island, IA-IL 1.0080 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH 0.9576 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL 0.9248 Flagler, FL Volusia, FL 2030 Decatur, AL 0.9248 Lawrence, AL Morgan, AL 2040 Decatur, IL 0.8867 Macon, IL 2080 Denver, CO 1.0857 Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA 0.9328 Dallas, IA Polk, IA Warren, IA 2160 Detroit, MI 1.1104 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL 0.8309 Dale, AL Houston, AL 2190 Dover, DE 0.9947 Kent, DE 2200 Dubuque, IA 0.9079 Dubuque, IA 2240 Duluth-Superior, MN-WI 1.0831 St. Louis, MN Douglas, WI 2281 Dutchess County, NY 1.1243 Dutchess, NY 2290 Eau Claire, WI 0.9544 Chippewa, WI Eau Claire, WI 2320 El Paso, TX 0.9533 El Paso, TX 2330 Elkhart-Goshen, IN 0.9994 Elkhart, IN 2335 Elmira, NY 0.9092 Chemung, NY 2340 Enid, OK 0.8474 Garfield, OK 2360 Erie, PA 0.9614 Erie, PA 2400 Eugene-Springfield, OR 1.1298 Lane, OR Start Printed Page 60075 2440 Evansville-Henderson, IN-KY 0.8847 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN 0.9185 Clay, MN Cass, ND 2560 Fayetteville, NC 0.9051 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR 0.8283 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT 1.1026 Coconino, AZ Kane, UT 2640 Flint, MI 1.1742 Genesee, MI 2650 Florence, AL 0.8447 Colbert, AL Lauderdale, AL 2655 Florence, SC 0.9183 Florence, SC 2670 Fort Collins-Loveland, CO 1.0977 Larimer, CO 2680 Ft. Lauderdale, FL 1.0839 Broward, FL 2700 Fort Myers-Cape Coral, FL 0.9537 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL 1.0653 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK 0.8357 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL 0.9284 Okaloosa, FL 2760 Fort Wayne, IN 0.9692 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 Fort Worth-Arlington, TX 1.0480 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA 1.0935 Fresno, CA Madera, CA 2880 Gadsden, AL 0.9258 Etowah, AL 2900 Gainesville, FL 1.0764 Alachua, FL 2920 Galveston-Texas City, TX 1.0370 Galveston, TX 2960 Gary, IN 1.0005 Lake, IN Porter, IN 2975 Glens Falls, NY 0.9170 Warren, NY Washington, NY 2980 Goldsboro, NC 0.8879 Wayne, NC 2985 Grand Forks, ND-MN 0.9693 Grand Forks, ND Polk, MN 2995 Grand Junction, CO 0.9790 Mesa, CO 3000 Grand Rapids-Muskegon-Holland, MI 1.0799 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT 1.1144 Cascade, MT 3060 Greeley, CO 1.0359 Weld, CO 3080 Green Bay, WI 0.9731 Brown, WI 3120 Greensboro-Winston-Salem-High Point, NC 0.9629 Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC 1.0123 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC 0.9790 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD 0.9422 Washington, MD 3200 Hamilton-Middletown, OH 0.9532 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA 1.0567 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 Hartford, CT 1.2483 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 Hattiesburg, MS 0.8134 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC 0.9709 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI 1.2228 Honolulu, HI 3350 Houma, LA 0.8350 Lafourche, LA Terrebonne, LA 3360 Houston, TX 1.0002 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH 1.0396 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL 0.9400 Limestone, AL Madison, AL 3480 Indianapolis, IN 1.0434 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA 1.0237 Johnson, IA 3520 Jackson, MI 0.9419 Jackson, MI 3560 Jackson, MS 0.8936 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN 0.9164 Madison, TN Chester, TN 3600 Jacksonville, FL 0.9544 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 Jacksonville, NC 0.8367 Onslow, NC 3610 Jamestown, NY 0.8372 Chautauqua, NY 3620 Janesville-Beloit, WI 1.0289 Rock, WI 3640 Jersey City, NJ 1.2440 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA 0.9433 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 Johnstown, PA 0.9206 Cambria, PA Somerset, PA Start Printed Page 60076 3700 Jonesboro, AR 0.8000 Craighead, AR 3710 Joplin, MO 0.8181 Jasper, MO Newton, MO 3720 Kalamazoo-Battlecreek, MI 1.0635 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL 0.9162 Kankakee, IL 3760 Kansas City, KS-MO 0.9932 Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Lafayette, MO Platte, MO Ray, MO 3800 