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AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Proposed rule.
SUMMARY:
This proposed rule would set forth the hospice wage index for fiscal year 2006 and identifies the revised labor market and metropolitan statistical areas. This proposed rule would also codify provisions of sections 408 and 946 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
DATES:
To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on June 28, 2005.
ADDRESSES:
In commenting, please refer to file code CMS-1286-P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.
You may submit comments in one of three ways (no duplicates, please):
1. Electronically. You may submit electronic comments on specific issues in this regulation to http://www.cms.hhs.gov/regulations/ecomments. (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.)
2. By mail. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1286-P, P.O. Box 8012, Baltimore, MD 21244-8012.
Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786-9994 in advance to schedule your arrival with one of our staff members.
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD 21244-1850.
(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)
Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.
Submission of comments on paperwork requirements. You may submit comments on this document's paperwork requirements by mailing your comments to the addresses provided at the end of the “Collection of Information Requirements” section in this document.
For information on viewing public comments, see the beginning of the SUPPLEMENTARY INFORMATION section.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Terri Deutsch, (410) 786-9462.
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION:
Submitting Comments: We welcome comments from the public on all issues set forth in this rule to assist us in fully considering issues and developing policies. You can assist us by referencing the file code CMS-1286-P and the specific “issue identifier” that precedes the section on which you choose to comment.
Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. CMS posts all electronic comments received before the close of the comment period on its public website as soon as possible after they have been received. Hard copy comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1-800-743-3951.
I. Background
A. General
1. Hospice Care
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 for relief of pain and for symptom management. 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 services and inpatient 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. Section 1824(i) of the Act provides payment for Medicare-participating hospices.
2. Medicare Payment for Hospice Care
Our regulations at 42 CFR part 418 establish eligibility requirements, payment standards and procedures, define covered services, and delineate the conditions a hospice must meet to be approved for participation in the Medicare program. Part 418 subpart G provides for payment in one of four prospectively-determined rate categories (routine home care, continuous home care, inpatient respite care, and general inpatient care) to hospices based on each day a qualified Medicare beneficiary is under a hospice election.
B. Hospice Wage Index
The hospice wage index is used to adjust payment rates for hospice agencies under the Medicare program to reflect local differences in area wage levels. The original hospice wage index was based on the 1981 Bureau of Labor Statistics hospital data and had not been updated since 1983. In 1994, because of disparity in wages from one geographical location to another, a committee was formulated to negotiate a wage index methodology that could be accepted by the industry and the government. This committee, functioning under a process established by the Negotiated Rulemaking Act of 1990, was comprised of national hospice associations; rural, urban, large, and small hospices; multisite hospices; consumer groups; and a government representative. On April 13, 1995, the Hospice Wage Index Negotiated Start Printed Page 22395Rulemaking Committee signed an agreement for the methodology to be used for updating the hospice wage index.
1. Updates to the Hospice Wage Index
In the August 8, 1997 Federal Register (62 FR 42860), we published a final rule implementing a new methodology for calculating the hospice wage index based on the recommendations of the negotiated rulemaking committee. The committee statement was included in the appendix of that final rule (62 FR 42883). The provisions of the final rule specified that the revised hospice wage index was to be— (1) calculated using the most current available hospital wage data; and (2) 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. The revised wage index was fully implemented during the third year of the transition period, October 1, 1999 through September 30, 2000.
The annual update to the hospice wage index is published in the Federal Register and is based on the most current available hospital wage data, as well as any changes by the Office of Management and Budget (OMB) to the definitions of Metropolitan Statistical Areas (MSAs). Raw wage index values (inpatient hospital pre-floor and pre-reclassified wage index values) (as described in the August 8, 1997 hospice wage index final rule (62 FR 42860)) are subject to either a budget neutrality adjustment or application of the wage index floor. Raw wage index values of 0.8 or greater are adjusted by the budget neutrality adjustment factor. Budget neutrality means that, in a given year, estimated aggregate payments for Medicare hospice services using the updated wage index values will equal estimated payments that would have been made for these services if the 1983 wage index values had remained in effect. To achieve this budget neutrality, the raw wage index is multiplied by a budget neutrality adjustment factor. The budget neutrality adjustment factor is computed and applied annually. The budget neutrality adjustment factor is calculated by comparing what we would have paid using current rates and the 1983 wage index to what would be paid using current rates and new wage index.
Raw wage index values below 0.8 are adjusted by the greater of: (1) The hospice budget neutrality adjustment factor; or (2) the hospice wage index floor (a 15 percent increase) subject to a maximum wage index value of 0.8.
C. Hospice Provisions of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003
On December 8, 2003, the Congress enacted the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 (Pub. L. 108-173). This legislation provided for the following provisions affecting hospice services:
- Section 408, Recognition of Attending Nurse Practitioners as Attending Physicians to Serve Hospice Patients.
- Section 512, Coverage of Hospice Consultation Services.
- Section 946, Authorizing Use of Arrangements to Provide Core Hospice Services in Certain Circumstances.
Section 408 of the MMA amended sections 1861(dd)(3)(B) and 1814(a)(7) of the Act to add nurse practitioners (NPs) to the definition of an attending physician for beneficiaries who have elected the hospice benefit. In other words, if a beneficiary's primary care provider before the determination of the terminal illness and election of the hospice benefit is an NP, the NP can remain as the attending physician, if the beneficiary chooses, after a hospice election. If the beneficiary does not have an attending physician or NP at the time of the terminal diagnosis, the beneficiary may choose to designate either a physician or an NP as his or her attending physician when electing the hospice benefit. Section 408 of the MMA was implemented through an administrative issuance (Change Request (CR) 3226, Transmittals 22 and 304, September 24, 2004).
Section 512 of the MMA provides for a one-time evaluation and consultation to Medicare beneficiaries who have been determined to have a 6-month prognosis if the disease runs its normal course, and who require the expertise of the medical director or physician employed by a hospice in order to be able to make end-of-life decisions. This provision was implemented in the CY 2005 Physician Fee Schedule final rule published in the November 15, 2004 Federal Register (69 FR 66335) and is incorporated in our regulations at § 418.205 and § 418.304(d).
Section 946(a) of the MMA allows a hospice program “in extraordinary, exigent, or other non-routine circumstances, such as unanticipated period of high patient loads, staffing shortages due to illness or other events, or temporary travel of a patient outside a hospice program's service area, * * * “ to enter into arrangements with another hospice program to provide services to beneficiaries. Section 946(b) of the MMA provides that “in the case of hospice care provided by a hospice program under arrangement under section 1861(dd)(5)(D) made by another hospice program, the hospice program that made the arrangements shall bill and be paid for the hospice care.” In section II.B.2 of this proposed rule, we discuss our proposal to revise the regulations to implement payment for hospice services made under arrangements. We will address the implementation of section 946(a) of the MMA in a future rulemaking document.
II. Provisions of the Proposed Rule
A. Hospice Wage Index for FY 2006
1. Revised OMB Definition for Geographical Statistical Areas
As required by § 418.306(c), each hospice's labor market is established using the MSA definitions issued by OMB. In the September 4, 1996 hospice wage index proposed rule (61 FR 46579), we explained that the MSA definitions were issued by OMB on December 28, 1992, based on the 1990 census, and updated by OMB based on the decennial census. In accordance with our regulations, changes to the MSA definitions are announced in a Federal Register notice.
In the August 27, 2004 Federal Register (69 FR 52710), we published a notice with respect to the hospice wage index for FY 2005. In that notice, we acknowledged that on June 6, 2003, OMB issued OMB Bulletin No. 03-04 announcing revised definitions for MSAs, new definitions for Micropolitan Statistical Areas and Combined Statistical Areas, and guidance on using the statistical definitions. (A copy of the Bulletin may be obtained at the following Internet address: http://www.whitehouse.gov/omb/bulletins/b03-04.html.) In addition, we noted that we would not address the new OMB definitions because the wage data used to calculate the FY 2005 hospice wage index (FY 2004 hospital wage data) did not reflect revisions based on the new definitions. We indicated that the new OMB definitions would be addressed in the FY 2006 wage index update.
a. Background
In general, OMB defines an urban area as a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA). A rural area is defined Start Printed Page 22396as any area outside of the urban area. Any area not included in an MSA is considered to be nonurban and receives the statewide rural rate.
Under the hospital inpatient prospective payment system (IPPS), the wage index is calculated and assigned to hospitals on the basis of the labor market area in which the hospital is located or geographically reclassified under sections 1886(d)(8) and (d)(10) of the Act. In accordance with our regulations for hospice payment, we also use MSAs to define labor market areas, but the application differs from IPPS. Section 1814(i)(2)(D) of the Act requires Medicare to pay for hospice services based on the geographic location where the service is furnished. The wage index value used is based upon the location of the beneficiary's home for routine home care and continuous home care and the location of the hospice agency for general inpatient and respite care.
In this proposed rule, we will address the new OMB definitions and their application to the hospice wage index. Since our regulations require the use of the IPPS wage data as the basis for determining the hospice wage index, we are providing the following summary of the revised geographical statistical areas adopted in the FY 2005 IPPS final rule. (For a more detailed discussion of the changes in the hospital wage index based on the new OMB definitions see the FY 2005 IPPS proposed and final rules published May 18, 2004 (69 FR 28196) and August 11, 2004 (69 FR 48916).)
b. Current Labor Market Areas Based on MSAs
As discussed in the FY 2005 IPPS final rule, “the [hospital] wage index is calculated and assigned to hospitals on the basis of the labor market area in which the hospital is located.” In addition, the IPPS final rule (69 FR 49026) defined hospital labor markets as follows:
We currently define hospital labor market areas based on the definitions of Metropolitan Statistical Areas (MSAs), Primary MSAs (PMSAs), and New England County Metropolitan Areas (NECMAs) issued by OMB. OMB also designates Consolidated MSAs (CMSAs). A CMSA is a metropolitan area with a population of one million or more, comprising two or more PMSAs (identified by their separate economic and social character). For purposes of the hospital wage index, we use the PMSAs rather than CMSAs because they allow a more precise breakdown of labor costs. If a metropolitan area is not designated as part of a PMSA, we use the applicable MSA.
These different designations use counties as the building blocks upon which they are based. Therefore, hospitals are assigned to either an MSA, PMSA, or NECMA based on whether the county in which the hospital is located is part of that area. For purposes of the IPPS wage index, we combine all of the counties in a State outside a designated MSA, PMSA, or NECMA together to calculate a statewide rural wage index.
c. Core-Based Statistical Areas
In the December 27, 2000 Federal Register (65 FR 82228 through 82238), OMB announced its new standards and in that notice, OMB defined a Core-Based Statistical Area (CBSA), beginning in 2003, as “a geographic entity associated with at least one core of 10,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties.” The standards designate and define two categories of CBSAs: MSAs and Micropolitan Statistical Areas (65 FR 82235).
According to OMB, MSAs are based on urbanized areas of 50,000 or more population, and Micropolitan Statistical Areas (referred to in further discussion as Micropolitan Areas) are based on urban clusters of at least 10,000 population but less than 50,000 population. Counties that do not fall within CBSA (either MSA or Micropolitan Areas) are deemed “Outside CBSAs.” In the past, OMB defined MSAs around areas with a minimum core population of 50,000, and smaller areas were “Outside MSAs.”
In its June 6, 2003 bulletin, OMB announced the new CBSAs, comprised of MSAs and the new Micropolitan Areas based on Census 2000 data. The new CBSA designations recognize 49 new (urban) MSAs and 565 new Micropolitan Areas, and revised the composition of many of the existing (urban) MSAs. There are 1,090 counties in MSAs under these new CBSA designations compared with 848 counties in the previous MSAs. Of these 1,090 counties, 737 are in the same MSA as they were before the changes, 65 are in different MSAs, and 288 were not previously designated to any MSA. There are 674 counties in Micropolitan Areas. Of these, 41 were previously in an MSA, while 633 were not previously designated to an MSA.
d. Revised Labor Market Areas
As discussed in the FY 2005 IPPS final rule (69 FR 49027), alternatives to the use of MSAs for the purpose of establishing labor market areas for the Medicare wage index were examined. In the May 27, 1994, IPPS proposed rule (59 FR 27724), the latest research concerning possible future refinements to the labor market areas was presented. Public comments received on the May 27, 1994 proposed rule were described in the June 2, 1995 proposed rule (60 FR 29219). In that rule, it was noted that there was no consensus among commenters on the choice for new labor market areas. Consequently, MSAs have continued to be used to define labor market areas for purposes of the wage index by many Medicare payment systems as noted in previous discussion.
(1) New England County Metropolitan Areas
NECMAs are currently used to define labor markets areas in New England, “* * * because these are county-based designations rather than the 1990 MSA definitions for New England which used minor civil divisions such as cities and towns.” Under the CBSA definition, “OMB has defined the MSAs and Micropolitan Areas in New England on the basis of counties. OMB also established New England City and Town Areas, which are similar to the previous New England MSAs.” Therefore, to maintain consistency in the definition of labor market areas between New England and the rest of the country, IPPS decided to use the New England MSAs under the new CBSA definition.
(2) Metropolitan Divisions
Under OMB's new CBSA designations, a Metropolitan Division is a county or group of counties within a CBSA that contains a core population of at least 2.5 million, representing an employment center, plus adjacent counties associated with the main county or counties through commuting lines. For the hospital wage index the PMSAs are used rather than CMSA to define labor market areas “because they comprise a smaller geographic area with potentially varying labor costs due to different local economies.”
(3) Micropolitan Areas
The IPPS final rule noted the following regarding the use of Micropolitan Areas to define labor markets (69 FR 49029):
One of the major issues with respect to the new definitions is whether to use Micropolitan Areas to define labor market areas for the purpose of the IPPS wage index. Because the new Micropolitan Areas are essentially a third area definition made up mostly of currently rural areas, but also some or all of current MSAs, how these areas are treated will have significant impacts on the calculation and application of the wage index. Treating Micropolitan Areas as separate and distinct labor market areas would affect both the wage indexes of the hospitals in the Micropolitan Areas and the Start Printed Page 22397hospitals in the labor market areas where those hospitals are currently located (both positively and negatively).
Because we currently use MSAs to define urban labor market areas and we group all the hospitals in counties within each State that are not assigned to an MSA together into a statewide rural labor market area, we have used the terms “urban” and “rural” wage indexes in the past for ease of reference. However, the introduction of Micropolitan Areas complicates this terminology because these areas include so many hospitals that are currently included in the statewide rural labor market areas. In order to facilitate the discussion below, we use the term “rural” hospitals to describe hospitals in counties that are not assigned to either an MSA or a Micropolitan Area. This should not be taken to indicate that hospitals in Micropolitan Areas are no longer “rural” hospitals. In fact, we proposed that hospitals in Micropolitan Areas are included in the statewide rural labor market areas, for the reasons outlined below.
2. Annual Update to the Hospice Wage Index
(If you choose to comment on issues in this section, please include the caption “Annual Update to the Hospice Wage Index” at the beginning of your comments)
a. Background
Section 418.306(c) requires that we issue annually in the Federal Register, hospice wage index based on our most current available hospital wage data, including any changes to the definitions of MSAs.
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 FYs 1998 through 2002. Hospice rates were to be updated by a factor equal to the hospital market basket index, minus 1 percentage point. However, neither the BBA nor subsequent legislation specified the hospital market basket adjustment to be used to compute payment for FY 2006. Therefore, payment rates for FY 2006 will be updated according to section 1814(i)(1)(C)(ii)(VII) of the Act, which specifies that the update to the payment rates after FY 2002 will be the hospital market basket percentage increase for the fiscal year. This rate update is implemented via administrative issuance to be published July 2005 to provide adequate time to implement system change requirements and is not part of this proposed rule.
The hospice wage index presented in this proposed rule would be effective October 1, 2005 through September 30, 2006. We note that we are not proposing any modifications to the hospice wage index methodology. In accordance with the our regulations and the agreement signed with other members of the Hospice Wage Index Negotiated Rulemaking Committee, we will continue to use the most current hospital data available to adjust for area wage differences. For this proposed rule, the FY 2005 hospital wage index was the most current hospital wage data available when the FY 2006 wage index values were calculated. We continue to use the pre-reclassified and prefloor hospital area wage index data. Payment rates for each of the four levels of care (routine home care, continuous home care, respite care, and general inpatient care) are adjusted annually based upon the hospital market basket for that year and are promulgated administratively to allow for sufficient time for system changes and provider notification. Due to the need to ensure appropriate time for implementing changes, we have not incorporated these payment rates into this proposed rule.
The payment rates are divided into the labor and nonlabor portions. The appropriate wage index value is applied to the labor portion of the hospice rate based on the geographic area in which the beneficiary resides when receiving routine home care or continuous home care. The appropriate wage index value is applied to the labor portion of the hospice rate based on the geographic area of the hospice agency for beneficiaries receiving general inpatient or respite level of care.
We use the previous fiscal year's hospital wage index data to calculate the hospice wage index values. For FY 2006 proposed hospice wage index, we use the FY 2005 hospital prefloor and pre-reclassified hospital wage data. This means that the hospital wage data used for the hospice wage index is not adjusted to take into account the geographic reclassification of hospitals in accordance with sections 1886(d)(8)(B) and 1886 (D)(10) of the Act. All wage index values for FY 2006 would be adjusted by either by the proposed FY 2006 budget neutrality adjustment factor, 1.063479, or the wage index floor adjustment. This means, that for wage index values 0.8 or greater, the value is multiplied by the budget neutrality adjustment factor. For wage index values that are below 0.8, either the budget neutrality adjustment factor or the wage index floor, not to exceed 0.8, is applied. In other words, the floor adjustment is the greater of the raw wage index value multiplied by the proposed budget neutrality adjustment factor (1.063479 for FY 2006) or the raw wage index value for that area is multiplied by 15 percent subject to a maximum value of 0.8. Budget neutrality means that, in a given year, estimated aggregate payments for Medicare hospice services using the updated wage index will equal estimated payments that would have been made for the same services if the wage index adopted for hospices in 1983 had remained in effect. (For a detailed discussion of the methodology used to compute the hospice wage index see the September 4, 1996 proposed rule (61 FR 46579) and the August 8, 1997 final rule (62 FR 42860)). The proposed FY 2006 hospice wage indexes for urban and rural areas are listed in Tables A and B of the Addendum.
b. Implementation of the Revised Labor Market Designations
(If you choose to comment on issues in this section, please include the caption “Implementation of Revised Labor Market Designations” at the beginning of your comments)
For the hospice payment system, § 418.306(c) requires that the hospice wage index be “based on the most current available CMS hospital wage index, including any changes to the definitions of Metropolitan Statistical Areas.” We continue to believe MSAs are a reasonable and appropriate proxy for developing geographic areas for purposes of adjusting for wage differences in hospice. We also note that MSAs are used to define labor market areas for purposes of the wage index for many of the other Medicare payment systems (for example, long term care hospital (LTCH) prospective payment system (PPS), inpatient rehabilitation facility (IRF) PPS, home health agency (HHA) PPS, skilled nursing facility (SNF) PPS, Outpatient PPS and inpatient psychiatric facility (IPF) PPS.
First, historically, Medicare prospective payment systems have used metropolitan area (MA) definitions developed by OMB. For example, in adopting the MSA designation for the IPPS area labor adjustment, the Secretary stated:
[i]n administering a national payment system, we must have a national classification system built on clear, objective standards. Otherwise the program becomes increasingly difficult to administer because the distinction between rural and urban hospitals is blurred. We believe that the MSA system is the only one that currently meets the requirements for use as a classification system in a national payment program. The MSA classification system is a statistical standard developed for use by Federal agencies in the production, analysis, and publication of data on metropolitan areas. The standards have been developed with the aim of producing definitions that will be consistent as possible for all MSAs nationwide.” (49 FR 27426).
Start Printed Page 22398In addition, in numerous instances, the Congress has recognized that the areas developed by OMB may be used for differentiating among geographic areas for Medicare payment purposes. For example, in the IPPS statutory section, section 1886(d)(2)(D) of the Act, the Congress defines an “urban area” as “an area within a Metropolitan Statistical Area (as defined by the Office of Management and Budget) or within such similar area as the Secretary has recognized.” Similarly, in the sections of the statute governing the guidelines to be used by the Medicare Geographic Classification Review Board for purposes of reclassification, sections 1886(d)(10)(A) and (D)(i)(II) of the Act, the Congress directed the Secretary to create guidelines for “determining whether the county in which the hospital is located should be treated as being part of a particular [MSA].” Thus, the Congress has accepted and ratified the use of MSAs as an inherently rational manner of dividing up labor-market areas for purposes of Medicare payments.
The process used by OMB to develop the MSAs creates geographic areas that are based upon characteristics we believe also generally reflect the characteristics of unified labor market areas. For example, the CBSAs reflect a core population plus an adjacent territory that reflects a high degree of social and economic integration. This integration is measured by commuting ties, thus demonstrating that these areas may draw workers from the same general areas. In addition, the most recent CBSAs reflect the most up to date information. OMB reviews its MA definitions preceding each decennial census to reflect recent population changes, and the CBSAs are based on the Census 2000 data. Finally, in the context of the inpatient prospective payment system, we have reviewed alternative methods for determining geographic areas for purposes of the wage index, and in each case, have determined to remain with the OMB designations rather than replace these designations with alternatives.
As stated previously, § 418.306(c) requires the hospice wage index to reflect changes to the definitions of MSA. Therefore, we are proposing to adopt the revised labor market area designations based on OMB's CBSA designations.
For the proposed FY 2006 hospice wage index, we would adopt the CBSA designations as finalized in the FY 2005 IPPS. We believe that OMB's CBSA designations, based on Census 2000 data reflect the most recent available geographic classifications (MA definitions). We are not proposing to change at this time, the methodology derived as a result of the negotiated rulemaking committee. We believe that there are factors which require evaluation to determine if the hospice methodology supports the cost of providing hospice services and if the methodology requires modification.
As discussed in the IPPS final rule (69 FR 49032), when the IPPS adopted the revised labor market areas based on OMB's new CBSA designations on October 1, 2004, IPPS established a transition to the new designations to mitigate the resulting adverse impact on certain hospitals. Section 1814(i)(1)(A) of the Act requires hospice payment to be based on “costs which are reasonable and related to the cost of providing hospice care or which are based on such other tests of reasonableness the Secretary may prescribe in regulations * * *.” Our regulations at § 418.306(c) require us to issue annually in the Federal Register “ a hospice wage index based on the most current available CMS hospital data wage data, including any changes to the definitions of Metropolitan Statistical Areas.” This language would not seem to permit us to establish a transition to the new CBSA designations. In addition, unlike IPPS and other payment systems where each entity uses a single MSA (CBSA), hospice agencies may use various wage indices to compute their payments based upon the location of the beneficiary for routine and continuous home care or the MSA (CBSA) for the location of the agency for respite and general inpatient care. The methodology for applying the hospice floor (15 percent) to wage index values below 0.8 is used to leverage areas where there are significantly low wage index values. Moreover, we do not believe that in the aggregate, hospice agencies would be impacted negatively by the new CBSA designations. The existing methodology of computing the hospice wage index, the annual calculation of the hospice payment rates based upon the market basket index, and the variability of CBSAs that may be attributed to different hospice agencies are sufficient to mitigate adverse effects on individual hospice agencies. While we understand that there are CBSAs that decrease based upon the new definitions, there are those that are positively affected. For example, many counties that have been included in the rural definitions under the MSA designations are now designated as urban areas under the CBSA will generally receive an increase in their wage index. We believe that adjustments made to CBSAs because of negative impact would necessitate adjustment to CBSAs that are positively impacted. Variability and changes in wage indices both positively and negatively have occurred under the MSA designations and occur as a result of geographic differences. As a result, we propose to adopt the CBSA definitions and resulting wage indices without transitions. The impact of the CBSA designations is discussed in section V of this proposed rule.
In adopting the CBSA designations, we identified that there were no IPPS hospitals and thus no hospital wage index data on which to base the calculation of the FY 2006 hospice wage index for rural Massachusetts. Because there is no reasonable proxy for more recent rural data within Massachusetts, we are proposing to use the prefloor, preclassified hospital wage index data for FY 2005 and apply the FY 2006 proposed budget neutrality factor of 1.063479. In the event that future rural areas do not have hospital wage index data to derive a hospice wage index, we propose to use a comparable methodology to derive a wage index. Similarly, if there urban areas without hospital wage index data, we propose to use all of the urban areas within the State as a reasonable proxy. We are soliciting comment on these approaches to calculating the wage index value for areas without hospital wage data for FY 2006 and subsequent years.
To facilitate an understanding of the policies related to the proposed changes in the hospice wage index discussed in section II.A of this proposed rule, we are providing the following tables in the Addendum to this proposed rule:
- Table A—Proposed Hospice Wage Index for Urban Areas by CBSA.
- Table B—Proposed Hospice Wage Index for Rural Areas by CBSA.
- Table C—Comparison of Hospice Wage Index for Urban Areas by MSA and CBSA. This table lists the counties by MSA designation and the wage index if we had retained the use of MSAs. It also presents the CBSA designation for these counties and the corresponding wage index using the CBSA designations. The MSA designations include those counties that were classified as rural and indicated the State rural MSA code and the corresponding CBSA for these counties which under the CBSA designation are now urban. We note that some counties that are classified as rural under the MSA designation would become rural under the new CBSA designation and vice versa.
- Table D—Comparison of the Hospice Wage Index for Rural Areas by MSA and CBSA. This table compares Start Printed Page 22399the State rural MSA designations and their corresponding wage indices to the CBSA designations and their respective wage indices.
- Table E—Rural Counties Converting to Urban Counties by State. This table presents the rural counties that under the CBSA designations convert to urban counties. The list includes the county name, State county code, MSA designation, MSA name, CBSA name, and CBSA designation. Please note that these conversions are based on the OMB designations.
- Table F—Crosswalk of Counties by State from MSA to CBSA. This table crosswalks all counties in each State from MSA to CBSA and includes the State, State county code, MSA designation, MSA name, CBSA designation, and CBSA name. These tables will assist providers in identifying their location and their catchment area(s) by their previous designations and their CBSA designation as well as the wage indices for those areas based upon the previous MSA designations as well as the CBSA designations.
3. Labeling Error in the Hospice Wage Index
We have discovered an error in the labeling of the wage index tables that we have been publishing in the annual hospice wage index update. That labeling error is the listing of Stanly County, North Carolina as one of the areas under MSA 1520 when, in fact, we consider Stanly County, NC to be a rural area in North Carolina. Stanly County wage data have always been correctly treated as rural in the actual creation of the hospice wage index values, and it has only been the listing of Stanly County under MSA 1520 that was in error. Consequently, we are correcting our labeling error from past notices for the hospice and have removed Stanly County from the list of areas that fall under the MSA 1520 wage index. Since this is strictly a ministerial correction that does not affect the actual computation of the wage index values, hospice providers in and beneficiaries who reside in Stanly County and receive routine home and continuous home care in Stanly County will continue to fall under, and use, the wage index for rural North Carolina.
B. Proposed Changes To Implement Hospice-Related Provisions of the MMA
(If you choose to comment on issues in this section, please include the caption “MMA Provisions” at the beginning of your comments)
In section I.C of this proposed rule, we note that section 408 of the MMA was effective upon enactment and initially implemented through administrative issuances. This proposed rule would incorporate the provisions in regulation.
1. Coverage of Nurse Practitioner as Attending Physician in Hospice (Section 408 of the MMA)
Section 408 of the MMA amended sections 1861(dd)(3)(B) and 1814(a)(7) of the Act to add nurse practitioners (NPs) to the definition of an attending physician, for beneficiaries who have elected the hospice benefit. In other words, if a beneficiary's primary care provider is an NP, before the determination of the terminal illness and election of the hospice benefit, the NP can remain as the attending physician, if chosen by the beneficiary. If the beneficiary does not have an attending physician or NP, the beneficiary must be provided with an option of either a physician or an NP (if available and if allowed by State law) to serve as the attending physician. An NP is defined as a registered nurse who performs such services as he or she is legally authorized to perform (in the State in which the services are performed) in accordance with State law (or State regulatory mechanism provided by State law) and who meets the training, education, and experience requirements as the Secretary may prescribe.
As discussed in Change Request 3226 (Transmittals 22 and 304, September 24, 2004), beginning December 8, 2003, Medicare pays for medically reasonable and necessary services provided by NPs to Medicare beneficiaries who have elected the hospice benefit and who have selected a nurse practitioner as their attending physician. Nurse practitioners are paid 85 percent of the fee schedule amount for their services as attending physicians. Services for the terminal and related conditions provided by an NP—
- Serving as the attending physician that are medical in nature must be reasonable and necessary and must be services that, in the absence of an NP, would be performed by a physician; and
- May not be separately billed if the—
++ Services would not be reasonable and necessary if provided by an attending physician;
++ NP is not the patient's attending physician; or
++ Services would be performed by a registered or licensed nurse in the absence of a physician or nurse practitioner.
Since NPs are not physicians, as defined in 1861(r)(1) of the Act, they may not act as medical directors or physicians of the hospice or certify the beneficiary's terminal illness and hospices may not contract for their attending physician services as described in 1861(dd)(2)(B)(i)(III) of the Act. All of these provisions apply to NPs without regard to whether they are hospice employees.
We are proposing to revise § 418.3, 418.22(c)(1)(ii), and § 418.304 to implement the provisions of section 408 of the MMA.
2. Payment for Authorizing Use of Arrangements To Provide Hospice Service Under Certain Circumstances (Section 946 of the MMA)
Section 946(a) of the MMA amended section 1861(dd)(5) of the Act by adding the following: “(D) In extraordinary, exigent, or other non-routine circumstances, such as unanticipated periods of high patient loads, staffing shortages due to illness or other events, or temporary travel of a patient outside a hospice program's service area, a hospice program may enter into arrangements with another hospice program for the provision by that other program of services described in paragraph (2)(A)(ii)(I).” Section 946(a) of the MMA is discussed in this proposed rule to assist the reader in understanding how hospices will be reimbursed for these types of arrangements. We will issue more specific regulations regarding section 946(a) of the MMA in future rulemaking.
Section 946(b) of the MMA amended section 1814(i) of the Act to add the following: “(5) In the case of hospice care provided by a hospice program under arrangements under section 1861(dd)(5)(D) made by another hospice program, the hospice program that made the arrangements shall bill and be paid for the hospice care.” This means that the hospice that establishes the contractual arrangement with the hospice that will be providing services to the beneficiary, continues to bill for and receive payment during the hospice election.
Section 4442 of the BBA amended section 1814(i)(2) of the Act, effective for services furnished on or after October 1, 1997, to require hospice agencies to submit claims for payment for hospice services furnished in an individual's home on the basis of the geographic location at which the service is furnished. Therefore, the methodology for applying the wage index to the labor portion of the payment rates remains the same. This means that the wage index for routine and continuous home care would reflect the place where the service is provided, Start Printed Page 22400which may be outside of the hospice program's service area during periods of temporary travel. We do not propose in this rule to define “temporary travel” since this would depend upon individual needs and abilities determined by the interdisciplinary group, the beneficiary, and his or her family. The wage index for general inpatient care would reflect the MSA for the hospice agency that retains management responsibility. Payment will continue to be made to the hospice agency for which the beneficiary has made the election. We are proposing to revise § 418.302(d) to implement this provision.
III. Collection of Information Requirements
Under the Paperwork Reduction Act of 1995, we are required to provide 30-day notice in the Federal Register and solicit public comment before a collection of information requirement is submitted to the Office of Management and Budget (OMB) for review and approval. In order to fairly evaluate whether an information collection should be approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act of 1995 requires that we solicit comment on the following issues:
- The need for the information collection and its usefulness in carrying out the proper functions of our agency.
- The accuracy of our estimate of the information collection burden.
- The quality, utility, and clarity of the information to be collected.
- Recommendations to minimize the information collection burden on the affected public, including automated collection techniques.
Section 418.22(c)(1) requires for the initial 90-day period, the hospice must obtain written certification statements (and oral certification statements if required under paragraph (a)(3) of this section) from the individual's attending physician, if the individual has an attending physician, that meets the definition of physician specified in § 410.20 of this subchapter.
