05-9934. Medicare Program; Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities for FY 2006

AGENCY:

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

ACTION:

Proposed rule.

SUMMARY:

This proposed rule would update the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2006, as required by statute. Annual updates to the PPS rates are required by section 1888(e) of the Social Security Act (the Act), as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (BBRA), the Medicare, Medicaid, and State Children's Health Insurance Program (SCHIP) Benefits Improvement and Protection Act of 2000 (BIPA), and the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), relating to Medicare payments and consolidated billing for SNFs. As part of this year's annual update, we are proposing to introduce refinements in the Resource Utilization Groups, version III (RUG-III), the case-mix classification system used under the SNF PPS.

DATES:

To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on July 12, 2005.

ADDRESSES:

In commenting, please refer to file code CMS-1282-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-1282-P, P.O. Box 8016, Baltimore, MD 21244-8016.

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, Maryland address, please call telephone number [phone] 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.

FOR FURTHER INFORMATION CONTACT:

Ellen Gay, [phone] (for information related to the case-mix classification methodology, and for information related to swing-bed providers).

Jeanette Kranacs, [phone] (for information related to the development of the payment rates, and for information related to the wage index).

Bill Ullman, [phone] (for information related to coverage requirements, level of care determinations, consolidated billing, and general information).

SUPPLEMENTARY 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-1282-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 Web site 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 [phone].

To assist readers in referencing sections contained in this document, we are providing the following Table of Contents.

Table of Contents

I. Background

A. Current System for Payment of Skilled Nursing Facility Services Under Part A of the Medicare Program

B. Requirements of the Balanced Budget Act of 1997 (the BBA) for Updating the Prospective Payment System for Skilled Nursing Facilities

C. The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (the BBRA)

D. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (the BIPA)

E. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the MMA)

F. Skilled Nursing Facility Prospective Payment—General Overview

1. Payment Provisions—Federal Rates

2. Payment Provisions—Initial Transition Period

G. Use of the Skilled Nursing Facility Market Basket Index

II. Update of Payment Rates Under the Prospective Payment System for Skilled Nursing Facilities

A. Federal Prospective Payment System

1. Costs and Services Covered by the Federal Rates

2. Methodology Used for the Calculation of the Federal Rates

B. Case-Mix Adjustment and Other Clinical Issues

1. Background

2. Case-Mix Refinement Research

a. Data Sources and Analyses

b. Constructing the New RUG-III Groups

c. Development of the Case-Mix Indexes

3. Proposed Refinements to the Case-Mix Classification System

4. Implementation Issues

5. Assessment Timeframes

6. SNF Certifications and Recertifications Performed by Nurse Practitioners and Clinical Nurse Specialists

7. Concurrent Therapy

C. Wage Index Adjustment to Federal Rates

D. Proposed Area Wage Index

1. Proposed Revision of SNF PPS Geographic Classifications

2. Current SNF PPS Labor Market Areas Based on MSAs

3. Core-Based Statistical Areas

4. Proposed Revisions to the SNF PPS Labor Market Areas

a. New England MSAs

b. Metropolitan Divisions

c. Micropolitan Areas

5. Implementation of the Revised Labor Market Areas

6. Wage Index Data

E. Updates to the Federal Rates

F. Relationship of RUG-III Classification System to Existing Skilled Nursing Facility Level-of-Care Criteria

G. Initial Three-Year Transition Period From Facility Specific to Federal Rates

H. Example of Computation of Adjusted PPS Rates and SNF Payment

III. The Skilled Nursing Facility Market Basket Index

A. Use of the Skilled Nursing Facility Market Basket Percentage

B. Market Basket Forecast Error Adjustment

C. Federal Rate Update Factor

IV. Consolidated Billing

V. Application of the SNF PPS to SNF Services Furnished by Swing-Bed Hospitals

VI. Qualifying Three-Day Inpatient Hospital Stay Requirement

VII. Provisions of the Proposed Rule

VIII. Collection of Information Requirements

IX. Regulatory Impact Analysis

A. Overall Impact

B. Anticipated Effects

C. Accounting Statement

D. Alternatives Considered

Regulation Text

Addendum: Table 8 (Proposed Wage Index For Urban Areas Based On Core-Based Statistical Area (CBSA) Labor Market Areas); Table 9 (Proposed Wage Index For Rural Areas Based On CBSA Labor Market Areas); and Table A (Metropolitan Statistical Area (MSA)/CBSA Crosswalk)

In addition, because of the many terms to which we refer by abbreviation in this proposed rule, we are listing these abbreviations and their corresponding terms in alphabetical order below:

ADL Activity of Daily Living

AHE Average Hourly Earnings

ARD Assessment Reference Date

BBA Balanced Budget Act of 1997, Pub. L. 105-33

BBRA Medicare, Medicaid and SCHIP Balanced Budget Refinement Act of 1999, Pub. L. 106-113

BEA (U.S. Department of Commerce) Bureau of Economic Analysis

BIPA Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000, Pub. L. 106-554

CAH Critical Access Hospital

CBSA Core-Based Statistical Area

CFR Code of Federal Regulations

CMS Centers for Medicare & Medicaid Services

CMSA Consolidated Metropolitan Statistical Area

CPT (Physicians') Current Procedural Terminology

DRG Diagnosis Related Group

FI Fiscal Intermediary

FR Federal Register

FY Fiscal Year

GAO Government Accountability Office

HCPCS Healthcare Common Procedure Coding System

ICD-9-CM International Classification of Diseases, Ninth Edition, Clinical Modification

IFC Interim Final Rule with Comment Period

MDS Minimum Data Set

MEDPAR Medicare Provider Analysis and Review File

MIP Medicare Integrity Program

MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Pub. L. 108-173

MSA Metropolitan Statistical Area

NECMA New England County Metropolitan Area

OIG Office of Inspector General

OMRA Other Medicare Required Assessment

PCE Personal Care Expenditures

PMSA Primary Metropolitan Statistical Area

PPI Producer Price Index

PPS Prospective Payment System

PRM Provider Reimbursement Manual

RAI Resident Assessment Instrument

RAP Resident Assessment Protocol

RAVEN Resident Assessment Validation Entry

RFA Regulatory Flexibility Act, Pub. L. 96-354

RIA Regulatory Impact Analysis

RUG Resource Utilization Groups

SCHIP State Children's Health Insurance Program

SNF Skilled Nursing Facility

STM Staff Time Measure

UMRA Unfunded Mandates Reform Act, Pub. L. 104-4

I. Background

On July 30, 2004, we published a notice in the Federal Register (69 FR 45775) that set forth updates to the payment rates used under the prospective payment system (PPS) for skilled nursing facilities (SNFs), for fiscal year (FY) 2005. Annual updates to the PPS rates are required by section 1888(e) of the Social Security Act (the Act), as amended by the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (the BBRA) and the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (the BIPA), relating to Medicare payments and consolidated billing for SNFs.

A. Current System for Payment of Skilled Nursing Facility Services Under Part A of the Medicare Program

Section 4432 of the Balanced Budget Act of 1997 (the BBA) amended section 1888 of the Act to provide for the implementation of a per diem PPS for SNFs, covering all costs (routine, ancillary, and capital-related) of covered SNF services furnished to Medicare beneficiaries under Part A of the Medicare program, effective for cost reporting periods beginning on or after July 1, 1998. In this proposed rule, we propose to update the per diem payment rates for SNFs for FY 2006. Major elements of the SNF PPS include:

• Rates. Per diem Federal rates were established for urban and rural areas using allowable costs from FY 1995 cost reports. These rates also included an estimate of the cost of services that, before July 1, 1998, had been paid under Part B but were furnished to Medicare beneficiaries in a SNF during a Part A covered stay. The rates were adjusted annually using a SNF market basket index. Rates were case-mix adjusted using a classification system (Resource Utilization Groups, version III (RUG-III)) based on beneficiary assessments (using the Minimum Data Set (MDS) 2.0). The rates were also adjusted by the hospital wage index to account for geographic variation in wages. (In section II.C of this preamble, we discuss the wage index adjustment in detail.)

Correction notices were published in the Federal Register on October 7, 2004 (69 FR 60158) and on December 30, 2004 (69 FR 78445), announcing corrections to several of the wage factors. Additionally, as noted in sections I.C through I.E of this proposed rule, section 101 of the BBRA, sections 311, 312, and 314 of the BIPA, and section 511 of the MMA also affect the payment rate.

• Transition. The SNF PPS included an initial 3-year, phased transition that blended a facility-specific payment rate with the Federal case-mix adjusted rate. For each cost reporting period after a facility migrated to the new system, the facility-specific portion of the blend decreased and the Federal portion increased in 25 percentage point increments. For most facilities, the facility-specific rate was based on allowable costs from FY 1995; however, since the last year of the transition was FY 2001, all facilities were paid at the full Federal rate by the following fiscal year (FY 2002). Therefore, as discussed in section I.F.2 of this proposed rule, we are no longer including adjustment factors related to facility-specific rates for the coming fiscal year.
• Coverage. The establishment of the SNF PPS did not change Medicare's fundamental requirements for SNF coverage. However, because RUG-III classification is based, in part, on the beneficiary's need for skilled nursing care and therapy, we have attempted, where possible, to coordinate claims review procedures involving level of care determinations with the outputs of beneficiary assessment and RUG-III classifying activities. We discuss this coordination in greater detail in section II.F of this preamble. Moreover, the Part A SNF benefit has not only level of care requirements, but also a set of technical, or “posthospital” requirements as well. In section VI of this preamble, we discuss one aspect of the technical requirement for a qualifying prior inpatient hospital stay of at least 3 consecutive days, on which we invite comment.
• Consolidated Billing. The SNF PPS includes a consolidated billing provision (described in greater detail in section IV of this proposed rule) that requires a SNF to submit consolidated Medicare bills for almost all of the services that its residents receive during the course of a covered Part A stay. (In addition, this provision places the Medicare billing responsibility for physical, occupational, and speech-language therapy that the resident receives during a noncovered stay with the SNF.) The statute excludes from the consolidated billing provision a small list of services—primarily those of physicians and certain other types of practitioners—which remain separately billable to Part B by the outside entity that furnishes them.
• Application of the SNF PPS to SNF services furnished by swing-bed hospitals. Section 1883 of the Act permits certain small, rural hospitals to enter into a Medicare swing-bed agreement, under which the hospital can use its beds to provide either acute or SNF care, as needed. For critical access hospitals (CAHs), Part A pays on a reasonable cost basis for SNF services furnished under a swing-bed agreement. However, in accordance with section 1888(e)(7) of the Act, those swing-bed SNF services furnished by non-CAH rural hospitals are paid under the SNF PPS, effective with cost reporting periods beginning on or after July 1, 2002. A more detailed discussion of this provision appears in section V of this proposed rule.

B. Requirements of the Balanced Budget Act of 1997 (the BBA) for Updating the Prospective Payment System for Skilled Nursing Facilities

Section 1888(e)(4)(H) of the Act requires that we publish in the Federal Register:

1. The unadjusted Federal per diem rates to be applied to days of covered SNF services furnished during the FY.

2. The case-mix classification system to be applied with respect to these services during the FY.

3. The factors to be applied in making the area wage adjustment with respect to these services.

In the July 30, 1999 final rule (64 FR 41670), we indicated that we would announce any changes to the guidelines for Medicare level of care determinations related to modifications in the RUG-III classification structure (see section II.F of this proposed rule).

Along with a number of other revisions discussed later in this preamble, this proposed rule provides the annual updates to the Federal rates as mandated by the Act.