Kenosha, WI 0.9625 Kenosha, WI 3810 Killeen-Temple, TX 1.0583 Bell, TX Coryell, TX 3840 Knoxville, TN 0.9802 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN 0.9503 Howard, IN Tipton, IN 3870 La Crosse, WI-MN 0.9519 Houston, MN La Crosse, WI 3880 Lafayette, LA 0.8886 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN 0.9386 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA 0.8488 Calcasieu, LA 3980 Lakeland-Winter Haven, FL 0.9393 Polk, FL 4000 Lancaster, PA 0.9862 Lancaster, PA 4040 Lansing-East Lansing, MI 1.0631 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX 0.8868 Webb, TX 4100 Las Cruces, NM 0.9153 Dona Ana, NM 4120 Las Vegas, NV-AZ 1.1996 Mohave, AZ Clarke, NV Nye, NV 4150 Lawrence, KS 0.8761 Douglas, KS 4200 Lawton, OK 1.0157 Comanche, OK 4243 Lewiston-Auburn, ME 0.9482 Androscoggin, ME 4280 Lexington, KY 0.9090 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH 0.9489 Allen, OH Auglaize, OH 4360 Lincoln, NE 1.0304 Lancaster, NE 4400 Little Rock-North Little Rock, AR 0.9179 Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX 0.9311 Gregg, TX Harrison, TX Upshur, TX 4480 Los Angeles-Long Beach, CA 1.2841 Los Angeles, CA 4520 Louisville, KY-IN 0.9996 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX 0.8962 Lubbock, TX 4640 Lynchburg, VA 0.9392 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA 0.9089 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI 1.0367 Dane, WI 4800 Mansfield, OH 0.9031 Crawford, OH Richland, OH 4840 Mayaguez, PR 0.5376 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX 0.8652 Hidalgo, TX 4890 Medford-Ashland, OR 1.1180 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL 0.9905 Brevard, Fl 4920 Memphis, TN-AR-MS 0.8784 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 Merced, CA 1.0950 Merced, CA 5000 Miami, FL 1.0904 Dade, FL 5015 Middlesex-Somerset-Hunterdon, NJ 1.1851 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 Milwaukee-Waukesha, WI 1.0490 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 Minneapolis-St. Paul, MN-WI 1.1645 Anoka, MN Carver, MN Chisago, MN Dakota, MN Hennepin, MN Isanti, MN Ramsey, MN Scott, MN Sherbune, MN Washington, MN Wright, MN Pierce, WI St. Croix, WI 5140 Missoula, MT 0.9681 Missoula, MT 5160 Mobile, AL 0.8809 Baldwin, AL Mobile, AL 5170 Modesto, CA 1.0774 Stanislaus, CA 5190 Monmouth-Ocean, NJ 1.1996 Monmouth, NJ Ocean, NJ 5200 Monroe, LA 0.8760 Ouachita, LA 5240 Montgomery, AL 0.8208 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN 1.1544 Delaware, IN 5330 Myrtle Beach, SC 0.9088 Horry, SC 5345 Naples, FL 1.0484 Collier, FL 5360 Nashville, TN 1.0068 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Start Printed Page 60077 Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 Nassau-Suffolk, NY 1.4997 Nassau, NY Suffolk, NY 5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT 1.3166 Fairfield, CT New Haven, CT 5523 New London-Norwich, CT 1.3242 New London, CT 5560 New Orleans, LA 0.9685 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 New York, NY 1.5469 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 Newark, NJ 1.2409 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA 1.1624 Orange, NY Pike, PA 5720 Norfolk-Virginia Beach-Newport News, VA-NC 0.8993 Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA James City, VA Isle of Wight, VA Mathews, 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 5775 Oakland, CA 1.6044 Alameda, CA Contra Costa, CA 5790 Ocala, FL 1.0245 Marion, FL 5800 Odessa-Midland, TX 0.9455 Ector, TX Midland, TX 5880 Oklahoma City, OK 0.9150 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA 1.1648 Thurston, WA 5920 Omaha, NE-IA 1.1140 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 Orange County, CA 1.2349 Orange, CA 5960 Orlando, FL 1.0437 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY 0.8635 Daviess, KY 6015 Panama City, FL 0.9770 Bay, FL 6020 Parkersburg-Marietta, WV-OH 0.8896 Washington, OH Wood, WV 6080 Pensacola, FL 0.8995 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL 0.8896 Peoria, IL Tazewell, IL Woodford, IL 6160 Philadelphia, PA-NJ 1.1891 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 Phoenix-Mesa, AZ 1.0084 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR 0.8202 Jefferson, AR 6280 Pittsburgh, PA 