While this requirement is subject to the PRA it is currently approved by OMB under control number 0938-0302, “ICRs in Hospice Care Regulation and Supporting Regulations”, with a current expiration date of September 30, 2006.
IV. Response to Comments
Because of the large number of public comments we normally receive on Federal Register documents, we are not able to acknowledge or respond to them individually. We will consider all comments we receive by the date and time specified in the DATES section of this preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document.
V. Regulatory Impact Analysis
(If you choose to comment on issues in this section, please include the caption “Impact Analysis” at the beginning of your comments)
A. Overall Impact
We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review), the Regulatory Flexibility Act (RFA) (September 19, 1980, Pub. L. 96-354), section 1102(b) of the Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132. We estimated the impact on hospices, as a result of the proposed changes to the FY 2006 hospice wage index. As discussed previously, 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 proposed rule updates the hospice wage index in accordance with our regulation and that methodology, incorporating the adoption of the CBSA designations used in the hospital wage index data. Table I reflects the proposed hospice wage index impact using the CBSA designations. Table II indicates the proposed wage index impact using the hospice wage indices under the MSA designations as well as the CBSA designations.
In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside an MSA and has fewer than 100 beds. We have determined that this proposed rule would not have a significant impact on the operations of a substantial number of small rural hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in expenditure in any 1 year by State, local, and tribal governments, in the aggregate, or by the private sector, of $110 million or more. This proposed rule would have no substantial effect on State, local, or tribal governments or on the private sector.
Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule (and subsequent final rule) that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. We have reviewed this proposed rule under the threshold criteria of Executive Order 13132, Federalism, and have determined that it would not have an impact on the rights, roles, and responsibilities of State, local, or tribal governments.
In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.
1. Hospice Size
The impact of hospice wage index changes have been analyzed according to type of hospice, geographic location, type of ownership, hospice base, and hospice size. Hospice size was determined by the number of routine home care days (RHC). Since routine home care days account for over 70 percent of the services provided by a hospice, we used RHC days as a proxy for the size of the hospice agency. In the past, we had, designated the size by four categories: (1) 0 to 1,754 RHC days representing small agencies; (2) 1,754 to 4,373 RHC days or (3) 4,373 to 9,681 RHC days representing medium-sized agencies; and (4) 9,681 RHC days or more representing large agencies.
To determine the statistical distribution of RHC days, based upon the total number of hospice agencies and their respective RHC days using FY 2003 claims processed through March 2004, were used. In determining the statistical distribution, we deleted data for four hospice agencies with RHC days that greatly exceeded the total number of RHC days of other agencies. However, these data have been included in the impact analysis since we recognize that the skewness existed in the “large” agency size distribution using four size categories and does not change with the use of three size categories.
Based upon this analysis, we are using only three size designations to present the impact analyses. We believe that these three designations better describe the size of the hospice. The three categories are: Small agencies having 0 to 3,499 RHC days; medium agencies having 3,500 to 19,999 RHC days; and large agencies having 20,000 or more RHC days.
2. Impact on Hospices
Our discussions for this proposed rule will focus on the impact of adopting the Start Printed Page 22401CBSA designations. Table I indicates the impact of using the proposed CBSA designations. Table II provides a comparison between impact using the MSA and CBSA designations. As discussed above, we use the latest claims file available to us to develop the impact table when we issue the annual yearly wage index update. For the purposes of this proposed rule, we used the 2003 claims that were processed through June 2004 since this was the latest file available. Thus the projections or anticipated payments indicated in Table I do not represent the expenditures that we anticipate for FY 2006. We anticipate that the final rule will more accurately project payment for FY 2006. For the purposes of this proposed rule, we compared estimated payments using the FY 1983 hospice wage index to estimated payments using the FY 2006 wage index and determined the proposed hospice wage index to be budget neutral. Budget neutrality means that, in a given year, estimated aggregate payments for Medicare hospice services using the proposed FY 2006 wage index would equal estimated aggregate payments that would have been made for the same services if the 1983 wage index had remained in effect. Budget neutrality to 1983 does not imply that estimated payments would not increase since the budget neutrality applies only to the wage index portion and not the total payment rate, which accommodates inflation.
Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). We have determined that this proposed rule is not an economically significant rule under this Executive Order.
The RFA requires agencies to analyze options for regulatory relief of small businesses. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and government agencies. Most hospices and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year (for details, see the Small Business Administration's regulation at 65 FR 69432, that sets forth size standards for health care industries). For purposes of the RFA, most hospices are small entities. As indicated in Table I below, there are 2,435 hospices. Approximately 70 percent of Medicare certified hospices are identified as voluntary, government, or other agencies and, therefore, are considered small entities. Because the National Hospice and Palliative Care Organization estimates that approximately 79 percent of hospice patients are Medicare beneficiaries, we have not considered other sources of revenue in this analysis. Furthermore, the wage index methodology was previously determined by consensus, through a negotiated rulemaking committee that included representatives of national hospice associations; rural, urban, large, and small hospices; multisite hospices; and consumer groups. Based on all of the options considered, the committee agreed on the methodology described in the committee statement, and it was adopted into regulation in the August 8, 1997 final rule. In developing the process for updating the wage index in the 1997 final rule, we considered the impact of this methodology on small entities and attempted to mitigate any potential negative effects.
As stated previously, the following discussions are limited to demonstrating trends rather than projected dollars if the subsequent final rule to this proposed rule were implemented for FY 2006. We used the CBSA designations and wage indices as well as the data from FY 2003 claims processed through June 2004 in developing the impact analysis. We will recalculate the impacts for the final rule using the FY 2004 claims file. We will discuss the estimated payments for FY 2006 at that time. Since the impact tables are intended to reflect the implementation of the CBSA in contrast with the current MSA designations, the introduction of the wage indices is the only variable used in the computation. It is important to note that the payment rates used reflect the FY 2005 rates. The FY 2006 payment rates will be adjusted to reflect the full FY 2006 hospital market basket, as required by section 1814(i)(1)(C) (ii)(VII) of the Act. As previously noted, we publish these rates through administrative issuances. As discussed in section II.A.1.a. of this proposed rule, hospice agencies may various wage indices to compute their payments based on the geographic location of the beneficiary for routine and continuous home care or the MSA (CBSA) or the location of the hospice agency for respite and general inpatient care. Therefore, we analyze the impact on hospices using the following parameters: geographic location; hospice size; type of ownership; and hospice base).
Our analysis demonstrates that, under this proposed rule, rural hospices would experience an increase in payment that is greater than that of urban hospices. Rural hospices are anticipated to experience a modest increase of 0.8 percent and urban hospices a slight decrease of 0.2 percent. However, the impact overall is anticipated to remain unchanged if the CBSA designations are adopted. This flat trend is also evident when contrasting the findings with projections using the MSA designations. However, the projections using the MSA designations remain flat for urban areas and decrease slightly by 0.1 percent for rural areas.
Of the urban hospices, we anticipate that most of the regions would experience decreases ranging from a 1.4 for the urban New England region to 0.1 decrease for the South Atlantic. A slight increase is anticipated for the West North Central, West South Central, and Pacific urban regions of 0.1, 0.2, and 0.1, respectively. In contrast, the rural regions are expected to receive an increase for all regions ranging from a substantial increase of 21.7 percent for rural Puerto Rico to a 1 percent increase for East North Central. We believe that that aberration for Puerto Rico can be attributed to the increase in the hospital wage indices in the region as well as the large number of rural counties under the MSA designations in Puerto Rico that have been designated as urban counties under the CBSA designations. Rural New England and West North Central regions are expected to remain flat. Only one rural region, the Mid-Atlantic, is anticipated to experience a decrease of 1.5 percent. The anticipated increase for the rural regions using the MSA designations is in contrast, more modest with increases ranging from 0.1 to 0.3 and decreases anticipated for the rural South Atlantic, East North Central, East South Central, and Middle Atlantic of 0.2, 0.3, 0.6, and 0.7, respectively.
As discussed previously, we have designated three hospice sizes based on routine home care days. Under the Medicare hospice benefit, hospices can provide four different levels of care days. The majority of the days provided by a hospice are routine home care days. Therefore, the number of routine home care days can be used as a proxy for the size of the hospice, that is, the more days of care provided, the larger the hospice. Using routine home care days as a proxy for size, our analysis indicates that the impact of the wage index update on small hospices (those Start Printed Page 22402that provide up to 3,499 days of routine home care) will experience a 0.1 percent increase in both the CBSA and MSA projections. The impact remains virtually the same for both the CBSA and MSA designations for all three sizes. As indicated above, a 0.1 percent increase is anticipated for small agencies and remains unchanged for large agencies. There is a scant decrease of 0.1 percent for medium sized agencies (with 3,500 to 19,999 RHC days) using the CBSA designations while it remains unchanged for MSA designations. The lack of variability by agency size indicates that this proposed rule would have no impact on a small number of small entities. Rural Puerto Rico with 6 hospice agencies and 184,000 routine care days, representing the smallest number of hospices and second lowest routine home care days in the rural region, is anticipated to experience a substantial increase of 21.7 percent while rural South Atlantic with 138 hospices and 1,394,000 routine home care days, which represents the highest number of routine home days, will have an increase of 0.6 percent. The rural Mid-Atlantic region with 39 hospices and 280,000 routine home care days is anticipated to decrease by 1.5 percent. Rural New England with 27 hospices representing the second lowest number of agencies with 112,000 routine home care days, and representing the lowest number of rural days, is anticipated to remain unchanged.
Urban Puerto Rico region with 30 hospice agencies with 428,000 routine home care days, representing the lowest number of urban agencies and routine home care days, is anticipated to experience a decrease of 0.5 percent using the CBSA designations in contrast to a 0.2 percent increase using the MSA designation. Urban East North Central with 244 hospice agencies representing the largest number of urban hospice agencies with 5,275,000 routine home care days is anticipated to experience a decrease of 0.3 percent using the CBSA designation and would remain unchanged using the MSA designation. Urban West South Central with the largest number of routine home care days of 5,765,000 is anticipated to experience a 0.2 percent increase using the CBSA designations and 0.4 percent increase using the MSA designations. Based upon these comparisons, the urban regions would expect a slightly larger increase in payment using the MSA designations while the rural areas are anticipated to experience a substantially larger increase using the CBSA designations. However, as indicated above, in the aggregate, hospice agencies overall are anticipated to remain unchanged using either the CBSA or MSA designations.
By type of ownership, proprietary hospice agencies are anticipated to increase by 0.2 percent while voluntary agencies with the largest number of agencies and routine home care days of 1,309 and 23,696,000, respectively, are anticipated to decrease by 0.2 percent and government by 0.3. Since we are unable to determine the ownership type for the unknown category, we are unable to determine the impact of the anticipated decrease of 1.1 percent. By MSA designation, in contrast, voluntary and proprietary hospice agencies are anticipated to remain unchanged with government agencies anticipated to decrease by 0.1 percent.
Freestanding hospice agencies with the largest number of agencies of 1,188 and routine home care days of 29,277,000 are anticipated to remain unchanged when using MSA as well as CBSA designations. Home health-based hospice agencies are anticipated to remain unchanged with the MSA designations but are anticipated to increase by 0.2 percent with CBSA designation. Hospital-based hospice agencies are anticipated to decrease slightly with both MSA and CBSA designations at 0.1 and 0.3 respectively. SNF-based hospice agencies with the lowest number of agencies and routine home care days of 15 and 174,000, respectively, are also anticipated to experience a decrease with both MSA and CBSA designations of 0.6 and 0.9, respectively.
As discussed above, the overall impact for hospice agencies remain unchanged using the CBSA designations with a slight decrease in urban and an increase in rural hospice agencies. While there are more decreases in urban hospice agencies, there is overall increase in the rural agencies. Hospice size remains virtually unchanged when comparing MSA to CBSA designations. Type of ownership and hospice base appear similar between the two designations. As a result, there is no compelling reason to maintain the use of the MSA designations as opposed to the CBSA designations based upon overall hospice agency impact.
3. Anticipated Effects
We have compared estimated payments using the FY 1983 hospice wage index to estimated payments using the proposed FY 2006 wage index and determined the current hospice wage index to be budget neutral. This impact analysis compares hospice payments using the FY 2005 hospice wage index to the estimated payments using the proposed FY 2006 wage index. The data used in developing the quantitative analysis for this proposed rule were obtained from the June 2004 update of the national claims history file of all FY 2003 claims processed through June 2004. We deleted bills from hospices that have since closed. As discussed above, for the purposes of this proposed rule, this file is adequate to demonstrate the impact of using the MSA and proposed CBSA designations and is not intended to project the anticipated expenditures for FY 2006. We will be using an updated file for the final rule which will more accurately indicate the expected expenditures for FY 2006.
Table I demonstrates the results of our analysis. In column 2 of Table I, 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 indicates payments that were made using the FY 2005 wage index. Column 4 is based on claims (for hospices in business during that time period) and estimates payments (with the caveat as discussed above) to be made to hospices using proposed CBSA designations and FY 2006 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 I 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 indicted that there are 1,494 hospices located in urban areas and 941 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 2004. 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.
Table II demonstrates the estimated payments using the CBSA and MSA designations. The groupings as well as columns 1 and 2 are the same as in Start Printed Page 22403Table I. Columns 3 and 4 represent the estimated payments using the CBSA and MSA designations, respectively. Column 5 represents the percentage change in the estimated payments using CBSA designations compared with the estimated payments using the MSA designations.
Our analysis shows that the majority of hospices are in urban areas and provide the vast majority of routine home care days. However, rural hospices are anticipated to receive a larger percent increase in payment of 0.8 percent in contrast to a decrease of 0.2 percent for urban hospices if CBSA designations were used in the proposed FY 2006 wage index. However, overall, there is no anticipated change using the CBSA designations.
Since the impact tables are intended to reflect the implementation of the CBSA as opposed to the current MSA designations, the introduction of the wage indices is the only variable used in the computation. It is important to note that the payment rates used reflect the FY2005 rates. The FY 2006 payment rates would be adjusted to reflect the full FY 2006 hospital market basket, as required by section 1814(i)(1)(C)(ii)(VII) of the Act. We publish these rates through administrative issuances.
Start Printed Page 22404Table I.—Impact of Hospice Wage Index Changes Based on Use of CBSA Designations
Number of hospices (1) Number of routine home care days in thousands (2) Payments using FY 2005 wage index in thousands (3) Estimated payments using FY 2006 wage index in thousands (CBSA designations) (4) Percent change in hospice payments (CBSA designations) (5) By Geographic Location: All Hospices 2,435 43,232 6,086,726 6,084,194 0.0 Urban Hospices 1,494 35,877 5,225,240 5,215,515 −0.2 Rural Hospices 941 7,355 861,486 868,680 0.8 By Region—Urban: New England 93 1,051 179,129 176,671 −1.4 Middle Atlantic 173 3,573 551,587 549,856 −0.3 South Atlantic 209 7,442 1,164,758 1,163,315 −0.1 East North Central 244 5,275 765,379 762,940 −0.3 East South Central 109 2,644 346,632 345,627 −0.3 West North Central 109 2,442 316,698 316,938 0.1 West South Central 228 5,765 740,895 742,569 0.2 Mountain 107 2,821 439,997 437,091 −0.7 Pacific 192 4,436 683,956 684,476 0.1 Puerto Rico 30 428 36,208 36,031 −0.5 By Region—Rural: New England 27 112 14,835 14,832 0.0 Middle Atlantic 39 280 29,000 28,572 −1.5 South Atlantic 138 1,394 170,695 171,752 0.6 East North Central 142 940 113,436 113,541 0.1 East South Central 114 1,571 179,805 180,434 0.3 West North Central 184 889 105,953 105,995 0.0 West South Central 126 1,096 119,455 121,527 1.7 Mountain 106 534 65,696 65,872 0.3 Pacific 59 355 47,512 47,772 0.5 Puerto Rico 6 184 15,098 18,381 21.7 Routine Home Care Days: 0-3499 DAYS (Small) 629 997 125,214 125,330 0.1 3500-19,999 DAYS (Medium) 1,192 11,623 1,531,060 1,529,182 −0.1 20,000+ DAYS (Large) 614 30,612 4,430,452 4,429,683 0.0 Type Of Ownership: Voluntary 1,309 23,696 3,417,506 3,411,195 −0.2 Proprietary 840 17,843 2,444,369 2,449,666 0.2 Government 185 874 116,914 116,593 −0.3 Unknown 101 819 107,937 106,741 −1.1 Hospice Base: Freestanding 1,188 29,277 4,137,979 4,136,404 0.0 Home Health Agency 623 7,802 1,107,707 1,110,134 0.2 Hospital 550 5,470 751,268 749,156 −0.3 Skilled Nursing Facility 15 174 28,536 28,273 −0.9 Unknown 59 509 61,237 60,227 −1.6 Note: For purposes of comparing the proposed CBSA designations with the current MSA designations, hospice listings are based on the MSA designations. FY 2005 payment rates were used for estimated payments for FY 2006. FY 2006 payment rates will be adjusted to reflect the full hospital market basket. Start List of SubjectsTable II.—Comparison of Impact of the Hospice Wage Index Using CBSA and MSA Designations
Number of hospices (1) Number of routine home care days (in thousands) (2) Estimated Payments using FY 2006 wage index and CBSA designations (in thousands) (4) Estimated payments using FY 2006 wage index and MSA designations (in thousands) (6) Percent change in hospice payments (CBSA vs. MSA designations) (7) By Geographic Location: All Hospices 2,435 43,232 6,084,194 6,086,314 0.0 Urban Hospices 1,494 35,877 5,215,515 5,224,948 −0.2 Rural Hospices 941 7,355 868,680 860,366 1.0 By Region—Urban: New England 93 1,051 176,671 178,262 −0.9 Middle Atlantic 173 3,573 549,856 548,915 0.2 South Atlantic 209 7,442 1,163,315 1,165,203 −0.2 East North Central 244 5,275 762,940 765,293 −0.3 East South Central 109 2,644 345,627 346,797 −0.3 West North Central 109 2,442 316,938 317,338 −0.1 West South Central 228 5,765 742,569 744,193 −0.2 Mountain 107 2,821 437,091 437,836 −0.2 Pacific 192 4,436 684,476 684,819 −0.1 Puerto Rico 30 428 36,031 36,292 −0.7 By Region—Rural: New England 27 112 14,832 14,846 −0.1 Middle Atlantic 39 280 28,572 28,811 −0.8 South Atlantic 138 1,394 171,752 170,429 0.8 East North Central 142 940 113,541 113,151 0.3 East South Central 114 1,571 180,434 178,743 0.9 West North Central 184 889 105,995 106,186 −0.2 West South Central 126 1,096 121,527 119,706 1.5 Mountain 106 534 65,872 65,695 0.3 Pacific 59 355 47,772 47,661 0.2 Puerto Rico 6 184 18,381 15,140 17.6 Routine Home Care Days: 0-3499 DAYS (Small) 629 997 125,330 125,398 −0.1 3500-19,999 DAYS (Medium) 1,192 11,623 1,529,182 1,531,330 −0.1 20,000+ DAYS (Large) 614 30,612 4,429,683 4,428,586 0.0 Type of Ownership Voluntary 1,309 23,696 3,411,195 3,415,970 −0.1 Proprietary 840 17,843 2,449,666 2,445,117 0.2 Government 185 874 116,593 116,753 −0.1 Unknown 101 819 106,741 107,476 −0.7 Hospice Base: Freestanding 1,188 29,277 4,136,404 4,137,689 0.0 Home Health Agency 623 7,802 1,110,134 1,108,210 0.2 Hospital 550 5,470 749,156 750,172 −0.1 Skilled Nursing Facility 15 174 28,273 28,351 −0.3 Unknown 59 509 60,227 60,892 −1.1 Note: For purposes of comparing the proposed CBSA designations with the current MSA designations, hospice listings are based on the MSA designations. FY 2005 payment rates were used for estimated payments for FY 2006. FY 2006 payment rates will be adjusted to reflect the full hospital market basket. List of Subjects for 42 CFR Part 418
- Health facilities
- Hospice care
- Medicare
- Reporting and recordkeeping requirements
For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services would amend 42 CFR part 418 as set forth below:
Start PartPART 418—HOSPICE CARE
1. The authority citation for part 418 continues to read as follows:
2. Section 418.3 is amended by revising the definition of Attending physician to read as follows:
Definitions.* * * * *Attending physician means a—(1)(i) Doctor of medicine or osteopathy legally authorized to practice medicine and surgery by the State in which he or she performs an action; or
(ii) Nurse practitioner who meets the training, education, and experience requirements as the Secretary may prescribe; and
(2) Is identified by the individual, at the time he or she elects to receive hospice care, as having the most significant role in the determination and delivery of the individual's medical care.
* * * * *3. Section 418.22 is amended by—
A. Republishing the heading of paragraph (c) and paragraph (c)(1).
B. Revising paragraph (c)(1)(ii).
The republication and revisions read as follows:
Certification of terminal illness.* * * * *Start Printed Page 22405(c) Sources of certification. (1) For the initial 90-day period, the hospice must obtain written certification statements (and oral certification statements if required under paragraph (a)(3) of this section) from—
(i) * * *
(ii) The individual's attending physician, if the individual has an attending physician. The attending physician must meet the definition of physician specified in § 410.20 of this subchapter.
* * * * *4. Section 418.302 is amended by revising paragraph (d) to read as follows:
Payment procedures for hospice care.* * * * *(d)(1) The intermediary reimburses the hospice its appropriate payment amount for each day for which an eligible Medicare beneficiary is under the hospice's care.
(2) Effective December 8, 2003, if a hospice makes arrangements with another hospice to provide services under the circumstances specified in section 1861(dd)(5)(D) of the Act, the intermediary reimburses the hospice for which the beneficiary has made an election as described in paragraph (d)(1) of this section.
* * * * *5. Section 418.304 is amended by—
A. Revising the section heading.
B. Revising the introductory text of paragraph (a).
C. Adding a new paragraph (e).
The revisions and additions read as follows:
Payment for physician and nurse practitioner services.(a) The following services performed by hospice physicians and nurse practitioners are included in the rates described in § 418.302:
* * * * *(e)(1) Effective December 8, 2003, Medicare pays for attending physician services provided by nurse practitioners to Medicare beneficiaries who have elected the hospice benefit and who have selected a nurse practitioner as their attending physician. This applies to nurse practitioners without regard to whether they are hospice employees.
(2) Nurse practitioners may bill and receive payment for services only if the—
(i) Nurse practitioner is the beneficiary's attending physician as defined in § 418.3;
(ii) Services are medically reasonable and necessary; and
(iii) Services are performed by a physician in the absence of the nurse practitioner; and
(iv) Services are not related to the certification of terminal illness specified in § 418.22.
(3) Payment for nurse practitioner services are made at 85 percent of the physician fee schedule amount.
(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare—Hospital Insurance; and Program No. 93.774, Medicare—Supplementary Medical Insurance Program)
Dated: April 7, 2005.
Mark B. McClellan,
Administrator, Centers for Medicare & Medicaid Services.
Approved: April 15, 2005.
Michael O. Leavitt,
Secretary.