C. The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 (the BBRA)

There were several provisions in the BBRA that resulted in adjustments to the SNF PPS. These provisions were described in detail in the final rule that we published in the Federal Register on July 31, 2000 (65 FR 46770). In particular, section 101 of the BBRA provided for a temporary 20 percent increase in the per diem adjusted payment rates for 15 specified RUG-III groups (SE3, SE2, SE1, SSC, SSB, SSA, CC2, CC1, CB2, CB1, CA2, CA1, RHC, RMC, and RMB). Under the law, this temporary increase remains in effect until the later of October 1, 2000, or the implementation of case-mix refinements in the PPS. A discussion of the case-mix refinements that we are proposing to implement appears in section II.B of this proposed rule. Section 101 also included a 4 percent across-the-board increase in the adjusted Federal per diem payment rates each year for FYs 2001 and 2002, exclusive of the 20 percent increase.

We included further information on all of the provisions of the BBRA that affect the SNF PPS in Program Memoranda A-99-53 and A-99-61 (December 1999), and Program Memorandum AB-00-18 (March 2000). In addition, for swing-bed hospitals with more than 49 (but less than 100) beds, section 408 of the BBRA provided for the repeal of certain statutory restrictions on length of stay and aggregate payment for patient days, effective with the end of the SNF PPS transition period described in section 1888(e)(2)(E) of the Act. In the July 31, 2001 final rule (66 FR 39562), we made conforming changes to the regulations in 42 CFR section 413.114(d), effective for services furnished in cost reporting periods beginning on or after July 1, 2002, to reflect section 408 of the BBRA.

D. The Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (the BIPA)

The BIPA also included several provisions that resulted in adjustments to the PPS for SNFs. These provisions were described in detail in the final rule that we published in the Federal Register on July 31, 2001 (66 FR 39562) as follows:

• Section 203 of the BIPA exempted critical access hospital (CAH) swing-beds from the SNF PPS; we included further information on this provision in Program Memorandum A-01-09 (January 16, 2001).
• Section 311 of the BIPA eliminated the 1 percent reduction in the SNF market basket that the statutory update formula had previously specified for FY 2001, and changed the 1 percent reduction specified for FYs 2002 and 2003 to a 0.5 percent reduction. As discussed in section II.B of this proposed rule, this provision also required us to conduct a study of alternative case-mix classification systems for the SNF PPS, and to submit a report to the Congress on the results of the study.
• Section 312 of the BIPA provided for a temporary 16.66 percent increase in the nursing component of the case-mix adjusted Federal rate for services furnished on or after April 1, 2001, and before October 1, 2002. This section also required the Government Accountability Office (GAO) to conduct an audit of SNF nursing staff ratios and submit a report to the Congress on whether the temporary increase in the nursing component should be continued. GAO issued this report (GAO-03-176) in November 2002.
• Section 313 of the BIPA repealed the consolidated billing requirement for services (other than physical, occupational, and speech-language therapy) furnished to SNF residents during noncovered stays, effective January 1, 2001.
• Section 314 of the BIPA adjusted the payment rates for all of the 14 rehabilitation RUGs (RUC, RUB, RUA, RVC, RVB, RVA, RHC, RHB, RHA, RMC, RMB, RMA, RLB, and RLA), in order to correct an anomaly under which the existing payment rates for three particular rehabilitation RUGs—RHC, RMC, and RMB—were higher than the rates for some other, more intensive rehabilitation RUGs. Under the BIPA adjustment, the temporary increase that section 101(a) of the BBRA had applied to the RHC, RMC, and RMB rehabilitation RUGs was revised from 20 percent to 6.7 percent, and the BIPA adjustment also applied this temporary 6.7 percent increase to each of the other 11 rehabilitation RUGs.
• Section 315 of the BIPA authorized us to establish a geographic reclassification procedure that is specific to SNFs, but only after collecting the data necessary to establish a SNF wage index that is based on wage data from nursing homes.

We included further information on several of these provisions in Program Memorandum A-01-08 (January 16, 2001).

E. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (the MMA)

A provision of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) resulted in a further adjustment to the PPS for SNFs. Specifically, section 511 of the MMA amended paragraph (12) of section 1888(e) of the Act to provide for a temporary 128 percent increase in the PPS per diem payment for any SNF resident with Acquired Immune Deficiency Syndrome (AIDS), effective with services furnished on or after October 1, 2004. As discussed in Transmittal #160 (Change Request #3291, April 30, 2004), this add-on applies to claims with diagnosis code 042. Like the temporary add-on payments created by section 101(a) of the BBRA (as amended by section 314 of the BIPA), this special AIDS add-on was not intended to remain in effect indefinitely. As amended by section 511 of the MMA, section 1888(e)(12)(B) of the Act specifies that this temporary increase for patients with AIDS is to remain in effect only until “* * * such date as the Secretary certifies that there is an appropriate adjustment in the case mix * * * to compensate for the increased costs associated with [such] residents * * *.” As discussed elsewhere in this proposed rule, we are not proposing at this time to address the issue of such certification and, accordingly, the temporary add-on payments created by section 511 of the MMA will remain in effect during FY 2006.

The law further provided that the 128 percent increase in payment under the AIDS add-on is to be “ * * * determined without regard to any increase” under section 101 of the BBRA (as amended by section 314 of the BIPA). As explained in the MMA Conference report, this means that if a resident qualifies for the temporary 128 percent increase in payment under the special AIDS add-on, “the BBRA temporary RUG add-on does not apply in this case * * *.” (H.R. Conf. Rep. No. 108-391 at 662). The AIDS add-on was also discussed in Transmittal #160 (Change Request #3291), issued on April 30, 2004, which is available online at http://www.cms.hhs.gov/​manuals/​pm_​trans/​2004/​transmittals/​comm_​date_​dsc.asp.

In addition, section 410 of the MMA contained a provision that affects the consolidated billing requirement, which we discuss in section IV of this proposed rule.

F. Skilled Nursing Facility Prospective Payment—General Overview

The Medicare SNF PPS was implemented for cost reporting periods beginning on or after July 1, 1998. Under the PPS, we pay SNFs through prospective, case-mix adjusted per diem payment rates applicable to all covered SNF services. These payment rates cover all the costs of furnishing covered skilled nursing services (routine, ancillary, and capital-related costs) other than costs associated with approved educational activities. Covered SNF services include post-hospital services for which benefits are provided under Part A and all items and services that, before July 1, 1998, had been paid under Part B (other than physician and certain other services specifically excluded under the BBA) but furnished to Medicare beneficiaries in a SNF during a covered Part A stay. A complete discussion of these provisions appears in the May 12, 1998 interim final rule (63 FR 26252).

1. Payment Provisions—Federal Rate

The PPS uses per diem Federal payment rates based on mean SNF costs in a base year updated for inflation to the first effective period of the PPS. We developed the Federal payment rates using allowable costs from hospital-based and freestanding SNF cost reports for reporting periods beginning in FY 1995. The data used in developing the Federal rates also incorporated an estimate of the amounts that would be payable under Part B for covered SNF services furnished to individuals during the course of a covered Part A stay in a SNF.

In developing the rates for the initial period, we updated costs to the first effective year of PPS (the 15-month period beginning July 1, 1998) using a SNF market basket, and then standardized for the costs of facility differences in case-mix and for geographic variations in wages. Providers that received new provider exemptions from the routine cost limits were excluded from the database used to compute the Federal payment rates, as well as costs related to payments for exceptions to the routine cost limits. In accordance with the formula prescribed in the BBA, we set the Federal rates at a level equal to the weighted mean of freestanding costs plus 50 percent of the difference between the freestanding mean and weighted mean of all SNF costs (hospital-based and freestanding) combined. We computed and applied separately the payment rates for facilities located in urban and rural areas. In addition, we adjusted the portion of the Federal rate attributable to wage-related costs by a wage index.

The Federal rate also incorporates adjustments to account for facility case-mix, using a classification system that accounts for the relative resource utilization of different patient types. This classification system, Resource Utilization Groups, version III (RUG-III), uses beneficiary assessment data from the Minimum Data Set (MDS) completed by SNFs to assign beneficiaries to one of 44 RUG-III groups. The May 12, 1998 interim final rule (63 FR 26252) included a complete and detailed description of the RUG-III classification system, and a further discussion appears in section II.B of this proposed rule.

The Federal rates in this proposed rule reflect an update to the rates that we published for FY 2005 equal to the full change in the SNF market basket index. According to section 1888(e)(4)(E)(ii)(IV) of the Act, for FY 2006, we would update the rate by adjusting the current rates by the full SNF market basket index.

2. Payment Provisions—Initial Transition Period

The SNF PPS included an initial, phased transition from a facility-specific rate (which reflected the individual facility's historical cost experience) to the Federal case-mix adjusted rate. The transition extended through the facility's first three cost reporting periods under the PPS, up to and including the one that began in FY 2001. Accordingly, starting with cost reporting periods beginning in FY 2002, we base payments entirely on the Federal rates and, as indicated in section II.G of this proposed rule, we no longer include adjustment factors related to facility-specific rates for the coming fiscal year.

G. Use of the Skilled Nursing Facility Market Basket Index

Section 1888(e)(5) of the Act requires us to establish a SNF market basket index that reflects changes over time in the prices of an appropriate mix of goods and services included in the covered SNF services. The SNF market basket index is used to update the Federal rates on an annual basis. The final rule published on July 31, 2001 (66 FR 39562) revised and rebased the market basket to reflect 1997 total cost data.

In addition, as explained in the FY 2004 final rule (68 FR 46058, August 4, 2003) and in section III.B of this proposed rule, the annual update of the payment rates includes, as appropriate, an adjustment to account for market basket forecast error. This adjustment takes into account the forecast error from the most recently available fiscal year for which there are final data, and is applied whenever the difference between the forecasted and actual change in the market basket exceeds a 0.25 percentage point threshold. For FY 2004 (the most recently available fiscal year for which there are final data), the estimated increase in the market basket index was 3.0 percentage points, while the actual increase was 3.1 percentage points. Therefore, the payment rates for FY 2006 do not include a forecast error adjustment, as the difference between the estimated and actual amounts of change does not exceed the 0.25 percentage point threshold. Table 1 below shows the forecasted and actual market basket amounts for FY 2004.

Table 1.—FY 2004 Forecast Error Correction for CMS SNF Market Basket

Index	Forecasted FY 2004 increase *	Actual FY 2004 increase **	FY 2004 forecast error correction ***
SNF	3.0	3.1	0.0
* Published in August 4, 2003 Federal Register; based on second quarter 2003 Global Insight/DRI-WEFA forecast.
** Based on the fourth quarter 2004 Global Insight/DRI-WEFA forecast.
*** The FY 2004 forecast error correction will be applied to the FY 2006 PPS update. Any forecast error less than 0.25 percentage points is not reflected in the update.

II. Update of Payment Rates Under the Prospective Payment System for Skilled Nursing Facilities

A. Federal Prospective Payment System

This proposed rule sets forth a schedule of Federal prospective payment rates applicable to Medicare Part A SNF services beginning October 1, 2005. The schedule incorporates per diem Federal rates that provide Part A payment for all costs of services furnished to a beneficiary in a SNF during a Medicare-covered stay.

1. Costs and Services Covered by the Federal Rates

The Federal rates apply to all costs (routine, ancillary, and capital-related costs) of covered SNF services other than costs associated with approved educational activities as defined in § 413.85. Under section 1888(e)(2) of the Act, covered SNF services include post-hospital SNF services for which benefits are provided under Part A (the hospital insurance program), as well as all items and services (other than those services excluded by statute) that, before July 1, 1998, were paid under Part B (the supplementary medical insurance program) but furnished to Medicare beneficiaries in a SNF during a Part A covered stay. (These excluded service categories are discussed in greater detail in section V.B.2 of the May 12, 1998 interim final rule (63 FR 26295 through 63 FR 26297)).