1.0265 Allegheny, PA Beaver,PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 Pittsfield, MA 1.0927 Berkshire, MA 6340 Pocatello, ID 0.9561 Bannock, ID 6360 Ponce, PR 0.5717 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME 1.0096 Cumberland, ME Sagadahoc, ME York, ME 6440 Portland-Vancouver, OR-WA 1.1694 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 Providence-Warwick-Pawtucket, RI 1.1391 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT 1.0461 Utah, UT 6560 Pueblo, CO 0.9433 Pueblo, CO 6580 Punta Gorda, FL 0.9509 Charlotte, FL 6600 Racine, WI 0.9820 Racine, WI 6640 Raleigh-Durham-Chapel Hill, NC 1.0170 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD 0.8911 Pennington, SD 6680 Reading, PA 1.0054 Berks, PA 6690 Redding, CA 1.2002 Shasta, CA 6720 Reno, NV 1.1353 Washoe, NV 6740 Richland-Kennewick-Pasco, WA 1.1959 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA 1.0171 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 1.1945 Riverside, CA San Bernardino, CA Start Printed Page 60078 6800 Roanoke, VA 0.8672 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN 1.2178 Olmsted, MN 6840 Rochester, NY 0.9786 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL 0.9359 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC 0.9307 Edgecombe, NC Nash, NC 6920 Sacramento, CA 1.3089 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI 0.9895 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN 1.0038 Benton, MN Stearns, MN 7000 St. Joseph, MO 0.9529 Andrew, MO Buchanan, MO 7040 St. Louis, MO-IL 0.9645 Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL 7080 Salem, OR 1.0601 Marion, OR Polk, OR 7120 Salinas, CA 1.5674 Monterey, CA 7160 Salt Lake City-Ogden, UT 1.0500 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX 0.8359 Tom Green, TX 7240 San Antonio, TX 0.8862 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320 San Diego, CA 1.2712 7360 San Francisco, CA 1.4918 Marin, CA San Francisco, CA San Mateo, CA 7400 San Jose, CA 1.4500 Santa Clara, CA 7440 San Juan-Bayamon, PR 0.5357 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 Robles, CA 1.1156 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA 1.1528 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA 1.4840 Santa Cruz, CA 7490 Santa Fe, NM 1.1121 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA 1.3852 Sonoma, CA 7510 Sarasota-Bradenton, FL 1.0554 Manatee, FL Sarasota, FL 7520 Savannah, GA 1.0605 Bryan, GA Chatham, GA Effingham, GA 7560 Scranton—Wilkes-Barre—Hazleton, PA 0.8921 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 Seattle-Bellevue-Everett, WA 1.2030 Island, WA King, WA Snohomish, WA 7610 Sharon, PA 0.8826 Mercer, PA 7620 Sheboygan, WI 0.8740 Sheboygan, WI 7640 Sherman-Denison, TX 0.9940 Grayson, TX 7680 Shreveport-Bossier City, LA 0.9642 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE 0.9108 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD 0.9351 Lincoln, SD Minnehaha, SD 7800 South Bend, IN 1.0435 St. Joseph, IN 7840 Spokane, WA 1.1507 Spokane, WA 7880 Springfield, IL 0.9252 Menard, IL Sangamon, IL 7920 Springfield, MO 0.8515 Christian, MO Greene, MO Webster, MO 8003 Springfield, MA 1.1377 Hampden, MA Hampshire, MA 8840 Washington, DC-MD-VA-WV 1.1778 District of Columbia, DC Calvert, MD Charles, MD Frederick, MD Montgomery, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Culpeper, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA King George, VA Loudoun, VA Manassas City, VA Start Printed Page 60079 Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Berkeley, WV Jefferson, WV 8920 Waterloo-Cedar Falls, IA 0.9075 Black Hawk, IA 8940 Wausau, WI 1.0064 Marathon, WI 8960 West Palm Beach-Boca Raton, FL 1.0668 Palm Beach, FL 9000 Wheeling, WV-OH 0.8144 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS 1.0038 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX 0.8154 Archer, TX Wichita, TX 8050 State College, PA 0.9737 Centre, PA 8080 Steubenville-Weirton, OH-WV 0.9179 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA 1.1207 San Joaquin, CA 8140 Sumter, SC 0.8778 Sumter, SC 8160 Syracuse, NY 1.1377 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA 1.2230 Pierce, WA 8240 Tallahassee, FL 0.9040 Gadsden, FL Leon, FL 8280 Tampa-St. Petersburg-Clearwater, FL 