Addendum
Table A.—Hospice Wage index for Urban Areas by CBSA
CBSA code number Urban area (Constituent counties or county equivalents) 1 Wage index 2 10180 Abilene, TX 0.8348 Callahan County, TX Jones County, TX Taylor County, TX 10380 Aguadilla-Isabela-San Sebastian, PR 0.4922 Aguada Municipio, PR Aguadilla Municipio, PR Anasco Municipio, PR Isabela Municipio, PR Lares Municipio, PR Moca Muncipio, PR Rincón Municipio, PR San Sebastián Municipio, PR 10420 Akron, OH 0.9630 Portage County, OH Summit County, OH 10500 Albany, GA 1.1981 Baker County, GA Dougherty County, GA Lee County, GA Terrell County, GA Worth County, GA 10580 Albany-Schenectady-Troy, NY 0.9199 Albany County, NY Rensselaer County, NY Saratoga County, NY Schenectady County, NY Schoharie County, NY 10740 Albuquerque, NM 1.1151 Bernalillo County, NM Sandoval County, NM Torrance County, NM Valencia County, NM 10780 Alexandria, LA 0.8690 Grant Parrish Start Printed Page 22406 Rapides Parish, LA 10900 Allentown-Bethlehem-Easton, PA-NJ 1.0104 Warren County, NJ Carbon County, PA Lehigh County, PA Northampton County, PA 11020 Altoona, PA 0.8999 Blair County, PA 11100 Amarillo, TX 0.9761 Armstrong County, TX Carson County, TX Potter County, TX Randall County, TX 11180 Ames, IA 1.0081 Story County, IA 11260 Anchorage, AK 1.2937 Anchorage Municipality, AK Matanuska-Susitna Borough, AK 11300 Anderson, IN 0.9266 Madison County, IN 11340 Anderson, SC 0.9220 Anderson County, SC 11460 Ann Arbor, MI 1.1722 Washtenaw County, MI 11500 Anniston-Oxford, AL 0.8381 Calhoun County, AL 11540 Appleton, WI 0.9711 Calumet County, WI Outagamie County, WI 11700 Asheville, NC 0.9774 Buncombe County, NC Haywood County, NC Henderson County, NC Madison County, NC 12020 Athens-Clarke County, GA 1.0850 Clarke County, GA Madison County, GA Oconee County, GA Oglethorpe County, GA 12060 Atlanta-Sandy Springs-Marietta, GA 1.0604 Barrow County, GA Bartow County, GA Butts County Carroll County, GA Cherokee County, GA Clayton County, GA Cobb County, GA Coweta County, GA Dawson County, GA DeKalb County, GA Douglas County, GA Fayette County, GA Forsyth County, GA Fulton County, GA Gwinnett County, GA Haralson County, GA Heard County, GA Henry County, GA Jasper County, GA Lamar County, GA Meriwether County, GA Newton County, GA Paulding County, GA Pickens County, GA Pike County, GA Rockdale County, GA Spalding County, GA Walton County, GA 12100 Atlantic City, NJ 1.1625 Atlantic County, NJ Start Printed Page 22407 12220 Auburn-Opelika, AL 0.8736 Lee County, AL 12260 Augusta-Richmond County, GA-SC 0.9735 Burke County, GA Columbia County, GA McDuffie County, GA Richmond County, GA Aiken County, SC Edgefield County, SC 12420 Austin-Round Rock, TX 1.0204 Bastrop County, TX Caldwell County, TX Hays County, TX Travis County, TX Williamson County, TX 12540 Bakersfield, CA 1.0673 Kern County, CA 12580 Baltimore-Towson, MD 1.0536 Anne Arundel County, MD Baltimore City, MD Baltimore County, MD Carroll County, MD Harford County, MD Howard County, MD Queen Anne's County, MD 12620 Bangor, ME 1.0587 Penobscot County, ME 12700 Barnstable Town, MA 1.3118 Barnstable County, MA 12940 Baton Rouge, LA 0.8847 Ascension Parish, LA East Baton Rouge Parish, LA East Feliciana Parish, LA Iberville Parish, LA Livingston Parish, LA Pointe Coupee Parish, LA St. Helena Parish, LA West Baton Rouge Parish, LA West Feliciana Parish, LA 12980 Battle Creek, MI 0.9961 Calhoun County, MI 13020 Bay City, MI 1.0182 Bay County, MI 13140 Beaumont-Port Arthur, TX 0.9163 Hardin County, TX Jefferson County, TX Orange County, TX 13380 Bellingham, WA 1.2381 Whatcom County, WA 13460 Bend, OR 1.1276 Deschutes County, OR 13644 Bethesda-Frederick-Gaithersburg, MD 1.1651 Frederick County, MD Montgomery County, MD 13740 Billings, MT 0.9530 Carbon County, MT Yellowstone County, MT 13780 Binghamton, NY 0.8983 Broome County, NY Tioga County, NY 13820 Birmingham-Hoover, AL 0.9738 Bibb County, AL Blount County, AL Chilton County, AL Jefferson County, AL St. Clair County, AL Shelby County, AL 13900 Bismarck, ND 0.8000 Burleigh County, ND Morton County, ND Start Printed Page 22408 13980 Blacksburg-Christiansburg-Radford, VA 0.8456 Giles County, VA Montgomery County, VA Pulaski County, VA Radford City, VA 14020 Bloomington, IN 0.9132 Greene County, IN Monroe County, IN Owen County, IN 14060 Bloomington-Normal, IL 0.9689 McLean County, IL 14260 Boise City, ID 0.9946 Ada County, ID Boise County, ID Canyon County, ID Gem County, ID Owyhee, County, ID 14484 Boston-Quincy, MA 1.2518 Norfolk County, MA Plymouth County, MA Suffolk County, MA 14500 Boulder, CO 1.0684 Boulder County, CO 14540 Bowling Green, KY 0.8657 Edmonson County, KY Warren County, KY 14740 Bremerton-Silverdale, WA 1.1288 Kitsap County, WA 14860 Bridgeport-Stamford-Norwalk, CT 1.3650 Fairfield County, CT 15180 Brownsville-Harlingen, TX 1.0768 Cameron County, TX 15260 Brunswick, GA 1.2690 Brantley County, GA Glynn County, GA McIntosh County, GA 15380 Buffalo-Niagara Falls, NY 0.9932 Erie County, NY Niagara County, NY 15500 Burlington, NC 0.9536 Alamance County, NC 15540 Burlington-South Burlington, VT 0.9914 Chittenden County, VT Franklin County, VT Grand Isle County, VT 15764 Cambridge-Newton-Framingham, MA 1.1899 Middlesex County, MA 15804 Camden, NJ 1.1353 Burlington County, NJ Camden County, NJ Gloucester County, NJ 15940 Canton-Massillon, OH 0.9460 Carroll County, OH Stark County, OH 15980 Cape Coral-Fort Myers, FL 0.9966 Lee County, FL 16180 Carson City, NV 1.1009 Carson City, NV 16220 Casper, WY 0.9830 Natrona County, WY 16300 Cedar Rapids, IA 0.9545 Benton County, IA Jones County, IA Linn County, IA 16580 Champaign-Urbana, IL 1.0132 Champaign County, IL Ford County, IL Piatt County, IL 16620 Charleston, WV 0.9439 Boone County, WV Start Printed Page 22409 Clay County, WV Kanawha County, WV Lincoln County, WV Putnam County, WV 16700 Charleston-North Charleston, SC 1.0018 Berkeley County, SC Charleston County, SC Dorchester County, SC 16740 Charlotte-Gastonia-Concord, NC-SC 1.0361 Anson County, NC Cabarrus County, NC Gaston County, NC Mecklenburg County, NC Union County, NC York County, SC 16820 Charlottesville, VA 1.0947 Albemarle County, VA Fluvanna County, VA Greene County, VA Nelson County, VA Charlottesville City, VA 16860 Chattanooga, TN-GA 0.9791 Catoosa County, GA Dade County, GA Walker County, GA Hamilton County, TN Marion County, TN Sequatchie County, TN 16940 Cheyenne, WY 0.9550 Laramie County, WY 16974 Chicago-Naperville-Joliet, IL 1.1558 Cook County, IL DeKalb County, IL Du Page County, IL Grundy County, IL Kane County, IL Kendall County, IL McHenry County, IL Will County, IL 17020 Chico-Paradise, CA 1.1211 Butte County, CA 17140 Cincinnati-Middletown, OH-KY-IN 1.0120 Dearborn County, IN Franklin County, IN Ohio County, IN Boone County, KY Bracken County, KY Campbell County, KY Gallatin County , KY Grant County, KY Kenton County, KY Pendleton County, KY Brown County, OH Butler County, OH Clermont County, OH Hamilton County, OH Warren County, OH 17300 Clarksville, TN-KY 0.8531 Christian County, KY Trigg County, KY Montgomery County, TN Stewart County, TN 17420 Cleveland, TN 0.8342 Bradley County, TN Polk County, TN 17460 Cleveland-Elyria-Mentor, OH 1.0263 Cuyahoga County, OH Geauga County, OH Lake County, OH Lorain County, OH Start Printed Page 22410 Medina County, OH 17660 Coeur d'Alene, ID 0.9932 Kootenai County, ID 17780 College Station-Bryan, TX 0.9830 Brazos County, TX Burleson County, TX Robertson County, TX 17820 Colorado Springs, CO 1.0414 El Paso County, CO Teller County, CO 17860 Columbia, MO 0.8929 Boone County, MO Howard County, MO 17900 Columbia, SC 0.9988 Calhoun County, SC Fairfield County, SC Kershaw County, SC Lexington County, SC Richland County, SC Saluda County, SC 17980 Columbus, GA-AL 0.9242 Russell County, AL Chattahoochee County, GA Harris County, GA Marion County, GA Muscogee County, GA 18020 Columbus, IN 0.9984 Bartholomew County, IN 18140 Columbus, OH 1.0355 Delaware County, OH Fairfield County, OH Franklin County, OH Licking County, OH Madison County, OH Morrow County, OH Pickaway County, OH Union County, OH 18580 Corpus Christi, TX 0.9196 Aransas, TX Nueces County, TX San Patricio County, TX 18700 Corvallis, Oregon 1.1214 Benton County, OR 19060 Cumberland, MD-WV 0.9212 Allegany County, MD Mineral County, WV 19124 Dallas-Plano-Irving TX 1.0713 Collin County, TX Dallas County, TX Delta County, TX Denton County, TX Ellis County, TX Hunt County, TX Kaufman County, TX Rockwall County, TX 19140 Dalton, GA 1.0165 Murray County, GA Whitfield County, GA 19180 Danville, IL 0.8925 Vermilion, County, IL 19260 Danville, VA 0.9192 Danville City, VA Pittsylvania County, VA 19340 Davenport-Moline-Rock Island, IA-IL 0.9330 Henry County, IL Mercer County, IL Rock Island County, IL Scott County, IA 19380 Dayton, OH 0.9894 Greene County, OH Start Printed Page 22411 Miami County, OH Montgomery County, OH Preble County, OH 19460 Decatur, AL 0.9459 Lawrence County, AL Morgan County, AL 19500 Decatur, IL 0.8638 Macon County, IL 19660 Deltona-Daytona Beach-Ormond Beach, FL 0.9463 Volusia County, FL 19740 Denver-Aurora, CO 1.1596 Adams County, CO Arapahoe County, CO Broomfield County, CO Clear Creek County, CO Denver County, CO Douglas County, CO Elbert County, CO Jefferson County, CO Park County, CO 19780 Des Moines, IA 0.9854 Dallas County, IA Guthrie County, IA Madison County, IA Polk County, IA Warren County, IA 19804 Detroit-Livonia-Dearborn, MI 1.1006 Wayne County, MI 20020 Dothan, AL 0.8015 Geneva County, AL Henry County, AL Houston County, AL 20100 Dover, DE 1.0449 Kent County, DE 20220 Dubuque, IA 0.9303 Dubuque County, IA 20260 Duluth, MN-WI 1.0996 Carlton County, MN St. Louis County, MN Douglas County, WI 20500 Durham, NC 1.1021 Chatham County, NC Durham County, NC Orange County, NC Person County, NC 20740 Eau Claire, WI 0.9719 Chippewa County, WI Eau Claire County, WI 20764 Edison, NJ 1.1843 Middlesex County, NJ Monmouth County, NJ Ocean County, NJ Somerset County, NJ 20940 El Centro, CA 0.9418 Imperial County, CA 21060 Elizabethtown, KY 0.9235 Hardin County, KY Larue County, KY 21140 Elkhart-Goshen, IN 0.9867 Elkhart County, IN 21300 Elmira, NY 0.8981 Chemung County, NY 21340 El Paso, TX 0.9764 El Paso County, TX 21500 Erie, PA 0.9251 Erie County, PA 21604 Essex County, MA 1.1339 Essex County, MA 21660 Eugene-Springfield, OR 1.1635 Lane County, OR Start Printed Page 22412 21780 Evansville, IN-KY 0.8903 Gibson County, IN Posey County, IN Vanderburgh County, IN Warrick County, IN Henderson County, KY Webster County, KY 21820 Fairbanks, AK 1.1854 Fairbanks North Star Borough, AK 21940 Fajardo, PR 0.4530 Ceiba Municipio, PR Fajardo Municipio, PR Luquillo Municipio, PR 22020 Fargo, ND-MN 0.9693 Clay County, MN Cass County, ND 22140 Farmington, NM 0.8560 San Juan County, NM 22180 Fayetteville, NC 0.9957 Cumberland County, NC Hoke County, NC 22220 Fayetteville-Springdale-Rogers, AR-MO 0.9184 Benton County, AR Madison County, AR Washington County, AR McDonald County, MO 22380 Flagstaff, AZ 1.1472 Coconino County, AZ 22420 Flint, MI 1.1888 Genesee County, MI 22500 Florence, SC 0.9394 Darlington County, SC Florence County, SC 22520 Florence-Muscle Shoals, AL 0.8383 Colbert County, AL Lauderdale County, AL 22540 Fond du Lac, WI 1.0525 Fond du Lac County, WI 22660 Fort Collins-Loveland, CO 1.0867 Larimer County, CO 22744 Ft. Lauderdale-Pompano Beach-Deerfield Beach, FL 1.0810 Broward County, FL 22900 Fort Smith, AR-OK 0.8809 Crawford County, AR Franklin County, AR Sebastian County, AR Le Flore County, OK Sequoyah County, OK 23020 Fort Walton Beach-Crestview-Destin, FL 0.9344 Okaloosa County, FL 23060 Fort Wayne, IN 1.0430 Allen County, IN Wells County, IN Whitley County, IN 23104 Forth Worth-Arlington, TX 1.0073 Johnson County, TX Parker County, TX Tarrant County, TX Wise County, TX 23420 Fresno, CA 1.1205 Fresno County, CA 23460 Gadsden, AL 0.8560 Etowah County, AL 23540 Gainesville, FL 1.0059 Alachua County, FL Gilchrist County, FL 23580 Gainesville, GA 1.0164 Hall County, GA 23844 Gary, IN 0.9901 Jasper County, IN Start Printed Page 22413 Lake County, IN Newton County, IN Porter County, IN 24020 Glens Falls, NY 0.9004 Warren County, NY Washington County, NY 24140 Goldsboro, NC 0.9335 Wayne County, NC 24220 Grand Forks, ND-MN 0.9668 Grand Forks County, ND Polk County, MN 24300 Grand Junction, CO 1.0528 Mesa County, CO 24340 Grand Rapids-Wyoming, MI 1.0018 Barry County, MI Ionia County, MI Kent County, MI Newaygo County, MI 24500 Great Falls, MT 0.9369 Cascade County, MT 24540 Greeley, CO 1.0043 Weld County, CO 24580 Green Bay, WI 1.0199 Brown County, WI Kewaunee County, WI Oconto County, WI 24660 Greensboro-High Point, NC 0.9773 Guilford County, NC Randolph County, NC Rockingham County, NC 24780 Greenville, NC 0.9766 Green County, NC Pitt County, NC 24860 Greenville, SC 1.0164 Greenville County, SC Laurens County, SC Pickens County, SC 25020 Guayama, PR 0.4606 Arroyo Municipio, PR Guayama Municipio, PR Patillas Municipio, PR 25060 Gulfport-Biloxi, MS 0.9518 Hancock County, MS Harrison County, MS Stone County, MS 25180 Hagerstown-Martinsburg, MD-WV 1.0332 Washington County, MD Berkeley County, WV Morgan County, WV 25260 Hanford-Corcoran, CA 0.9886 Kings County, CA 25420 Harrisburg—Carlisle, PA 0.9953 Cumberland County, PA Dauphin County, PA Perry County, PA 25500 Harrisonburg, VA 0.9864 Rockingham County, VA Harrisonburg City, VA 25540 Hartford-West Hartford-East Hartford, CT 1.1756 Hartford County, CT Middlesex County, CT Tolland County, CT 25620 Hattiesburg, MS 0.8000 Forrest County, MS Lamar County, MS Perry County, MS 25860 Hickory-Morganton-Lenoir, NC 1.0105 Alexander County, NC Burke County, NC Caldwell County, NC Start Printed Page 22414 Catawba County, NC 25980 Hinesville-Fort Stewart, GA 0.8205 Liberty County, GA Long County, GA 26100 Holland-Grand Haven, MI 0.9984 Ottawa County, MI 26180 Honolulu, HI 1.1712 Honolulu County, HI 26300 Hot Springs, AR 0.9836 Garland County, AR 26380 Houma-Bayou Cane-Thibodaux, LA 0.8211 Lafourche Parish, LA Terrebonne Parish, LA 26420 Houston-Baytown-Sugar Land, TX 1.0606 Austin County, TX Brazoria County, TX Chambers County, TX Fort Bend County, TX Galveston County, TX Harris County, TX Liberty County, TX Montgomery County, TX San Jacinto County, TX Waller County, TX 26580 Huntington-Ashland, WV-KY-OH 1.0171 Boyd County, KY Greenup County, KY Lawrence County, OH Cabell County, WV Wayne County, WV 26620 Huntsville, AL 0.9413 Limestone County, AL Madison County, AL 26820 Idaho Falls, ID 0.9634 Bonneville County, ID Jefferson County, ID 26900 Indianapolis, IN 1.0755 Boone County, IN Brown County, IN Hamilton County, IN Hancock County, IN Hendricks County, IN Johnson County, IN Marion County, IN Morgan County, IN Putnam County, IN Shelby County, IN 26980 Iowa City, IA 1.0267 Johnson County, IA Washington County, IA 27060 Ithaca, NY 1.0198 Tompkins County, NY 27100 Jackson, MI 0.9727 Jackson County, MI 27140 Jackson, MS 0.8817 Copiah County, MS Hinds County, MS Madison County, MS Rankin County, MS Simpson County, MS 27180 Jackson, TN 0.9465 Chester County, TN Madison County, TN 27260 Jacksonville, FL 1.0142 Baker County, FL Clay County, FL Duval County, FL Nassau County, FL St. Johns County, FL 27340 Jacksonville, NC 0.8934 Start Printed Page 22415 Onslow County, NC 27500 Janesville, WI 1.0191 Rock County, WI 27620 Jefferson City, MO 0.8867 Callaway County, MO Cole County, MO Moniteau County, MO Osage County, MO 27740 Johnson City, TN 0.8663 Carter County, TN Unicoi County, TN Washington County, TN 27780 Johnstown, PA 0.8912 Cambria County, PA 27860 Jonesboro, AR 0.8661 Craighead County, AR Poinsett County, AR 27900 Joplin, MO 0.9275 Jasper County, MO Newton County, MO 28020 Kalamazoo-Portage, MI 1.1354 Kalamazoo County, MI Van Buren County, MI 28100 Kankakee-Bradley, IL 1.1276 Kankakee County, IL 28140 Kansas City, KS-MO 1.0240 Franklin County, KS Johnson County, KS Leavenworth County, KS Linn County, KS Miami County, KS Wyandotte County, KS Bates County, MO Caldwell County, MO Cass County, MO Clay County, MO Clinton County, MO Jackson County, MO Lafayette County, MO Platte County, MO Ray County, MO 28420 Kennewick-Richland-Pasco, WA 1.1188 Benton County, WA Franklin County, WA 28660 Killeen-Temple-Fort Hood, TX 0.9829 Bell County, TX Coryell County, TX Lampasas County, TX 28700 Kingsport-Bristol, TN-VA 0.8763 Hawkins County, TN Sullivan County, TN Bristol City, VA Scott County, VA Washington County, VA 28740 Kingston, NY 0.9571 Ulster County, NY 28940 Knoxville, TN 0.9091 Anderson County, TN Blount County, TN Knox County, TN Loudon County, TN Union County, TN 29020 Kokomo, IN 0.9556 Howard County, IN Tipton County, IN 29100 La Crosse, WI-MN 0.9879 Houston County, MN La Crosse County, WI 29140 Lafayette, IN 0.9643 Benton County, IN Start Printed Page 22416 Carroll County, IN Tippecanoe, IN 29180 Lafayette, LA 0.8833 Lafayette County, LA St. Martin County, LA 29340 Lake Charles, LA 0.8439 Calcasieu Parish, LA Cameron Parish 29404 Lake County-Kenosha County, IL-WI 1.0998 Lake County, IL Kenosha County, WI 29460 Lakeland, FL 0.9497 Polk County, FL 29540 Lancaster, PA 1.0510 Lancaster County, PA 29620 Lansing-East Lansing, MI 1.0271 Clinton County, MI Eaton County, MI Ingham County, MI 29700 Laredo, TX 0.9302 Webb County, TX 29740 Las Cruces, NM 0.9342 Dona Ana County, NM 29820 Las Vegas-Paradise, NV 1.2100 Clarke County, NV 29940 Lawrence, KS 0.9193 Douglas County, KS 30020 Lawton, OK 0.8733 Comanche County, OK 30140 Lebanon, PA 0.9114 Lebanon County, PA 30300 Lewiston, ID-WA 0.9905 Nez Perce County, ID Asotin County, WA 30340 Lewiston-Auburn, ME 1.0169 Androscoggin County, ME 30460 Lexington-Fayette, KY 0.9953 Bourbon County, KY Clark County, KY Fayette County, KY Jessamine County, KY Scott County, KY Woodford County, KY 30620 Lima, OH 0.9922 Allen County, OH 30700 Lincoln, NE 1.0856 Lancaster County, NE 30780 Little Rock-North Little Rock, AR 0.9386 Faulkner County, AR Grant County, AR Lonoke County, AR Perry County, AR Pulaski County, AR Saline County, AR 30860 Logan, UT-ID 0.9671 Franklin County, ID Cache County, UT 30980 Longview, TX 0.9360 Gregg County, TX Rusk County, TX Upshur County, TX 31020 Longview, WA 1.0873 Cowlitz County, WA 31084 Los Angeles-Long Beach-Glendale-Santa Ana, CA 1.2477 Los Angeles County, CA 31140 Louisville, KY-IN 0.9701 Clark County, IN Floyd County, IN Harrison County, IN Washington County, IN Start Printed Page 22417 Bullitt County, KY Henry County, KY Jefferson County, KY Meade County, KY Nelson County, KY Oldham County, KY Shelby County, KY Spencer County, KY Trimble County, KY 31180 Lubbock, TX 0.9334 Crosby County, TX Lubbock County, TX 31340 Lynchburg, VA 0.9589 Amherst County, VA Appomattox County, VA Bedford County, VA Campbell County, VA Bedford City, VA Lynchburg City, VA 31420 Macon, GA 1.0515 Bibb County, GA Crawford County, GA Jones County, GA Monroe County, GA Twiggs County, GA 31460 Madera, CA 0.9062 Madera County, CA 31540 Madison, WI 1.0960 Columbia County, WI Dane County, WI Iowa County, WI 31700 Manchester-Nashua, NH 1.1318 Hillsborough County, NI 31900 Mansfield, OH 0.9772 Richland County, OH 32420 Mayagũez, PR 0.5167 Hormigueros Municipio, PR Mayagũez, PR 32580 McAllen-Edinburg-Pharr, TX 0.9148 Hidalgo County, TX 32780 Medford, OR 1.1203 Jackson County, OR 32820 Memphis, TN-AR-MS 0.9802 Crittenden County, AR DeSoto County, MS Marshall County, MS Tate County, MS Tunica, County, MS Fayette County, TN Shelby County, TN Tipton County, TN 32900 Merced, CA 1.1246 Merced County, CA 33124 Miami-Miami Beach-Kendall, FL 1.0497 Miami-Dade County, FL 33140 Michigan City-La Porte, IN 0.9924 La Porte County, IN 33260 Midland TX 0.9980 Midland County, TX 33340 Milwaukee-Waukesha-West Allis, WI 1.0716 Milwaukee County, WI Ozaukee County, WI Washington County, WI Waukesha County, WI 33460 Minneapolis-St. Paul-Bloomington, MN-WI 1.1768 Anoka County, MN Carver County, MN Chisago County, MN Dakota County, MN Hennepin County, MN Start Printed Page 22418 Isanti County, MN Ramsey County, MN Scott County, MN Sherburne County, MN Washington County, MN Wright County, MN Pierce County, WI St. Croix County, WI 33540 Missoula, MT 1.0229 Missoula County, MT 33660 Mobile, AL 0.8503 Mobile County, AL 33700 Modesto, CA 1.2726 Stanislaus County, CA 33740 Monroe, LA 0.8405 Ouachita Parish, LA Union Parish, LA 33780 Monroe, MI 1.0109 Monroe County, MI 33860 Montgomery, AL 0.8827 Autauga County, AL Elmore County, AL Lowndes County, AL Montgomery County, AL 34060 Morgantown, WV 0.9284 Monongalia County, WV Preston County, WV 34100 Morristown, TN 0.8285 Grainger County, TN Hamblen County, TN Jefferson County, TN 34580 Mount Vernon-Anacortes, WA 1.1247 Skagit County, WA 34620 Muncie, IN 0.9125 Delaware County, IN 34740 Muskegon-Norton Shores, MI 1.0359 Muskegon County, MI 34820 Myrtle Beach-Conway-North Myrtle Beach, SC 0.9595 Horry County, SC 34900 Napa, CA 1.3326 Napa County, CA 34940 Naples-Marco Island, FL 1.1228 Collier County, FL 34980 Nashville-Davidson-Murfreesboro, TN 1.0726 Cannon County, TN Cheatham County, TN Davidson County, TN Dickson County, TN Hickman County, TN Macon County, TN Robertson County, TN Rutherford County, TN Sumner County, TN Trousdale County, TN Williamson County, TN Wilson County, TN 35004 Nassau-Suffolk, NY 1.3726 Nassau County, NY Suffolk County, NY 35084 Newark-Union, NJ-PA 1.2429 Essex County, NJ Hunterdon County, NJ Morris County, NJ Sussex County, NJ Union County, NJ Pike County, PA 35300 New Haven-Milford, CT 1.2556 New Haven County, CT 35380 New Orleans-Metairie-Kenner, LA 0.9681 Jefferson Parish, LA Start Printed Page 22419 Orleans Parish, LA Plaquemines Parish, LA St. Bernard Parish, LA St. Charles Parish, LA St. John The Baptist Parish, LA St. Tammany Parish, LA 35644 New York-Wayne-White Plains, NY-NJ 1.4156 Bergen County, NJ Hudson County, NJ Passaic County, NJ Bronx County, NY Kings County, NY New York County, NY Putnam County, NY Queens County, NY Richmond County, NY Rockland County, NY Westchester County, NY 35660 Niles-Benton Harbor, MI 0.9409 Berrien County, MI 35980 Norwich-New London Ct 1.2332 New London County, CT 36084 Oakland-Fremont-Hayward, CA 1.6186 Alameda County, CA Contra Costa County, CA 36100 Ocala, FL 0.9734 Marion County, FL 36140 Ocean City, NJ 1.1496 Cape May County, NJ 36220 Odessa, TX 1.0420 Ector County, TX 36260 Ogden-Clearfield, UT 0.9801 Davis County, UT Morgan County, UT Weber County, UT 36420 Oklahoma City, OK 0.9552 Canadian County, OK Cleveland County, OK Grady County, OK Lincoln County, OK Logan County, OK McClain County, OK Oklahoma County, OK 36500 Olympia, WA 1.1705 Thurston County, WA 36540 Omaha-Council Bluffs, NE-IA 1.0373 Harrison County, IA Mills County, IA Pottawattamie County, IA Cass County, NE Douglas County, NE Sarpy County, NE Saunders County, NE Washington County, NE 36740 Orlando, FL 1.0360 Lake County, FL Orange County, FL Osceola County, FL Seminole County, FL 36780 Oshkosh-Neenah, WI 0.9677 Winnebago County, WI 36980 Owensboro, KY 0.8969 Daviess County, KY Hancock County, KY McLean County, KY 37100 Oxnard-Thousand Oaks-Ventura, CA 1.1810 Ventura County, CA 37340 Palm Bay-Melbourne-Titusville, FL 1.0244 Brevard County, FL 37460 Panama City-Lynn Haven, FL 0.8640 Start Printed Page 22420 Bay County, FL 37620 Parkersburg-Marietta, WV-OH 0.8814 Washington County, OH Pleasants County, WV Wirt County, WV Wood County, WV 37700 Pascagoula, MS 0.8480 George County, MS Jackson County, MS 37860 Pensacola-Ferry Pass-Brent, FL 0.8833 