2. Methodology Used for the Calculation of the Federal Rates

The proposed FY 2006 rates would reflect an update using the full amount of the latest market basket index. The FY 2006 market basket increase factor is estimated to be 3.0 percent. Consistent with previous years, this factor may be revised in the final rule when later forecast data are available. For a complete description of the multi-step process, see the May 12, 1998 interim final rule (63 FR 26252). We note that in accordance with section 101(a) of the BBRA and section 314 of the BIPA, the existing, temporary increase in the per diem adjusted payment rates of 20 percent for certain specified clinically complex RUGs (and 6.7 percent for rehabilitation RUGs) remains in effect until the implementation of case-mix refinements. (A discussion of the case-mix refinements that we now propose to implement appears in section II.B of this preamble.)

We used the SNF market basket to adjust each per diem component of the Federal rates forward to reflect cost increases occurring between the midpoint of the Federal fiscal year beginning October 1, 2004, and ending September 30, 2005, and the midpoint of the Federal fiscal year beginning October 1, 2005, and ending September 30, 2006, to which the payment rates apply. In accordance with section 1888(e)(4)(E)(ii)(IV) of the Act, the payment rates for FY 2006 are updated by a factor equal to the full market basket index percentage. The rates would be further adjusted by a wage index budget neutrality factor, described later in this section. The unadjusted rates are the same under both the existing 44 group RUG classification system and the proposed RUG-53 classification system. Tables 2 and 3 reflect the updated components of the unadjusted Federal rates for FY 2006.

Table 2.—FY 2006 Unadjusted Federal Rate Per Diem—Urban

Rate component	Nursing—case-mix	Therapy—case-mix	Therapy—non-case-mix	Non-case-mix
Per Diem Amount	$137.44	$103.53	$13.63	$70.15

Table 3.—FY 2006 Unadjusted Federal Rate Per Diem—Rural

Rate component	Nursing—case-mix	Therapy—case-mix	Therapy—non-case-mix	Non-case-mix
Per Diem Amount	$131.30	$119.38	$14.56	$71.45

B. Case-Mix Adjustment and Other Clinical Issues

[If you choose to comment on issues in this section, please include the caption “Case-Mix Adjustment and Other Clinical Issues” at the beginning of your comments.]

Under the BBA, we must publish the SNF PPS case-mix classification methodology applicable for the next Federal FY before August 1 of each year. As discussed in the following sections, we propose to begin utilizing a refinement to the RUG-III case-mix classification system applicable to the SNF PPS during FY 2006, and we specifically solicit comments on the proposed refinement.

1. Background

The SNF PPS replaced the cost-based structure that had been in effect since the inception of the Medicare program. Under the SNF PPS, providers have more flexibility in the use of Medicare funds but are responsible not only for furnishing the full range of services to Medicare beneficiaries, but for the cost effectiveness of their purchasing decisions. Like the inpatient hospital PPS, reimbursement for all services, including therapy and other ancillaries such as diagnostic tests, supplies, and pharmacy, were for the first time included in the SNF Part A “bundle of services” and reimbursed directly to the SNF rather than to the actual entity furnishing the service.

In addition, in response to over a decade of rapidly rising Medicare SNF payments, the SNF PPS instituted controls to adjust for identified overutilization and inflated charge structures for therapy and other ancillary services. By restructuring the payment system to reflect a more appropriate expenditure level, there was an aggregate decrease in Medicare expenditure levels for the first SNF PPS year. Providers responded to the SNF PPS by restructuring their operations and practice patterns in an effort to adapt to the new payment structure and incentives.

These rapid changes in facility practices and Medicare payment also generated significant concerns that the transition to a prospective payment system would impede access for beneficiaries with complex medical needs and, by decreasing aggregate payments to SNFs, negatively affect the quality of care in nursing homes across the country. The research presented in this proposed rule was initiated as part of a broad-based effort to investigate and respond to access, quality, and payment concerns raised by industry, advocates, and other stakeholders.

During the course of this effort, CMS developed tools to monitor and evaluate quality of care that are now integral components of our program oversight activities, including the use of Quality Indicators, Quality Measures, and Nursing Home Compare. As discussed later in this section, the development of these new capabilities has also positioned us to move forward in new areas. The refinements discussed in this section are based on research originally conducted by Abt Associates (and later validated by the Urban Institute) that was initiated immediately after the introduction of the SNF PPS in 1999.

In the BBRA, the Congress acted to address these access and quality concerns by enacting a series of temporary payment adjustments. At present, only one of these payment adjustments is still in effect, a 20 percent increase in the per diem adjusted payment rates for 12 complex medical RUG-III groups (SE3, SE2, SE1, SSC, SSB, SSA, CC2, CC1, CB2, CB1, CA2, and CA1,) and a 6.7 percent increase to all 14 rehabilitation groups. This legislation specified that the payment adjustments would continue until the later of: (1) October 1, 2000, or (2) implementation of a refined case-mix classification system under section 1888(e)(4)(G)(i) of the Act that would better account for medically complex patients.

As we noted in the SNF PPS proposed rule for FY 2001 (65 FR 19190, April 10, 2000), this mandated rate increase was intended to serve as a temporary, interim adjustment to the payment rates and RUG-III case-mix classification system as published in the final rule of July 30, 1999, until implementation of the case-mix refinements described in the legislation. In that FY 2001 proposed rule, we included a proposal for an extensive, comprehensive set of refinements to the existing case-mix classification system that collectively would have resulted in expanding the existing 44-group structure to well over 150 groups.

The speed with which we conducted this initial evaluation of the SNF PPS demonstrated our commitment to ensuring the accuracy and equity of the new payment system, but the evaluation had important limitations. Comprehensive SNF PPS data were not yet available, and the research was conducted using 1995-1997 data housed in a large, cross-linked research database collected from only six states that had implemented a RUG-III payment system prior to July 1998 (either through the Federal case-mix demonstration project or for state Medicaid payment). These limitations were explained in the proposed rule along with our plans to validate the data using a national SNF PPS database (65 FR 19193, April 10, 2000).

In conducting the validation analyses, it became clear that the introduction of the SNF PPS and SNF consolidated billing had caused changes in facility practice patterns and billing. Some of these changes could also have been related to the use of a national database and to changing industry practices during the early stages of the SNF PPS implementation. While it was still true that beneficiaries requiring both rehabilitation and extensive medical services used greater amounts of ancillary services, the distribution patterns for those high-cost ancillaries (such as medications and respiratory therapy) had changed from the patterns in the six-state data. These results, in conjunction with the high degree of intra-group and inter-group variability in ancillary utilization identified in both the initial and validation analyses, raised new questions that needed to be addressed prior to implementing refinements. For these reasons, we decided not to implement such refinements at that time. (See the FY 2001 final rule, 65 FR 46773, July 31, 2000.)

Several months later, the Congress enacted the BIPA. Of the various provisions of this legislation that addressed the SNF PPS, one directive also addressed the future development of the SNF PPS. Specifically, section 311(e) of the BIPA directed us to conduct a study of the different systems for categorizing patients in Medicare SNFs in a manner that accounts for the relative resource utilization of different patient types and to issue a report with any appropriate recommendations to the Congress.

Based upon the broad language describing the purpose of this study, and the multi-year timeframe provided for conducting it, we believe that the Congress clearly intended for this study to address comprehensive changes, by evaluating a number of different classification systems and considering the full range of patient types. In contrast, since the BBRA specifically ties the duration of its temporary payment increases to the implementation of a case-mix refinement that would “better account for medically complex patients,” we believe that even case-mix refinements of a more incremental nature would meet this more targeted mandate to better account for medically complex patients, and need not await the completion of the broader changes envisioned in the BIPA provision.

Moreover, ongoing analysis of the SNF PPS showed that providers have adjusted to it, and that the SNF PPS rates have generally covered the cost of care to Medicare beneficiaries. For example, in its March 2005 report, MedPAC estimated 2005 profit margins for freestanding SNFs of 13 percent. In this environment, it is appropriate to reevaluate the need for maintaining payment adjustments that were always intended to be temporary.

2. Case-Mix Refinement Research

a. Data Sources and Analyses

In July 2001, we awarded a contract to the Urban Institute (Urban) for performance of research to aid us in making refinements to the case-mix classification system under section 1888(e)(4)(G)(i) of the Act and starting the case-mix study mandated by section 311(e) of the BIPA. The first phase of the contract focused on developing options for refining the case-mix classification system under section 1888(e)(4)(G)(i) of the Act to account for medically complex patients. As part of this research, Urban updated and broadened the database created for the previous refinement analyses by using 1999 matched MDS and SNF claims, and applied the latest cost report data (1998 and 1999) to estimate costs more accurately for non-therapy ancillary and other services.

We then used this updated and broadened database to replicate and validate the earlier studies conducted by Abt. The study used Medicare SNF claims data for calendar year 1999 and MDS data from our National MDS Repository. We matched the claims to the MDS assessments upon which they were based, yielding approximately 2.7 million MDS segments, resulting in every national facility that billed Medicare for a Part A SNF stay in 1999 being represented in the database. We allocated the non-therapy ancillary costs to the portion of the stay in which they were most likely to have been incurred according to a set of decision rules. We performed comparative analyses of cost and charge data to other existing administrative data sets in order to establish the validity of these data. We also performed a further regression analysis of costs and RUG-III groups.

In addition, we constructed anew the case-mix indexes using our Staff Time Measurement (STM) study data. The STM data were collected in 1990, 1995, and 1997, and are described in the May 12, 1998 interim final rule (63 FR 26252) that implemented the SNF PPS.

Urban then analyzed 270,215 records, a 10 percent sample of this updated and broadened database. As expected, our analyses again verified that non-therapy ancillary costs are higher for Medicare beneficiaries who classify into the Extensive Services category than for those who classify to other categories. In these analyses, Urban found that the addition of a combined Rehabilitation plus Extensive group improved the predictive power of the model. These results were very similar to the preliminary Abt results discussed in our FY 2001 proposed rule, and provided validation for the preliminary Abt analyses (that is, both studies showed an increase in the R-square (explanation of variance) for non-therapy ancillaries from approximately 4.1 percent in the 44-group model to 8 percent in the 58-group model that added nine Rehabilitation plus Extensive groups).

Urban then replicated its results with 2001 data using the same analytic protocols. In this study, Urban found that the addition of a new RUG-III Rehabilitation plus Extensive category was consistent with the prior research. Urban used a 163,386 record test sample and found that the R-square for non-therapy ancillaries improved to 9.5 percent from the previous result of 4.1 percent mentioned above. The analyses were repeated on a 170,253 record validation sample with a comparable result; that is, an R-square of 10.3 percent.

While maintaining the general structure of the RUG-III system, we found that the most viable way to refine the system at the present time would be to add groups to the top of the hierarchy to capture beneficiaries who qualify for both the Extensive Services category and the Rehabilitation Therapy category. In addition, beneficiaries who qualify for Extensive Services and receive rehabilitation services have assumed a larger percentage of the Medicare patient population in SNFs in recent years. Therefore, we believe that the RUG-III case-mix classification system can provide even more accurate payment for these beneficiaries if refined to create a new RUG-III category for beneficiaries who qualify for both the Extensive Services and Rehabilitation Therapy categories.

b. Constructing the New RUG-III Groups

Our research findings showed little or no correlation between the groups within the Extensive Services category (that is, SE1, SE2, SE3) and the level of rehabilitation services used. For this reason, the structure for this new hierarchy level would closely mirror that of the existing Rehabilitation Therapy groups. Normally, this methodology would result in the creation of 14 new groups, the number that was originally proposed in the FY 2001 proposed rule. However, for the reasons discussed below, the more recent research (Urban 2003) has shown that a smaller number of RUG-III groups are sufficient to address the needs of beneficiaries eligible for a new RUG-III category, Combined Rehabilitation and Extensive Care.