0.9637 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 Terre Haute, IN 0.9132 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR-Texarkana, TX 0.8668 Miller, AR Bowie, TX 8400 Toledo, OH 1.0458 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS 0.9937 Shawnee, KS 8480 Trenton, NJ 1.0764 Mercer, NJ 8520 Tucson, AZ 0.9315 Pima, AZ 8560 Tulsa, OK 0.8616 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 Tuscaloosa, AL 0.8593 Tuscaloosa, AL 8640 Tyler, TX 0.9983 Smith 8680 Utica-Rome, NY 0.8842 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA 1.4220 Napa, CA Solano, CA 8735 Ventura, CA 1.2206 8750 Victoria, TX 0.8927 8760 Vineland-Millville-Bridgeton, NJ 1.1206 Cumberland, NJ 8780 Visalia-Turlare-Porterville, CA 1.1093 Tulare, CA 8800 Waco, TX 0.8604 McLennan, TX 9140 Williamsport, PA 0.9003 Lycoming, PA 9160 Wilmington-Newark, DE-MD 1.2013 New Castle, DE Cecil, MD 9200 Wilmington, NC 1.0343 Brunswick, NC New Hanover, NC 9260 Yakima, WA 1.1009 Yakima, WA 9270 Yolo, CA 1.0356 Yolo, CA 9280 York, PA 0.9919 York, PA 9320 Youngstown-Warren, OH 1.0651 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA 1.1361 Sutter, CA Yuba, CA 9360 Yuma, AZ 1.0574 Yuma, AZ 1 This column lists each MSA area name (in italics) and each county, or county equivalent, in the MSA area. Counties not listed in this Table are considered to be Rural Areas. Wage Index values for these areas are found in Table B. 2 Wage index values are based on FY 1996 hospital cost report data before reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of 1.065425. 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. We have completed all of these adjustments and included them in the wage index values reflected in this table. Table B.—Wage Index for Rural Areas
MSA code No. Nonurban area Wage index 1 9901 Alabama 0.8000 9902 Alaska 1.2847 9903 Arizona 0.9104 9904 Arkansas 0.8000 9905 California 1.0603 9906 Colorado 0.9391 9907 Connecticut 1.3226 9908 Delaware 0.9767 9910 Florida 0.9575 9911 Georgia 0.8625 9912 Hawaii 1.1430 9913 Idaho 0.9218 9914 Illinois 0.8575 9915 Indiana 0.8946 9916 Iowa 0.8446 Start Printed Page 60080 9917 Kansas 0.8000 9918 Kentucky 0.8569 9919 Louisiana 0.8000 9920 Maine 0.9205 9921 Maryland 0.9197 9922 Massachusetts 1.2114 9923 Michigan 0.9392 9924 Minnesota 0.9237 9925 Mississippi 0.8000 9926 Missouri 0.8229 9927 Montana 0.8945 9928 Nebraska 0.8532 9929 Nevada 0.9693 9930 New Hampshire 1.0554 9931 New Jersey 2 9932 New Mexico 0.8927 9933 New York 0.9202 9934 North Carolina 0.8832 9935 North Dakota 0.8148 9936 Ohio 0.9216 9937 Oklahoma 0.8000 9938 Oregon 1.0514 9939 Pennsylvania 0.9083 9940 Puerto Rico 0.4886 9941 Rhode Island 2 9942 South Carolina 0.8805 9943 South Dakota 0.8073 9944 Tennessee 0.8152 9945 Texas 0.8000 9946 Utah 0.9490 9947 Vermont 1.0024 9948 Virgin Islands 0.7252 9949 Virginia 0.8421 9950 Washington 1.1131 9951 West Virginia 0.8597 9952 Wisconsin 0.9333 9953 Wyoming 0.9440 9965 Guam 1.0240 1 Wage index values are based on FY 1996 hospital cost report data before reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of 1.065425. 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. We have completed all of these adjustments and have included them in the wage index values reflected in this table. 2 All counties within the State are classified as urban. II. Regulatory Impact Statement
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) (Pub. L. 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). We recognize that the BBRA adjusted hospice payments upward by 0.5 percent; however, we did not do a separate analysis of the impact of this payment adjustment. We used the new rates adjusted by the BBRA when estimating the payments to be made under the new wage index and when calculating the budget-neutrality adjustment factor. Overall, we believe the changes included in this notice 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 73 percent of Medicare certified hospices are identified as voluntary, government, or other agencies, and, therefore, are considered small entities. Because the National Hospice Organization estimates that approximately 70 percent of hospice patients are Medicare beneficiaries, we have not considered other sources of revenue in this analysis.