Escambia County, FL Santa Rosa County, FL 37900 Peoria, IL 0.9450 Marshall County, IL Peoria County, IL Stark County, IL Tazewell County, IL Woodford County, IL 37964 Philadelphia, PA 1.1555 Bucks County, PA Chester County, PA Delaware County, PA Montgomery County, PA Philadelphia County, PA 38060 Phoenix-Mesa-Scottsdale, AZ 1.0616 Maricopa County, AZ Pinal County, AZ 38220 Pine Bluff, AR 0.9224 Cleveland County, AR Jefferson County, AR Lincoln County, AR 38300 Pittsburgh, PA 0.9291 Allegheny County, PA Armstrong County, PA Beaver County, PA Butler County, PA Fayette County, PA Washington County, PA Westmoreland County, PA 38340 Pittsfield, MA 1.1102 Berkshire County, MA 38540 Pocatello, ID 1.0210 Bannock County, ID Power County, ID 38660 Ponce, PR 0.5757 Juana Diaz Municipio, PR Ponce Municipio, PR Villalba Municipio, PR 38860 Portland-South Portland-Biddeford, ME 1.0754 Cumberland County, ME Sagadahoc County, ME York County, ME 38900 Portland-Vancouver-Beaverton, OR-WA 1.2127 Clackamas County, OR Columbia County, OR Multnomah County, OR Washington County, OR Yamhill County, OR Clark County, WA Skamania County, WA 38940 Port St. Lucie-Fort Pierce, FL 1.0684 Martin County, FL St. Lucie County, FL 39100 Poughkeepsie-Newburgh-Middletown, NY 1.2084 Duchess County, NY Orange County, NY 39140 Prescott, AZ 1.0520 Yavapai County, AZ 39300 Providence-New Bedford-Fall River, RI-MA 1.1623 Bristol County, MA Start Printed Page 22421 Bristol County, RI Kent County, RI Newport County, RI Providence County, RI Washington County, RI 39340 Provo-Orem, UT 1.0197 Juab County, UT Utah County, UT 39380 Pueblo, CO 0.9308 Pueblo County, CO 39460 Punta Gorda, FL 1.0040 Charlotte County, FL 39540 Racine, WI 0.9619 Racine County, WI 39580 Raleigh-Cary, NC 1.0695 Franklin County, NC Johnston County, NC Wake County, NC 39660 Rapid City, SD 0.9478 Meade County, SD Pennington County, SD 39740 Reading, PA 0.9800 Berks County, PA 39820 Redding, CA 1.2586 Shasta County, CA 39900 Reno-Sparks, NV 1.1120 Storey County, NV Washoe County, NV 40060 Richmond, VA 0.9994 Amelia County, VA Caroline County, VA Charles City County, VA Chesterfield County, VA Cumberland County, VA Dinwiddie County, VA Goochland County, VA Hanover County, VA Henrico County, VA King and Queen County, VA King William County, VA Louisa County, VA New Kent County, VA Powhatan County, VA Prince George County, VA Sussex County, VA Colonial Heights City, VA Hopewell City, VA Petersburg City, VA Richmond City, VA 40140 Riverside-San Bernardino-Ontario, CA 1.1666 Riverside County, CA San Bernardino County, CA 40220 Roanoke, VA 0.8949 Botetourt County, VA Craig County, VA Franklin County, VA Roanoke County, VA Roanoke City, VA Salem City, VA 40340 Rochester, MN 1.2234 Dodge County, MN Olmsted County, MN Wabasha County, MN 40380 Rochester, NY 0.9870 Livingston County, NY Monroe County, NY Ontario County, NY Orleans County, NY Wayne County, NY 40420 Rockford, IL 1.0237 Start Printed Page 22422 Boone County, IL Winnebago County, IL 40484 Rockingham County, NH 1.0870 Rockingham County, NH Stafford County, NH 40580 Rocky Mount, NC 0.9569 Edgecombe County, NC Nash County, NC 40660 Rome, Georgia 0.9442 Floyd County, GA 40900 Sacramento-Arden-Arcade-Roseville, CA 1.2443 El Dorado County, CA Placer County, CA Sacramento County, CA Yolo County, CA 40980 Saginaw-Saginaw Township North, MI 1.0437 Saginaw County, MI 41060 St. Cloud, MN 1.0863 Benton County, MN Stearns County, MN 41100 St. George, UT 1.0058 Washington County, UT 41140 St. Joseph, MO-KS 1.0649 Doniphan County, KS Andrew County, MO Buchanan County, MO DeKalb County, MO 41180 St. Louis, MO-IL 0.9652 Bond County, IL Calhoun County, IL Clinton County, IL Jersey County, IL Macoupin County, IL Madison County, IL Monroe County, IL St. Clair County, IL Crawford County, MO Franklin County, MO Jefferson County, MO Lincoln County, MO St. Charles County, MO St. Louis County, MO St. Louis City, MO Warren County, MO Washington County, MO 41420 Salem, OR 1.1226 Marion County, OR Polk County, OR 41500 Salinas, CA 1.4700 Monterey County, CA 41540 Salisbury, MD 0.9702 Somerset County, MD Wicomico County, MD 41620 Salt Lake City, UT 1.0168 Salt Lake County, UT Summit County, UT Tooele County, UT 41660 San Angelo, TX 0.8685 Irion County, TX Tom Green County, TX 41700 San Antonio, TX 0.9575 Atascosa County, TX Bandera County, TX Bexar County, TX Comal County, TX Guadalupe County, TX Kendall County, TX Medina County, TX Wilson County, TX 41740 San Diego-Carlsbad-San Marcos, CA 1.1982 Start Printed Page 22423 San Diego County, CA 41780 Sandusky, OH 0.9589 Erie County, OH 41884 San Francisco-San Mateo-Redwood City, CA 1.5646 Marin County, CA San Francisco County, CA San Mateo County, CA 41900 San Germán-Cabo Rojo, PR 0.6026 Cabo Rojo Municipio, PR Lajas Municipio, PR Sabana Grande Municipio, PR San Germán-Cabo Rojo Municipio, PR 41940 San Jose-Sunnyvale-Santa Clara, CA 1.5657 San Benito County, CA Santa Clara County, CA 41980 San Juan-Caguas-Guaynabo, PR 0.5342 Aguas Buenas Municipio, PR Aibonito Municipio, PR Arecibo Municipio, PR Barceloneta Municipio, PR Barranquitas Municipio, PR Bayamón Municipio, PR Caguas Municipio, PR Camuy Municipio, PR Canóvanas Municipio, PR Carolina Municipio, PR Catano Municipio, PR Cayey, Municipio PR Ciales Municipio, PR Cidra Municipio, PR Comerio Municipio, PR Corozal Municipio, PR Dorado Municipio, PR Florida Municipio, PR Guaynabo Municipio, PR Gurabo Municipiobo, PR Hatillo Municipio, PR Humacao Municipio, PR Juncos Municipio, PR Las Piedras Municipio, PR Loiza Municipio, PR Manatí Municipio, PR Maunabo Municipio, PR Morovis Municipio, PR Naguabo Municipio, PR Naranjito Municipio, PR Orocovis Municipio, PR Quebradillas Municipio, PR Rio Grande Municipio, PR San Juan Municipio, PR San Lorenzo Municipio, PR Toa Alta Municipio, PR Toa Baja Municipio, PR Trujillo Alto Municipio, PR Vega Alta Municipio, PR Vega Baja Municipio, PR Yabucoa Municipio, PR 42020 San Luis Obispo-Paso Robles, CA 1.1824 San Luis Obispo County, CA 42044 Santa Ana-Anaheim-Irvine, CA 1.2348 Orange County, CA 42060 Santa Barbara-Santa Maria-Goleta, CA 1.1455 Santa Barbara County, CA 42100 Santa Cruz-Watsonville, CA 1.5717 Santa Cruz County, CA 42140 Santa Fe, NM 1.1601 Santa Fe County, NM 42220 Santa Rosa-Petaluma, CA 1.3784 Sonoma County, CA 42260 Sarasota-Bradenton-Venice, FL 1.0240 Start Printed Page 22424 Manatee County, FL Sarasota County, FL 42340 Savannah, GA 1.0061 Bryan County, GA Chatham County, GA Effingham County, GA 42540 Scranton—Wilkes-Barre, PA 0.9085 Lackawanna County, PA Luzerne County, PA Wyoming County, PA 42644 Seattle-Bellevue-Everett, WA 1.2222 King County, WA Snohomish County, WA 43100 Sheboygan, WI 0.9516 Sheboygan County, WI 43300 Sherman-Denison, TX 1.0227 Grayson County, TX 43340 Shreveport-Bossier City, LA 0.9712 Bossier Parish, LA Caddo Parish, LA De Soto Parish, LA 43580 Sioux City, IA-NE-SD 0.9646 Woodbury County, IA Dakota County, NE Dixon County, NE Union County, SD 43620 Sioux Falls, SD 1.0040 Lincoln County, SD McCook County, SD Minnehaha County, SD Turner County, SD 43780 South Bend-Mishawaka, IN-MI 1.0047 St. Joseph County, IN Cass County, MI 43900 Spartanburg, SC 1.0123 Spartanburg, SC 44060 Spokane, WA 1.1337 Spokane County, WA 44100 Springfield, IL 0.9293 Menard County, IL Sangamon County, IL 44140 Springfield, MA 1.0822 Franklin County, MA Hampden County, MA Hampshire County, MA 44180 Springfield, MO 0.9100 Christian County, MO Dallas County, MO Greene County, MO Polk County, MO Webster County, MO 44220 Springfield, OH 0.9303 Clark County, OH 44300 State College, PA 0.8998 Centre County, PA 44700 Stockton, CA 1.1235 San Joaquin County, CA 44940 Sumter, SC 0.9061 Sumter County, SC 45060 Syracuse, NY 1.0069 Madison County, NY Onondaga County, NY Oswego County, NY 45104 Tacoma, WA 1.1781 Pierce County, WA 45220 Tallahassee, FL 0.9204 Gadsden County, FL Jefferson County, FL Leon County, FL Wakulla County, FL Start Printed Page 22425 45300 Tampa-St. Petersburg-Clearwater, FL 0.9597 Hernando County, FL Hillsborough County, FL Pasco County, FL Pinellas County, FL 45460 Terre Haute, IN 0.9058 Clay County, IN Sullivan County, IN Vermillion County, IN Vigo County, IN 45500 Texarkana, AR-Texarkana, TX 0.8947 Miller County, AR Bowie County, TX 45780 Toledo, OH 1.0129 Fulton County, OH Lucas County, OH Ottawa County, OH Wood County, OH 45820 Topeka, KS 0.9469 Jackson County, KS Jefferson County, KS Osage County, KS Shawnee County, KS Wabaunsee County, KS 45940 Trenton-Ewing, NJ 1.0928 Mercer County, NJ 46060 Tucson, AZ 0.9493 Pima County, AZ 46140 Tulsa, OK 0.9242 Creek County, OK Okmulgee County, OK Osage County, OK Pawnee County, OK Rogers County, OK Tulsa County, OK Wagoner County, OK 46220 Tuscaloosa, AL 0.8865 Greene County, AL Hale County, AL Tuscaloosa County, AL 46340 Tyler, TX 1.0105 Smith County, TX 46540 Utica-Rome, NY 0.8822 Herkimer County, NY Oneida County, NY 46660 Valdosta, GA 0.8870 Brooks County, GA Echols County, GA Lanier County, GA Lowndes County, GA 46700 Vallejo-Fairfield, CA 1.5185 Solano County, CA 46940 Vero Beach, FL 1.0079 Indian River County, FL 47020 Victoria, TX 0.9008 Calhoun County, TX Goliad County, TX Victoria County, TX 47220 Vineland-Millville-Bridgeton, NJ 1.1244 Cumberland County, NJ 47260 Virginia Beach-Norfolk-Newport News, VA-NC 0.9459 Currituck County, NC Gloucester County, VA Isle of Wight County, VA James City County, VA Mathews County, VA Surry County, VA York County, VA Chesapeake City, VA Hampton City, VA Start Printed Page 22426 Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City, VA Williamsburg City, VA 47300 Visalia-Tulare-Porterville, CA 1.0608 Tulare County, CA 47380 Waco, TX 0.8663 McLennan County, TX 47580 Warner Robins, GA 0.9028 Houston County, GA 47644 Warren-Farmington Hills-Troy, MI 1.0754 Lapeer County, MI Livingston County, MI Macomb County, MI Oakland County, MI St. Clair County, MI 47894 Washington-Arlington-Alexandria, DC-VA 1.1723 District of Columbia, DC Calvert County, MD Charles County, MD Prince George's County, MD Alexandria City, VA Arlington County, VA Clarke County, VA Fairfax City, VA Fairfax County, VA Falls Church City, VA Fauquier County, VA Fredericksburg City, VA Loudoun County, VA Manassas City, VA Manassas Park City, VA Prince William County, VA Spotsylvania County, VA Stafford County, VA Warren County, VA Jefferson County, WV 47940 Waterloo-Cedar Falls, IA 0.9181 Black Hawk County, IA Bremer County, IA Grundy County, IA 48140 Wausau, WI 1.0177 Marathon County, WI 48260 Weirton-Steubenville, WV-OH 0.8806 Jefferson County, OH Brooke County, WV Hancock County, WV 48300 Wenatchee, WA 1.0025 Chelan County, WA Douglas County, WA 48424 West Palm Beach-Boca Raton-Boynton Beach, FL 1.1020 Palm Beach County, FL 48540 Wheeling, WV-OH 0.8000 Belmont County, OH Marshall County, WV Ohio County, WV 48620 Wichita, KS 1.0057 Butler County, KS Harvey County, KS Sedgwick County, KS Sumner County, KS 48660 Wichita Falls, TX 0.8861 Archer County, TX Clay County, TX Wichita County, TX 48700 Williamsport, PA 0.9024 Lycoming County, PA Start Printed Page 22427 48864 Wilmington, DE-MD-NJ 1.1750 New Castle County, DE Cecil County, MD Salem County, NJ 48900 Wilmington, NC 0.9823 Brunswick County, NC New Hanover County, NC Pender County, NC 49020 Winchester, VA-WV 1.1162 Frederick County, VA Winchester City, VA Hampshire County, WV 49180 Winston-Salem, NC 0.9998 Davie County, NC Forsyth County, NC Stokes County, NC Yadkin County, NC 49340 Worcester, MA 1.1694 Worcester County, MA 49420 Yakima, WA 1.0977 Yakima County, WA 49500 Yauco, PR 0.5167 Guánica Municipio, PR Guayanilla Municipio, PR Penuelas Municipio, PR Yauco Municipio, PR 49620 York-Hanover, PA 0.9731 York County, PA 49660 Youngstown-Warren-Boardman, OH-PA 0.9823 Mahoning County, OH Trumbull County, OH Mercer County, PA 49700 Yuba City, CA 1.1021 Sutter County, CA Yuba County, CA 49740 Yuma, AZ 0.9434 Yuma County, AZ 1 This column lists each CBSA area name and each county or county equivalent, in the CBSA 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 2000 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 calculated by multiplying the hospital wage index value for a given area by the proposed budget neutrality factor of 1.063479. 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 a budget neutrality adjustment calculated by multiplying the hospital wage index value for a given area by the budget neutrality factor. We have completed all of these adjustments and included them in the wage index values reflected in this table. Table B.—Hospice Wage Index for Rural Areas by CBSA
CBSA code number Nonurban area Wage index 3 01 Alabama 0.8112 02 Alaska 1.2492 03 Arizona 0.9503 04 Arkansas 0.8000 05 California 1.1192 06 Colorado 0.9963 07 Connecticut 1.2673 08 Delaware 1.0106 10 Florida 0.9118 11 Georgia 0.8224 12 Hawaii 1.1190 13 Idaho 0.8749 14 Illinois 0.8868 15 Indiana 0.9202 16 Iowa 0.9013 17 Kansas 0.8592 18 Kentucky 0.8247 19 Louisiana 0.8000 20 Maine 0.9613 21 Maryland 0.9805 22 Massachusetts 5 1.0865 23 Michigan 0.9344 24 Minnesota 0.9922 25 Mississippi 0.8120 26 Missouri 0.8255 27 Montana 0.9253 28 Nebraska 0.9609 29 Nevada 0.9869 30 New Hampshire 1.0571 31 New Jersey 4 32 New Mexico 0.9231 33 New York 0.8668 34 North Carolina 0.9107 35 North Dakota 0.8235 36 Ohio 0.9245 37 Oklahoma 0.8174 38 Oregon 1.0543 39 Pennsylvania 0.8838 40 Puerto Rico 0.8000 41 Rhode Island 4 42 South Carolina 0.9234 43 South Dakota 0.8931 44 Tennessee 0.8369 45 Texas 0.8472 46 Utah 0.8813 47 Vermont 0.9970 48 Virgin Islands 0.8000 49 Virginia 0.8560 50 Washington 1.0967 51 West Virginia 0.8364 52 Wisconsin 1.0095 53 Wyoming 0.9765 Start Printed Page 22428 65 Guam 1.0221 3 Wage index values are based on FY 2000 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 calculated by multiplying the hospital wage index value for a given area by the proposed budget neutrality factor of 1.063479. 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 a budget neutrality adjustment calculated by multiplying the hospital wage index value for a given area by the budget neutrality factor. We have completed all of these adjustments and included them in the wage index values reflected in this table. 4 All counties within the State are classified as urban. Massachusetts has areas designated as rural, however, no short-term, acute care hospitals are located in the area(s) for FY 2006. Because more recent data is not available for those areas, we are using last year's wage index value. 5 Based on CBSA designations Massachusetts has areas designated as rural. However, no IPPS hospitals are located in those rural area(s) for FY 2006. Because more recent data is not available for those areas, we are using the FY 2005 prefloor, preclassified hospital wage index value, for rural Massachusetts multiplied by the proposed FY 2006 budget neutrality factor of 1.063479. Table C.—Hospice Wage Index for Urban Areas by MSA and CBSA
MSA code number Wage index 2 MSA urban area designations (Constituent counties or county equivalents) 1 CBSA code number Wage index 2 0040 0.8525 Abilene, TX 10180 0.8348 Taylor, TX 0060 0.4938 Aguadilla, PR 10380 0.4922 Aguada, PR Aguadilla, PR Moca, PR 0080 0.9638 Akron, OH 10420 0.9630 Portage, OH Summit, OH 0120 1.1992 Albany, GA 10500 1.1981 Dougherty, GA Lee, GA 0160 0.9122 Albany-Schenectady-Troy, NY 10580 0.9199 Albany, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0160 0.9122 Albany-Schenectady-Troy, NY 10580 0.9199 Montgomery, NY Rural 0.8668 0200 1.1161 Albuquerque, NM 10740 1.1151 Bernalillo, NM Sandoval, NM Valencia, NM 0220 0.8697 Alexandria, LA 10780 0.8690 Rapides, LA 0240 1.0150 Allentown-Bethlehem-Easton, PA 10900 1.0104 Carbon, PA Lehigh, PA Northampton, PA 0280 0.9007 Altoona, PA 11020 0.8999 Blair, PA 0320 0.9769 Amarillo, TX 11100 0.9761 Potter, TX Randall, TX 0380 1.2889 Anchorage, AK 11260 1.2937 Anchorage, AK 0440 1.1513 Ann Arbor, MI Lenawee, MI Rural 0.9344 Livingston, MI 47644 1.0754 0440 1.1513 Ann Arbor, MI 11460 1.1722 Washtenaw, MI 0450 0.8389 Anniston, AL 11500 0.8381 Calhoun, AL 0460 0.9702 Oshkosh-Neenah, WI 36780 0.9677 Start Printed Page 22429 Winnebago, WI 0460 0.9702 Appleton, WI 11540 0.9711 Calumet, WI Outagamie, WI 0470 0.4321 Arecibo, PR 41980 0.5342 Arecibo, PR Camuy, PR Hatillo, PR 0480 1.0113 Asheville, NC 11700 0.9774 Buncombe, NC Madison, NC 0500 1.0859 Athens, GA 12020 1.0850 Clarke, GA Madison, GA Oconee, GA 0520 1.0613 Atlanta, GA 12060 1.0604 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 1.1610 Cape May, NJ 36140 1.1496 Cape May, NJ 0560 1.1610 Atlantic, NJ 12100 1.1625 Atlantic, NJ 0580 0.8744 Aubrn-Opelika, AL 12220 0.8736 Lee, AL 0600 0.9801 Augusta-Aiken, GA-SC 12260 0.9735 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 1.0213 Austin-San Marcos, TX 12420 1.0204 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 1.0683 Bakersfield, CA 12540 1.0673 Kern, CA 0720 1.0545 Baltimore, MD 12580 1.0536 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 1.0596 Bangor, ME 12620 1.0587 Penobscot, ME 0743 1.3130 Barnstable-Yarmouth, MA 12700 1.3118 Barnstable, MA 0760 0.8892 Baton Rouge, LA 12940 0.8847 Ascension, LA Start Printed Page 22430 East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 0.9171 Beaumont-Port Arthur, TX 13140 0.9163 Hardin, TX Jefferson, TX Orange, TX 0860 1.2392 Bellingham, WA 13380 1.2381 Whatcom, WA 0870 0.9417 Benton Harbor, MI 35660 0.9409 Berrien, MI 0875 1.2738 Bergen-Passaic, NJ 35644 1.4156 Bergen, NJ Passaic, NJ 0880 0.9538 Billings, MT 13740 0.9530 Yellowstone, MT 0920 0.9206 Biloxi-Gulfport, MS 25060 0.9518 Hancock, MS Harrison, MS 0920 0.9206 Pascagoula, MS 37700 0.8480 Jackson, MS 0960 0.8991 Binghamton, NY 13780 0.8983 Broome, NY Tioga, NY 1000 0.9791 Birmingham, AL 13820 0.9738 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 0.8000 Bismarck, ND 13900 0.8000 Burleigh, ND Morton, ND 1020 0.9140 Bloomington, IN 14020 0.9132 Monroe, IN 1040 0.9698 Bloomington-Normal, IL 14060 0.9689 McLean, IL 1080 0.9955 Boise City, ID 14260 0.9946 Ada, ID Canyon, ID 1123 1.2017 Boston, MA 14484 1.2518 Norfolk, MA Plymouth, MA Suffolk, MA 1123 1.2017 Worcester-Lawrence-Lowell-Brockton, MA-NH Bristol, MA Essex, MA 39300 1.1623 Middlesex, MA 21604 1.1339 Worcester, MA 15764 1.1899 Hillsborough, NH 49340 1.1694 Merrimack, NH 31700 1.1318 Rockingham, NH 31700 1.1318 Strafford, NH 31700 1.1318 40484 1.0870 1125 1.0693 Boulder, CO 14500 1.0684 Boulder, CO 1125 1.0693 Longmont, CO 14500 1.0684 Boulder, CO 1145 0.9073 Brazoria, TX 26420 1.0606 Brazoria, TX 1150 1.1298 Bremerton, WA 14740 1.1288 Kitsap, WA 1240 1.0777 Brownsville-Harlingeno, TX 15180 1.0768 Cameron, TX 1240 1.0777 San Benito, TX 15180 1.0768 Cameron, TX 1260 0.9839 Bryan-College Station, TX 17780 0.9830 Brazos, TX 1280 0.9941 Buffalo-Niagara Falls, NY 15380 0.9932 Erie, NY Niagara, NY Start Printed Page 22431 1303 0.9923 Burlington, VT 15540 0.9914 Chittenden, VT Franklin, VT Grand Isle, VT 1310 0.4670 Caguas, PR 41980 0.5342 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 0.9468 Canton-Massillon, OH 15940 0.9460 Carroll, OH Stark, OH 1350 0.9839 Casper, WY 16220 0.9830 Natrona, WY 1360 0.9553 Cedar Rapids, IA 16300 0.9545 Linn, IA 1400 1.0141 Champaign-Urbana, IL 16580 1.0132 Champaign, IL 1440 1.0027 Charleston-North Charleston, SC 16700 1.0018 Berkeley, SC Charleston, SC Dorchester, SC 1480 0.9448 Charleston, WV 16620 0.9439 Kanawha, WV Putnam, WV 1520 1.0337 Charlotte-Gastonia-Rock Hill, NC-SC Cabarrus, NC Gaston, NC 16740 1.0361 Mecklenburg, NC Union, NC York, SC 1520 1.0337 Charlotte-Gastonia-Rock Hill, NC-SC Lincoln, NC Rowan, NC 34 0.9107 1540 1.0957 Charlottesville, VA 16820 1.0947 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 0.9800 Chattanooga, TN-GA 16860 0.9791 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 0.9559 Cheyenne, WY 16940 0.9550 Laramie, WY 1600 1.1550 Chicago, IL 16974 1.1558 Cook, IL DeKalb, IL Du Page, IL Grundy, IL Kane, IL Kendall, IL McHenry, IL Will, IL 1600 1.1550 Chicago, IL 29404 1.0998 Lake, IL 1620 1.1221 Chico-Paradise, CA 17020 1.1211 Butte, CA 1640 1.0213 Cincinnati, OH-KY-IN 17140 1.0120 Brown, OH Clermont, OH Hamilton, OH Warren, OH Boone, KY Campbell, KY Gallatin, KY Grant, KY Start Printed Page 22432 Kenton, KY Pendleton, KY Dearborn, IN Ohio, IN 1660 0.8539 Clarksville, TN-KY 17300 0.8531 Christian, KY Montgomery, TN Hopkinsville 1680 1.0246 Cleveland-Elyria, OH 17460 1.0263 Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1680 1.0246 Elyria, OH 36 0.9245 Ashtabula, OH 1720 1.0423 Colorado Springs, CO 17820 1.0414 El Paso, CO 1740 0.8937 Columbia, MO 17860 0.8929 Boone, MO 1760 1.0059 Columbia, SC 17900 0.9988 Lexington, SC Richland, SC 1800 0.9250 Columbus, GA-AL 17980 0.9242 Chattahochee, GA Harris, GA Muscogee, GA Russell, AL 1840 1.0381 Columbus, OH 18140 1.0355 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 0.9204 Corpus Christi, TX 18580 0.9196 Nueces, TX San Patricio, TX 1890 1.1224 Corvallis, Oregon 18700 1.1214 Benton, OR 1900 0.9220 Cumberland, MD-WV 19060 0.9212 Allegany, MD Mineral, WV 1920 1.0702 Dallas, TX 19124 1.0713 Collin, TX Dallas, TX Denton, TX Ellis, TX Hunt, TX Kaufman, TX Rockwall, TX 1920 1.0702 Dallas, TX Henderson, TX 45 0.8472 1950 0.9200 Danville, VA 19260 0.9192 Danville City, VA Pittsylvania, VA 1960 0.9338 Davenport-Moline-Rock Island, IA-IL 19340 0.9330 Scott, IA Henry, IL Rock Island, IL 2000 0.9826 Dayton, OH 19380 0.9894 Greene, OH Miami, OH Montgomery, OH 2000 0.9826 Dayton-Springfield, OH 44220 0.9303 Clark, OH 2020 0.9473 Daytona Beach, FL Flagler, FL 10 0.9118 Volusia, FL 19660 0.9463 2030 0.9467 Decatur, AL 19460 0.9459 Start Printed Page 22433 Lawrence, AL Morgan, AL 2040 0.8645 Decatur, IL 19500 0.8638 Macon, IL 2080 1.1607 Denver, CO 19740 1.1596 Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO 2120 0.9863 Des Moines, IA 19780 0.9854 Dallas, IA Polk, IA Warren, IA 2160 1.0886 Detroit, MI 19804 1.1006 Wayne, MI 2160 1.0886 Detroit, MI 47644 1.0754 Lapeer, MI Macomb, MI Oakland, MI St. Clair, MI 2160 1.0886 Detroit, MI 33780 1.0109 Monroe, MI 2180 0.8085 Dothan, AL 20020 0.8015 Houston, AL 2180 0.8085 Dothan, AL 20020 0.8015 Dale, AL 2190 1.0458 Dover, DE 20100 1.0449 Kent, DE 2200 0.9312 Dubuque, IA 20220 0.9303 Dubuque, IA 2240 1.1023 Dulut, MN-WI 20260 1.0996 St. Louis, MN Douglas, WI 2240 1.1023 Superior, MN-WI 20260 1.0996 St. Louis, MN Douglas, WI 2281 1.2408 Dutchess County, NY 39100 1.2084 Dutchess, NY 2290 0.9728 Eau Claire, WI 20740 0.9719 Chippewa, WI Eau Claire, WI 2320 0.9773 El Paso, TX 21340 0.9764 El Paso, TX 2330 0.9876 Elkhart-Goshen, IN 21140 0.9867 Elkhart, IN 2335 0.8989 Elmira, NY 21300 0.8981 Chemung, NY 2340 0.9581 Enid, OK 37 0.8174 Garfield, OK 2360 0.9260 Erie, PA 21500 0.9251 Erie, PA 2400 1.1645 Eugene-Springfield, OR 21660 1.1634 Lane, OR 2440 0.8936 Evansville, IN-KY 21780 0.8903 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2440 0.8936 Henderson, IN-KY 21780 0.8903 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 0.9701 Fargo, ND-MN 22020 0.9693 Clay, MN Cass, ND 2520 0.9701 Moorhead, ND-MN 22020 0.9693 Clay, MN Cass, ND Start Printed Page 22434 2560 0.9966 Fayetteville, NC 22180 0.9957 Cumberland, NC 2580 0.9192 Fayetteville-Springdale-Rogers, AR 22220 0.9184 Benton, AR Washington, AR 2620 1.1295 Flagstaff, AZ 22380 1.1472 Coconino, AZ 2620 1.1295 Flagstaff, UT Kane, UT 46 0.8813 2640 1.1898 Flint, MI 22420 1.1888 Genesee, MI 2650 0.8391 Florence, AL 22520 0.8383 Colbert, AL