First, we found that several of the groups had very few beneficiaries assigned to them. In fact, no beneficiaries at all were assigned to several of the lowest ADL score rehabilitation groups. Second, under the present structure, each Rehabilitation group is sub-divided into three levels based on the activities of daily living (ADL) score. The lowest level ADL score for the Rehabilitation groups is either 4-7 or 4-8, and very few beneficiaries currently classify into those groups. No beneficiaries who would qualify for the proposed newly created groups would classify into such a low ADL score level, as a minimum ADL score of seven is required for classification into an Extensive Care group.

Therefore, it appears that stratification for the lowest level ADL scores for the proposed new groups would add needless complexity and, thus, would not be warranted. Instead, we propose to combine that level with the next higher level, and would no longer use the ADL scores lower than 7. Thus, the proposed new groups would be stratified only by two levels of ADL score. For example, the Rehabilitation High plus Extensive Services group would be subdivided into only two ADL levels, ADL scores of 7-12 and 13-18. This left us with only one level for Rehabilitation Low plus Extensive Services and with only two levels at each of the other sub-categories in the new category, for a total of 9 new groups. As a result, we are proposing the addition of 9 new RUG-III groups.

Table 3a.—Crosswalk Between Existing RUG-III Rehabilitation Groups and the Proposed Extensive Plus Rehabilitation Groups

	Current rehabilitation groups	New combined extensive plus rehabilitation groups
Rehab Ultra	• RUC-ADL 16-18. • RUB-ADL 9-15 • RUA-ADL 4-8	• RUX-ADL 16-18. • RUL-ADL 7-15.
Rehab Very High	• RVC-ADL 16-18. • RVB-ADL 9-15. • RVA-ADL 4-8	• RVX-ADL 16-18. • RVL-ADL 7-15.
Rehab High	• RHC-ADL 13-18. • RHB-ADL 8-12 . • RHA-ADL 4-7	• RUX-ADL 13-18. • RUL-ADL 7-12.
Rehab Medium	• RHC-ADL 15-18 • RHB-ADL 8-14. • RHA-ADL 4-7	• RUX-ADL 15-18. • RUL-ADL 7-14.
Rehab Low	• RLB-ADL 14-18 • RLA-ADL 4-13	• RUX-ADL 7-18

c. Development of the Case-Mix Indexes

We developed the case-mix indexes for the proposed refined RUG-III system using the same method used for calculating the initial SNF PPS case-mix indexes. The original staff time studies conducted in 1990, 1995, and 1997 resulted in the assignment of resident-specific and non-resident specific time (minutes) to individual SNF residents. In the initial determination of the case-mix indexes, the residents were classified into the 44-group system and the minutes of staff time, nursing, and therapy services, where appropriate, remained associated with those residents. All of the staff time was stratified by type of staff providing the minutes of time (for example, RN, LPN, etc.), and the minutes were weighted for salary.

In order to calculate weights for the proposed refined system, we used the minutes as originally assigned at the individual patient level. We reclassified the patients into the proposed 53 groups with their associated wage-weighted minutes of resident-specific and nonresident-specific staff time. The next step was to apply these wage-weighted minutes to the entire sample population of 26 million days. We multiplied the population in each group by the wage-weighted minutes for each of the staff types. We then derived an average for the group using the sum of the wage-weighted minutes for all staff (nursing and therapy staff minutes were calculated separately) xxdivided by the total population for that group. The relative weight was then calculated by dividing that average by the average minutes across all of the RUG-III groups.

The nursing weights changed more than the therapy weights, due to the redistribution of patients from existing groups to the newly created proposed groups. Even though many of the beneficiaries who move into one of the proposed new groups are from an existing therapy group, the therapy weights are affected only slightly. This is because the amount of therapy time does not change significantly between the existing groups and the proposed new groups. The therapy groups were already narrowly stratified by minutes of therapy provided. The groups' weights would be affected only to the extent that the individual beneficiaries who are reclassified into one of the proposed new groups have unusually high or low minutes of therapy within the specific limits. The nursing weights are more affected by the reclassifications, as those are based on a much broader scope of possible minute values.

The therapy weights for the nine proposed Rehabilitation Therapy plus Extensive Services groups were identical to those for the comparable existing RUG-III rehabilitation therapy groups. Although we are capturing increased medical/clinical complexity with the proposed new groups, the therapy contribution remains the same as for the existing therapy groups. In this way, the Rehabilitation High therapy weight is identical to the new Rehabilitation High plus Extensive Services sub-category.

The effect of the increased number of groups and changes in the case-mix indexes should be distributional. By this we mean that the relative weights assigned to each RUG-III group would shift so that the proposed new Rehabilitation plus Extensive groups would have the highest relative weights and the weights for other RUG-III groups would decrease proportionally.

The results of applying these methods to index calculation worked well and yielded hierarchically sound indexes for all of the groups; that is, the indexes for the highest groups in the hierarchy are higher than for those below it, and this pattern holds throughout the proposed new category.

The nursing indexes in the new category, as well as in the existing rehabilitation category, are naturally more compressed (that is, encompass a smaller range) than those in the 44-group RUG-III rehabilitation groups. The groups within the new Rehabilitation plus Extensive category are more homogeneous than were the rehabilitation groups of the 44-group system. By removing the most clinically complex cases and better accounting for them by putting them in rehabilitation groups of their own, both the resulting proposed new category and the remaining rehabilitation category groups would be more homogeneous and, therefore, the relative weights for each set of groups would exhibit less variance.

Next, we simulated payments using the existing weights compared to the new weights to ensure that the refinement did not result in greater or lesser aggregate payments. The simulation results showed an almost exact match in payments under both case-mix models. However, the proposed new 53-group model did yield a slight decrease (less than 1 percent) in aggregate Medicare payments. To remove this minor variance, we then applied a factor of +.02 to calibrate the nursing indexes and re-ran the simulation. Using this calibration factor of +.02, we are able to ensure absolute parity of aggregate payment under the 53-group RUG-III system compared to the 44-group system.

Finally, we propose to provide for an additional adjustment to the nursing component of the case-mix weights (which includes non-therapy ancillary services) for all RUG-53 groups. As discussed further in section II.B.3 of this proposed rule, we have reviewed data that show a high degree of variability in non-therapy ancillary utilization, not only within but across RUG groups. Therefore, we believe that it is appropriate to adjust the case-mix weights for all 53 groups (that is, the existing 44 RUG-III groups plus the 9 new groups that we are proposing to create in this proposed rule) to better account for non-therapy ancillary variability. We would do this under our authority in section 1888(e)(4)(G)(i) of the Act to establish an “appropriate adjustment to account for case mix * * * *”

In determining the size of this adjustment, we considered not only the high degree of variability in non-therapy ancillary costs, but also the absence of an outlier policy under the SNF PPS. Accordingly, we looked at the outlier pool established under another post-acute care PPS, the one for inpatient rehabilitation facility (IRF) services, which is set at 3 percent of aggregate expenditures. For the purpose of this refinement, our calculations employed a comparable funding level that could be targeted toward payment of non-therapy ancillaries. Based on this analysis, we are proposing an increase to the nursing component of the case-mix weights (the component that includes non-therapy ancillaries) of approximately 8.4 percent, which equates to approximately 3 percent of aggregate expenditures under the SNF PPS. The final RUG-53 nursing indexes are presented in Tables 4a and 5a. Further information regarding this adjustment can be found in section II.B.3 of this proposed rule.

3. Proposed Refinements to the Case-Mix Classification System

[If you choose to comment on issues in this section, please include the caption “Proposed Refinements to the Case-Mix Classification System” at the beginning of your comments.]

We note that, of the various individual refinements that were collectively set forth in the FY 2001 proposed rule (65 FR 19194), the particular refinement that entailed the least amount of added complexity (yet addressed the medically complex patient) involved the creation of several additional groups that would comprise a new, combined Rehabilitation plus Extensive Services category. As we noted in that proposed rule:

There are * * * a significant number of beneficiaries who would classify into the Extensive Services category based on clinical conditions but who, because they are also receiving rehabilitation services, classify into one of the Rehabilitation groups instead (due to the hierarchical logic of the RUG-III classification system). These beneficiaries carry with them the same non-therapy ancillary costs associated with their complex clinical needs even though they are classified into a RUG-III Rehabilitation category. The high costs for beneficiaries in the Extensive Services category suggest that the payment rate for Extensive Services should be increased. However, increasing the payment rate without further adjustments could adversely affect provider incentives to provide therapy to beneficiaries requiring Extensive Services. Therefore, we expanded the scope of the proposed refinement to include new categories for beneficiaries who qualify for both Extensive Services and a RUG-III Rehabilitation category.

Further, as our subsequent research (discussed in the previous section) confirmed, the creation of a proposed new Rehabilitation plus Extensive category would be a means of accounting more accurately for the costs of certain medically complex patients, with the added benefit of a minimal degree of added complexity. We note that, in the past, some support has been expressed for making this particular type of modification to the existing case-mix classification system.

Therefore, we propose to refine the case-mix classification system under section 1888(e)(4)(G)(i) of the Act by creating a new, combined Rehabilitation plus Extensive category, that better accounts for medically complex patients, as required in section 101 of the BBRA. Accordingly, the payment rates set forth in this proposed rule reflect the use of the refined 53-group RUG classification system that we are proposing. The nine groups that we propose to add to the existing RUG-III system are as follows:

RUX Rehabilitation Ultra High plus Extensive Services, High

RUL Rehabilitation Ultra High plus Extensive Services, Low

RVX Rehabilitation Very High plus Extensive Services, High

RVL Rehabilitation Very High plus Extensive Services, Low

RHX Rehabilitation High plus Extensive Services, High

RHL Rehabilitation High plus Extensive Services, Low

RMX Rehabilitation Medium plus Extensive Services, High

RML Rehabilitation Medium plus Extensive Services, Low

RLX Rehabilitation Low plus Extensive Services

We note that, like our current proposal, the case-mix refinement that we considered in our FY 2001 proposed rule would have reconfigured the RUGs themselves, in a general effort to allocate payments more accurately under the SNF PPS. However, that earlier proposal also included an additional element, which was intended to help ensure more accurate allocation of payments specifically with regard to non-therapy ancillaries (such as drugs and medications, laboratory services, supplies and other equipment). For example, it proposed moving the non-therapy ancillary costs used in establishing the nursing case-mix component of the payment rates to a separate, newly created “medical ancillary” component (65 FR 19192, April 10, 2000). In addition, it suggested a number of possible models, both weighted and unweighted, for a new non-therapy ancillary index (65 FR 19248ff). As noted in the FY 2001 final rule, these elements ultimately were not adopted when subsequent research indicated that their added complexity would outweigh their increased predictive power (65 FR 46774, July 31, 2000).

Following the publication of that final rule, further research in this area revealed a high degree of variability in non-therapy ancillary utilization, both within and across the various RUG-III groups. This finding suggested that using an index model to address non-therapy ancillary services might require the creation of such a high number of groups as to be impractical.