As discussed below, the estimated decreases in payment to hospices overall are very slight. The most significant change is an increase in estimated payments to rural areas in East and West South Central, at 4.8 and 9.1 percent, respectively. The effects of this notice on West South Central alone, indicate that 54 of the 85 hospices in urban West South Central can be considered small entities that will experience an 9.1-percent increase in Medicare payments. Therefore, we anticipate this notice will have a significant, albeit positive, 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 the options considered, the committee determined that the methodology described in the committee statement, and adopted into regulation in the August 8, 1997 final rule, was favorable for the hospice community as well as for beneficiaries. Therefore, we believe that mitigating any negative effects on small entities has been taken into consideration.
2. Congressional Review
Section 804(2) of Title 5, United States Code (U.S.C.) (as added by section 251 of Pub. L. 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 notice is not a major rule as defined in Title 5, United States Code, section 804(2) and is not being forwarded to the 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 expenditure by State, local, and tribal governments, in the aggregate, or by the private sector, of $100 million or more in any one year. The notice has no consequential effect on State, local, or tribal governments. We believe the private sector costs of this notice 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 an MSA 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 Start Printed Page 60081Secretary certifies that this notice will not have a significant impact on the operations of a substantial number of small rural hospitals.
5. Federalism
We have reviewed this notice under the threshold criteria of Executive Order 13132, Federalism, and have determined that this notice will not have any negative impact on the rights, roles, and responsibilities of State, local, or tribal governments.
A. Anticipated Effects
We have compared estimated payments using the FY 1983 hospice wage index to estimated payments using the FY 2001 wage index and determined the current hospice rates to be budget-neutral. As mentioned above, the negotiated rulemaking committee agreement required that we not pay more under the new wage index in the aggregate than we would have paid under the original wage index.
This impact analysis compares hospice payments under the FY 2000 hospice wage index to the estimated payments using the FY 2001 wage index. The data used in developing the quantitative analysis for this notice were obtained from the March 2000 update of the national claims history file of all bills submitted during FY 1999. We deleted bills from hospices that have since closed.
Table C demonstrates the results of our analysis. In Column 2 of Table C, 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 indicates payments that were made using the FY 2000 wage index. Column 4 of Table C is based on FY 1999 claims and estimates payments to be made to hospices using the FY 2001 wage index. The final column, which compares Columns 3 and 4, shows the percent change in estimated hospice payments made based on the category of the hospice.
Table C categorizes hospices by various geographic and provider characteristics. The first row displays the results of the impact analysis for all Medicare certified hospices. The second and third rows of the table categorize hospices according to their geographic location (urban and rural). Our analysis indicated that there are 1,351 hospices located in urban areas and 798 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 sixth 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 1999. 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 shows that the greatest increases in payment are for rural areas in the West and East South Central Regions, with a 9.1 percent and 4.8 percent increase, respectively. The greatest decreases in payment are for urban areas in the New England and Mountain regions, each with a 0.4 percent decrease, and for rural areas in the Middle Atlantic and Pacific regions, each with a 0.4 percent decrease.