Lauderdale, AL 2655 0.9537 Florence, SC 22500 0.9394 Florence, SC 2670 1.0876 Fort Collins-Loveland, CO 22660 1.0867 Larimer, CO 2680 1.0820 Ft. Lauderdale, FL 22744 1.0810 Broward, FL 2700 0.9975 Fort Myers-Cape Coral, FL 15980 0.9966 Lee, FL 2710 1.0693 Fort Pierce-Port St. Lucie, FL 38940 1.0684 Martin, FL St. Lucie, FL 2720 0.8838 Fort Smith, AR-OK 22900 0.8809 Crawford, AR Sebastian, AR Sequoyah, OK 2750 0.9352 Fort Walton Beach, FL 23020 0.9344 Okaloosa, FL 2760 1.0364 Allen, IN 23060 1.0430 Wells, IN Whitley, IN 2760 1.0364 Fort Wayne, IN 15 0.9202 Adams, IN De Kalb, IN Huntington, IN 2800 1.0133 Forth Worth-Arlington, TX 23104 1.0073 Johnson, TX Parker, TX Tarrant, TX 2800 1.0133 Hood, TX 45 0.8472 2840 1.1078 Fresno, CA 23420 1.1205 Fresno, CA 2840 1.1078 Madera, CA 31460 0.9062 2880 0.8568 Gadsden, AL 23460 0.8560 Etowah, AL 2900 1.0068 Gainesville, FL 23540 1.0059 Alachua, FL 2920 1.0009 Galveston-Texas City, TX 26420 1.0606 Galveston, TX 2960 0.9944 Gary, IN 23844 0.9901 Lake, IN Porter, IN 2975 0.9013 Glens Falls, NY 24020 0.9004 Warren, NY Washington, NY 2980 0.9344 Goldsboro, NC 24140 0.9335 Wayne, NC 2985 0.9677 Grand Forks, ND-MN 24220 0.9668 Grand Forks, ND Polk, MN 2995 1.0538 Grand Junction, CO 24300 1.0528 Mesa, CO 3000 1.0132 Grand Rapids-Muskegon-Holland, MI Allegan, MI Kent, MI 23 0.9344 Muskegon, MI 24340 1.0018 Ottawa, MI 34740 1.0359 Start Printed Page 22435 26100 0.9984 3040 0.9378 Great Falls, MT 24500 0.9369 Cascade, MT 3060 1.0053 Greeley, CO 24540 1.0043 Weld, CO 3080 1.0204 Green Bay, WI 24580 1.0199 Brown, WI 3120 0.9912 Greensboro-Winston-Salem-High Point, NC Alamance, NC Davidson, NC 15500 0.9536 Davie, NC 34 0.9107 Forsyth, NC 49180 0.9998 Guilford, NC 49180 0.9998 Randolph, NC 24660 0.9773 Stokes, NC 24660 0.9773 Yadkin, NC 49180 0.9998 49180 0.9998 3150 0.9775 Greenville, NC 24780 0.9766 Pitt, NC 3160 1.0006 Greenville-Spartanburg-Anderson, SC Anderson, SC Cherokee, SC 11340 0.9220 Greenville, SC 42 0.9234 Pickens, SC 24860 1.0164 Spartanburg, SC 24860 1.0164 43900 1.0123 3180 1.0580 Hagerstown, MD 25180 1.0332 Washington, MD 3200 0.9650 Hamilton-Middletown, OH 17140 1.0120 Butler, OH 3240 0.9884 Harrisburg-Carlisle, PA 25420 0.9953 Cumberland, PA Dauphin, PA Perry, PA 3240 0.9884 Lebanon, PA 30140 0.9114 Lebanon, PA 3283 1.1766 Hartford, CT 25540 1.1756 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 0.8000 Hattiesburg, MS 25620 0.8000 Forrest, MS Lamar, MS 3290 1.0114 Hickory-Morganton-Lenoir, NC 25860 1.0105 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 1.1723 Honolulu, HI 26180 1.1712 Honolulu, HI 3350 0.8219 Houma, LA 26380 0.8211 Lafourche, LA Terrebonne, LA 3360 1.0769 Houston, TX 26420 1.0606 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 1.0180 Huntington-Ashland, WV-KY-OH 26580 1.0171 Boyd, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3400 1.0180 Carter, KY 18 0.8247 3440 0.9421 Huntsville, AL 26620 0.9413 Limestone, AL Start Printed Page 22436 Madison, AL 3480 1.0686 Indianapolis, IN 26900 1.0755 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Marion, IN Morgan, IN Shelby, IN 3480 1.0686 Indianapolis, IN 11300 0.9266 Madison, IN 3500 1.0276 Iowa City, IA 26980 1.0267 Johnson, IA 3520 0.9735 Jackson, MI 27100 0.9727 Jackson, MI 3560 0.8948 Jackson, MS 27140 0.8817 Hinds, MS Madison, MS Rankin, MS 3580 0.9473 Jackson, TN 27180 0.9465 Madison, TN Chester, TN 3600 1.0163 Jacksonville, FL 27260 1.0142 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 0.8942 Jacksonville, NC 27340 0.8934 Onslow, NC 3610 0.8078 Jamestown, NY 33 0.8668 Chautauqua, NY 3620 1.0200 Janesville-Beloit, WI 27500 1.0191 Rock, WI 3640 1.1627 Jersey City, NJ 35644 1.4156 Hudson, NJ 3660 0.8730 Johnson City-Kingsport-Bristol, TN-VA 34980 1.0726 Carter, TN 3660 0.8730 Kingsport-Bristol, TN-VA 28700 0.8763 Hawkins, TN Sullivan, TN Bristol City, VA Scott, VA Washington, VA 3660 0.8730 Johnson City, TN 27740 0.8663 Unicoi, TN Washington, TN 3680 0.8494 Johnstown, PA Cambria, PA 27780 0.8912 Somerset, PA 39 0.8838 3700 0.8669 Jonesboro, AR Craighead, AR 27860 0.8661 3710 0.9283 Joplin, MO 27900 0.9275 Jasper, MO Newton, MO 3720 1.1017 Kalamazoo-Battlecreek, MI Calhoun, MI 12980 0.9961 Kalamazoo, MI 28020 1.1354 Van Buren, MI 28020 1.1354 3740 1.1286 Kankakee, IL 28100 1.1276 Kankakee, IL 3760 1.0262 Kansas City, KS-MO 28140 1.0240 Johnson, KS Leavenworth, KS Miami, KS Wyandotte, KS Cass, MO Clay, MO Clinton, MO Jackson, MO Start Printed Page 22437 Lafayette, MO Platte, MO Ray, MO 3800 1.0402 Kenosha, WI 29404 1.0998 Kenosha, WI 3810 0.9838 Killeen-Temple, TX 28660 0.9829 Bell, TX Coryell, TX 3840 0.9056 Knoxville, TN 28940 0.9091 Anderson, TN Blount, TN Knox, TN Loudon, TN Union, TN 3840 0.9056 Sevier, TN 44 0.8369 3850 0.9565 Kokomo, IN 29020 0.9556 Howard, IN Tipton, IN 3870 0.9888 La Crosse, WI-MN 29100 0.9879 Houston, MN La Crosse, WI 3880 0.8627 Lafayette, LA 19 0.8000 Acadia, LA St. Landry, LA 3880 0.8627 Lafayette, LA 29180 0.8833 Lafayette, LA St. Martin, LA 3920 0.9651 Lafayette, IN Clinton, IN 15 0.9202 Tippecanoe, IN 29140 0.9643 3960 0.8486 Lake Charles, LA 29340 0.8439 Calcasieu, LA 3980 0.9505 Lakeland-Winter Haven, FL 29460 0.9497 Polk, FL 4000 1.0520 Lancaster, PA 29540 1.0510 Lancaster, PA 4040 1.0280 Lansing-East Lansing, MI 29620 1.0271 Clinton, MI Eaton, MI Ingham, MI 4080 0.9311 Laredo, TX 29700 0.9302 Webb, TX 4100 0.9350 Las Cruces, NM 29740 0.9342 Dona Ana, NM 4120 1.1838 Las Vegas, NV-AZ Mohave, AZ 03 0.9503 Clarke, NV 29820 1.2100 Nye, NV 29 0.9869 4150 0.9201 Lawrence, KS 29940 0.9193 Douglas, KS 4200 0.8741 Lawton, OK 30020 0.8733 Comanche, OK 4243 1.0178 Lewiston-Auburn, ME 30340 1.0169 Androscoggin, ME 4280 0.9813 Lexington, KY 30460 0.9953 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Scott, KY Woodford, KY 4280 0.9813 Madison, KY 18 0.8247 4320 0.9855 Lima, OH Allen, OH 30620 0.9922 Auglaize, OH 36 0.9245 4360 1.0866 Lincoln, NE 30700 1.0856 Lancaster, NE 4400 0.9395 Little Rock-North Little Rock, AR 30780 0.9386 Faulkner, AR Lonoke, AR Start Printed Page 22438 Pulaski, AR Saline, AR 4420 0.9302 Longview-Marshall, TX 30980 0.9360 Gregg, TX Upshur, TX 4420 0.9302 Harrison, TX 45 0.9245 4480 1.2488 Los Angeles-Long Beach, CA 1.2477 Los Angeles, CA 31084 4520 0.9752 Louisville, KY-IN 31140 0.9701 Clark, IN Floyd, IN Harrison, IN Bullitt, KY Jefferson, KY Oldham, KY 4520 0.9752 Louisville, KY-IN 19340 0.9330 Scott, IN 4600 0.9343 Lubbock, TX 31180 0.9334 Lubbock, TX 4640 0.9598 Lynchburg, VA 31340 0.9589 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 1.0214 Macon, GA 31420 1.0515 Bibb, GA Jones, GA Twiggs, GA 4680 1.0214 Macon, GA Houston, GA 47580 0.9028 Peach, GA 11 0.8224 4720 1.1065 Madison, WI 31540 1.0960 Dane, WI 4800 0.9692 Mansfield, OH Crawford, OH 36 0.9245 Richland, OH 31900 0.9772 4840 0.5484 Mayaguez, PR 41900 0.6026 Anasco, PR Cabo Rojo, PR Sabana Grande, PR San German, PR 4840 0.5484 Mayaguez, PR 32420 0.5167 Hormigueros, PR Mayaguez, PR 4880 0.9156 McAllen-Edinburg-Mission, TX 32580 0.9148 Hidalgo, TX 4890 1.1213 Medford-Ashland, OR 32780 1.1203 Jackson, OR 4900 1.0254 Melbourne-Titusville-Palm Bay, FL 37340 1.0244 Brevard, Fl 4920 0.9829 Memphis, TN-AR-MS 32820 0.9802 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 1.1256 Merced, CA 32900 1.1246 Merced, CA 5000 1.0506 Miami, FL 33124 1.0497 Dade, FL 5015 1.2092 Hunterdon, NJ 35084 1.2429 Hunterdon, NJ 5015 1.2092 Middlesex-Somerset, NJ 20764 1.1843 Middlesex, NJ Somerset, NJ 5080 1.0725 Milwaukee-Waukesha, WI 33340 1.0716 Milwaukee, WI Ozaukee, WI Washington, WI Start Printed Page 22439 Waukesha, WI 5120 1.1779 Minneapolis-St. Paul, MN-WI 33460 1.1768 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 1.0238 Missoula, MT 33540 1.0229 Missoula, MT 5160 0.8443 Mobile, AL Baldwin, AL 01 0.8112 Mobile, AL 33660 0.8503 5170 1.2737 Modesto, CA 33700 1.2726 Stanislaus, CA 5190 1.1590 Monmouth-Ocean, NJ 20764 1.1843 Monmouth, NJ Ocean, NJ 5200 0.8423 Monroe, LA 33740 0.8405 Ouachita, LA 5240 0.8835 Montgomery, AL 33860 0.8827 Autauga, AL Elmore, AL Montgomery, AL 5280 0.9133 Muncie, IN 34620 0.9125 Delaware, IN 5330 0.9603 Myrtle Beach, SC 34820 0.9595 Horry, SC 5345 1.1238 Naples, FL 34940 1.1228 Collier, FL 5360 1.0759 Nashville, TN 34980 1.0726 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 1.3739 Nassau-Suffolk, NY 35004 1.3726 Nassau, NY Suffolk, NY 5483 1.3044 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT Fairfield, CT New Haven, CT 14860 1.3650 35300 1.2556 5523 1.2343 New London-Norwich, CT 35980 1.2332 New London, CT 5560 0.9690 New Orleans, LA 35380 0.9681 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. John The Baptist, LA St. Tammany, LA 5560 0.9690 St. James, LA 19 0.8000 5600 1.4461 New York, NY 35644 1.4156 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Start Printed Page 22440 Richmond, NY Rockland, NY Westchester, NY 5640 1.2374 Newark, NJ 35084 1.2429 Essex, NJ Morris, NJ Sussex, NJ Union, NJ 5640 1.2374 Newark, NJ 10900 1.0104 Warren, NJ 5660 1.1890 Newburgh, NY-PA Orange, NY 39100 1.2084 Pike, PA 35084 1.2429 5720 0.9467 Norfolk-Virginia Beach-Newport News, VA-NC 47260 0.9459 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 1.6201 Oakland, CA 36084 1.6186 Alameda, CA Contra Costa, CA 5790 0.9743 Ocala, FL 36100 0.9734 Marion, FL 5800 1.0253 Odessa-Midland, TX Ector, TX 36220 1.0420 Midland, TX 33260 0.9980 5880 0.9544 Oklahoma City, OK 36420 0.9552 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK 5880 0.9544 Pottawatomie, OK 37 0.8174 5910 1.1715 Olympia, WA 36500 1.1705 Thurston, WA 5920 1.0382 Omaha, NE-IA 36540 1.0373 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 1.2359 Orange County, CA 42044 1.2348 Orange, CA 5960 1.0370 Orlando, FL 36740 1.0360 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 0.8977 Owensboro, KY 36980 0.8969 Daviess, KY 6015 0.8647 Panama City, FL 37460 0.8640 Bay, FL 6020 0.8822 Parkersburg-Marietta, WV-OH 37620 0.8814 Washington, OH Wood, WV 6080 0.8841 Pensacola, FL 37860 0.8833 Escambia, FL Santa Rosa, FL 6120 0.9459 Peoria-Pekin, IL 37900 0.9450 Start Printed Page 22441 Peoria, IL Tazewell, IL Woodford, IL 6160 1.1521 Philadelphia, NJ 15804 1.1353 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ 6160 1.1521 Philadelphia, PA 37964 1.1555 Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 1.0625 Phoenix-Mesa, AZ 38060 1.0616 Maricopa, AZ Pinal, AZ 6240 0.9232 Pine Bluff, AR 38220 0.9224 Jefferson, AR 6280 0.9320 Pittsburgh, PA 38300 0.9291 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 1.1112 Pittsfield, MA 38340 1.1102 Berkshire, MA 6340 1.0220 Pocatello, ID 38540 1.0210 Bannock, ID 6360 0.5697 Ponce, PR 49500 0.5167 Guayanilla, PR Juana Diaz, PR Penuelas, PR Yauco, PR 6360 0.5697 Ponce, PR 38660 0.5757 Ponce, PR Villalba, PR 6403 1.0764 Portland, ME 38860 1.0754 Cumberland, ME Sagadahoc, ME York, ME 6440 1.2138 Portland-Vancouver, OR-WA 38900 1.2127 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 1.1774 Providence-Warwick-Pawtucket, RI 39300 1.1623 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 1.0232 Provo-Orem, UT 39340 1.0197 Utah, UT 6560 0.9316 Pueblo, CO 39380 0.9308 Pueblo, CO 6580 1.0049 Punta Gorda, FL 39460 1.0040 Charlotte, FL 6600 0.9628 Racine, WI 39540 0.9619 Racine, WI 6640 1.0919 Durham-Chapel Hill, NC 20500 1.1021 Chatham, NC Durham, NC Orange, NC 6640 1.0919 Raleigh, NC 39580 1.0695 Franklin, NC Johnston, NC Start Printed Page 22442 Wake, NC 6660 0.9486 Rapid City, SD 39660 0.9478 Pennington, SD 6680 0.9809 Reading, PA 39740 0.9800 Berks, PA 6690 1.2598 Redding, CA 39820 1.2586 Shasta, CA 6720 1.1130 Reno, NV 39900 1.1120 Washoe, NV 6740 1.1198 Richland-Kennewick-Pasco, WA Benton, WA 28420 1.1188 Franklin, WA 6760 1.0002 Richmond-Petersburg, VA 40060 0.9994 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 1.1677 Riverside-San Bernardino, CA 40140 1.1666 Riverside, CA San Bernardino, CA 6800 0.8971 Roanoke, VA 40220 0.8949 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 1.2245 Rochester, MN 40340 1.2234 Olmsted, MN 6840 0.9789 Rochester, NY 40380 0.9870 Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6840 0.9789 Genesee, NY 33 0.8668 6880 1.0246 Rockford, IL 40420 1.0237 Boone, IL Winnebago, IL 6880 1.0246 Ogle, IL 14 0.8868 6895 0.9578 Rocky Mount, NC 40580 0.9569 Edgecombe, NC Nash, NC 6920 1.2611 Sacramento, CA 40900 1.2443 El Dorado, CA Placer, CA Sacramento, CA 6960 1.0321 Saginaw-Bay City-Midland, MI Bay, MI Midland, MI 13020 1.0182 Saginaw, MI 23 0.9344 40980 1.0437 6980 1.0873 St. Cloud, MN 41060 1.0863 Benton, MN Stearns, MN 7000 1.0658 St. Joseph, MO 41140 1.0649 Andrew, MO Buchanan, MO 7040 0.9666 St. Louis, MO-IL 41180 0.9652 Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO Start Printed Page 22443 St. Louis City, MO Warren, MO Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL 7080 1.1236 Salem, OR 41420 1.1226 Marion, OR Polk, OR 7120 1.4714 Salinas, CA Monterey, CA 41500 1.4700 7160 1.0098 Ogden, UT 36260 0.9801 Davis, UT Weber, UT 7160 1.0098 Salt Lake City, UT 41620 1.0168 Salt Lake, UT 7200 0.8693 San Angelo, TX 41660 0.8685 Tom Green, TX 7240 0.9604 San Antonio, TX 41700 0.9575 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320 1.1993 San Diego, CA 41740 1.1982 San Diego, CA 7360 1.5660 San Francisco, CA 41884 1.5646 Marin, CA San Francisco, CA San Mateo, CA 7400 1.5694 San Jose, CA 41940 1.5657 Santa Clara, CA 7440 0.5522 San Juan-Bayamon, PR 41980 0.5342 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Comerio, PR Corozal, PR Dorado, PR Florida, PR Guaynabo, PR Humacao, PR Juncos, PR Los Piedras, PR Loiza, 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 7440 0.5522 San Juan-Bayamon, PR 21940 0.4530 Ceiba, PR Fajardo, PR Luguillo, PR 7460 1.1834 San Luis Obispo-Atascadero-Paso Robles, CA 42020 1.1824 San Luis Obispo, CA 7480 1.1465 Santa Barbara-Santa Maria-Lompoc, CA 42060 1.1455 Santa Barbara, CA 7485 1.5731 Santa Cruz-Watsonville, CA 42100 1.5717 Santa Cruz, CA Start Printed Page 22444 7490 1.1272 Santa Fe, NM Los Alamos, NM 32 0.9231 Santa Fe, NM 42140 1.1601 7500 1.3796 Santa Rosa, CA 42220 1.3784 Sonoma, CA 7510 1.0249 Sarasota-Bradenton, FL 42260 1.0240 Manatee, FL Sarasota, FL 7520 1.0070 Savannah, GA 42340 1.0061 Bryan, GA Chatham, GA Effingham, GA 7560 0.9071 Scranton—Wilkes-Barre—Hazleton, PA 42540 0.9085 Lackawanna, PA Luzerne, PA Wyoming, PA 7560 0.9071 Columbia, PA 39 0.8838 7600 1.2219 Seattle-Bellevue-Everett, WA 42644 1.2222 King, WA Snohomish, WA 7600 1.2219 Island, WA 50 1.0967 7610 0.8389 Sharon, PA 49660 0.9823 Mercer, PA 7620 0.9525 Sheboygan, WI 43100 0.9516 Sheboygan, WI 7640 1.0237 Sherman-Denison, TX 43300 1.0227 Grayson, TX 7680 0.9698 Shreveport-Bossier City, LA 43340 0.9712 Bossier, LA Caddo, LA 7680 0.9698 Webster, LA 19 0.8000 7720 0.9680 Sioux City, IA-NE 43580 0.9646 Woodbury, IA Dakota, NE 7760 1.0049 Sioux Falls, SD 43620 1.0040 Lincoln, SD Minnehaha, SD 7800 1.0056 South Bend, IN 43780 1.0047 St. Joseph, IN 7840 1.1347 Spokane, WA 44060 1.1337 Spokane, WA 7880 0.9301 Springfield, IL 44100 0.9293 Menard, IL Sangamon, IL 7920 0.9151 Springfield, MO 44180 0.9100 Christian, MO Greene, MO Webster, MO 8003 1.0828 Springfield, MA 44140 1.0822 Hampden, MA Hampshire, MA 8050 0.9006 State College, PA 44300 0.8998 Centre, PA 8080 0.8814 Steubenville-Weirton, OH-WV 48260 0.8806 Brooke, WV Hancock, WV Jefferson, OH 8120 1.1245 Stockton-Lodi, CA 44700 1.1235 San Joaquin, CA 8140 0.9069 Sumter, SC 44940 0.9061 Sumter, SC 8160 0.9999 Syracuse, NY 45060 1.0069 Madison, NY Onondaga, NY Oswego, NY 8160 0.9999 Cayuga, NY 33 0.8668 8200 1.1792 Tacoma, WA 45104 1.1781 Pierce, WA 8240 0.9213 Tallahassee, FL 45220 0.9204 Gadsden, FL Start Printed Page 22445 Leon, FL 8280 0.9605 Tampa-St. Petersburg-Clearwater, FL 45300 0.9597 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 0.9135 Terre Haute, IN 45460 0.9058 Clay, IN Vermillion, IN Vigo, IN 8360 0.8955 Texarkana, AR-Texarkana, TX 45500 0.8947 Miller, AR Bowie, TX 8400 1.0138 Toledo, OH 45780 1.0129 Fulton, OH Lucas, OH Wood, OH 8440 0.9478 Topeka, KS 45820 0.9469 Shawnee, KS 8480 1.0938 Trenton, NJ 45940 1.0928 Mercer, NJ 8520 0.9501 Tucson, AZ 46060 0.9493 Pima, AZ 8560 0.9291 Tulsa, OK 46140 0.9242 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 0.8984 Tuscaloosa, AL 46220 0.8865 Tuscaloosa, AL 8640 1.0114 Tyler, TX 46340 1.0105 Smith, TX 8680 0.8829 Utica-Rome, NY 46540 0.8822 Herkimer, NY Oneida, NY 8720 1.4388 Vallejo-Fairfield-Napa, CA Napa, CA 34900 1.3326 Solano, CA 46700 1.5185 8735 1.1821 Ventura, CA 37100 1.1810 Ventura, CA 8750 0.9015 Victoria, TX 47020 0.9008 Victoria, TX 8760 1.1254 Vineland-Millville-Bridgeton, NJ 47220 1.1244 Cumberland, NJ 8780 1.0591 Visalia-Tulare-Porterville, CA 47300 1.0608 Tulare, CA 8800 0.8671 Waco, TX 47380 0.8663 McLennan, TX 8840 1.1678 Washington, DC-MD-VA-WV 47894 1.1723 District of Columbia, DC Calvert, MD Charles, MD Prince Georges, MD Alexandria City, VA Arlington, VA Clarke, VA Fairfax, VA Fairfax City, VA Falls Church City, VA Fauquier, VA Fredericksburg City, VA Loudoun, VA Manassas City, VA Manassas Park City, VA Prince William, VA Spotsylvania, VA Stafford, VA Warren, VA Jefferson, WV Start Printed Page 22446 8840 1.1678 Washington, DC-MD-VA-WV 13644 1.1651 Frederick, MD Montgomery, MD 8840 1.1678 Culpeper, VA 49 0.8560 King George, VA 8840 1.1678 Washington, DC-MD-VA-WV 25180 1.0332 Berkeley, WV 8920 0.9189 Waterloo-Cedar Falls, IA 47940 0.9181 Black Hawk, IA 8940 1.0187 Wausau, WI 48140 1.0177 Marathon, WI 8960 1.1030 West Palm Beach-Boca Raton, FL 48424 1.1020 Palm Beach, FL 9000 0.8000 Wheeling, WV-OH 48540 0.8000 Belmont, OH Marshall, WV Ohio, WV 9040 1.0097 Wichita, KS 48620 1.0057 Butler, KS Harvey, KS Sedgwick, KS 9080 0.8936 Wichita Falls, TX 48660 0.8861 Archer, TX Wichita, TX 9140 0.9032 Williamsport, PA 48700 0.9024 Lycoming, PA 9160 1.1838 Wilmington-Newark, DE-MD 48864 1.1750 New Castle, DE Cecil, MD 9200 0.9832 Wilmington, NC 48900 0.9823 Brunswick, NC New Hanover, NC 9260 1.0987 Yakima, WA 49420 1.0977 Yakima, WA 9270 0.9982 Yolo, CA 40900 1.2443 Yolo, CA 9280 0.9740 York, PA 49620 0.9731 York, PA 9320 1.0130 Youngstown-Warren, OH 49660 0.9823 Mahoning, OH Trumbull, OH 9320 1.0130 Columbiana, OH 36 0.9245 9340 1.1031 Yuba City, CA 49700 1.1021 Sutter, CA Yuba, CA 9360 0.9443 Yuma, AZ 49740 0.9434 Yuma, AZ 01 0.8129 Bibb, AL 13820 0.9738 Chilton, AL Walker, AL 01 0.8129 Geneva, AL 20020 0.8015 Henry, AL 01 0.8129 Greene, AL 46220 0.8865 Hale, AL 01 0.8129 Lowndes, AL 33860 0.8827 02 1.2387 Fairbanks North Star AK 21820 1.1854 Matanuska-Susitna, AK 11260 1.2937 03 0.9729 Yavapai, AZ 39140 1.0520 04 0.8199 Cleveland, AR 38220 0.9224 Franklin, AR 22900 0.8809 Garland, AR 26300 0.9836 Grant, AR 30780 0.9386 Lincoln, AR 38220 0.9224 Madison, AR 22220 0.9184 Perry, AR 30780 0.9386 Poinsett, AR 27860 0.8661 05 1.0960 Imperial, CA 20940 0.9418 Kings, CA 25260 0.9886 San Benito, CA 41940 1.5657 06 0.9972 Clear, Creek, CO 19740 1.1596 Start Printed Page 22447 Elbert, CO Gilpin, CO Park, CO 06 0.9972 Teller, CO 17820 1.0414 10 0.9283 Baker, FL 27260 1.0142 Gilchrist, FL 23540 1.0059 Indian River, FL 46940 1.0079 10 0.9283 Jefferson, FL 45220 0.9204 Wakulla, FL 11 0.8778 Brooks, GA 46660 0.8870 Echols, GA Lanier, GA Lowndes, GA 11 0.8778 Hall, GA 23580 1.0164 Marion, GA 17980 0.9242 Oglethorpe, GA 12020 1.0850 11 0.8778 Long, GA 25980 0.8205 Liberty, GA 11 0.8778 Murray, GA 19140 1.0165 Whitfield, GA 11 0.8778 Baker, GA 10500 1.1981 Terrell, GA Worth, GA 11 0.8778 Crawford, GA 31420 1.0515 Monroe, GA 11 0.8778 Brantley, GA 15260 1.2690 Glynn, GA MCIntosh, GA 11 0.8778 Butts, GA 12060 1.0604 Dawson, GA Haralson, GA Heard, GA Jasper, GA Lamar, GA Meriwether, GA Pike, GA 11 0.8778 Burke, GA 12260 0.9735 Floyd, GA 0.9442 40660 13 0.9395 Boise, ID 14260 0.9946 Gem, ID Owyhee, ID 13 0.9395 Bonneville, ID 26820 0.9634 Jefferson, ID 13 0.9395 Franklin, ID 30860 0.9671 Kootenai, ID 17660 0.9932 Nez Perce, ID 30300 0.9905 Power, ID 38540 1.0210 14 0.8877 Bond, IL 41180 0.9652 Calhoun, IL Macoupin, IL 14 0.8877 Ford, IL 16580 1.0132 Platt 14 0.8877 Marshall, IL 37900 0.9450 Stark, IL 37900 14 0.8877 Mercer 19340 0.9330 Vermilion, IL 19180 0.8925 15 0.9299 Bartholomew, IN 18020 0.9984 Franklin, IN 17140 1.0120 Gibson, IN 21780 0.8903 La Porte, IN 33140 0.9924 Sullivan, IN 45460 0.9058 Washington, IN 31140 0.9701 15 0.9299 Brown, IN 26900 1.0755 Putnam, IN 15 0.9299 Benton, IN 29140 0.9643 Carroll, IN 15 0.9299 Greene, IN 14020 0.9132 Owen, IN 15 0.9299 Jasper, IN 23844 0.9901 Start Printed Page 22448 Newton, IN 16 0.9101 Benton, IA 16300 0.9545 Jones, IA 16 0.9101 Bremer, IA 47940 0.9181 Grundy, IA 16 0.9101 Guthrie, IA 19780 0.9854 Madison, IA 16 0.9101 Harrison, IA 36540 1.0373 Mills, IA 16 0.9101 Story, IA 11180 1.0081 Washington, IA 26980 1.0267 17 0.8608 Doniphan, KS 41140 1.0649 Sumner, KS 48620 1.0057 17 0.8608 Franklin, KS 28140 1.0240 Linn, KS 17 0.8608 Jackson, KS 45820 0.9469 Jefferson, KS Osage, KS Wabaunsee, KS 18 0.8349 Bracken, KY 17140 1.0120 Trigg, KY 17300 0.8531 Webster, KY 21780 0.8903 18 0.8349 Edmonson, KY 14540 0.8657 Warren, KY 18 0.8349 Hancock, KY 36980 0.8969 Mc Lean, KY 18 0.8349 Hardin, KY 21060 0.9235 Larue, KY 18 0.8349 Henry, KY 31140 0.9701 Meade, KY Nelson, KY Shelby, KY Spencer, KY Trimble, KY 19 0.8000 Cameron, LA 29340 0.8439 DE Soto, LA 43340 0.9712 Grant, LA 10780 0.8690 Union, LA 33740 0.8405 19 0.8000 East Feliciana, LA 12940 0.8847 Iberville, LA Pointe Coupee, LA St. Helena, LA West Feliciana, LA 21 0.9770 Somerset, MD 41540 0.9702 Wicomico 22 1.0874 Franklin, MA 44140 1.0822 23 0.9303 Barry, MI 24340 1.0018 Ionia, MI Newaygo, MI 23 0.9303 Cass, MI 43780 1.0047 24 0.9941 Carlton, MN 20260 1.0996 24 0.9941 Dodge, MN 40340 1.2234 Wabasha, MN 25 0.8072 Copiah, MS 27140 0.8817 Simpson, MS 25 0.8072 George, MS 37700 0.8480 Perry, MS 25620 0.8000 Stone, MS 25060 0.9518 25 0.8072 Marshall, MS 32820 0.9802 Tate, MS Tunica, MS 26 0.8333 Bates, MO 28140 1.0240 Caldwell, MO 26 0.8333 Callaway, MO 27620 0.8867 Cole, MO Moniteau, MO Osage, MO 26 0.8333 Crawford, Mo 41180 0.9652 Washington, MO 26 0.8333 Dallas, MO 44180 0.9100 Start Printed Page 22449 Polk, MO 26 0.8333 DeKalb, MO 41140 1.0649 Howard, MO 17860 0.8929 McDonald, MO 22220 0.9184 27 0.9262 Carbon, MT 13740 0.9530 28 0.9617 Dixon, NE 43580 0.9646 Saunders, NE 36540 1.0373 Seward, NE 30700 1.0856 29 1.0466 Storey, NV 39900 1.1120 Carson City, NV 16180 1.1009 32 0.9079 San Juan, NM 22140 0.8560 Torrance, NM 10740 1.1151 33 0.8944 Tompkins, NY 27060 1.0198 Ulster, NY 28740 0.9571 34 0.9048 Anson, NC 16740 1.0361 Greene, NC 24780 0.9766 Hoke, NC 22180 0.9957 Pender, NC 48900 0.9823 Person, NC 20500 1.1021 Rockingham, NC 24660 0.9773 34 0.9048 Haywood, NC 11700 0.9774 Henderson, NC 36 0.9323 Erie, OH 41780 0.9589 Ottawa, OH 45780 1.0129 Preble, OH 19380 0.9894 36 0.9323 Morrow, OH 18140 1.0355 Union, OH 37 0.8023 Grady, OK 36420 0.9552 Lincoln, OK 37 0.8023 Le Flore, OK 22900 0.8809 37 0.8023 Okmulgee, OK 46140 0.9242 Pawnee, OK 38 1.0697 Deschutes, OR 13460 1.1276 39 0.8886 Armstrong, PA 38300 0.9291 40 0.4654 Albonito, PR 41980 0.5342 Barranquitas, PR Ciales, PR Maunabo, PR Orocovis, PR Quebradillas, PR 40 0.4654 Arroyo, PR 25020 0.4606 Guayama, PR Patillas, PR 40 0.4654 Guanica, PR 49500 0.5167 Lajas, PR 41900 0.6026 40 0.4654 Isabela, PR 10380 0.4922 Lares, PR Rincon, PR San Sebastian, PR 42 0.9197 Calhoun, SC 17900 0.9988 Fairfield, SC Kershaw, SC Saluda, SC 42 0.9197 Darlington, SC 22500 0.9394 Laurens, SC 24860 1.0164 43 0.8934 Mc Cook, SD 43620 1.0040 Turner, SD 43 0.8934 Meade, SD 39660 0.9478 Union, SD 43580 0.9646 44 0.8383 Bradley, TN 17420 0.8342 Polk, TN 1.0726 44 0.8383 Cannon, TN 34980 1.0726 Hickman, TN Macon, TN Smith, TN Trousdale, TN 44 0.8383 Grainger, TN 34100 0.8285 Hamblen, TN Jefferson, TN 44 0.8383 Sequatchie, TN 16860 0.9791 Start Printed Page 22450 Stewart, TN 17300 0.8531 45 0.8420 Aransas, TX 18580 0.9196 Calhoun, TX 47020 0.9008 Clay, TX 48660 0.8861 Crosby, TX 31180 0.9334 Delta, TX 19124 1.0713 Goliad, TX 47020 0.9008 Irion, TX 41660 0.8685 Lampasas, TX 28660 0.9829 Rusk, TX 30980 0.9360 Wise, TX 23104 1.0073 45 0.8420 Armstrong, TX 11100 0.9761 Carson, TX 45 0.8420 Callahan, TX 10180 0.8348 Jones, TX 45 0.8420 Atascosa, TX 41700 0.9575 Bandera, TX Kendall, TX Medina, TX 45 0.8420 Austin, TX 26420 1.0606 San Jacinto, TX 45 0.8420 Burleson, TX 17780 0.9830 Robertson, TX 46 0.9413 Cache, UT 30860 0.9671 Juab, UT 39340 1.0197 Morgan, UT 36260 0.9801 Washington, UT 41100 1.0058 46 0.9413 Summit, UT 41620 1.0168 Tooele, UT 49 0.9025 Amelia, VA 40060 0.9994 Caroline, VA Cumberland, VA King and Queen, VA King William, VA Louisa, VA Sussex, VA 49 0.9025 Appomattox, VA 31340 0.9589 Nelson, VA 16820 1.0947 Surry, VA 47260 0.9459 49 0.9025 Craig, VA 40220 0.8949 Franklin, VA 49 0.9025 Frederick, VA 49020 1.1162 Winchester City, VA 49 0.9025 Giles, VA 13980 0.8456 Montgomery, VA Pulaski, VA Radford City, VA 49 0.9025 Rockingham, VA 25500 0.9864 Harrisonburg City, VA 50 1.0721 Asotin, WA 30300 0.9905 Cowlitz, WA 31020 1.0873 Skagit, WA 34580 1.1247 Skamania, WA 38900 1.2127 50 1.0721 Chelan, WA 48300 1.0025 Douglas, WA 51 0.8604 Boone, WV 16620 0.9439 Clay, WV Lincoln, WV 51 0.8604 Hampshire, WV 49020 1.1162 Morgan, WV 25180 1.0332 51 0.8604 Monongalia, WV 34060 0.9284 Preston, WV 51 0.8604 Pleasants, WV 37620 0.8814 Wirt, WV 52 1.0110 Columbia, WI 31540 1.0960 Iowa, WI 52 1.0110 Fund Du Lac 22540 1.0525 52 1.0110 Kewaunee, WI 24580 1.0199 Start Printed Page 22451 Oconto, WI 1 This column lists each MSA area name 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 D. 2 Wage index values are based on FY 2000 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 calculated by multiplying the hospital wage index value for a given area by a budget neutrality factor of 1.064435 for wage indices based on MSA designations and 1.063479 for wage indices based on CBSA designations. 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 a budget neutrality adjustment calculated by multiplying the hospital wage index value for a given area by the budget neutrality factor. We have completed all of these adjustments and included them in the wage index values reflected in this table. Table D.—Comparison Wage Index for Rural Areas by MSA and CBSA