In fact, the ability of the SNF PPS to account adequately for non-therapy ancillary services has been the subject of attention (and a focus of our research) since the very inception of the system. When the Congress originally enacted the SNF PPS in the BBA, it expressed concern in the accompanying legislative history “* * * that under a prospective payment system that includes all services there may be incentives to decrease the use of ancillary services' (H. Rep. No. 105-149 at 1318). Subsequent legislative initiatives, such as the BBRA mandate to develop case-mix refinements that better account for “medically complex” patients, and the directive in section 311(d) of the BIPA for the GAO to conduct a study of the adequacy of Medicare's SNF payment rates, can all be viewed in the context of an ongoing Congressional concern in this area.

For those reasons, and because the data that we have show wide variability in non-therapy ancillary utilization within each RUG, we believe the refinement that we now propose should include not only a reconfiguration of the RUGs that addresses the accuracy of payment allocation in general terms, but also an additional element that improves the accuracy of payment allocation and accounts more directly for cost variations related to non-therapy ancillary services. Accordingly, as part of our proposed refinement, we propose to increase the case-mix indexes of the existing 44 RUG-III groups (as well as those of the nine proposed new Rehabilitation plus Extensive Services RUGs), by calculating a percentage increase that would increase aggregate payments.

As noted previously, we have reviewed data that show great variability in the ancillary services (such as pharmacy) utilized by different SNF residents who are classified into the same RUG-III group. For example, two different patients, both classified into the SE3 group, might utilize markedly different amounts of ancillary services for reasons that are not captured within the current RUG-III classification methodology. Our data show that the same is true across all of the existing 44 RUG-III groups. The addition of the 9 new groups does not, in itself, compensate for this discrepancy. Although the SNF payment system is designed as a prospective payment system, under which SNFs that treat patients grouped into the same clinical condition should receive the same base payment, the variability in ancillary usage that our data show makes it difficult to account fully for non-therapy ancillary costs by adjusting the number of groups. Therefore, we believe that it is appropriate, considering the data that we have available to us, to provide for an adjustment to each RUG case-mix weight to account for the variability in non-therapy ancillaries, using the authority that we have under section 1888(e)(4)(G)(i) of the Act.

Additionally, we have found a high degree of variability in non-therapy ancillaries not only within but across RUG groups. We have reviewed data showing that an individual patient who is classified into a less intensive RUG may nonetheless be significantly more expensive to treat in terms of non-therapy ancillaries than an individual patient in a more intensive RUG. The data that we have do not adequately explain these discrepancies, and the addition of the 9 new RUGs does not eliminate them. Our data show that the same is true across all 44 RUG-III groups. We note that in creating the SNF PPS, the Congress enacted the only PPS legislation in the Medicare program that does not establish an outlier policy to capture high variability in resource utilization. Therefore, in view of the data that we have available to us that demonstrates wide disparities in non-therapy ancillary resources consumed by patients both within and across RUG-III groups, we believe that it is appropriate to adjust the case-mix weights for all 53 groups (that is, the existing 44 RUG-III groups plus the 9 new groups that we are proposing to create in this proposed rule) to better account for non-therapy ancillary variability. We would do this by exercising our authority under section 1888(e)(4)(G)(i) of the Act to establish an “appropriate adjustment to account for case mix,” in order to maintain access and quality of care for heavy-care patients.

In determining the size of this adjustment, we considered the high degree of variability in non-therapy ancillary costs (which was not yet known at the time that the BBA and the BBRA were enacted), and the absence of an outlier policy under the SNF PPS. Accordingly, we looked at the outlier pool established under another PPS for post-acute care, the inpatient rehabilitation facility prospective payment system (IRF PPS), which is set at 3 percent of aggregate expenditures. For the purpose of this refinement, we calculated the SNF dollars needed to achieve a comparable funding level that could be targeted towards payment of non-therapy ancillaries. Based on this analysis, we are proposing an increase to the nursing component of the case-mix weights (the component that includes non-therapy ancillaries) of approximately 8.4 percent, which equates to approximately 3 percent of aggregate expenditures under the SNF PPS.

Moreover, we believe that this type of adjustment can essentially serve as a proxy for the non-therapy ancillary index that we proposed previously as a means of achieving more appropriate payment for these services, without the potential drawbacks of our earlier proposal in terms of complexity and addressing variability in utilization. In fact, while we are confident that the decision to maintain a relatively small number of RUG groups is correct in terms of the overall operation of the SNF PPS, it is still true that this number of groups made it extremely difficult to distinguish different levels of non-therapy ancillary use. The problem may be less severe in other PPSs that use a greater number of groups. For example, the IRF PPS was initially structured to have 100 groups, and the inpatient hospital PPS (IPPS) has over 500 diagnosis-related groups. Similarly, there are over 7,000 relative value units under the resource-based relative value scale that determines the payment rates for physician and other Part B services. By contrast, under this proposed rule, there will be only 53 RUGs. By definition, then, there will be wider variation in the resource needs of patients classified into a particular RUG. We, therefore, believe that it is appropriate to provide for a further adjustment to the case-mix index to compensate for these broad discrepancies.

We note that we are advancing these proposed changes under our authority in section 101(a) of the BBRA to establish case-mix refinements, and that the changes we are hereby proposing will represent the final adjustments made under this authority. Accordingly, any future changes to the case-mix weights or other components of the SNF PPS would be accomplished through staff time measures and other validated analytical studies.

As further explained in section II.B.4 of this proposed rule, these additional payments would partially offset the expiration of the temporary add-on payments that will occur, under the terms of section 101(c) of the BBRA, upon the implementation of this proposed case-mix refinement. We believe that implementing the proposed case-mix refinement in this manner will carry out Congressional intent that the BBRA's temporary payment add-ons should not continue indefinitely into the future, while at the same time ensuring that payments under the SNF PPS continue to support the quality of care furnished in this setting.

Further, the creation of the proposed new Rehabilitation plus Extensive Services groups underscores the importance of ensuring the accuracy of patient classifications, particularly with regard to those categories, such as Extensive Services, that encompass medically complex patients. One way to accomplish this could be by ensuring that the MDS data used in making such classifications reflect only those services that are actually furnished during the SNF stay itself rather than during the preadmission period (for example, during the prior qualifying hospital stay). In the July 30, 1999 SNF PPS final rule (64 FR 41668 through 41669), we noted a public comment that questioned the appropriateness of the MDS's 14-day “look-back” provision in the specific context of the SNF level of care presumption. While we made no revisions to the look-back provision at that time, we specifically reserved the right to reconsider the continued use of this mechanism in the future.

Subsequent analysis in this area has focused on the four items contained in the Special Service section of the MDS (P1a—IV medications, suctioning, tracheostomy care, and use of a ventilator/respirator) that serve to classify residents into Extensive Care, the category used for the most medically complex SNF patients under the RUG-III classification system. This analysis indicates that the use of the look-back provision has caused a significant number of residents to classify to the Extensive Services category based solely on services (such as intravenous medications) that were furnished exclusively during the period before SNF admission. Depending on how such a proposal was formulated, it has the potential to reduce overall SNF payments by better aligning them with the services actually provided. Therefore, we seek comment on the potential savings and other impacts of revising the MDS Manual instructions to include only those special care treatments and programs (MDS Section P1a) furnished to the resident since admission or re-admission to the SNF, similar to the requirement for P1b. We anticipate that this change can be accomplished through an update to the MDS Manual instructions, and will not involve system changes at the facility, State agency, or Federal level.

In addition, we are inviting comments on other policy options that could enhance the accuracy of the payment system and improve the quality of care provided to Medicare beneficiaries during an SNF stay, without limiting access to post-acute care. For example, we have received recommendations to decrease or eliminate the grace day period specifically for the 5-day PPS MDS assessment. We invite comments on this specific recommendation as well as decreasing or eliminating the grace periods associated with all PPS MDS assessments. Another example of a possible policy change on which we invite comment would be whether it might be appropriate to eliminate the projection of anticipated therapy services during the 5-day PPS assessment. We invite comments on these and other existing SNF policies that may have an impact on the quality of care in this setting.

In accordance with section 101 of the BBRA, implementing these proposed refinements to the case-mix system means that the payment rates set forth in this proposed rule would no longer reflect the temporary add-ons to the Federal rates for specified RUG-III groups. We understand that the expiration of the temporary payment increases, provided for in that legislation, results in a significant reduction in Medicare's payments between FY 2005 and FY 2006. In fact, MedPAC has consistently urged that, until CMS can design a new payment methodology, some or all of the temporary add-on payments be retained and allocated towards beneficiaries with complex medical needs.

While this proposed rule sets forth refinements to the existing case-mix classification system and RUG-III categories, we are soliciting comments on the economic impact of the resulting payment changes, as well as their potential impact on beneficiaries' access to quality SNF care. We also invite comments on possible ways in which the case-mix classification system itself might be further modified to help mitigate the effect of the payment changes.

We note that the expiration of the BBRA add-on payments would not necessarily affect the temporary 128 percent increase in the per diem adjusted payment rates for SNF residents with AIDS. In enacting that temporary increase, the Congress cited past research indicating that “* * * AIDS patients have much higher costs than other patients in the same resource utilization groups in skilled nursing facilities” (H. Rep. No. 108-178, Part 2, at 221). This underscored the Congress' view that AIDS patients are unique among SNF residents in that they incur significantly higher care costs than residents with other diagnoses, including those who classify to the same RUG-III group. We believe that even if a case-mix refinement can meet the BBRA criterion of better accounting for the needs of medically complex patients generally, this still might not enable the Secretary to certify under section 1888(e)(12)(B) of the Act “* * * that there is an appropriate adjustment in the case mix * * * to compensate for the increased costs” specifically associated with this particular group of patients. Thus, while the implementation of case-mix refinements will trigger the expiration of the 20 percent and 6.7 percent add-on payments under section 101(a) of the BBRA (as amended by section 314 of the BIPA), this may not necessarily be the case for the AIDS add-on payments under section 511 of the MMA. Accordingly, pending further examination of this issue, we believe that it would be premature at this time for the Secretary to make the required certification under section 1888(e)(12)(B) of the Act with respect to the unique conditions that pertain to the care of SNF residents with AIDS. As a result, the 128 percent add-on payments for SNF residents with AIDS will remain in effect during FY 2006.

The case-mix adjusted payment rates are listed separately for urban and rural SNFs for the existing 44 group RUG and proposed RUG-53 classification systems in Tables 4, 4a, 5, and 5a, with the corresponding case-mix index values.

We also remain committed to our long-term efforts to monitor the RUG-III case-mix classification system and to an ongoing effort to increase the accuracy and efficiency of the SNF PPS. A series of analyses, including the studies used to develop the refinements discussed above, will be discussed in a forthcoming report to the Congress. In this report, we will discuss the findings and put forth a series of next steps that will provide a framework for future progress. In addition, we have posted data describing the research conducted by ABT and the Urban Institute on our SNF PPS Web site at http://www.cms.hhs.gov/​providers/​SNF PPS. Commenters may wish to consult this material to facilitate a more in depth understanding of the proposals contained in this document.

Moreover, we would like to take this opportunity to discuss our thinking related to broader initiatives in this area related to quality of care. Through the Nursing Home Quality Initiative, the Long Term Care Task Force and other forums for collaborative action, CMS has worked with the SNF industry on the development of valid quality measures, and a variety of quality improvement efforts focused on nursing homes. These efforts and others have resulted in improvements in the quality of care, particularly in facilities that adopt a culture that promotes quality through continuous quality initiatives (CQI), culture change, and other similar programs. Pay for performance is a tool that could provide additional support to improve the quality of care provided in nursing homes. In this way, we could recognize and support the ongoing efforts of nursing homes to improve quality.