The breakdown by size, type of ownership, and facility base showed an increase in payments to all hospice programs. Small hospice programs showed significant increases of about 10 percent, while larger programs experienced only a negligible increase. Government-owned hospices showed the greatest estimated increase of 2.7 percent, while payments to voluntary hospices are expected to increase by 0.4 percent. In terms of hospice base, freestanding hospices showed the greatest estimated payment increase while home health agencies showed the smallest amount of payment increase.
Table C.—Impact of Hospice Wage Index Change
Number of hospices (1) Number of routine home care days in thousands (2) Payments using FY 2000 wage index in thousands (3) Estimated payments using FY 2001 wage index in thousands (4) Percent change in Hospice payments (5) (By geographic location): All Hospices 2,149 21,354 2,490,702 2,504,439 0.6 Urban Hospices 1,351 18,120 2,185,780 2,190,590 0.2 Rural Hospices 798 3,234 304,922 313,849 2.9 By Region—Urban: New England 94 642 89,447 89,051 −0.4 Middle Atlantic 170 2,245 290,927 291,894 0.3 South Atlantic 185 4,030 509,079 511,583 0.5 East North Central 224 2,862 334,861 336,694 0.5 East South Central 94 1,169 123,023 123,530 0.4 West North Central 96 1,061 113,167 113,498 0.3 West South Central 188 2,408 261,632 261,287 −0.1 Mountain 88 1,135 149,035 148,443 −0.4 Pacific 183 2,325 298,138 298,086 0 Puerto Rico 29 243 16,470 16,524 0.3 By Region—Rural: New England 26 72 7,666 7,811 1.9 Middle Atlantic 35 168 17,282 17,214 −0.4 South Atlantic 117 681 63,904 65,005 1.7 East North Central 136 561 53,801 54,541 1.4 East South Central 81 524 48,159 50,481 4.8 West North Central 174 409 37,622 38,969 3.6 West South Central 85 362 29.640 32.351 9.1 Mountain 87 217 21.359 22,048 3.2 Pacific 54 217 24,012 23,922 −0.4 Start Printed Page 60082 Puerto Rico 3 23 1,476 1,507 2.1 (Skilled) Routine home care days: 0-1,754 days 437 390 36,700 40,609 10.6 1,754-4,373 days 502 1,504 150,829 154,399 2.4 4,373-9,681 days 556 3,669 388,427 390,269 0.5 9,681 + days 653 15,449 1,875,339 1,879,969 0.2 Type of ownership: Voluntary 1,351 13,975 1,638,339 1,644,677 0.4 Proprietary 573 6,714 784,488 790,194 0.7 Government 192 568 58,174 59,770 2.7 Other 33 97 9,701 9,797 1.0 Hospice base: Freestanding 874 12,368 1,451,898 1,461,421 0.7 Home health agency 716 5,357 625,165 627,440 0.4 Hospital 538 3,503 395,997 397,830 0.5 Skilled nursing facility 21 126 17,642 17,748 0.6 In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
Start SignatureEnd Signature End Supplemental Information(Catalog of Federal Domestic Assistance Program No. 93.773 Medicare—Hospital Insurance Program; and No. 93.774, Medicare—Supplementary Medical Insurance Program)
Dated: August 21, 2000.
Nancy-Ann Min DeParle,
Administrator, Health Care Financing Administration.
Dated: September 22, 2000.
Donna E. Shalala,
Secretary.
[FR Doc. 00-25547 Filed 10-2-00; 12:23 pm]
BILLING CODE 4120-01-P
Document Information
- Effective Date:
- 10/1/2000
- Published:
- 10/06/2000
- Department:
- Health Care Finance Administration
- Entry Type:
- Notice
- Action:
- Notice.
- Document Number:
- 00-25547
- Dates:
- This notice is effective on October 1, 2000.
- Pages:
- 60071-60082 (12 pages)
- Docket Numbers:
- HCFA-1135-N
- PDF File:
- 00-25547.pdf