MSA code number Wage index 3 MSA designation Nonurban area CBSA code number Wage index 3 CBSA designation 9901 0.8129 Alabama 01 0.8112 9902 1.2387 Alaska 02 1.2492 9903 0.9729 Arizona 03 0.9503 9904 0.8199 Arkansas 04 0.8000 9905 1.0960 California 05 1.1192 9906 0.9972 Colorado 06 0.9963 9907 1.2685 Connecticut 07 1.2673 9908 1.0115 Delaware 08 1.0106 9910 0.9283 Florida 10 0.9118 9911 0.8778 Georgia 11 0.8224 9912 1.1200 Hawaii 12 1.1190 9913 0.9395 Idaho 13 0.8749 9914 0.8877 Illinois 14 0.8868 9915 0.9299 Indiana 15 0.9202 9916 0.9101 Iowa 16 0.9013 9917 0.8608 Kansas 17 0.8592 9918 0.8349 Kentucky 18 0.8247 9919 0.8000 Louisiana 19 0.8000 9920 0.9621 Maine 30 0.9613 9921 0.9770 Maryland 21 0.9805 9922 1.0874 Massachusetts 5 22 1.0865 9923 0.9303 Michigan 23 0.9344 9924 0.9941 Minnesota 24 0.9922 9925 0.8072 Mississippi 25 0.8120 9926 0.8333 Missouri 26 0.8255 9927 0.9262 Montana 27 0.9253 9928 0.9617 Nebraska 28 0.9609 9929 TBD Nevada 29 0.9869 9930 1.0580 New Hampshire 30 1.0571 9931 New Jersey 4 9932 0.9079 New Mexico 32 0.9231 9933 0.8944 New York 33 0.8668 9934 0.9048 North Carolina 34 0.9107 9935 0.8242 North Dakota 35 0.8235 9936 0.9323 Ohio 36 0.9245 9937 0.8023 Oklahoma 37 0.8174 9938 1.0697 Oregon 38 1.0543 9939 0.8886 Pennsylvania 39 0.8838 9940 0.4654 Puerto Rico 40 0.8000 9941 Rhode Island 4 9942 0.9197 South Carolina 42 0.9234 9943 0.8934 South Dakota 43 0.8931 9944 0.8383 Tennessee 44 0.8369 9945 0.8420 Texas 45 0.8472 9946 0.9413 Utah 46 0.8813 9947 0.9979 Vermont 47 0.9970 9948 0.8000 Virgin Islands 48 0.8000 9949 0.9025 Virginia 49 0.8560 9950 1.0721 Washington 50 1.0967 9951 0.8604 West Virginia 51 0.8364 9952 1.0110 Wisconsin 52 1.0095 9953 0.9774 Wyoming 53 0.9765 Start Printed Page 22452 9965 1.0230 Guam 54 1.0221 3 Wage index values are based on FY 2000 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 calculated by multiplying the hospital wage index value for a given area by a proposed budget neutrality factor of 1.064435 for wage indices based on MSA designations and 1.063479 for wage indices based on CBSA designations. 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 a budget neutrality adjustment calculated by multiplying the hospital wage index value for a given area by the budget neutrality factor. We have completed all of these adjustments and included them in the wage index values reflected in this table. 4 All counties within the State are classified as urban. 5 Based on CBSA designations Massachusetts has areas designated as rural. However, no IPPS hospitals are located in those rural area(s) for FY 2006. Because more recent data is not available for those areas, we are using the FY 2005 prefloor, preclassified hospital wage index value, for rural Massachusetts multiplied by the proposed FY 2006 budget neutrality factor of 1.063479. Start Printed Page 22457Table E.—Rural Counties Converting to Urban Counties by State
County name State county code MSA code MSA name CBSA code CBSA name BIBB 01030 01 ALABAMA 13820 Birmingham-Hoover, AL CHILTON 01100 01 ALABAMA 13820 Birmingham-Hoover, AL GENEVA 01300 01 ALABAMA 20020 Dothan, AL GREENE 01310 01 ALABAMA 46220 Tuscaloosa, AL HALE 01320 01 ALABAMA 46220 Tuscaloosa, AL HENRY 01330 01 ALABAMA 20020 Dothan, AL LOWNDES 01420 01 ALABAMA 33860 Montgomery, AL WALKER 01630 01 ALABAMA 13820 Birmingham-Hoover, AL FAIRBANKS NORTH STAR 02090 02 ALASKA 21820 Fairbanks, AK MATANUSKA-SUSITNA 02170 02 ALASKA 11260 Anchorage, AK YAVAPAI 03120 03 ARIZONA 39140 Prescott, AZ CLEVELAND 04120 04 ARKANSAS 38220 Pine Bluff, AR FRANKLIN 04230 04 ARKANSAS 22900 Fort Smith, AR-OK GARLAND 04250 04 ARKANSAS 26300 Hot Springs, AR GRANT 04260 04 ARKANSAS 30780 Little Rock-North Little Rock, AR LINCOLN 04390 04 ARKANSAS 38220 Pine Bluff, AR MADISON 04430 04 ARKANSAS 2220 Fayetteville-Springdale-Rogers, AR-MO PERRY 04520 04 ARKANSAS 30780 Little Rock-North Little Rock, AR POINSETT 04550 04 ARKANSAS 27860 Jonesboro, AR IMPERIAL 05120 05 CALIFORNIA 20940 El Centro, CA KINGS 05150 05 CALIFORNIA 25260 Hanford-Corcoran, CA SAN BENITO 05450 05 CALIFORNIA 41940 San Jose-Sunnyvale-Santa Clara, CA CLEAR CREEK 06090 06 COLORADO 19740 Denver-Aurora, CO ELBERT 06190 06 COLORADO 19740 Denver-Aurora, CO GILPIN 06230 06 COLORADO 19740 Denver-Aurora, CO PARK 06460 06 COLORADO 19740 Denver-Aurora, CO TELLER 06590 06 COLORADO 17820 Colorado Springs, CO BAKER 10010 10 FLORIDA 27260 Jacksonville, FL GILCHRIST 10200 10 FLORIDA 23540 Gainesville, FL INDIAN RIVER 10300 10 FLORIDA 46940 Vero Beach, FL JEFFERSON 10320 10 FLORIDA 45220 Tallahassee, FL WAKULLA 10640 10 FLORIDA 45220 Tallahassee, FL BAKER 11020 11 GEORGIA 10500 Albany, GA BRANTLEY 11110 11 GEORGIA 15260 Brunswick, GA BROOKS 11120 11 GEORGIA 46660 Valdosta, GA BURKE 11150 11 GEORGIA 12260 Augusta-Richmond County, GA-SC BUTTS 11160 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA CRAWFORD 11330 11 GEORGIA 31420 Macon, GA DAWSON 11350 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA ECHOLS 11420 11 GEORGIA 46660 Valdosta, GA FLOYD 11460 11 GEORGIA 40660 Rome, GA GLYNN 11490 11 GEORGIA 15260 Brunswick, GA HALL 11550 11 GEORGIA 23580 Gainesville, GA HARALSON 11570 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA HEARD 11590 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA Start Printed Page 22453 JASPER 11611 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA LAMAR 11651 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA LANIER 11652 11 GEORGIA 46660 Valdosta, GA LIBERTY 11680 11 GEORGIA 25980 Hinesville-Fort Stewart, GA LONG 11691 11 GEORGIA 25980 Hinesville-Fort Stewart, GA LOWNDES 11700 11 GEORGIA 46660 Valdosta, GA MC INTOSH 11703 11 GEORGIA 15260 Brunswick, GA MARION 11730 11 GEORGIA 17980 Columbus, GA-AL MERIWETHER 11740 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA MONROE 11760 11 GEORGIA 31420 Macon, GA MURRAY 11772 11 GEORGIA 19140 Dalton, GA OGLETHORPE 11801 11 GEORGIA 12020 Athens-Clarke County, GA PIKE 11821 11 GEORGIA 12060 Atlanta-Sandy Springs-Marietta, GA TERRELL 11885 11 GEORGIA 10500 Albany, GA WHITFIELD 11970 11 GEORGIA 19140 Dalton, GA WORTH 11980 11 GEORGIA 10500 Albany, GA BOISE 13070 13 IDAHO 14260 Boise City-Nampa, ID BONNEVILLE 13090 13 IDAHO 26820 Idaho Falls, ID FRANKLIN 13200 13 IDAHO 30860 Logan, UT-ID GEM 13220 13 IDAHO 14260 Boise City-Nampa, ID JEFFERSON 13250 13 IDAHO 26820 Idaho Falls, ID KOOTENAI 13270 13 IDAHO 17660 Coeur d'Alene, ID NEZ PERCE 13340 13 IDAHO 30300 Lewiston, ID-WA OWYHEE 13360 13 IDAHO 14260 Boise City-Nampa, ID POWER 13380 13 IDAHO 38540 Pocatello, ID BOND 14020 14 ILLINOIS 41180 St. Louis, MO-IL CALHOUN 14060 14 ILLINOIS 41180 St. Louis, MO-IL FORD 14350 14 ILLINOIS 16580 Champaign-Urbana, IL MACOUPIN 14670 14 ILLINOIS 41180 St. Louis, MO-IL MARSHALL 14700 14 ILLINOIS 37900 Peoria, IL MERCER 14740 14 ILLINOIS 19340 Davenport-Moline-Rock Island, IA-IL PIATT 14820 14 ILLINOIS 16580 Champaign-Urbana, IL STARK 14960 14 ILLINOIS 37900 Peoria, IL VERMILION 14982 14 ILLINOIS 19180 Danville, IL BARTHOLOMEW 15020 15 INDIANA 18020 Columbus, IN BENTON 15030 15 INDIANA 29140 Lafayette, IN BROWN 15060 15 INDIANA 26900 Indianapolis, IN CARROLL 15070 15 INDIANA 29140 Lafayette, IN FRANKLIN 15230 15 INDIANA 17140 Cincinnati-Middletown, OH-KY-IN GIBSON 15250 15 INDIANA 21780 Evansville, IN-KY GREENE 15270 15 INDIANA 14020 Bloomington, IN JASPER 15360 15 INDIANA 23844 Gary, IN LA PORTE 15450 15 INDIANA 33140 Michigan City-La Porte, IN NEWTON 15550 15 INDIANA 23844 Gary, IN OWEN 15590 15 INDIANA 14020 Bloomington, IN PUTNAM 15660 15 INDIANA 26900 Indianapolis, IN SULLIVAN 15760 15 INDIANA 45460 Terre Haute, IN WASHINGTON 15870 15 INDIANA 31140 Louisville, KY-IN BENTON 16050 16 IOWA 16300 Cedar Rapids, IA BREMER 16080 16 IOWA 47940 Waterloo-Cedar Falls, IA GRUNDY 16370 16 IOWA 47940 Waterloo-Cedar Falls, IA GUTHRIE 16380 16 IOWA 19780 Des Moines, IA HARRISON 16420 16 IOWA 36540 Omaha-Council Bluffs, NE-IA JONES 16520 16 IOWA 16300 Cedar Rapids, IA MADISON 16600 16 IOWA 19780 Des Moines, IA MILLS 16640 16 IOWA 36540 Omaha-Council Bluffs, NE-IA STORY 16840 16 IOWA 11180 Ames, IA WASHINGTON 16910 16 IOWA 26980 Iowa City, IA DONIPHAN 17210 17 KANSAS 41140 St. Joseph, MO-KS FRANKLIN 17290 17 KANSAS 28140 Kansas City, MO-KS JACKSON 17420 17 KANSAS 45820 Topeka, KS JEFFERSON 17430 17 KANSAS 45820 Topeka, KS LINN 17530 17 KANSAS 28140 Kansas City, MO-KS OSAGE 17690 17 KANSAS 45820 Topeka, KS SUMNER 17950 17 KANSAS 48620 Wichita, KS Start Printed Page 22454 WABAUNSEE 17980 17 KANSAS 45820 Topeka, KS BRACKEN 18110 18 KENTUCKY 17140 Cincinnati-Middletown, OH-KY-IN EDMONSON 18291 18 KENTUCKY 14540 Bowling Green, KY HANCOCK 18450 18 KENTUCKY 36980 Owensboro, KY HARDIN 18460 18 KENTUCKY 21060 Elizabethtown, KY HENRY 18510 18 KENTUCKY 31140 Louisville, KY-IN LARUE 18610 18 KENTUCKY 21060 Elizabethtown, KY MC LEAN 18740 18 KENTUCKY 36980 Owensboro, KY MEADE 18801 18 KENTUCKY 31140 Louisville, KY-IN NELSON 18890 18 KENTUCKY 31140 Louisville, KY-IN SHELBY 18978 18 KENTUCKY 31140 Louisville, KY-IN SPENCER 18980 18 KENTUCKY 31140 Louisville, KY-IN TRIGG 18983 18 KENTUCKY 17300 Clarksville, TN-KY TRIMBLE 18984 18 KENTUCKY 31140 Louisville, KY-IN WARREN 18986 18 KENTUCKY 14540 Bowling Green, KY WEBSTER 18989 18 KENTUCKY 21780 Evansville, IN-KY CAMERON 19110 19 LOUISIANA 29340 Lake Charles, LA DE SOTO 19150 19 LOUISIANA 43340 Shreveport-Bossier City, LA EAST FELICIANA 19180 19 LOUISIANA 12940 Baton Rouge, LA GRANT 19210 19 LOUISIANA 10780 Alexandria, LA IBERVILLE 19230 19 LOUISIANA 12940 Baton Rouge, LA POINTE COUPEE 19380 19 LOUISIANA 12940 Baton Rouge, LA ST. HELENA 19450 19 LOUISIANA 12940 Baton Rouge, LA UNION 19550 19 LOUISIANA 33740 Monroe, LA WEST FELICIANA 19620 19 LOUISIANA 12940 Baton Rouge, LA SOMERSET 21190 21 MARYLAND 41540 Salisbury, MD WICOMICO 21220 21 MARYLAND 41540 Salisbury, MD FRANKLIN 22060 22 MASSACHUSETTS 44140 Springfield, MA BARRY 23070 23 MICHIGAN 24340 Grand Rapids-Wyoming, MI CASS 23130 23 MICHIGAN 43780 South Bend-Mishawaka, IN-MI IONIA 23330 23 MICHIGAN 24340 Grand Rapids-Wyoming, MI NEWAYGO 23610 23 MICHIGAN 24340 Grand Rapids-Wyoming, MI CARLTON 24080 24 MINNESOTA 20260 Duluth, MN-WI DODGE 24190 24 MINNESOTA 40340 Rochester, MN WABASHA 24780 24 MINNESOTA 40340 Rochester, MN COPIAH 25140 25 MISSISSIPPI 27140 Jackson, MS GEORGE 25190 25 MISSISSIPPI 37700 Pascagoula, MS MARSHALL 25460 25 MISSISSIPPI 32820 Memphis, TN-MS-AR PERRY 25550 25 MISSISSIPPI 25620 Hattiesburg, MS SIMPSON 25630 25 MISSISSIPPI 27140 Jackson, MS STONE 25650 25 MISSISSIPPI 25060 Gulfport-Biloxi, MS TATE 25680 25 MISSISSIPPI 32820 Memphis, TN-MS-AR TUNICA 25710 25 MISSISSIPPI 32820 Memphis, TN-MS-AR BATES 26060 26 MISSOURI 28140 Kansas City, MO-KS CALDWELL 26120 26 MISSOURI 28140 Kansas City, MO-KS CALLAWAY 26130 26 MISSOURI 27620 Jefferson City, MO COLE 26250 26 MISSOURI 27620 Jefferson City, MO CRAWFORD 26270 26 MISSOURI 41180 St. Louis, MO-IL DALLAS 26290 26 MISSOURI 44180 Springfield, MO DE KALB 26310 26 MISSOURI 41140 St. Joseph, MO-KS HOWARD 26440 26 MISSOURI 17860 Columbia, MO MC DONALD 26590 26 MISSOURI 22220 Fayetteville-Springdale-Rogers, AR-MO MONITEAU 26670 26 MISSOURI 27620 Jefferson City, MO OSAGE 26750 26 MISSOURI 27620 Jefferson City, MO POLK 26821 26 MISSOURI 44180 Springfield, MO WASHINGTON 26992 26 MISSOURI 41180 St. Louis, MO-IL CARBON 27040 27 MONTANA 13740 Billings, MT DIXON 28250 28 NEBRASKA 43580 Sioux City, IA-NE-SD SAUNDERS 28770 28 NEBRASKA 36540 Omaha-Council Bluffs, NE-IA SEWARD 28790 28 NEBRASKA 30700 Lincoln, NE STOREY 29140 29 NEVADA 39900 Reno-Sparks, NV CARSON CITY 29120 29 NEVADA 16180 Carson City, NV SAN JUAN 32220 32 NEW MEXICO 22140 Farmington, NM TORRANCE 32280 32 NEW MEXICO 10740 Albuquerque, NM TOMPKINS 33730 33 NEW YORK 27060 Ithaca, NY ULSTER 33740 33 NEW YORK 28740 Kingston, NY ANSON 34030 34 NORTH CAROLINA 16740 Charlotte-Gastonia-Concord, NC-SC GREENE 34390 34 NORTH CAROLINA 24780 Greenville, NC Start Printed Page 22455 HAYWOOD 34430 34 NORTH CAROLINA 11700 Asheville, NC HENDERSON 34440 34 NORTH CAROLINA 11700 Asheville, NC HOKE 34460 34 NORTH CAROLINA 22180 Fayetteville, NC PENDER 34700 34 NORTH CAROLINA 48900 Wilmington, NC PERSON 34720 34 NORTH CAROLINA 20500 Durham, NC ROCKINGHAM 34780 34 NORTH CAROLINA 24660 Greensboro-High Point, NC ERIE 36220 36 OHIO 41780 Sandusky, OH MORROW 36600 36 OHIO 18140 Columbus, OH OTTAWA 36630 36 OHIO 45780 Toledo, OH PREBLE 36690 36 OHIO 19380 Dayton, OH UNION 36810 36 OHIO 18140 Columbus, OH GRADY 37250 37 OKLAHOMA 36420 Oklahoma City, OK LE FLORE 37390 37 OKLAHOMA 22900 Fort Smith, AR-OK LINCOLN 37400 37 OKLAHOMA 36420 Oklahoma City, OK OKMULGEE 37550 37 OKLAHOMA 46140 Tulsa, OK PAWNEE 37580 37 OKLAHOMA 46140 Tulsa, OK DESCHUTES 38080 38 OREGON 13460 Bend, OR ARMSTRONG 39070 39 PENNSYLVANIA 38300 Pittsburgh, PA CALHOUN 42080 42 SOUTH CAROLINA 17900 Columbia, SC DARLINGTON 42150 42 SOUTH CAROLINA 22500 Florence, SC FAIRFIELD 42190 42 SOUTH CAROLINA 17900 Columbia, SC KERSHAW 42270 42 SOUTH CAROLINA 17900 Columbia, SC LAURENS 42290 42 SOUTH CAROLINA 24860 Greenville, SC SALUDA 42400 42 SOUTH CAROLINA 17900 Columbia, SC MC COOK 43430 43 SOUTH DAKOTA 43620 Sioux Falls, SD MEADE 43460 43 SOUTH DAKOTA 39660 Rapid City, SD TURNER 43620 43 SOUTH DAKOTA 43620 Sioux Falls, SD UNION 43630 43 SOUTH DAKOTA 43580 Sioux City, IA-NE-SD BRADLEY 44050 44 TENNESSEE 17420 Cleveland, TN CANNON 44070 44 TENNESSEE 34980 Nashville-Davidson—Murfreesboro, TN GRAINGER 44280 44 TENNESSEE 34100 Morristown, TN HAMBLEN 44310 44 TENNESSEE 34100 Morristown, TN HICKMAN 44400 44 TENNESSEE 34980 Nashville-Davidson—Murfreesboro, TN JEFFERSON 44440 44 TENNESSEE 34100 Morristown, TN MACON 44550 44 TENNESSEE 34980 Nashville-Davidson—Murfreesboro, TN POLK 44690 44 TENNESSEE 17420 Cleveland, TN SEQUATCHIE 44760 44 TENNESSEE 16860 Chattanooga, TN-GA SMITH 44790 44 TENNESSEE 34980 Nashville-Davidson—Murfreesboro, TN STEWART 44800 44 TENNESSEE 17300 Clarksville, TN-KY TROUSDALE 44840 44 TENNESSEE 34980 Nashville-Davidson—Murfreesboro, TN ARANSAS 45030 45 TEXAS 18580 Corpus Christi, TX ARMSTRONG 45050 45 TEXAS 11100 Amarillo, TX ATASCOSA 45060 45 TEXAS 41700 San Antonio, TX AUSTIN 45070 45 TEXAS 26420 Houston-Baytown-Sugar Land, TX BANDERA 45090 45 TEXAS 41700 San Antonio, TX BURLESON 45221 45 TEXAS 17780 College Station-Bryan, TX CALHOUN 45224 45 TEXAS 47020 Victoria, TX CALLAHAN 45230 45 TEXAS 10180 Abilene, TX CARSON 45251 45 TEXAS 11100 Amarillo, TX CLAY 45291 45 TEXAS 48660 Wichita Falls, TX CROSBY 45362 45 TEXAS 31180 Lubbock, TX DELTA 45400 45 TEXAS 19124 Dallas-Plano-Irving, TX GOLIAD 45561 45 TEXAS 47020 Victoria, TX IRION 45672 45 TEXAS 41660 San Angelo, TX JONES 45721 45 TEXAS 10180 Abilene, TX KENDALL 45731 45 TEXAS 41700 San Antonio, TX LAMPASAS 45752 45 TEXAS 28660 Killeen-Temple-Fort Hood, TX MEDINA 45792 45 TEXAS 41700 San Antonio, TX ROBERTSON 45878 45 TEXAS 17780 College Station-Bryan, TX RUSK 45881 45 TEXAS 30980 Longview, TX SAN JACINTO 45884 45 TEXAS 26420 Houston-Baytown-Sugar Land, TX WISE 45973 45 TEXAS 23104 Fort Worth-Arlington, TX CACHE 46020 46 UTAH 30860 Logan, UT-ID JUAB 46110 46 UTAH 39340 Provo-Orem, UT MORGAN 46140 46 UTAH 36260 Ogden-Clearfield, UT Start Printed Page 22456 SUMMIT 46210 46 UTAH 41620 Salt Lake City, UT TOOELE 46220 46 UTAH 41620 Salt Lake City, UT WASHINGTON 46260 46 UTAH 41100 St. George, UT AMELIA 49030 49 VIRGINIA 40060 Richmond, VA APPOMATTOX 49050 49 VIRGINIA 31340 Lynchburg, VA CAROLINE 49160 49 VIRGINIA 40060 Richmond, VA CRAIG 49220 49 VIRGINIA 40220 Roanoke, VA CUMBERLAND 49240 49 VIRGINIA 40060 Richmond, VA FRANKLIN 49330 49 VIRGINIA 40220 Roanoke, VA FREDERICK 49340 49 VIRGINIA 49020 Winchester, VA-WV GILES 49350 49 VIRGINIA 13980 Blacksburg-Christiansburg-Radford, VA KING AND QUEEN 49480 49 VIRGINIA 40060 Richmond, VA KING WILLIAM 49500 49 VIRGINIA 40060 Richmond, VA LOUISA 49540 49 VIRGINIA 40060 Richmond, VA MONTGOMERY 49600 49 VIRGINIA 13980 Blacksburg-Christiansburg-Radford, VA NELSON 49620 49 VIRGINIA 16820 Charlottesville, VA PULASKI 49770 49 VIRGINIA 13980 Blacksburg-Christiansburg-Radford, VA ROCKINGHAM 49820 49 VIRGINIA 25500 Harrisonburg, VA SURRY 49900 49 VIRGINIA 47260 Virginia Beach-Norfolk-Newport News, VA SUSSEX 49910 49 VIRGINIA 40060 Richmond, VA HARRISONBURG CITY 49421 49 VIRGINIA 25500 Harrisonburg, VA RADFORD CITY 49771 49 VIRGINIA 13980 Blacksburg-Christiansburg-Radford, VA WINCHESTER CITY 49962 49 VIRGINIA 49020 Winchester, VA-WV ASOTIN 50010 50 WASHINGTON 30300 Lewiston, ID-WA CHELAN 50030 50 WASHINGTON 48300 Wenatchee, WA COWLITZ 50070 50 WASHINGTON 31020 Longview, WA DOUGLAS 50080 50 WASHINGTON 48300 Wenatchee, WA SKAGIT 50280 50 WASHINGTON 34580 Mount Vernon-Anacortes, WA a SKAMANIA 50290 50 WASHINGTON 38900 Portland-Vancouver-Beaverton, OR-WA BOONE 51020 51 WEST VIRGINIA 16620 Charleston, WV CLAY 51070 51 WEST VIRGINIA 16620 Charleston, WV HAMPSHIRE 51130 51 WEST VIRGINIA 49020 Winchester, VA-WV LINCOLN 51210 51 WEST VIRGINIA 16620 Charleston, WV MONONGALIA 51300 51 WEST VIRGINIA 34060 Morgantown, WV MORGAN 51320 51 WEST VIRGINIA 25180 Hagerstown-Martinsburg, MD-WV PLEASANTS 51360 51 WEST VIRGINIA 37620 Parkersburg-Marietta, WV-OH PRESTON 51380 51 WEST VIRGINIA 34060 Morgantown, WV WIRT 51520 51 WEST VIRGINIA 37620 Parkersburg-Marietta, WV-OH COLUMBIA 52100 52 WISCONSIN 31540 Madison, WI FOND DU LAC 52190 52 WISCONSIN 22540 Fond du Lac, WI IOWA 52240 52 WISCONSIN 31540 Madison, WI KEWAUNEE 52300 52 WISCONSIN 24580 Green Bay, WI OCONTO 52410 52 WISCONSIN 24580 Green Bay, WI AIBONITO 40050 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR ARROYO 40080 40 PUERTO RICO 25020 Guayama, PR BARRANQUITAS 40100 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR CIALES 40190 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR GUANICA 40270 40 PUERTO RICO 49500 Yauco, PR GUAYAMA 40280 40 PUERTO RICO 25020 Guayama, PR ISABELA 40350 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR LAJAS 40390 40 PUERTO RICO 41900 San German-Cabo Rojo, PR LARES 40400 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR MAUNABO 40470 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR OROCOVIS 40530 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR PATILLAS 40540 40 PUERTO RICO 25020 Guayama, PR QUEBRADILLAS 40570 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR RINCON 40580 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR SAN SEBASTIAN 40660 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR End Part End Supplemental InformationTable F.—Crosswalk of Counties by State From MSA to CBSA