Designing Pay for Performance programs for the SNF setting presents some significant issues. While Medicare beneficiaries are the primary users of SNF services, only a small percentage of these beneficiaries (that is, approximately 10 percent) receive services that are reimbursed under Medicare Part A. The majority of beneficiaries receive services that are reimbursed by multiple payers, including Medicare Part B, Medicaid, and private insurance, and that are delivered within different parts of a nursing facility. Therefore, it is not enough to change practice patterns in just a part of a nursing home (that is, skilled units), as Medicare beneficiaries can be placed anywhere in the facility. In addition, the focus of the nursing, rehabilitative, and medical interventions will typically vary for persons who are receiving short-term skilled nursing facility services versus those persons who are long-term residents in nursing facilities.

For these reasons, quality measures must be carefully constructed; that is, broad-based and designed to effect change across the mix of patients residing in the facility. Similarly, we need to consider how to design effective incentives; that is, superior performance measured against pre-established benchmarks and/or performance improvements.

In addition, while our efforts to develop the various post-acute care PPSs (including the SNF PPS) have generated substantial improvements over the preexisting cost-based systems, each of these individual systems was developed independently. As a result, we have focused on phases of a patient's illness as defined by a specific site of service, rather than on the entirety of the post-acute episode from the standpoint of the patient rather than the facility. As the various provider types (such as SNFs and inpatient rehabilitation facilities (IRFs)) provide similar types of services in some cases, and as the opportunities to provide similar services in different settings increase, we need to investigate a more coordinated approach to payment and delivery of post-acute services that focuses on the overall post-acute episode.

This could entail a strategy of developing payment policy that is as neutral as possible regarding provider and patient decisions about the use of particular post-acute services. That is, Medicare should provide payments sufficient to ensure that beneficiaries receive high quality care in the most appropriate setting, so that admissions and any transfers between settings occur only when consistent with good care, rather than to generate additional revenues. In order to accomplish this objective, we need to collect and compare clinical data across different sites of service.

In fact, in the long run, our ability to compare clinical data across care settings is one of the benefits that will be realized as a basic component of our interest in the use of standardized electronic health records (EHRs) and other steps to promote continuity of care across all settings, including nursing homes. It is also important to recognize the complexity of the effort, not only in developing an integrated assessment tool that is designed using health information standards, but in examining the various provider-centric prospective payment methodologies and considering patient-centric payment approaches that are based on patient characteristics and outcomes. MedPAC has recently taken a preliminary look at the challenges in improving the coordination of our post-acute care payment methods, and suggested that it may be appropriate to explore additional options for reimbursing post-acute services. We agree that CMS, in conjunction with MedPAC and other stakeholders, should consider a full range of options in analyzing our post-acute care payment methods, including the SNF PPS.

We also want to encourage incremental changes that will help us build toward these longer-term objectives. For example, several automated medical record tools are now available that could allow hospitals and SNFs to coordinate discharge planning procedures more closely. These tools can be used to ensure communication of a standardized data set that can also be used to establish a comprehensive SNF care plan. Improved communications may reduce the incidence of potentially avoidable re-hospitalizations and other negative effects on quality of care that occur when patients are transferred to SNFs without a full understanding of their care needs. CMS is looking at ways that Medicare providers can use these tools to generate timely data to support continuity across settings. We are also interested in comments on payment reforms that could promote and reward such continuity, and avoid the medical complications and additional costs associated with re-hospitalization.

Some of the ideas discussed here may exceed CMS's current statutory authority. However, we believe that it is useful to encourage discussion of a broad range of ideas for debate of the relative advantages and disadvantages of the various policies affecting this important component of the health care sector, to ensure that our administrative actions provide maximum support for further steps toward higher quality post-acute care. We welcome comments on these and other approaches.

4. Implementation Issues

[If you choose to comment on issues in this section, please include the caption “Implementation Issues” at the beginning of your comments.]

As noted previously in this proposed rule, the temporary add-on payments enacted by section 101(a) of the BBRA expire upon the implementation of case-mix refinements. Section 101(c) of the BBRA specifies that the actual date on which these temporary add-on payments are to expire is “the later of—(1) October 1, 2000; or (2) the date on which the Secretary implements a refined case mix classification system under section 1888(e)(4)(G)(i) of the Social Security Act (42 U.S.C. 1395yy(e)(4)(G)(i)) to better account for medically complex patients”. Section 1888(e)(4)(G)(i) of the Act, in turn, specifies that the Secretary shall provide for an “appropriate adjustment” to account for case mix.

While this proposed rule sets forth proposed updates to the SNF PPS payment rates that are to take effect as of October 1, 2005, we recognize that adopting the proposed refinements to the case-mix classification system will likely entail significant changes for SNFs as well as for Medicare contractors. Therefore, in order to allow sufficient time for preparation and to ease the transition to the proposed refinements, we believe that it would be appropriate under section 1888(e)(4)(G)(i) of the Act to make a case-mix adjustment that reflects the implementation of the refinements described below.

Accordingly, from October 1, 2005, through December 31, 2005, we propose to make payment based entirely on the existing 44-group RUG-III classification system. Beginning on January 1, 2006, we propose to make payment based entirely on the proposed new RUG-53 classification system. This means that under the terms of section 101(c) of the BBRA, the temporary add-on payments for certain designated RUG-III groups will expire as of January 1, 2006. We note that the resulting reduction in payment will be partially offset by the increase in the RUG case-mix indexes, as explained previously in section II.B.3 of this proposed rule. We invite comments on all aspects of implementing the proposed case-mix refinements, including our plan to defer implementation until January 1, 2006.

Further, along with those matters relating specifically to the case-mix classification system, we have identified a number of broader clinical issues that we are also taking this opportunity to address:

5. Assessment Timeframes

We would like to take this opportunity to clarify existing requirements regarding completion of Other Medicare Required Assessments (OMRAs) for beneficiaries reimbursed under the SNF PPS. An OMRA is due 8 to 10 days after the cessation of all therapy (occupational and physical therapies and speech-language pathology services) in all situations where the beneficiary was assigned a rehabilitation RUG-III group on the previous assessment.

The “last day of therapy” is the last day on which a therapy service was furnished. It is not the day the discharge order for therapy was received and/or written on the resident's medical record. Therefore, when the last day that therapy was provided falls on a Friday, the Saturday and Sunday directly following are counted as days 1 and 2, respectively, toward the total 8 to 10 days of the OMRA window. The same principles apply when the “midnight rule” is initiated during a beneficiary's Part A SNF stay.

In addition, in the relatively uncommon situations where a resident starts a leave of absence after the therapy services have been discontinued and is out of the facility for part of the 8 to 10 day period during which the OMRA must be completed, those therapeutic leave days are to be counted when determining the OMRA due date. While this information is not new, we determined that it would be beneficial to clarify and remind the public of these specific issues involving the OMRA.

6. SNF Certifications and Recertifications Performed by Nurse Practitioners and Clinical Nurse Specialists

[If you choose to comment on issues in this section, please include the caption “SNF Certifications and Recertifications Performed by Nurse Practitioners and Clinical Nurse Specialists” at the beginning of your comments.]

We are taking this opportunity to clarify the requirement for physician signature on the certification and recertification of the need for SNF care (§ 424.20(e)(2)) as it relates to nurse practitioners (NPs) and clinical nurse specialists (CNSs). In section 6028 of the Omnibus Budget Reconciliation Act of 1989, the Congress amended section 1814(a)(2) of the Act. As amended, the Act specifies that an NP or CNS “* * * who does not have a direct or indirect employment relationship” with the facility but is working in collaboration with a physician may sign the required certification (or recertification) for a beneficiary's SNF stay. (Section 1819(b)(6)(A) of the Act further specifies that the medical care of each SNF resident must be under the supervision of a physician (see also the regulations at 42 CFR 483.40(a)(1)).) This provision that bars NPs and CNSs from having a direct or indirect employment relationship with a SNF in order to sign a certification or recertification of the need for care is very restrictive. By contrast, a similar statutory limitation (see section 1919(b)(6)(A) of the Act) on the delegation of physician tasks in Medicaid nursing facilities only bars NPs, CNSs, and physician assistants (PAs) from performing delegated tasks if they are actually employed by the facility.

Following the enactment of this legislation, we received numerous inquiries asking us to define “direct” and “indirect” employment relationships in greater detail. In the July 26, 1995 final rule (60 FR 38268), we stated that factors indicating whether a NP or CNS has a direct or indirect employment relationship include, but are not limited to the following:

• The facility or someone on its medical staff has the authority to hire or fire the nurse;
• The facility or someone on its medical staff furnishes the equipment or place to work, sets the hours, and pays the nurse by the hour, week, or month;
• The facility or someone on its medical staff restricts the nurse's ability to work for someone else or provides training and requires the nurse to follow instructions.

We note that the longstanding common law test, as set forth in regulations at 20 CFR 404.1005, 404.1007, and 404.1009, continues to determine the presence of a direct employment relationship for the purposes of this provision. However, numerous inquiries from providers and other stakeholders continue to request that we specifically clarify the definition of an “indirect” employment relationship in those situations where no direct employment relationship exists. Accordingly, we propose to revise the regulations at § 424.20(e)(2) to identify the existence of an indirect employment relationship in terms of the type of services that the practitioner performs in the SNF. We note that NPs and CNSs who are employed by SNFs not only perform the types of delegated physician tasks that are permitted under the long-term care facility requirements for participation at 42 CFR 483.40(e), but typically perform general nursing services as well. We believe that, even in the absence of a direct employment relationship, an SNF that has an NP or CNS perform these general nursing services is essentially utilizing the NP or CNS in the same manner as it would an employee, so that an indirect employment relationship can be considered to exist. Accordingly, in situations where there is no direct employment relationship between the SNF and the NP or CNS, we propose that an indirect employment relationship exists whenever the NP or CNS not only performs delegated physician tasks, but also provides nursing services under the regulations at 42 CFR 409.21, which include such services within the scope of coverage under the Part A SNF benefit. We believe that this criterion is appropriate, because there would be a potential conflict of interest if an NP or CNS who is engaged in furnishing covered Part A nursing services to an SNF's resident were also permitted to certify as to that resident's need for Part A SNF care. We invite comments on the effects of establishing our proposed distinction in this context.

7. Concurrent Therapy

[If you choose to comment on issues in this section, please include the caption “Concurrent Therapy” at the beginning of your comments.]

The SNF PPS proposed rule for FY 2002 (66 FR 23991, May 10, 2001) included a discussion of concurrent therapy, a practice also known as “dovetailing.” In that discussion, we noted that this practice involves a single professional therapist treating more than one Medicare beneficiary at a time—in some cases, many more than one individual at a time. In contrast to group therapy, in which all participants are working on some common skill development, each beneficiary who receives concurrent therapy likely is not receiving services that relate to those needed by any of the other participants. Although the care that each beneficiary receives may be prescribed in his or her individual plan of treatment, it may not conform to Medicare coverage guidelines; that is, the therapy is not being provided individually, and it is unlikely that the services being delivered are at the complex skill level required for coverage by Medicare. We expressed particular concern over instances in which facility management might inappropriately attempt to increase productivity by coercing a therapist, against his or her own professional judgment, to perform concurrent therapy.

In the SNF PPS final rule for FY 2002 (66 FR 39567, July 31, 2001), we noted that most of the public comments that we received on this discussion urged us to continue to recognize concurrent therapy as skilled therapy, and contended that therapists are treating more than one beneficiary concurrently only when appropriate. However, others indicated that our concerns regarding concurrent therapy were, in fact, warranted. They reported that since the implementation of the SNF PPS, professional therapists are encountering increased pressure to be more productive than they have in the past, including the need to see more than one patient at a time, and performing documentation and collaboration with other members of the care team as non-reimbursed time. In response to the comments, we acknowledged that concurrent therapy can have a legitimate place in the spectrum of care options available to therapists treating Medicare beneficiaries, as long as its use is driven by valid clinical considerations. However, while we declined to make any specific policy changes at that time, we reiterated that it is inappropriate for a facility to require, as a condition of employment, that a therapist agree to treat more than one beneficiary at a time in situations where providing treatment in such a manner would compromise the therapist's professional judgment. We also noted that we might revisit this issue in the future should the need to do so arise.

Since that time, we have continued to encounter reports of facilities that attempt to override the therapist's professional judgment and have concurrent therapy performed in the absence of valid clinical considerations. Accordingly, we believe it is appropriate at this time to consider once again whether there is a need to issue additional guidelines to preclude the inappropriate provision of concurrent therapy. We invite comment on the most effective way to prevent the abuse of this practice, and to ensure that concurrent therapy is performed only in those instances where it is clinically justified.

We propose to establish an effective date of January 1, 2006, as the beginning date for the use of the proposed case-mix refinements. Accordingly, from October 1, 2005, through December 31, 2005, we propose to make payment based entirely on the existing 44-group RUG-III classification system. Tables 4, 5, 6, and 7 reflect the corresponding rate information for the existing 44 group RUG-III classification system to be used during this time.

Beginning on January 1, 2006, we propose to make payment based on the proposed new RUG-53 classification system (and, thus, would not include the add-on payments). Tables 4a, 5a, 6a, and 7a reflect the corresponding rate information for the proposed RUG-53 classification system.

Tables 4 and 5 reflect the updated SNF Federal rates for FY 2006 for the existing 44 group RUG-III classification system. Tables 4a and 5a reflect the updated SNF Federal rates for FY 2006 for the RUG-53 classification system. The first nine groups listed in the tables are for new Rehabilitation plus Extensive Services groups.

Table 4.—RUG-44, Case-Mix Adjusted Federal Rates and Associated Indexes—Urban

RUG III category	Nursing index	Therapy index	Nursing component	Therapy component	Non-case mix therapy component	Non-case mix component	Total rate
RUC	1.30	2.25	178.67	232.94		70.15	481.76
RUB	0.95	2.25	130.57	232.94		70.15	433.66
RUA	0.78	2.25	107.20	232.94		70.15	410.29
RVC	1.13	1.41	155.31	145.98		70.15	371.44
RVB	1.04	1.41	142.94	145.98		70.15	359.07
RVA	0.81	1.41	111.33	145.98		70.15	327.46
RHC	1.26	0.94	173.17	97.32		70.15	340.64
RHB	1.06	0.94	145.69	97.32		70.15	313.16
RHA	0.87	0.94	119.57	97.32		70.15	287.04
RMC	1.35	0.77	185.54	79.72		70.15	335.41
RMB	1.09	0.77	149.81	79.72		70.15	299.68
RMA	0.96	0.77	131.94	79.72		70.15	281.81
RLB	1.11	0.43	152.56	44.52		70.15	267.23
RLA	0.80	0.43	109.95	44.52		70.15	224.62
SE3	1.70		233.65		13.63	70.15	317.43
SE2	1.39		191.04		13.63	70.15	274.82
SE1	1.17		160.80		13.63	70.15	244.58
SSC	1.13		155.31		13.63	70.15	239.09
SSB	1.05		144.31		13.63	70.15	228.09
SSA	1.01		138.81		13.63	70.15	222.59
CC2	1.12		153.93		13.63	70.15	237.71
CC1	0.99		136.07		13.63	70.15	219.85
CB2	0.91		125.07		13.63	70.15	208.85
CB1	0.84		115.45		13.63	70.15	199.23
CA2	0.83		114.08		13.63	70.15	197.86
CA1	0.75		103.08		13.63	70.15	186.86
IB2	0.69		94.83		13.63	70.15	178.61
IB1	0.67		92.08		13.63	70.15	175.86
IA2	0.57		78.34		13.63	70.15	162.12
IA1	0.53		72.84		13.63	70.15	156.62
BB2	0.68		93.46		13.63	70.15	177.24
BB1	0.65		89.34		13.63	70.15	173.12
BA2	0.56		76.97		13.63	70.15	160.75
BA1	0.48		65.97		13.63	70.15	149.75
PE2	0.79		108.58		13.63	70.15	192.36
PE1	0.77		105.83		13.63	70.15	189.61
PD2	0.72		98.96		13.63	70.15	182.74
PD1	0.70		96.21		13.63	70.15	179.99
PC2	0.65		89.34		13.63	70.15	173.12
PC1	0.64		87.96		13.63	70.15	171.74
PB2	0.51		70.09		13.63	70.15	153.87
PB1	0.50		68.72		13.63	70.15	152.50
PA2	0.49		67.35		13.63	70.15	151.13
PA1	0.46		63.22		13.63	70.15	147.00

Table 4a.—RUG-53, Case-Mix Adjusted Federal Rates and Associated Indexes—Urban

RUG-53 category	Nursing index	Therapy index	Nursing component	Therapy component	Non-case mix therapy component	Non-case mix component	Total rate
RUX	1.80	2.24	247.39	231.91		70.15	549.45
RUL	1.33	2.24	182.80	231.91		70.15	484.86
RVX	1.46	1.32	200.66	136.66		70.15	407.47
RVL	1.26	1.32	173.17	136.66		70.15	379.98
RHX	1.34	1.10	184.17	113.88		70.15	368.20
RHL	1.30	1.10	178.67	113.88		70.15	362.70
RMX	1.83	1.03	251.52	106.64		70.15	428.31
RML	1.60	1.03	219.90	106.64		70.15	396.69
RLX	1.25	0.79	171.80	81.79		70.15	323.74
RUC	1.21	2.24	166.30	231.91		70.15	468.36
RUB	0.94	2.24	129.19	231.91		70.15	431.25
RUA	0.79	2.24	108.58	231.91		70.15	410.64
RVC	1.16	1.32	159.43	136.66		70.15	366.24
RVB	1.02	1.32	140.19	136.66		70.15	347.00
RVA	0.79	1.32	108.58	136.66		70.15	315.39
RHC	1.15	1.10	158.06	113.88		70.15	342.09
RHB	1.05	1.10	144.31	113.88		70.15	328.34
RHA	0.89	1.10	122.32	113.88		70.15	306.35
RMC	1.09	1.03	149.81	106.64		70.15	326.60
RMB	1.02	1.03	140.19	106.64		70.15	316.98
RMA	0.99	1.03	136.07	106.64		70.15	312.86
RLB	1.08	0.79	148.44	81.79		70.15	300.38
RLA	0.80	0.79	109.95	81.79		70.15	261.89
SE3	1.76		241.89		13.63	70.15	325.67
SE2	1.41		193.79		13.63	70.15	277.57
SE1	1.19		163.55		13.63	70.15	247.33
SSC	1.16		159.43		13.63	70.15	243.21
SSB	1.07		147.06		13.63	70.15	230.84
SSA	1.03		141.56		13.63	70.15	225.34
CC2	1.15		158.06		13.63	70.15	241.84
CC1	1.01		138.81		13.63	70.15	222.59
CB2	0.93		127.82		13.63	70.15	211.60
CB1	0.86		118.20		13.63	70.15	201.98
CA2	0.85		116.82		13.63	70.15	200.60
CA1	0.77		105.83		13.63	70.15	189.61
IB2	0.70		96.21		13.63	70.15	179.99
IB1	0.68		93.46		13.63	70.15	177.24
IA2	0.59		81.09		13.63	70.15	164.87
IA1	0.54		74.22		13.63	70.15	158.00
BB2	0.69		94.83		13.63	70.15	178.61
BB1	0.66		90.71		13.63	70.15	174.49
BA2	0.57		78.34		13.63	70.15	162.12
BA1	0.49		67.35		13.63	70.15	151.13
PE2	0.80		109.95		13.63	70.15	193.73
PE1	0.78		107.20		13.63	70.15	190.98
PD2	0.74		101.71		13.63	70.15	185.49
PD1	0.72		98.96		13.63	70.15	182.74
PC2	0.67		92.08		13.63	70.15	175.86
PC1	0.65		89.34		13.63	70.15	173.12
PB2	0.52		71.47		13.63	70.15	155.25
PB1	0.51		70.09		13.63	70.15	153.87
PA2	0.50		68.72		13.63	70.15	152.50
PA1	0.48		65.97		13.63	70.15	149.75

Table 5.—RUG-44, Case-Mix Adjusted Federal Rates and Associated Indexes—Rural

RUG III category	Nursing index	Therapy index	Nursing component	Therapy component	Non-case mix therapy component	Non-case mix component	Total rate
RUC	1.30	2.25	170.69	268.61		71.45	510.75
RUB	0.95	2.25	124.74	268.61		71.45	464.80
RUA	0.78	2.25	102.41	268.61		71.45	442.47
RVC	1.13	1.41	148.37	168.33		71.45	388.15
RVB	1.04	1.41	136.55	168.33		71.45	376.33
RVA	0.81	1.41	106.35	168.33		71.45	346.13
RHC	1.26	0.94	165.44	112.22		71.45	349.11
RHB	1.06	0.94	139.18	112.22		71.45	322.85
RHA	0.87	0.94	114.23	112.22		71.45	297.90
RMC	1.35	0.77	177.26	91.92		71.45	340.63
RMB	1.09	0.77	143.12	91.92		71.45	306.49
RMA	0.96	0.77	126.05	91.92		71.45	289.42
RLB	1.11	0.43	145.74	51.33		71.45	268.52
RLA	0.80	0.43	105.04	51.33		71.45	227.82
SE3	1.70		223.21		14.56	71.45	309.22
SE2	1.39		182.51		14.56	71.45	268.52
SE1	1.17		153.62		14.56	71.45	239.63
SSC	1.13		148.37		14.56	71.45	234.38
SSB	1.05		137.87		14.56	71.45	223.88
SSA	1.01		132.61		14.56	71.45	218.62
CC2	1.12		147.06		14.56	71.45	233.07
CC1	0.99		129.99		14.56	71.45	216.00
CB2	0.91		119.48		14.56	71.45	205.49
CB1	0.84		110.29		14.56	71.45	196.30
CA2	0.83		108.98		14.56	71.45	194.99
CA1	0.75		98.48		14.56	71.45	184.49
IB2	0.69		90.60		14.56	71.45	176.61
IB1	0.67		87.97		14.56	71.45	173.98
IA2	0.57		74.84		14.56	71.45	160.85
IA1	0.53		69.59		14.56	71.45	155.60
BB2	0.68		89.28		14.56	71.45	175.29
BB1	0.65		85.35		14.56	71.45	171.36
BA2	0.56		73.53		14.56	71.45	159.54
BA1	0.48		63.02		14.56	71.45	149.03
PE2	0.79		103.73		14.56	71.45	189.74
PE1	0.77		101.10		14.56	71.45	187.11
PD2	0.72		94.54		14.56	71.45	180.55
PD1	0.70		91.91		14.56	71.45	177.92
PC2	0.65		85.35		14.56	71.45	171.36
PC1	0.64		84.03		14.56	71.45	170.04
PB2	0.51		66.96		14.56	71.45	152.97
PB1	0.50		65.65		14.56	71.45	151.66
PA2	0.49		64.34		14.56	71.45	150.35
PA1	0.46		60.40		14.56	71.45	146.41