County name State State county code MSA code MSA name CBSA code CBSA name AUTAUGA AL 01000 5240 MONTGOMERY, AL 33860 Montgomery, AL BALDWIN AL 01010 5160 MOBILE, AL * BARBOUR AL 01020 01 ALABAMA * BIBB AL 01030 01 ALABAMA 13820 Birmingham-Hoover, AL BLOUNT AL 01040 1000 BIRMINGHAM, AL 13820 Birmingham-Hoover, AL BULLOCK AL 01050 01 ALABAMA * BUTLER AL 01060 01 ALABAMA * CALHOUN AL 01070 0450 ANNISTON, AL 11500 Anniston-Oxford, AL CHAMBERS AL 01080 01 ALABAMA * CHEROKEE AL 01090 01 ALABAMA CHILTON AL 01100 01 ALABAMA 13820 Birmingham-Hoover, AL CHOCTAW AL 01110 01 ALABAMA * CLARKE AL 01120 01 ALABAMA * CLAY AL 01130 01 ALABAMA * CLEBURNE AL 01140 01 ALABAMA * COFFEE AL 01150 01 ALABAMA * COLBERT AL 01160 2650 FLORENCE, AL 22520 Florence-Muscle Shoals, AL CONECUH AL 01170 01 ALABAMA * COOSA AL 01180 01 ALABAMA * COVINGTON AL 01190 01 ALABAMA * CRENSHAW AL 01200 01 ALABAMA * CULLMAN AL 01210 01 ALABAMA * DALE AL 01220 2180 DOTHAN, AL * DALLAS AL 01230 01 ALABAMA * DE KALB AL 01240 01 ALABAMA * ELMORE AL 01250 5240 MONTGOMERY, AL 33860 Montgomery, AL ESCAMBIA AL 01260 01 ALABAMA * ETOWAH AL 01270 2880 GADSDEN, AL 23460 Gadsden, AL FAYETTE AL 01280 01 ALABAMA * FRANKLIN AL 01290 01 ALABAMA * GENEVA AL 01300 01 ALABAMA 20020 Dothan, AL GREENE AL 01310 01 ALABAMA 46220 Tuscaloosa, AL HALE AL 01320 01 ALABAMA 46220 Tuscaloosa, AL HENRY AL 01330 01 ALABAMA 20020 Dothan, AL HOUSTON AL 01340 2180 DOTHAN, AL 20020 Dothan, AL JACKSON AL 01350 01 ALABAMA * JEFFERSON AL 01360 1000 BIRMINGHAM, AL 13820 Birmingham-Hoover, AL LAMAR AL 01370 01 ALABAMA * LAUDERDALE AL 01380 2650 FLORENCE, AL 22520 Florence-Muscle Shoals, AL LAWRENCE AL 01390 2030 DECATUR, AL 19460 Decatur, AL LEE AL 01400 0580 AUBURN-OPELIKA, AL 12220 Auburn-Opelika, AL LIMESTONE AL 01410 3440 HUNTSVILLE, AL 26620 Huntsville, AL LOWNDES AL 01420 01 ALABAMA 33860 Montgomery, AL MACON AL 01430 01 ALABAMA * MADISON AL 01440 3440 HUNTSVILLE, AL 26620 Huntsville, AL MARENGO AL 01450 01 ALABAMA * MARION AL 01460 01 ALABAMA * MARSHALL AL 01470 01 ALABAMA * MOBILE AL 01480 5160 MOBILE, AL 33660 Mobile, AL MONROE AL 01490 01 ALABAMA * MONTGOMERY AL 01500 5240 MONTGOMERY, AL 33860 Montgomery, AL MORGAN AL 01510 2030 DECATUR, AL 19460 Decatur, AL PERRY AL 01520 01 ALABAMA * PICKENS AL 01530 01 ALABAMA * PIKE AL 01540 01 ALABAMA * RANDOLPH AL 01550 01 ALABAMA RUSSELL AL 01560 1800 COLUMBUS, GA-AL 17980 Columbus, GA-AL ST. CLAIR AL 01570 1000 BIRMINGHAM, AL 13820 Birmingham-Hoover, AL SHELBY AL 01580 1000 BIRMINGHAM, AL 13820 Birmingham-Hoover, AL SUMTER AL 01590 01 ALABAMA * TALLADEGA AL 01600 01 ALABAMA * TALLAPOOSA AL 01610 01 ALABAMA * TUSCALOOSA AL 01620 8600 TUSCALOOSA, AL 46220 Tuscaloosa, AL WALKER AL 01630 01 ALABAMA 13820 Birmingham-Hoover, AL WASHINGTON AL 01640 01 ALABAMA * WILCOX AL 01650 01 ALABAMA * WINSTON AL 01660 01 ALABAMA * STATEWIDE AL 01999 01 ALABAMA * ALEUTIANS EAST AK 02013 02 ALASKA * ALEUTIANS WEST AK 02016 02 ALASKA * Start Printed Page 22458 ANCHORAGE AK 02020 0380 ANCHORAGE,AK 11260 Anchorage, AK ANGOON AK 02030 02 ALASKA * BARROW-NORTH SLOPE AK 02040 02 ALASKA * BETHEL AK 02050 02 ALASKA * BRISTOL BAY BOROUGH AK 02060 02 ALASKA * DENALI AK 02068 02 ALASKA * DILLINGHAM AK 02070 02 ALASKA * CORDOVA-MCCARTHY AK 02080 02 ALASKA * FAIRBANKS NORTH STAR AK 02090 02 ALASKA 21820 Fairbanks, AK HAINES AK 02100 02 ALASKA * JUNEAU AK 02110 02 ALASKA * KENAI-COOK INLET AK 02120 02 ALASKA * KENAI PENINSULA AK 02122 02 ALASKA * KETCHIKAN GATEWAY AK 02130 02 ALASKA * KOBUK AK 02140 02 ALASKA * KODIAK ISLAND BOROUGH AK 02150 02 ALASKA * KSUKOKWIN AK 02160 02 ALASKA * LAKE AND PENINSULA AK 02164 02 ALASKA * MATANUSKA-SUSITNA AK 02170 02 ALASKA 11260 Anchorage, AK NOME AK 02180 02 ALASKA * NORTH SLOPE BOROUH AK 02185 02 ALASKA * NORTHWEST ARTIC BOROUGH AK 02188 02 ALASKA * OUTER KETCHIKAN AK 02190 02 ALASKA * PR.OF WALES AK 02200 02 ALASKA * PR.OF WALES-OUT.KETCHIKAN AK 02201 02 ALASKA * SEWARD AK 02210 02 ALASKA * SITKA BOROUGH AK 02220 02 ALASKA * SKAGWAY-YAKUTAT AK 02230 02 ALASKA * SKAGWAY-YAKUTAT-ANGOON AK 02231 02 ALASKA * SKAGWAY-HOONAH-ANGOON AK 02232 02 ALASKA * SOUTHEAST FAIRBANKS AK 02240 02 ALASKA * UPPER YUKON AK 02250 02 ALASKA * VALDEZ-CHITNA-WHITTIER AK 02260 02 ALASKA * VALDEZ-CORDOVA AK 02261 02 ALASKA * WADE HAMPTON AK 02270 02 ALASKA * WRANGELL-PETERSBURG AK 02280 02 ALASKA * YAKUTAT BOROUGH AK 02282 02 ALASKA * YUKON-KOYUKUK AK 02290 02 ALASKA * STATEWIDE AK 02999 02 ALASKA * APACHE AZ 03000 03 ARIZONA * COCHISE AZ 03010 03 ARIZONA * COCONINO AZ 03020 2620 FLAGSTAFF, ARIZONA-UTAH 22380 Flagstaff, AZ GILA AZ 03030 03 ARIZONA * GRAHAM AZ 03040 03 ARIZONA * GREENLEE AZ 03050 03 ARIZONA * LAPAZ AZ 03055 03 ARIZONA * MARICOPA AZ 03060 6200 PHOENIX-MESA, AZ 38060 Phoenix-Mesa-Scottsdale, AZ MOHAVE AZ 03070 4120 LAS VEGAS, NV-AZ * NAVAJO AZ 03080 03 ARIZONA * PIMA AZ 03090 8520 TUCSON, AZ 46060 Tucson, AZ PINAL AZ 03100 6200 PHOENIX-MESA, AZ 38060 Phoenix-Mesa-Scottsdale, AZ SANTA CRUZ AZ 03110 03 ARIZONA * YAVAPAI AZ 03120 03 ARIZONA 39140 Prescott, AZ YUMA AZ 03130 9360 YUMA, AZ 49740 Yuma, AZ STATEWIDE AZ 03999 03 ARIZONA * ARKANSAS AR 04000 04 ARKANSAS * ASHLEY AR 04010 04 ARKANSAS * BAXTER AR 04020 04 ARKANSAS * BENTON AR 04030 2580 FAYETTEVILLE-SPRINGDALE-ROGERS, AR 22220 Fayetteville-Springdale-Rogers, AR-MO BOONE AR 04040 04 ARKANSAS * BRADLEY AR 04050 04 ARKANSAS * CALHOUN AR 04060 04 ARKANSAS * CARROLL AR 04070 04 ARKANSAS * CHICOT AR 04080 04 ARKANSAS * CLARK AR 04090 04 ARKANSAS * Start Printed Page 22459 CLAY AR 04100 04 ARKANSAS * CLEBURNE AR 04110 04 ARKANSAS * CLEVELAND AR 04120 04 ARKANSAS 38220 Pine Bluff, AR COLUMBIA AR 04130 04 ARKANSAS * CONWAY AR 04140 04 ARKANSAS * CRAIGHEAD AR 04150 3700 JONESBORO, AR 27860 Jonesboro, AR CRAWFORD AR 04160 2720 FORT SMITH, AR-OK 22900 Fort Smith, AR-OK CRITTENDEN AR 04170 4920 MEMPHIS, TN-AR-MS 32820 Memphis, TN-MS-AR CROSS AR 04180 04 ARKANSAS * DALLAS AR 04190 04 ARKANSAS * DESHA AR 04200 04 ARKANSAS * DREW AR 04210 04 ARKANSAS * FAULKNER AR 04220 4400 LITTLE ROCK-NORTH LITTLE ROCK, AR 30780 Little Rock-North Little Rock, AR FRANKLIN AR 04230 04 ARKANSAS 22900 Fort Smith, AR-OK FULTON AR 04240 04 ARKANSAS GARLAND AR 04250 04 ARKANSAS 26300 Hot Springs, AR GRANT AR 04260 04 ARKANSAS 30780 Little Rock-North Little Rock, AR GREENE AR 04270 04 ARKANSAS * HEMPSTEAD AR 04280 04 ARKANSAS * HOT SPRING AR 04290 04 ARKANSAS * HOWARD AR 04300 04 ARKANSAS * INDEPENDENCE AR 04310 04 ARKANSAS * IZARD AR 04320 04 ARKANSAS * JACKSON AR 04330 04 ARKANSAS * JEFFERSON AR 04340 6240 PINE BLUFF, AR 38220 Pine Bluff, AR JOHNSON AR 04350 04 ARKANSAS * LAFAYETTE AR 04360 04 ARKANSAS * LAWRENCE AR 04370 04 ARKANSAS * LEE AR 04380 04 ARKANSAS * LINCOLN AR 04390 04 ARKANSAS 38220 Pine Bluff, AR LITTLE RIVER AR 04400 04 ARKANSAS * LOGAN AR 04410 04 ARKANSAS * LONOKE AR 04420 4400 LITTLE ROCK-NORTH LITTLE ROCK, AR 30780 Little Rock-North Little Rock, AR MADISON AR 04430 04 ARKANSAS 22220 Fayetteville-Springdale-Rogers, AR-MO MARION AR 04440 04 ARKANSAS * MILLER AR 04450 8360 TEXARKANA, TX-TEXARKANA, AR 45500 Texarkana, TX-Texarkana, AR MISSISSIPPI AR 04460 04 ARKANSAS * MONROE AR 04470 04 ARKANSAS * MONTGOMERY AR 04480 04 ARKANSAS * NEVADA AR 04490 04 ARKANSAS * NEWTON AR 04500 04 ARKANSAS * OUACHITA AR 04510 04 ARKANSAS * PERRY AR 04520 04 ARKANSAS 30780 Little Rock-North Little Rock, AR PHILLIPS AR 04530 04 ARKANSAS * PIKE AR 04540 04 ARKANSAS * POINSETT AR 04550 04 ARKANSAS 27860 Jonesboro, AR POLK AR 04560 04 ARKANSAS * POPE AR 04570 04 ARKANSAS * PRAIRIE AR 04580 04 ARKANSAS * PULASKI AR 04590 4400 LITTLE ROCK-NORTH LITTLE ROCK, AR 30780 Little Rock-North Little Rock, AR RANDOLPH AR 04600 04 ARKANSAS * ST. FRANCIS AR 04610 04 ARKANSAS * SALINE AR 04620 4400 LITTLE ROCK-NORTH LITTLE ROCK, AR 30780 Little Rock-North Little Rock, AR SCOTT AR 04630 04 ARKANSAS * SEARCY AR 04640 04 ARKANSAS * SEBASTIAN AR 04650 2720 FORT SMITH, AR-OK 22900 Fort Smith, AR-OK SEVIER AR 04660 04 ARKANSAS * SHARP AR 04670 04 ARKANSAS * STONE AR 04680 04 ARKANSAS * UNION AR 04690 04 ARKANSAS * VAN BUREN AR 04700 04 ARKANSAS * WASHINGTON AR 04710 2580 FAYETTEVILLE-SPRINGDALE-ROGERS, AR 22220 Fayetteville-Springdale-Rogers, AR-MO Start Printed Page 22460 WHITE AR 04720 04 ARKANSAS * WOODRUFF AR 04730 04 ARKANSAS * YELL AR 04740 04 ARKANSAS * STATEWIDE AR 04999 04 ARKANSAS * ALAMEDA CA 05000 5775 OAKLAND, CA 36084 Oakland-Fremont-Hayward, CA ALPINE CA 05010 05 CALIFORNIA * AMADOR CA 05020 05 CALIFORNIA * BUTTE CA 05030 1620 CHICO-PARADISE, CA 17020 Chico, CA CALAVERAS CA 05040 05 CALIFORNIA * COLUSA CA 05050 05 CALIFORNIA * CONTRA COSTA CA 05060 5775 OAKLAND, CA 36084 Oakland-Fremont-Hayward, CA DEL NORTE CA 05070 05 CALIFORNIA * EL DORADO CA 05080 6920 SACRAMENTO, CA 40900 Sacramento-Arden-Arcade-Roseville, CA FRESNO CA 05090 2840 FRESNO, CA 23420 Fresno, CA GLENN CA 05100 05 CALIFORNIA * HUMBOLDT CA 05110 05 CALIFORNIA * IMPERIAL CA 05120 05 CALIFORNIA 20940 El Centro, CA INYO CA 05130 05 CALIFORNIA * KERN CA 05140 0680 BAKERSFIELD, CA 12540 Bakersfield, CA KINGS CA 05150 05 CALIFORNIA 25260 Hanford-Corcoran, CA LAKE CA 05160 05 CALIFORNIA * LASSEN CA 05170 05 CALIFORNIA * LOS ANGELES CA 05200 4480 LOS ANGELES-LONG BEACH, CA 31084 Los Angeles-Long Beach-Santa Ana, CA LOS ANGELES CA 05210 4480 LOS ANGELES-LONG BEACH, CA 31084 Los Angeles-Long Beach-Santa Ana, CA MADERA CA 05300 2840 FRESNO, CA 31460 Madera, CA MARIN CA 05310 7360 SAN FRANCISCO, CA 41884 San Francisco-San Mateo-Redwood City, CA MARIPOSA CA 05320 05 CALIFORNIA * MENDOCINO CA 05330 05 CALIFORNIA * MERCED CA 05340 4940 MERCED, CA 32900 Merced, CA MODOC CA 05350 05 CALIFORNIA * MONO CA 05360 05 CALIFORNIA * MONTEREY CA 05370 7120 SALINAS, CA 41500 Salinas, CA NAPA CA 05380 8720 VALLEJO-FAIRFIELD-NAPA, CA 34900 Napa, CA NEVADA CA 05390 05 CALIFORNIA * ORANGE CA 05400 5945 ORANGE COUNTY, CA 42044 Santa Ana-Anaheim-Irvine, CA PLACER CA 05410 6920 SACRAMENTO, CA 40900 Sacramento—Arden-Arcade—Roseville, CA PLUMAS CA 05420 05 CALIFORNIA * RIVERSIDE CA 05430 6780 RIVERSIDE-SAN BERNARDINO, CA 40140 Riverside-San Bernardino-Ontario, CA SACRAMENTO CA 05440 6920 SACRAMENTO, CA 40900 Sacramento—Arden-Arcade—Roseville, CA SAN BENITO CA 05450 05 CALIFORNIA 41940 San Jose-Sunnyvale-Santa Clara, CA SAN BERNARDINO CA 05460 6780 RIVERSIDE-SAN BERNARDINO, CA 40140 Riverside-San Bernardino-Ontario, CA SAN DIEGO CA 05470 7320 SAN DIEGO, CA 41740 San Diego-Carlsbad-San Marcos, CA SAN FRANCISCO CA 05480 7360 SAN FRANCISCO, CA 41884 San Francisco-San Mateo-Redwood City, CA SAN JOAQUIN CA 05490 8120 STOCKTON-LODI, CA 44700 Stockton, CA SAN LUIS OBISPO CA 05500 7460 SAN LUIS OBISPO-ATASCADERO-PASO ROBLES, CA 42020 San Luis Obispo-Paso Robles, CA SAN MATEO CA 05510 7360 SAN FRANCISCO, CA 41884 San Francisco-San Mateo-Redwood City, CA SANTA BARBARA CA 05520 7480 SANTA BARBARA-SANTA MARIA-LOMPOC, CA 42060 Santa Barbara-Santa Maria-Goleta, CA SANTA CLARA CA 05530 7400 SAN JOSE, CA 41940 San Jose-Sunnyvale-Santa Clara, CA SANTA CRUZ CA 05540 7485 SANTA CRUZ-WATSONVILLE, CA 42100 Santa Cruz-Watsonville, CA SHASTA CA 05550 6690 REDDING, CA 39820 Redding, CA SIERRA CA 05560 05 CALIFORNIA * SISKIYOU CA 05570 05 CALIFORNIA * Start Printed Page 22461 SOLANO CA 05580 8720 VALLEJO-FAIRFIELD-NAPA, CA 46700 Vallejo-Fairfield, CA SONOMA CA 05590 7500 SANTA ROSA, CA 42220 Santa Rosa-Petaluma, CA STANISLAUS CA 05600 5170 MODESTO, CA 33700 Modesto, CA SUTTER CA 05610 340 YUBA CITY, CA 49700 Yuba City, CA TEHAMA CA 05620 05 CALIFORNIA * TRINITY CA 05630 05 CALIFORNIA * TULARE CA 05640 8780 VISALIA-TULARE-PORTERVILLE, CA 47300 Visalia-Porterville, CA TUOLUMNE CA 05650 05 CALIFORNIA * VENTURA CA 05660 8735 VENTURA, CA 37100 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LOUIS, MO-IL 41180 St. Louis, MO-IL MARION IL 14690 14 ILLINOIS * MARSHALL IL 14700 14 ILLINOIS 37900 Peoria, IL MASON IL 14710 14 ILLINOIS * MASSAC IL 14720 14 ILLINOIS * MENARD IL 14730 7880 SPRINGFIELD, IL 44100 Springfield, IL MERCER IL 14740 14 ILLINOIS 19340 Davenport-Moline-Rock Island, IA-IL MONROE IL 14750 7040 ST. LOUIS, MO-IL 41180 St. Louis, MO-IL MONTGOMERY IL 14760 14 ILLINOIS * MORGAN IL 14770 14 ILLINOIS * MOULTRIE IL 14780 14 ILLINOIS * OGLE IL 14790 6880 ROCKFORD, IL * PEORIA IL 14800 6120 PEORIA-PEKIN, IL 37900 Peoria, IL PERRY IL 14810 14 ILLINOIS * PIATT IL 14820 14 ILLINOIS 16580 Champaign-Urbana, IL PIKE IL 14830 14 ILLINOIS * POPE IL 14831 14 ILLINOIS * PULASKI IL 14850 14 ILLINOIS * PUTNAM IL 14860 14 ILLINOIS * RANDOLPH IL 14870 14 ILLINOIS * RICHLAND IL 14880 14 ILLINOIS * ROCK ISLAND IL 14890 1960 DAVENPORT-ROCK ISLAND-MOLINE, IA-IL 19340 Davenport-Moline-Rock Island, IA-IL ST. CLAIR IL 14900 7040 ST. 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JOSEPH IN 15700 7800 SOUTH BEND, IN 43780 South Bend-Mishawaka, IN-MI SCOTT IN 15710 4520 LOUISVILLE, KY-IN * SHELBY IN 15720 3480 INDIANAPOLIS, IN 26900 Indianapolis, IN SPENCER IN 15730 15 INDIANA * STARKE IN 15740 15 INDIANA * STEUBEN IN 15750 15 INDIANA * SULLIVAN IN 15760 15 INDIANA 45460 Terre Haute, IN SWITZERLAND IN 15770 15 INDIANA * TIPPECANOE IN 15780 3920 LAFAYETTE, IN 29140 Lafayette, IN TIPTON IN 15790 3850 KOKOMO, IN 29020 Kokomo, IN UNION IN 15800 15 INDIANA * VANDERBURGH IN 15810 2440 EVANSVILLE-HENDERSON, IN-KY 21780 Evansville, IN-KY Start Printed Page 22470 VERMILLION IN 15820 8320 TERRE HAUTE, IN 45460 Terre Haute, IN VIGO IN 15830 8320 TERRE HAUTE, IN 45460 Terre Haute, IN WABASH IN 15840 15 INDIANA * WARREN IN 15850 15 INDIANA * WARRICK IN 15860 2440 EVANSVILLE-HENDERSON, IN-KY 21780 Evansville, IN-KY WASHINGTON IN 15870 15 INDIANA 31140 Louisville, KY-IN WAYNE IN 15880 15 INDIANA * WELLS IN 15890 2760 FORT WAYNE, IN 23060 Fort Wayne, IN WHITE IN 15900 15 INDIANA * WHITLEY IN 15910 2760 FORT WAYNE, IN 23060 Fort Wayne, IN STATEWIDE IN 15999 15 INDIANA * ADAIR IA 16000 16 IOWA * ADAMS IA 16010 16 IOWA * ALLAMAKEE IA 16020 16 IOWA * APPANOOSE IA 16030 16 IOWA * AUDUBON IA 16040 16 IOWA * BENTON IA 16050 16 IOWA 16300 Cedar Rapids, IA BLACK HAWK IA 16060 8920 WATERLOO-CEDAR FALLS, IA 47940 Waterloo-Cedar Falls, IA BOONE IA 16070 16 IOWA * BREMER IA 16080 16 IOWA 47940 Waterloo-Cedar Falls, IA BUCHANAN IA 16090 16 IOWA * BUENA VISTA IA 16100 16 IOWA * BUTLER IA 16110 16 IOWA * CALHOUN IA 16120 16 IOWA * CARROLL IA 16130 16 IOWA * CASS IA 16140 16 IOWA * CEDAR IA 16150 16 IOWA * CERRO GORDO IA 16160 16 IOWA * CHEROKEE IA 16170 16 IOWA * CHICKASAW IA 16180 16 IOWA * CLARKE IA 16190 16 IOWA * CLAY IA 16200 16 IOWA * CLAYTON IA 16210 16 IOWA * CLINTON IA 16220 16 IOWA * CRAWFORD IA 16230 16 IOWA * DALLAS IA 16240 2120 DES MOINES, IA 19780 Des Moines, IA DAVIS IA 16250 16 IOWA * DECATUR IA 16260 16 IOWA * DELAWARE IA 16270 16 IOWA * DES MOINES IA 16280 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6640 RALEIGH-DURHAM-CHAPEL HILL, NC 39580 Raleigh-Cary, NC GASTON NC 34350 1520 CHARLOTTE-GASTONIA-ROCK HILL, NC-SC 16740 Charlotte-Gastonia-Concord, NC-SC GATES NC 34360 34 NORTH CAROLINA * GRAHAM NC 34370 34 NORTH CAROLINA * GRANVILLE NC 34380 34 NORTH CAROLINA * GREENE NC 34390 34 NORTH CAROLINA 24780 Greenville, NC GUILFORD NC 34400 3120 GREENSBORO—WINSTON-SALEM—HIGH POINT, NC 24660 Greensboro-High Point, NC HALIFAX NC 34410 34 NORTH CAROLINA * HARNETT NC 34420 34 NORTH CAROLINA * HAYWOOD NC 34430 34 NORTH CAROLINA 11700 Asheville, NC HENDERSON NC 34440 34 NORTH CAROLINA 11700 Asheville, NC HERTFORD NC 34450 34 NORTH CAROLINA * HOKE NC 34460 34 NORTH CAROLINA 22180 Fayetteville, NC HYDE NC 34470 34 NORTH CAROLINA * IREDELL NC 34480 34 NORTH CAROLINA * JACKSON NC 34490 34 NORTH CAROLINA * JOHNSTON NC 34500 6640 RALEIGH-DURHAM-CHAPEL HILL, NC 39580 Raleigh-Cary, NC JONES NC 34510 34 NORTH CAROLINA LEE NC 34520 34 NORTH CAROLINA LENOIR NC 34530 34 NORTH CAROLINA LINCOLN NC 34540 1520 CHARLOTTE-GASTONIA-ROCK HILL, NC-SC MC DOWELL NC 34550 34 NORTH CAROLINA MACON NC 34560 34 NORTH CAROLINA MADISON NC 34570 0480 ASHEVILLE, NC 11700 Asheville, NC MARTIN NC 34580 34 NORTH CAROLINA * MECKLENBURG NC 34590 1520 CHARLOTTE-GASTONIA-ROCK HILL, NC-SC 16740 Charlotte-Gastonia-Concord, NC-SC MITCHELL NC 34600 34 NORTH CAROLINA * MONTGOMERY NC 34610 34 NORTH CAROLINA * MOORE NC 34620 34 NORTH CAROLINA * Start Printed Page 22489 NASH NC 34630 6895 ROCKY MOUNT, NC 40580 Rocky Mount, NC NEW HANOVER NC 34640 9200 WILMINGTON, NC 48900 Wilmington, NC NORTHAMPTON NC 34650 34 NORTH CAROLINA * ONSLOW NC 34660 3605 JACKSONVILLE, NC 27340 Jacksonville, NC ORANGE NC 34670 6640 RALEIGH-DURHAM-CHAPEL HILL, NC 20500 Durham, NC PAMLICO NC 34680 34 NORTH CAROLINA * PASQUOTANK NC 34690 34 NORTH CAROLINA * PENDER NC 34700 34 NORTH CAROLINA 48900 Wilmington, NC PERQUIMANS NC 34710 34 NORTH CAROLINA * PERSON NC 34720 34 NORTH CAROLINA 20500 Durham, NC PITT NC 34730 3150 GREENVILLE, NC 24780 Greenville, NC POLK NC 34740 34 NORTH CAROLINA * RANDOLPH NC 34750 3120 GREENSBORO—WINSTON-SALEM—HIGH POINT, NC 24660 Greensboro-High Point, NC RICHMOND NC 34760 34 NORTH CAROLINA * ROBESON NC 34770 34 NORTH CAROLINA * ROCKINGHAM NC 34780 34 NORTH CAROLINA 24660 Greensboro-High Point, NC ROWAN NC 34790 1520 CHARLOTTE-GASTONIA-ROCK HILL, NC-SC * RUTHERFORD NC 34800 34 NORTH CAROLINA * SAMPSON NC 34810 34 NORTH CAROLINA * SCOTLAND NC 34820 34 NORTH CAROLINA * STANLY NC 34830 1520 CHARLOTTE-GASTONIA-ROCK HILL, NC-SC * STOKES NC 34840 3120 GREENSBORO—WINSTON-SALEM—HIGH POINT, NC 49180 Winston-Salem, NC SURRY NC 34850 34 NORTH CAROLINA * SWAIN NC 34860 34 NORTH CAROLINA * TRANSYLVANIA NC 34870 34 NORTH CAROLINA * TYRRELL NC 34880 34 NORTH CAROLINA * UNION NC 34890 1520 CHARLOTTE-GASTONIA-ROCK HILL, NC-SC 16740 Charlotte-Gastonia-Concord, NC-SC VANCE NC 34900 34 NORTH CAROLINA * WAKE NC 34910 6640 RALEIGH-DURHAM-CHAPEL HILL, NC 39580 Raleigh-Cary, NC WARREN NC 34920 34 NORTH CAROLINA * WASHINGTON NC 34930 34 NORTH CAROLINA * WATAUGA NC 34940 34 NORTH CAROLINA * WAYNE NC 34950 2980 GOLDSBORO, NC 24140 Goldsboro, NC WILKES NC 34960 34 NORTH CAROLINA * WILSON NC 34970 34 NORTH CAROLINA * YADKIN NC 34980 3120 GREENSBORO—WINSTON-SALEM—HIGH POINT, NC 49180 Winston-Salem, NC YANCEY NC 34981 34 NORTH CAROLINA * STATEWIDE NC 34999 34 NORTH CAROLINA * ADAMS ND 35000 35 NORTH DAKOTA * BARNES ND 35010 35 NORTH DAKOTA * BENSON ND 35020 35 NORTH DAKOTA * BILLINGS ND 35030 35 NORTH DAKOTA * BOTTINEAU ND 35040 35 NORTH DAKOTA * BOWMAN ND 35050 35 NORTH DAKOTA * BURKE ND 35060 35 NORTH DAKOTA * BURLEIGH ND 35070 1010 BISMARCK, ND 13900 Bismarck, ND CASS ND 35080 2520 FARGO-MOORHEAD, ND-MN 22020 Fargo, ND-MN CAVALIER ND 35090 35 NORTH DAKOTA * DICKEY ND 35100 35 NORTH DAKOTA * DIVIDE ND 35110 35 NORTH DAKOTA * DUNN ND 35120 35 NORTH DAKOTA * EDDY ND 35130 35 NORTH DAKOTA * EMMONS ND 35140 35 NORTH DAKOTA * FOSTER ND 35150 35 NORTH DAKOTA * GOLDEN VALLEY ND 35160 35 NORTH DAKOTA * GRAND FORKS ND 35170 2985 GRAND FORKS, ND-MN 24220 Grand Forks, ND-MN GRANT ND 35180 35 NORTH DAKOTA * GRIGGS ND 35190 35 NORTH DAKOTA * HETTINGER ND 35200 35 NORTH DAKOTA * KIDDER ND 35210 35 NORTH DAKOTA * LA MOURE ND 35220 35 NORTH DAKOTA * LOGAN ND 35230 35 NORTH DAKOTA * Start Printed Page 22490 MCHENRY ND 35240 35 NORTH DAKOTA * MCINTOSH ND 35250 35 NORTH DAKOTA * MCKENZIE ND 35260 35 NORTH DAKOTA * MCLEAN ND 35270 35 NORTH DAKOTA * MERCER ND 35280 35 NORTH DAKOTA * MORTON ND 35290 1010 BISMARCK, ND 13900 Bismarck, ND DMOUNTRAIL ND 35300 35 NORTH DAKOTA * NELSON ND 35310 35 NORTH DAKOTA * OLIVER ND 35320 35 NORTH DAKOTA * PEMBINA ND 35330 35 NORTH DAKOTA * PIERCE ND 35340 35 NORTH DAKOTA * RAMSEY ND 35350 35 NORTH DAKOTA * RANSOM ND 35360 35 NORTH DAKOTA * RENVILLE ND 35370 35 NORTH DAKOTA * RICHLAND ND 35380 35 NORTH DAKOTA * ROLETTE ND 35390 35 NORTH DAKOTA * SARGENT ND 35400 35 NORTH DAKOTA * SHERIDAN ND 35410 35 NORTH DAKOTA * SIOUX ND 35420 35 NORTH DAKOTA * SLOPE ND 35430 35 NORTH DAKOTA * STARK ND 35440 35 NORTH DAKOTA * STEELE ND 35450 35 NORTH DAKOTA * STUTSMAN ND 35460 35 NORTH DAKOTA * TOWNER ND 35470 35 NORTH DAKOTA * TRAILL ND 35480 35 NORTH DAKOTA * WALSH ND 35490 35 NORTH DAKOTA * WARD ND 35500 35 NORTH DAKOTA * WELLS ND 35510 35 NORTH DAKOTA * WILLIAMS ND 35520 35 NORTH DAKOTA * STATEWIDE ND 35999 35 NORTH DAKOTA * ADAMS OH 36000 36 OHIO * ALLEN OH 36010 4320 LIMA, OH 30620 Lima, OH ASHLAND OH 36020 36 OHIO * ASHTABULA OH 36030 1680 CLEVELAND-LORAIN-ELYRIA, OH * ATHENS OH 36040 36 OHIO * AUGLAIZE OH 36050 4320 LIMA, OH * BELMONT OH 36060 9000 WHEELING, WV-OH 48540 Wheeling, WV-OH BROWN OH 36070 1640 CINCINNATI, OH-KY-IN 17140 Cincinnati-Middletown, OH-KY-IN BUTLER OH 36080 3200 HAMILTON-MIDDLETOWN, OH 17140 Cincinnati-Middletown, OH-KY-IN CARROLL OH 36090 1320 CANTON-MASSILLON, OH 15940 Canton-Massillon, OH CHAMPAIGN OH 36100 36 OHIO * CLARK OH 36110 2000 DAYTON-SPRINGFIELD, OH 44220 Springfield, OH CLERMONT OH 36120 1640 CINCINNATI, OH-KY-IN 17140 Cincinnati-Middletown, OH-KY-IN CLINTON OH 36130 36 OHIO * COLUMBIANA OH 36140 9320 YOUNGSTOWN-WARREN, OH * COSHOCTON OH 36150 36 OHIO * CRAWFORD OH 36160 4800 MANSFIELD, OH * CUYAHOGA OH 36170 1680 CLEVELAND-LORAIN-ELYRIA, OH 17460 Cleveland-Elyria-Mentor, OH DARKE OH 36190 36 OHIO * DEFIANCE OH 36200 36 OHIO * DELAWARE OH 36210 1840 COLUMBUS, OH 18140 Columbus, OH ERIE OH 36220 36 OHIO 41780 Sandusky, OH FAIRFIELD OH 36230 1840 COLUMBUS, OH 18140 Columbus, OH FAYETTE OH 36240 36 OHIO * FRANKLIN OH 36250 1840 COLUMBUS, OH 18140 Columbus, OH FULTON OH 36260 8400 TOLEDO, OH 45780 Toledo, OH GALLIA OH 36270 36 OHIO * GEAUGA OH 36280 1680 CLEVELAND-LORAIN-ELYRIA, OH 17460 Cleveland-Elyria-Mentor, OH GREENE OH 36290 2000 DAYTON-SPRINGFIELD, OH 19380 Dayton, OH GUERNSEY OH 36300 36 OHIO * HAMILTON OH 36310 1640 CINCINNATI, OH-KY-IN 17140 Cincinnati-Middletown, OH-KY-IN HANCOCK OH 36330 36 OHIO * Start Printed Page 22491 HARDIN OH 36340 36 OHIO * HARRISON OH 36350 36 OHIO * HENRY OH 36360 36 OHIO * HIGHLAND OH 36370 36 OHIO * HOCKING OH 36380 36 OHIO * HOLMES OH 36390 36 OHIO * HURON OH 36400 36 OHIO * JACKSON OH 36410 36 OHIO * JEFFERSON OH 36420 8080 STEUBENVILLE-WEIRTON, OH-WV 48260 Weirton-Steubenville, WV-OH KNOX OH 36430 36 OHIO * LAKE OH 36440 1680 CLEVELAND-LORAIN-ELYRIA, OH 17460 Cleveland-Elyria-Mentor, OH LAWRENCE OH 36450 3400 HUNTINGTON-ASHLAND, WV-KY-OH 26580 Huntington-Ashland, WV-KY-OH LICKING OH 36460 1840 COLUMBUS, OH 18140 Columbus, OH LOGAN OH 36470 36 OHIO * LORAIN OH 36480 1680 CLEVELAND-LORAIN-ELYRIA, OH 17460 Cleveland-Elyria-Mentor, OH LUCAS OH 36490 8400 TOLEDO, OH 45780 Toledo, OH MADISON OH 36500 1840 COLUMBUS, OH 18140 Columbus, OH MAHONING OH 36510 9320 YOUNGSTOWN-WARREN, OH 49660 Youngstown-Warren-Boardman, OH-PA MARION OH 36520 36 OHIO * MEDINA OH 36530 1680 CLEVELAND-LORAIN-ELYRIA, OH 17460 Cleveland-Elyria-Mentor, OH MEIGS OH 36540 36 OHIO * MERCER OH 36550 36 OHIO * MIAMI OH 36560 2000 DAYTON-SPRINGFIELD, OH 19380 Dayton, OH MONROE OH 36570 36 OHIO * MONTGOMERY OH 36580 2000 DAYTON-SPRINGFIELD, OH 19380 Dayton, OH MORGAN OH 36590 36 OHIO * MORROW OH 36600 36 OHIO 18140 Columbus, OH MUSKINGUM OH 36610 36 OHIO * NOBLE OH 36620 36 OHIO * OTTAWA OH 36630 36 OHIO 45780 Toledo, OH PAULDING OH 36640 36 OHIO * PERRY OH 36650 36 OHIO * PICKAWAY OH 36660 1840 COLUMBUS, OH 18140 Columbus, OH PIKE OH 36670 36 OHIO * PORTAGE OH 36680 0080 AKRON, OH 10420 Akron, OH PREBLE OH 36690 36 OHIO 19380 Dayton, OH PUTNAM OH 36700 36 OHIO * RICHLAND OH 36710 4800 MANSFIELD, OH 31900 Mansfield, OH ROSS OH 36720 36 OHIO * SANDUSKY OH 36730 36 OHIO * SCIOTO OH 36740 36 OHIO * SENECA OH 36750 36 OHIO * SHELBY OH 36760 36 OHIO * STARK OH 36770 1320 CANTON-MASSILLON, OH 15940 Canton-Massillon, OH SUMMIT OH 36780 0080 AKRON, OH 10420 Akron, OH TRUMBULL OH 36790 9320 YOUNGSTOWN-WARREN, OH 49660 Youngstown-Warren-Boardman, OH-PA TUSCARAWAS OH 36800 36 OHIO * UNION OH 36810 36 OHIO 18140 Columbus, OH VAN WERT OH 36820 36 OHIO * VINTON OH 36830 36 OHIO * WARREN OH 36840 1640 CINCINNATI, OH-KY-IN 17140 Cincinnati-Middletown, OH-KY-IN WASHINGTON OH 36850 6020 PARKERSBURG-MARIETTA, WV-OH 37620 Parkersburg-Marietta, WV-OH WAYNE OH 36860 36 OHIO * WILLIAMS OH 36870 36 OHIO * WOOD OH 36880 8400 TOLEDO, OH 45780 Toledo, OH WYANDOT OH 36890 36 OHIO * STATEWIDE OH 36999 36 OHIO * ADAIR OK 37000 37 OKLAHOMA * ALFALFA OK 37010 37 OKLAHOMA * ATOKA OK 37020 37 OKLAHOMA * BEAVER OK 37030 37 OKLAHOMA * Start Printed Page 22492 BECKHAM OK 37040 37 OKLAHOMA * BLAINE OK 37050 37 OKLAHOMA * BRYAN OK 37060 37 OKLAHOMA * CADDO OK 37070 37 OKLAHOMA * CANADIAN OK 37080 5880 OKLAHOMA CITY, OK 36420 Oklahoma City, OK CARTER OK 37090 37 OKLAHOMA * CHEROKEE OK 37100 37 OKLAHOMA * CHOCTAW OK 37110 37 OKLAHOMA * CIMARRON OK 37120 37 OKLAHOMA * CLEVELAND OK 37130 5880 OKLAHOMA CITY, OK 36420 Oklahoma City, OK COAL OK 37140 37 OKLAHOMA * COMANCHE OK 37150 4200 LAWTON, OK 30020 Lawton, OK COTTON OK 37160 37 OKLAHOMA * CRAIG OK 37170 37 OKLAHOMA * CREEK OK 37180 8560 TULSA, OK 46140 Tulsa, OK CUSTER OK 37190 37 OKLAHOMA * DELAWARE OK 37200 37 OKLAHOMA * DEWEY OK 37210 37 OKLAHOMA * ELLIS OK 37220 37 OKLAHOMA * GARFIELD OK 37230 2340 ENID, OK * GARVIN OK 37240 37 OKLAHOMA * GRADY OK 37250 37 OKLAHOMA 36420 Oklahoma City, OK GRANT OK 37260 37 OKLAHOMA * GREER OK 37270 37 OKLAHOMA * HARMON OK 37280 37 OKLAHOMA * HARPER OK 37290 37 OKLAHOMA * HASKELL OK 37300 37 OKLAHOMA * HUGHES OK 37310 37 OKLAHOMA * JACKSON OK 37320 37 OKLAHOMA * JEFFERSON OK 37330 37 OKLAHOMA * JOHNSTON OK 37340 37 OKLAHOMA * KAY OK 37350 37 OKLAHOMA * KINGFISHER OK 37360 37 OKLAHOMA * KIOWA OK 37370 37 OKLAHOMA * LATIMER OK 37380 37 OKLAHOMA * LE FLORE OK 37390 37 OKLAHOMA 22900 Fort Smith, AR-OK LINCOLN OK 37400 37 OKLAHOMA 36420 Oklahoma City, OK LOGAN OK 37410 5880 OKLAHOMA CITY, OK 36420 Oklahoma City, OK LOVE OK 37420 37 OKLAHOMA * MCCLAIN OK 37430 5880 OKLAHOMA CITY, OK 36420 Oklahoma City, OK MCCURTAIN OK 37440 37 OKLAHOMA * MCINTOSH OK 37450 37 OKLAHOMA * MAJOR OK 37460 37 OKLAHOMA * MARSHALL OK 37470 37 OKLAHOMA * MAYES OK 37480 37 OKLAHOMA * MURRAY OK 37490 37 OKLAHOMA * MUSKOGEE OK 37500 37 OKLAHOMA * NOBLE OK 37510 37 OKLAHOMA * NOWATA OK 37520 37 OKLAHOMA * OKFUSKEE OK 37530 37 OKLAHOMA * OKLAHOMA OK 37540 5880 OKLAHOMA CITY, OK 36420 Oklahoma City, OK OKMULGEE OK 37550 37 OKLAHOMA 46140 Tulsa, OK OSAGE OK 37560 8560 TULSA, OK 46140 Tulsa, OK OTTAWA OK 37570 37 OKLAHOMA * PAWNEE OK 37580 37 OKLAHOMA 46140 Tulsa, OK PAYNE OK 37590 37 OKLAHOMA * PITTSBURG OK 37600 37 OKLAHOMA * PONTOTOC OK 37610 37 OKLAHOMA * POTTAWATOMIE OK 37620 5880 OKLAHOMA CITY, OK * PUSHMATAHA OK 37630 37 OKLAHOMA * ROGER MILLS OK 37640 37 OKLAHOMA * ROGERS OK 37650 8560 TULSA, OK 46140 Tulsa, OK SEMINOLE OK 37660 37 OKLAHOMA * SEQUOYAH OK 37670 2720 FORT SMITH, AR-OK 22900 Fort Smith, AR-OK STEPHENS OK 37680 37 OKLAHOMA * TEXAS OK 37690 37 OKLAHOMA * TILLMAN OK 37700 37 OKLAHOMA * TULSA OK 37710 8560 TULSA, OK 46140 Tulsa, OK WAGONER OK 37720 8560 TULSA, OK 46140 Tulsa, OK WASHINGTON OK 37730 37 OKLAHOMA * Start Printed Page 22493 WASHITA OK 37740 37 OKLAHOMA * WOODS OK 37750 37 OKLAHOMA * WOODWARD OK 37760 37 OKLAHOMA * STATEWIDE OK 37999 37 OKLAHOMA * BAKER OR 38000 38 OREGON * BENTON OR 38010 1890 CORVALLIS, OR 18700 Corvallis, OR CLACKAMAS OR 38020 6440 PORTLAND-VANCOUVER, OR-WA 38900 Portland-Vancouver-Beaverton, OR-WA CLATSOP OR 38030 38 OREGON * COLUMBIA OR 38040 6440 PORTLAND-VANCOUVER, OR-WA 38900 Portland-Vancouver-Beaverton, OR-WA COOS OR 38050 38 OREGON * CROOK OR 38060 38 OREGON * CURRY OR 38070 38 OREGON * DESCHUTES OR 38080 38 OREGON 13460 Bend, OR DOUGLAS OR 38090 38 OREGON * GILLIAM OR 38100 38 OREGON * GRANT OR 38110 38 OREGON * HARNEY OR 38120 38 OREGON * HOOD RIVER OR 38130 38 OREGON * JACKSON OR 38140 4890 MEDFORD-ASHLAND, OR 32780 Medford, OR JEFFERSON OR 38150 38 OREGON * JOSEPHINE OR 38160 38 OREGON * KLAMATH OR 38170 38 OREGON * LAKE OR 38180 38 OREGON * LANE OR 38190 2400 EUGENE-SPRINGFIELD, OR 21660 Eugene-Springfield, OR LINCOLN OR 38200 38 OREGON * LINN OR 38210 38 OREGON * MALHEUR OR 38220 38 OREGON * MARION OR 38230 7080 SALEM, OR 41420 Salem, OR MORROW OR 38240 38 OREGON * MULTNOMAH OR 38250 6440 PORTLAND-VANCOUVER, OR-WA 38900 Portland-Vancouver-Beaverton, OR-WA POLK OR 38260 7080 SALEM, OR 41420 Salem, OR SHERMAN OR 38270 38 OREGON * TILLAMOOK OR 38280 38 OREGON * UMATILLA OR 38290 38 OREGON * UNION OR 38300 38 OREGON * WALLOWA OR 38310 38 OREGON * WASCO OR 38320 38 OREGON * WASHINGTON OR 38330 6440 PORTLAND-VANCOUVER, OR-WA 38900 Portland-Vancouver-Beaverton, OR-WA WHEELER OR 38340 38 OREGON * YAMHILL OR 38350 6440 PORTLAND-VANCOUVER, OR-WA 38900 Portland-Vancouver-Beaverton, OR-WA STATEWIDE OR 38999 38 OREGON * ADAMS PA 39000 39 PENNSYLVANIA * ALLEGHENY PA 39010 6280 PITTSBURGH, PA 38300 Pittsburgh, PA ARMSTRONG PA 39070 39 PENNSYLVANIA 38300 Pittsburgh, PA BEAVER PA 39080 6280 PITTSBURGH, PA 38300 Pittsburgh, PA BEDFORD PA 39100 39 PENNSYLVANIA * BERKS PA 39110 6680 READING, PA 39740 Reading, PA BLAIR PA 39120 0280 ALTOONA, PA 11020 Altoona, PA BRADFORD PA 39130 39 PENNSYLVANIA * BUCKS PA 39140 6160 PHILADELPHIA, PA-NJ 37964 Philadelphia, PA BUTLER PA 39150 6280 PITTSBURGH, PA 38300 Pittsburgh, PA CAMBRIA PA 39160 3680 JOHNSTOWN, PA 27780 Johnstown, PA CAMERON PA 39180 39 PENNSYLVANIA * CARBON PA 39190 0240 ALLENTOWN-BETHLEHEM-EASTON, PA 10900 Allentown-Bethlehem-Easton, PA-NJ CENTRE PA 39200 8050 STATE COLLEGE, PA 44300 State College, PA CHESTER PA 39210 6160 PHILADELPHIA, PA-NJ 37964 Philadelphia, PA CLARION PA 39220 39 PENNSYLVANIA * CLEARFIELD PA 39230 39 PENNSYLVANIA * CLINTON PA 39240 39 PENNSYLVANIA * COLUMBIA PA 39250 7560 SCRANTON-WILKES-BARRE-HAZLETON, PA * CRAWFORD PA 39260 39 PENNSYLVANIA * CUMBERLAND PA 39270 3240 HARRISBURG-LEBANON-CARLISLE, PA 25420 Harrisburg-Carlisle, PA Start Printed Page 22494 DAUPHIN PA 39280 3240 HARRISBURG-LEBANON-CARLISLE, PA 25420 Harrisburg-Carlisle, PA DELAWARE PA 39290 6160 PHILADELPHIA, PA-NJ 37964 Philadelphia, PA ELK PA 39310 39 PENNSYLVANIA ERIE PA 39320 2360 ERIE, PA 21500 Erie, PA FAYETTE PA 39330 6280 PITTSBURGH, PA 38300 Pittsburgh, PA FOREST PA 39340 39 PENNSYLVANIA * FRANKLIN PA 39350 39 PENNSYLVANIA * FULTON PA 39360 39 PENNSYLVANIA * GREENE PA 39370 39 PENNSYLVANIA * HUNTINGDON PA 39380 39 PENNSYLVANIA * INDIANA PA 39390 39 PENNSYLVANIA * JEFFERSON PA 39400 39 PENNSYLVANIA * JUNIATA PA 39410 39 PENNSYLVANIA * LACKAWANNA PA 39420 7560 SCRANTON-WILKES-BARRE-HAZLETON, PA 42540 Scranton—Wilkes-Barre, PA LANCASTER PA 39440 4000 LANCASTER, PA 29540 Lancaster, PA LAWRENCE PA 39450 39 PENNSYLVANIA * LEBANON PA 39460 3240 HARRISBURG-LEBANON-CARLISLE, PA 30140 Lebanon, PA LEHIGH PA 39470 0240 ALLENTOWN-BETHLEHEM-EASTON, PA 10900 Allentown-Bethlehem-Easton, PA-NJ LUZERNE PA 39480 7560 SCRANTON-WILKES-BARRE-HAZLETON, PA 42540 Scranton—Wilkes-Barre, PA LYCOMING PA 39510 9140 WILLIAMSPORT, PA 48700 Williamsport, PA MC KEAN PA 39520 39 PENNSYLVANIA * MERCER PA 39530 7610 SHARON, PA 49660 Youngstown-Warren-Boardman, OH-PA MIFFLIN PA 39540 39 PENNSYLVANIA * MONROE PA 39550 39 PENNSYLVANIA * MONTGOMERY PA 39560 6160 PHILADELPHIA, PA-NJ 37964 Philadelphia, PA MONTOUR PA 39580 39 PENNSYLVANIA * NORTHAMPTON PA 39590 0240 ALLENTOWN-BETHLEHEM-EASTON, PA 10900 Allentown-Bethlehem-Easton, PA-NJ NORTHUMBERLAND PA 39600 39 PENNSYLVANIA * PERRY PA 39610 3240 HARRISBURG-LEBANON-CARLISLE, PA 25420 Harrisburg-Carlisle, PA PHILADELPHIA PA 39620 6160 PHILADELPHIA, PA-NJ 37964 Philadelphia, PA PIKE PA 39630 5660 NEWBURGH, NY-PA 35084 Newark-Union, NJ-PA POTTER PA 39640 39 PENNSYLVANIA * SCHUYLKILL PA 39650 39 PENNSYLVANIA * SNYDER PA 39670 39 PENNSYLVANIA * SOMERSET PA 39680 3680 JOHNSTOWN, PA * SULLIVAN PA 39690 39 PENNSYLVANIA * SUSQUEHANNA PA 39700 39 PENNSYLVANIA * TIOGA PA 39710 39 PENNSYLVANIA * UNION PA 39720 39 PENNSYLVANIA * VENANGO PA 39730 39 PENNSYLVANIA * WARREN PA 39740 39 PENNSYLVANIA * WASHINGTON PA 39750 6280 PITTSBURGH, PA 38300 Pittsburgh, PA WAYNE PA 39760 39 PENNSYLVANIA * WESTMORELAND PA 39770 6280 PITTSBURGH, PA 38300 Pittsburgh, PA WYOMING PA 39790 7560 SCRANTON-WILKES-BARRE-HAZLETON, PA 42540 Scranton—Wilkes-Barre, PA YORK PA 39800 9280 YORK, PA 49620 York-Hanover, PA STATEWIDE PA 39999 39 PENNSYLVANIA * ADJUNTAS PR 40010 40 PUERTO RICO * AGUADA PR 40020 0060 AGUADILLA, PR 10380 Aguadilla-Isabela-San Sebastian, PR AGUADILLA PR 40030 0060 AGUADILLA, PR 10380 Aguadilla-Isabela-San Sebastian, PR AGUAS BUENAS PR 40040 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR AIBONITO PR 40050 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR ANASCO PR 40060 4840 MAYAGUEZ, PR 10380 Aguadilla-Isabela-San Sebastian, PR ARECIBO PR 40070 0470 ARECIBO, PR 41980 San Juan-Caguas-Guaynabo, PR ARROYO PR 40080 40 PUERTO RICO 25020 Guayama, PR Start Printed Page 22495 BARCELONETA PR 40090 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR BARRANQUITAS PR 40100 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR BAYAMON PR 40110 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR CABO ROJO PR 40120 4840 MAYAGUEZ, PR 41900 San German-Cabo Rojo, PR CAGUAS PR 40130 1310 CAGUAS, PR 41980 San Juan-Caguas-Guaynabo, PR CAMUY PR 40140 0470 ARECIBO, PR 41980 San Juan-Caguas-Guaynabo, PR CANOVANAS PR 40145 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR CAROLINA PR 40150 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR CATANO PR 40160 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR CAYEY PR 40170 1310 CAGUAS, PR 41980 San Juan-Caguas-Guaynabo, PR CEIBA PR 40180 7440 SAN JUAN-BAYAMON, PR 21940 Fajardo, PR CIALES PR 40190 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR CIDRA PR 40200 1310 CAGUAS, PR 41980 San Juan-Caguas-Guaynabo, PR COAMO PR 40210 40 PUERTO RICO * COMERIO PR 40220 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR COROZAL PR 40230 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR CULEBRA PR 40240 40 PUERTO RICO * DORADO PR 40250 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR FAJARDO PR 40260 7440 SAN JUAN-BAYAMON, PR 21940 Fajardo, PR FLORIDA PR 40265 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR GUANICA PR 40270 40 PUERTO RICO 49500 Yauco, PR GUAYAMA PR 40280 40 PUERTO RICO 25020 Guayama, PR GUAYANILLA PR 40290 6360 PONCE, PR 49500 Yauco, PR GUAYNABO PR 40300 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR GURABO PR 40310 1310 CAGUAS, PR 41980 San Juan-Caguas-Guaynabo, PR HATILLO PR 40320 0470 ARECIBO, PR 41980 San Juan-Caguas-Guaynabo, PR HORMIGUEROS PR 40330 4840 MAYAGUEZ, PR 32420 Mayaguez, PR HUMACAO PR 40340 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR ISABELA PR 40350 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR JAYUYA PR 40360 40 PUERTO RICO * JUANA DIAZ PR 40370 6360 PONCE, PR 38660 Ponce, PR JUNCOS PR 40380 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR LAJAS PR 40390 40 PUERTO RICO 41900 San German-Cabo Rojo, PR LARES PR 40400 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR AS MARIAS PR 40410 40 PUERTO RICO * LAS PIEDRAS PR 40420 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR LOIZA PR 40430 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR LUQUILLO PR 40440 7440 SAN JUAN-BAYAMON, PR 21940 Fajardo, PR MANATI PR 40450 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR MARICAO PR 40460 40 PUERTO RICO * MAUNABO PR 40470 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR MAYAGUEZ PR 40480 4840 MAYAGUEZ, PR 32420 Mayaguez, PR MOCA PR 40490 0060 AGUADILLA, PR 10380 Aguadilla-Isabela-San Sebastian, PR Start Printed Page 22496 MOROVIS PR 40500 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR MAGUABO PR 40510 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR NARANJITO PR 40520 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR OROCOVIS PR 40530 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR PATILLAS PR 40540 40 PUERTO RICO 25020 Guayama, PR PENUELAS PR 40550 6360 PONCE, PR 49500 Yauco, PR PONCE PR 40560 6360 PONCE, PR 38660 Ponce, PR QUEBRADILLAS PR 40570 40 PUERTO RICO 41980 San Juan-Caguas-Guaynabo, PR RINCON PR 40580 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR RIO GRANDE PR 40590 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR SABANA GRANDE PR 40610 4840 MAYAGUEZ, PR 41900 San German-Cabo Rojo, PR SALINAS PR 40620 40 PUERTO RICO * SAN GERMAN PR 40630 4840 MAYAGUEZ, PR 41900 San German-Cabo Rojo, PR SAN JUAN PR 40640 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR SAN LORENZO PR 40650 1310 CAGUAS, PR 41980 San Juan-Caguas-Guaynabo, PR SAN SEBASTIAN PR 40660 40 PUERTO RICO 10380 Aguadilla-Isabela-San Sebastian, PR SANTA ISABEL PR 40670 40 PUERTO RICO * TOA ALTA PR 40680 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR TOA BAJA PR 40690 7440 SAN JUAN-BAYAMON, PR 41980 San Juan-Caguas-Guaynabo, PR TRUJILLO ALTO PR 40700 7440 SAN JUAN-BAYAMON, PR 41980 San 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Nashville-Davidson—Murfreesboro, TN UNICOI TN 44850 3660 JOHNSON CITY-KINGSPORT-BRISTOL, TN-VA 27740 Johnson City, TN UNION TN 44860 3840 KNOXVILLE, TN 28940 Knoxville, TN VAN BUREN TN 44870 44 TENNESSEE * WARREN TN 44880 44 TENNESSEE * WASHINGTON TN 44890 3660 JOHNSON CITY-KINGSPORT-BRISTOL, TN-VA 27740 Johnson City, TN WAYNE TN 44900 44 TENNESSEE * WEAKLEY TN 44910 44 TENNESSEE * WHITE TN 44920 44 TENNESSEE * WILLIAMSON TN 44930 5360 NASHVILLE, TN 34980 Nashville-Davidson—Murfreesboro, TN WILSON TN 44940 5360 NASHVILLE, TN 34980 Nashville-Davidson—Murfreesboro, TN STATEWIDE TN 44999 44 TENNESSEE * ANDERSON TX 45000 45 TEXAS * ANDREWS TX 45010 45 TEXAS * ANGELINA TX 45020 45 TEXAS * ARANSAS TX 45030 45 TEXAS 18580 Corpus Christi, TX ARCHER TX 45040 9080 WICHITA FALLS, TX 48660 Wichita Falls, TX ARMSTRONG TX 45050 45 TEXAS 11100 Amarillo, TX ATASCOSA TX 45060 45 TEXAS 41700 San Antonio, TX AUSTIN TX 45070 45 TEXAS 26420 Houston-Baytown-Sugar Land, TX BAILEY TX 45080 45 TEXAS * BANDERA TX 45090 45 TEXAS 41700 San Antonio, TX BASTROP TX 45100 0640 AUSTIN-SAN MARCOS, TX 12420 Austin-Round Rock, TX BAYLOR TX 45110 45 TEXAS * BEE TX 45113 45 TEXAS * BELL TX 45120 3810 KILLEEN-TEMPLE, TX 28660 Killeen-Temple-Fort Hood, TX BEXAR TX 45130 7240 SAN ANTONIO, TX 41700 San Antonio, TX BLANCO TX 45140 45 TEXAS * BORDEN TX 45150 45 TEXAS * BOSQUE TX 45160 45 TEXAS * BOWIE TX 45170 8360 TEXARKANA, TX-TEXARKANA, AR 45500 Texarkana, TX-Texarkana, AR BRAZORIA TX 45180 1145 BRAZORIA, TX 26420 Houston-Baytown-Sugar Land, TX BRAZOS TX 45190 1260 BRYAN-COLLEGE STATION, TX 17780 College Station-Bryan, TX BREWSTER TX 45200 45 TEXAS * BRISCOE TX 45201 45 TEXAS * BROOKS TX 45210 45 TEXAS * BROWN TX 45220 45 TEXAS * BURLESON TX 45221 45 TEXAS 17780 College Station-Bryan, TX BURNET TX 45222 45 TEXAS * CALDWELL TX 45223 0640 AUSTIN-SAN MARCOS, TX 12420 Austin-Round Rock, TX CALHOUN TX 45224 45 TEXAS 47020 Victoria, TX CALLAHAN TX 45230 45 TEXAS 10180 Abilene, TX CAMERON TX 45240 1240 BROWNSVILLE-HARLINGEN-SAN BENITO, TX 15180 Brownsville-Harlingen, TX CAMP TX 45250 45 TEXAS * CARSON TX 45251 45 TEXAS 11100 Amarillo, TX CASS TX 45260 45 TEXAS * CASTRO TX 45270 45 TEXAS * CHAMBERS TX 45280 3360 HOUSTON, TX 26420 Houston-Baytown-Sugar Land, TX CHEROKEE TX 45281 45 TEXAS * CHILDRESS TX 45290 45 TEXAS * CLAY TX 45291 45 TEXAS 48660 Wichita Falls, TX Start Printed Page 22501 COCHRAN TX 45292 45 TEXAS * COKE TX 45300 45 TEXAS * COLEMAN TX 45301 45 TEXAS * COLLIN TX 45310 1920 DALLAS, TX 19124 Dallas-Plano-Irving, TX COLLINGSWORTH TX 45311 45 TEXAS * COLORADO TX 45312 45 TEXAS * COMAL TX 45320 7240 SAN ANTONIO, TX 41700 San Antonio, TX COMANCHE TX 45321 45 TEXAS * CONCHO TX 45330 45 TEXAS * COOKE TX 45340 45 TEXAS * CORYELL TX 45341 3810 KILLEEN-TEMPLE, TX 28660 Killeen-Temple-Fort Hood, TX COTTLE TX 45350 45 TEXAS * CRANE TX 45360 45 TEXAS * CROCKETT TX 45361 45 TEXAS * CROSBY TX 45362 45 TEXAS 31180 Lubbock, TX CULBERSON TX 45370 45 TEXAS * DALLAM TX 45380 45 TEXAS * 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GALVESTON-TEXAS CITY, TX 26420 Houston-Baytown-Sugar Land, TX GARZA TX 45551 45 TEXAS * GILLESPIE TX 45552 45 TEXAS * GLASSCOCK TX 45560 45 TEXAS * GOLIAD TX 45561 45 TEXAS 47020 Victoria, TX GONZALES TX 45562 45 TEXAS * GRAY TX 45563 45 TEXAS * GRAYSON TX 45564 7640 SHERMAN-DENISON, TX 43300 Sherman-Denison, TX GREGG TX 45570 4420 LONGVIEW-MARSHALL, TX 30980 Longview, TX GRIMES TX 45580 45 TEXAS * GUADALUPE TX 45581 7240 SAN ANTONIO, TX 41700 San Antonio, TX HALE TX 45582 45 TEXAS * HALL TX 45583 45 TEXAS * HAMILTON TX 45590 45 TEXAS * HANSFORD TX 45591 45 TEXAS * HARDEMAN TX 45592 45 TEXAS * HARDIN TX 45600 0840 BEAUMONT-PORT ARTHUR, TX 13140 Beaumont-Port Arthur, TX HARRIS TX 45610 3360 HOUSTON, TX 26420 Houston-Baytown-Sugar Land, TX HARRISON TX 45620 4420 LONGVIEW-MARSHALL, TX * HARTLEY TX 45621 45 TEXAS * HASKELL TX 45630 45 TEXAS * HAYS TX 45631 0640 AUSTIN-SAN MARCOS, TX 12420 Austin-Round Rock, TX Start Printed Page 22502 HEMPHILL TX 45632 45 TEXAS * HENDERSON TX 45640 1920 DALLAS, TX * HIDALGO TX 45650 4880 MCALLEN-EDINBURG-MISSION, TX 32580 McAllen-Edinburg-Pharr, TX HILL TX 45651 45 TEXAS * HOCKLEY TX 45652 45 TEXAS * HOOD TX 45653 2800 FORT WORTH-ARLINGTON, TX * HOPKINS TX 45654 45 TEXAS * HOUSTON TX 45660 45 TEXAS * HOWARD TX 45661 45 TEXAS * HUDSPETH TX 45662 45 TEXAS * HUNT TX 45670 1920 DALLAS, TX 19124 Dallas-Plano-Irving, TX HUTCHINSON TX 45671 45 TEXAS * IRION TX 45672 45 TEXAS 41660 San Angelo, TX JACK TX 45680 45 TEXAS * JACKSON TX 45681 45 TEXAS * JASPER TX 45690 45 TEXAS * JEFF DAVIS TX 45691 45 TEXAS * JEFFERSON TX 45700 0840 BEAUMONT-PORT ARTHUR, TX 13140 Beaumont-Port Arthur, TX JIM HOGG TX 45710 45 TEXAS * JIM WELLS TX 45711 45 TEXAS * JOHNSON TX 45720 2800 FORT WORTH-ARLINGTON, TX 23104 Fort Worth-Arlington, TX JONES TX 45721 45 TEXAS 10180 Abilene, TX KARNES TX 45722 45 TEXAS * KAUFMAN TX 45730 1920 DALLAS, TX 19124 Dallas-Plano-Irving, TX KENDALL TX 45731 45 TEXAS 41700 San Antonio, TX KENEDY TX 45732 45 TEXAS * KENT TX 45733 45 TEXAS * KERR TX 45734 45 TEXAS * KIMBLE TX 45740 45 TEXAS * KING TX 45741 45 TEXAS * KINNEY TX 45742 45 TEXAS * KLEBERG TX 45743 45 TEXAS * KNOX TX 45744 45 TEXAS * LAMAR TX 45750 45 TEXAS * LAMB TX 45751 45 TEXAS * LAMPASAS TX 45752 45 TEXAS 28660 Killeen-Temple-Fort Hood, TX LA SALLE TX 45753 45 TEXAS * LAVACA TX 45754 45 TEXAS * LEE TX 45755 45 TEXAS * LEON TX 45756 45 TEXAS * LIBERTY TX 45757 3360 HOUSTON, TX 26420 Houston-Baytown-Sugar Land, TX LIMESTONE TX 45758 45 TEXAS * LIPSCOMB TX 45759 45 TEXAS * LIVE OAK TX 45760 45 TEXAS * LLANO TX 45761 45 TEXAS * LOVING TX 45762 45 TEXAS * LUBBOCK TX 45770 4600 LUBBOCK, TX 31180 Lubbock, TX LYNN TX 45771 45 TEXAS * MC CULLOCH TX 45772 45 TEXAS * MC LENNAN TX 45780 8800 WACO, TX 47380 Waco, TX MC MULLEN TX 45781 45 TEXAS * MADISON TX 45782 45 TEXAS * MARION TX 45783 45 TEXAS * MARTIN TX 45784 45 TEXAS * MASON TX 45785 45 TEXAS * MATAGORDA TX 45790 45 TEXAS * MAVERICK TX 45791 45 TEXAS * MEDINA TX 45792 45 TEXAS 41700 San Antonio, TX MENARD TX 45793 45 TEXAS * MIDLAND TX 45794 5800 ODESSA-MIDLAND, TX 33260 Midland, TX MILAM TX 45795 45 TEXAS * MILLS TX 45796 45 TEXAS * MITCHELL TX 45797 45 TEXAS * MONTAGUE TX 45800 45 TEXAS * MONTGOMERY TX 45801 3360 HOUSTON, TX 26420 Houston-Baytown-Sugar Land, TX Start Printed Page 22503 MOORE TX 45802 45 TEXAS * MORRIS TX 45803 45 TEXAS * MOTLEY TX 45804 45 TEXAS * NACOGDOCHES TX 45810 45 TEXAS * NAVARRO TX 45820 45 TEXAS * NEWTON TX 45821 45 TEXAS * NOLAN TX 45822 45 TEXAS * NUECES TX 45830 1880 CORPUS CHRISTI, TX 18580 Corpus Christi, TX OCHILTREE TX 45831 45 TEXAS * OLDHAM TX 45832 45 TEXAS * ORANGE TX 45840 0840 BEAUMONT-PORT ARTHUR, TX 13140 Beaumont-Port Arthur, TX PALO PINTO TX 45841 45 TEXAS * PANOLA TX 45842 45 TEXAS * PARKER TX 45843 2800 FORT WORTH-ARLINGTON, TX 23104 Fort Worth-Arlington, TX PARMER TX 45844 45 TEXAS * PECOS TX 45845 45 TEXAS * POLK TX 45850 45 TEXAS * POTTER TX 45860 0320 AMARILLO, TX 11100 Amarillo, TX PRESIDIO TX 45861 45 TEXAS * RAINS TX 45870 45 TEXAS * RANDALL TX 45871 0320 AMARILLO, TX 11100 Amarillo, TX REAGAN TX 45872 45 TEXAS * REAL TX 45873 45 TEXAS * RED RIVER TX 45874 45 TEXAS * REEVES TX 45875 45 TEXAS * REFUGIO TX 45876 45 TEXAS * ROBERTS TX 45877 45 TEXAS * ROBERTSON TX 45878 45 TEXAS 17780 College Station-Bryan, TX ROCKWALL TX 45879 1920 DALLAS, TX 19124 Dallas-Plano-Irving, TX RUNNELS TX 45880 45 TEXAS * RUSK TX 45881 45 TEXAS 30980 Longview, TX SABINE TX 45882 45 TEXAS * SAN AUGUSTINE TX 45883 45 TEXAS * SAN JACINTO TX 45884 45 TEXAS 26420 Houston-Baytown-Sugar Land, TX SAN PATRICIO TX 45885 1880 CORPUS CHRISTI, TX 18580 Corpus Christi, TX SAN SABA TX 45886 45 TEXAS * SCHLEICHER TX 45887 45 TEXAS * SCURRY TX 45888 45 TEXAS * SHACKELFORD TX 45889 45 TEXAS * SHELBY TX 45890 45 TEXAS * SHERMAN TX 45891 45 TEXAS * SMITH TX 45892 8640 TYLER, TX 46340 Tyler, TX SOMERVELL TX 45893 45 TEXAS * STARR TX 45900 45 TEXAS * STEPHENS TX 45901 45 TEXAS * STERLING TX 45902 45 TEXAS * STONEWALL TX 45903 45 TEXAS * SUTTON TX 45904 45 TEXAS * SWISHER TX 45905 45 TEXAS * TARRANT TX 45910 2800 FORT WORTH-ARLINGTON, TX 23104 Fort Worth-Arlington, TX TAYLOR TX 45911 0040 ABILENE, TX 10180 Abilene, TX TERRELL TX 45912 45 TEXAS * TERRY TX 45913 45 TEXAS * THROCKMORTON TX 45920 45 TEXAS * TITUS TX 45921 45 TEXAS * TOM GREEN TX 45930 7200 SAN ANGELO, TX 41660 San Angelo, TX TRAVIS TX 45940 0640 AUSTIN-SAN MARCOS, TX 12420 Austin-Round Rock, TX TRINITY TX 45941 45 TEXAS * TYLER TX 45942 45 TEXAS * UPSHUR TX 45943 4420 LONGVIEW-MARSHALL, TX 30980 Longview, TX UPTON TX 45944 45 TEXAS * UVALDE TX 45945 45 TEXAS * VAL VERDE TX 45946 45 TEXAS * VAN ZANDT TX 45947 45 TEXAS * VICTORIA TX 45948 8750 VICTORIA, TX 47020 Victoria, TX WALKER TX 45949 45 TEXAS * Start Printed Page 22504 WALLER TX 45950 3360 HOUSTON, TX 26420 Houston-Baytown-Sugar Land, TX WARD TX 45951 45 TEXAS * WASHINGTON TX 45952 45 TEXAS * WEBB TX 45953 4080 LAREDO, TX 29700 Laredo, TX WHARTON TX 45954 45 TEXAS * WHEELER TX 45955 45 TEXAS * WICHITA TX 45960 9080 WICHITA FALLS, TX 48660 Wichita Falls, TX WILBARGER TX 45961 45 TEXAS * WILLACY TX 45962 45 TEXAS * WILLIAMSON TX 45970 0640 AUSTIN-SAN MARCOS, TX 12420 Austin-Round Rock, TX WILSON TX 45971 7240 SAN ANTONIO, TX 41700 San Antonio, TX WINKLER TX 45972 45 TEXAS * WISE TX 45973 45 TEXAS 23104 Fort Worth-Arlington, TX WOOD TX 45974 45 TEXAS * YOAKUM TX 45980 45 TEXAS * YOUNG TX 45981 45 TEXAS * ZAPATA TX 45982 45 TEXAS * ZAVALA TX 45983 45 TEXAS * STATEWIDE TX 45999 45 TEXAS * BEAVER UT 46000 46 UTAH * BOX ELDER UT 46010 46 UTAH * CACHE UT 46020 46 UTAH 30860 Logan, UT-ID CARBON UT 46030 46 UTAH * DAGGETT UT 46040 46 UTAH * DAVIS UT 46050 7160 SALT LAKE CITY-OGDEN, UT 36260 Ogden-Clearfield, UT DUCHESNE UT 46060 46 UTAH * EMERY UT 46070 46 UTAH * GARFIELD UT 46080 46 UTAH * GRAND UT 46090 46 UTAH * IRON UT 46100 46 UTAH * JUAB UT 46110 46 UTAH 39340 Provo-Orem, UT KANE UT 46120 2620 FLAGSTAFF, ARIZONA-UTAH * MILLARD UT 46130 46 UTAH * MORGAN UT 46140 46 UTAH 36260 Ogden-Clearfield, UT 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Appleton, WI OZAUKEE WI 52440 5080 MILWAUKEE-WAUKESHA, WI 33340 Milwaukee-Waukesha-West Allis, WI PEPIN WI 52450 52 WISCONSIN * PIERCE WI 52460 5120 MINNEAPOLIS-ST. PAUL, MN-WI 33460 Minneapolis-St. Paul-Bloomington, MN-WI Start Printed Page 22510 POLK WI 52470 52 WISCONSIN * PORTAGE WI 52480 52 WISCONSIN * PRICE WI 52490 52 WISCONSIN * RACINE WI 52500 6600 RACINE, WI 39540 Racine, WI RICHLAND WI 52510 52 WISCONSIN * ROCK WI 52520 3620 JANESVILLE-BELOIT, WI 27500 Janesville, WI RUSK WI 52530 52 WISCONSIN * ST. CROIX WI 52540 5120 MINNEAPOLIS-ST. PAUL, MN-WI 33460 Minneapolis-St. Paul-Bloomington, MN-WI SAUK WI 52550 52 WISCONSIN * SAWYER WI 52560 52 WISCONSIN * SHAWANO WI 52570 52 WISCONSIN * SHEBOYGAN WI 52580 7620 SHEBOYGAN, WI 43100 Sheboygan, WI TAYLOR WI 52590 52 WISCONSIN * TREMPEALEAU WI 52600 52 WISCONSIN * VERNON WI 52610 52 WISCONSIN * VILAS WI 52620 52 WISCONSIN * WALWORTH WI 52630 52 WISCONSIN * WASHBURN WI 52640 52 WISCONSIN * WASHINGTON WI 52650 5080 MILWAUKEE-WAUKESHA, WI 33340 Milwaukee-Waukesha-West Allis, WI WAUKESHA WI 52660 5080 MILWAUKEE-WAUKESHA, WI 33340 Milwaukee-Waukesha-West Allis, WI WAUPACA WI 52670 52 WISCONSIN * WAUSHARA WI 52680 52 WISCONSIN * WINNEBAGO WI 52690 0460 APPLETON-OSHKOSH-NEENAH, WI 36780 Oshkosh-Neenah, WI WOOD WI 52700 52 WISCONSIN * STATEWIDE WI 52999 52 WISCONSIN * ALBANY WY 53000 53 WYOMING * BIG HORN WY 53010 53 WYOMING * CAMPBELL WY 53020 53 WYOMING * CARBON WY 53030 53 WYOMING * CONVERSE WY 53040 53 WYOMING * CROOK WY 53050 53 WYOMING * FREMONT WY 53060 53 WYOMING * GOSHEN WY 53070 53 WYOMING * HOT SPRINGS WY 53080 53 WYOMING * JOHNSON WY 53090 53 WYOMING * LARAMIE WY 53100 1580 CHEYENNE, WY 16940 Cheyenne, WY LINCOLN WY 53110 53 WYOMING * NATRONA WY 53120 1350 CASPER, WY 16220 Casper, WY NIOBRARA WY 53130 53 WYOMING * PARK WY 53140 53 WYOMING * PLATTE WY 53150 53 WYOMING * SHERIDAN WY 53160 53 WYOMING * SUBLETTE WY 53170 53 WYOMING * SWEETWATER WY 53180 53 WYOMING * TETON WY 53190 53 WYOMING * UINTA WY 53200 53 WYOMING * WASHAKIE WY 53210 53 WYOMING * WESTON WY 53220 53 WYOMING * STATEWIDE WY 53999 53 WYOMING * *Rural designation. [FR Doc. 05-8387 Filed 4-22-05; 2:58 pm]
BILLING CODE 4120-03-P
Document Information
- Published:
- 04/29/2005
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Proposed Rule
- Action:
- Proposed rule.
- Document Number:
- 05-8387
- Dates:
- To be assured consideration, comments must be received at one of
- Pages:
- 22393-22510 (118 pages)
- Docket Numbers:
- CMS-1286-P
- RINs:
- 0938-AN89
- Topics:
- Health facilities, Hospice care, Medicare, Reporting and recordkeeping requirements
- PDF File:
- 05-8387.pdf
- CFR: (4)
- 42 CFR 418.3
- 42 CFR 418.22
- 42 CFR 418.302
- 42 CFR 418.304