Table 5a.—RUG-53, Case-Mix Adjusted Federal Rates and Associated Indexes—Rural

RUG-53 category	Nursing index	Therapy index	Nursing component	Therapy component	Non-case mix therapy component	Non-case mix component	Total rate
RUX	1.8	2.24	236.34	267.41		71.45	575.20
RUL	1.33	2.24	174.63	267.41		71.45	513.49
RVX	1.46	1.32	191.70	157.58		71.45	420.73
RVL	1.26	1.32	165.44	157.58		71.45	394.47
RHX	1.34	1.10	175.94	131.32		71.45	378.71
RHL	1.3	1.10	170.69	131.32		71.45	373.46
RMX	1.83	1.03	240.28	122.96		71.45	434.69
RML	1.6	1.03	210.08	122.96		71.45	404.49
RLX	1.25	0.79	164.13	94.31		71.45	329.89
RUC	1.21	2.24	158.87	267.41		71.45	497.73
RUB	0.94	2.24	123.42	267.41		71.45	462.28
RUA	0.79	2.24	103.73	267.41		71.45	442.59
RVC	1.16	1.32	152.31	157.58		71.45	381.34
RVB	1.02	1.32	133.93	157.58		71.45	362.96
RVA	0.79	1.32	103.73	157.58		71.45	332.76
RHC	1.15	1.10	151.00	131.32		71.45	353.77
RHB	1.05	1.10	137.87	131.32		71.45	340.64
RHA	0.89	1.10	116.86	131.32		71.45	319.63
RMC	1.09	1.03	143.12	122.96		71.45	337.53
RMB	1.02	1.03	133.93	122.96		71.45	328.34
RMA	0.99	1.03	129.99	122.96		71.45	324.40
RLB	1.08	0.79	141.80	94.31		71.45	307.56
RLA	0.80	0.79	105.04	94.31		71.45	270.80
SE3	1.76		231.09		14.56	71.45	317.10
SE2	1.41		185.13		14.56	71.45	271.14
SE1	1.19		156.25		14.56	71.45	242.26
SSC	1.16		152.31		14.56	71.45	238.32
SSB	1.07		140.49		14.56	71.45	226.50
SSA	1.03		135.24		14.56	71.45	221.25
CC2	1.15		151.00		14.56	71.45	237.01
CC1	1.01		132.61		14.56	71.45	218.62
CB2	0.93		122.11		14.56	71.45	208.12
CB1	0.86		112.92		14.56	71.45	198.93
CA2	0.85		111.61		14.56	71.45	197.62
CA1	0.77		101.10		14.56	71.45	187.11
IB2	0.70		91.91		14.56	71.45	177.92
IB1	0.68		89.28		14.56	71.45	175.29
IA2	0.59		77.47		14.56	71.45	163.48
IA1	0.54		70.90		14.56	71.45	156.91
BB2	0.69		90.60		14.56	71.45	176.61
BB1	0.66		86.66		14.56	71.45	172.67
BA2	0.57		74.84		14.56	71.45	160.85
BA1	0.49		64.34		14.56	71.45	150.35
PE2	0.80		105.04		14.56	71.45	191.05
PE1	0.78		102.41		14.56	71.45	188.42
PD2	0.74		97.16		14.56	71.45	183.17
PD1	0.72		94.54		14.56	71.45	180.55
PC2	0.67		87.97		14.56	71.45	173.98
PC1	0.65		85.35		14.56	71.45	171.36
PB2	0.52		68.28		14.56	71.45	154.29
PB1	0.51		66.96		14.56	71.45	152.97
PA2	0.50		65.65		14.56	71.45	151.66
PA1	0.48		63.02		14.56	71.45	149.03

C. Wage Index Adjustment to Federal Rates

Section 1888(e)(4)(G)(ii) of the Act requires that we adjust the Federal rates to account for differences in area wage levels, using a wage index that we find appropriate. Since the inception of a PPS for SNFs, we have used hospital wage data in developing a wage index to be applied to SNFs. We propose to continue that practice for FY 2006, as we continue to believe that in the absence of SNF-specific wage data, using the hospital wage index is appropriate and reasonable for the SNF PPS.

The wage index adjustment would be applied to the proposed labor-related portion of the Federal rate, which is 76.087 percent of the total rate. This percentage reflects the labor-related relative importance for FY 2006. The labor-related relative importance is calculated from the SNF market basket, and approximates the labor-related portion of the total costs after taking into account historical and projected price changes between the base year and FY 2006. The price proxies that move the different cost categories in the market basket do not necessarily change at the same rate, and the relative importance captures these changes. Accordingly, the relative importance figure more closely reflects the cost share weights for FY 2006 than the base year weights from the SNF market basket.

We calculate the labor-related relative importance for FY 2006 in four steps. First, we compute the FY 2006 price index level for the total market basket and each cost category of the market basket. Second, we calculate a ratio for each cost category by dividing the FY 2006 price index level for that cost category by the total market basket price index level. Third, we determine the FY 2006 relative importance for each cost category by multiplying this ratio by the base year (FY 1997) weight. Finally, we sum the FY 2006 relative importance for each of the labor-related cost categories (wages and salaries, employee benefits, nonmedical professional fees, labor-intensive services, and capital-related expenses) to produce the FY 2006 labor-related relative importance. Tables 6 and 7 show the Federal rates by labor-related and non-labor-related components for the existing 44 group RUG classification system. Tables 6a and 7a show the Federal rates by labor-related and non-labor-related components for the proposed RUG-53 classification system.

Table 6.—RUG-44, Case-Mix Adjusted Federal Rates for Urban SNFs by Labor and Non-Labor Component

RUG III category	Total rate	Labor portion	Non-labor portion
RUC	481.76	366.56	115.20
RUB	433.66	329.96	103.70
RUA	410.29	312.18	98.11
RVC	371.44	282.62	88.82
RVB	359.07	273.21	85.86
RVA	327.46	249.15	78.31
RHC	340.64	259.18	81.46
RHB	313.16	238.27	74.89
RHA	287.04	218.40	68.64
RMC	335.41	255.20	80.21
RMB	299.68	228.02	71.66
RMA	281.81	214.42	67.39
RLB	267.23	203.33	63.90
RLA	224.62	170.91	53.71
SE3	317.43	241.52	75.91
SE2	274.82	209.10	65.72
SE1	244.58	186.09	58.49
SSC	239.09	181.92	57.17
SSB	228.09	173.55	54.54
SSA	222.59	169.36	53.23
CC2	237.71	180.87	56.84
CC1	219.85	167.28	52.57
CB2	208.85	158.91	49.94
CB1	199.23	151.59	47.64
CA2	197.86	150.55	47.31
CA1	186.86	142.18	44.68
IB2	178.61	135.90	42.71
IB1	175.86	133.81	42.05
IA2	162.12	123.35	38.77
IA1	156.62	119.17	37.45
BB2	177.24	134.86	42.38
BB1	173.12	131.72	41.40
BA2	160.75	122.31	38.44
BA1	149.75	113.94	35.81
PE2	192.36	146.36	46.00
PE1	189.61	144.27	45.34
PD2	182.74	139.04	43.70
PD1	179.99	136.95	43.04
PC2	173.12	131.72	41.40
PC1	171.74	130.67	41.07
PB2	153.87	117.08	36.79
PB1	152.50	116.03	36.47
PA2	151.13	114.99	36.14
PA1	147.00	111.85	35.15

Table 6A.—RUG-53, Case-Mix Adjusted Federal Rates for Urban SNFs by Labor and Non-Labor Component

RUG 53 category	Total rate	Labor portion	Non-labor portion
RUX	549.45	418.06	131.39
RUL	484.86	368.92	115.94
RVX	407.47	310.03	97.44
RVL	379.98	289.12	90.86
RHX	368.20	280.15	88.05
RHL	362.70	275.97	86.73
RMX	428.31	325.89	102.42
RML	396.69	301.83	94.86
RLX	323.74	246.32	77.42
RUC	468.36	356.36	112.00
RUB	431.25	328.13	103.12
RUA	410.64	312.44	98.20
RVC	366.24	278.66	87.58
RVB	347.00	264.02	82.98
RVA	315.39	239.97	75.42
RHC	342.09	260.29	81.80
RHB	328.34	249.82	78.52
RHA	306.35	233.09	73.26
RMC	326.60	248.50	78.10
RMB	316.98	241.18	75.80
RMA	312.86	238.05	74.81
RLB	300.38	228.55	71.83
RLA	261.89	199.26	62.63
SE3	325.67	247.79	77.88
SE2	277.57	211.19	66.38
SE1	247.33	188.19	59.14
SSC	243.21	185.05	58.16
SSB	230.84	175.64	55.20
SSA	225.34	171.45	53.89
CC2	241.84	184.01	57.83
CC1	222.59	169.36	53.23
CB2	211.60	161.00	50.60
CB1	201.98	153.68	48.30
CA2	200.60	152.63	47.97
CA1	189.61	144.27	45.34
IB2	179.99	136.95	43.04
IB1	177.24	134.86	42.38
IA2	164.87	125.44	39.43
IA1	158.00	120.22	37.78
BB2	178.61	135.90	42.71
BB1	174.49	132.76	41.73
BA2	162.12	123.35	38.77
BA1	151.13	114.99	36.14
PE2	193.73	147.40	46.33
PE1	190.98	145.31	45.67
PD2	185.49	141.13	44.36
PD1	182.74	139.04	43.70
PC2	175.86	133.81	42.05
PC1	173.12	131.72	41.40
PB2	155.25	118.13	37.12
PB1	153.87	117.08	36.79
PA2	152.50	116.03	36.47
PA1	149.75	113.94	35.81

Table 7.—RUG-44, Case-Mix Adjusted Federal Rates for Rural SNFs by Labor and Non-Labor Component

RUG III category	Total rate	Labor portion	Non-labor portion
RUC	510.75	388.61	122.14
RUB	464.80	353.65	111.15
RUA	442.47	336.66	105.81
RVC	388.15	295.33	92.82
RVB	376.33	286.34	89.99
RVA	346.13	263.36	82.77
RHC	349.11	265.63	83.48
RHB	322.85	245.65	77.20
RHA	297.90	226.66	71.24
RMC	340.63	259.18	81.45
RMB	306.49	233.20	73.29
RMA	289.42	220.21	69.21
RLB	268.52	204.31	64.21
RLA	227.82	173.34	54.48
SE3	309.22	235.28	73.94
SE2	268.52	204.31	64.21
SE1	239.63	182.33	57.30
SSC	234.38	178.33	56.05
SSB	223.88	170.34	53.54
SSA	218.62	166.34	52.28
CC2	233.07	177.34	55.73
CC1	216.00	164.35	51.65
CB2	205.49	156.35	49.14
CB1	196.30	149.36	46.94
CA2	194.99	148.36	46.63
CA1	184.49	140.37	44.12
IB2	176.61	134.38	42.23
IB1	173.98	132.38	41.60
IA2	160.85	122.39	38.46
IA1	155.60	118.39	37.21
BB2	175.29	133.37	41.92
BB1	171.36	130.38	40.98
BA2	159.54	121.39	38.15
BA1	149.03	113.39	35.64
PE2	189.74	144.37	45.37
PE1	187.11	142.37	44.74
PD2	180.55	137.38	43.17
PD1	177.92	135.37	42.55
PC2	171.36	130.38	40.98
PC1	170.04	129.38	40.66
PB2	152.97	116.39	36.58
PB1	151.66	115.39	36.27
PA2	150.35	114.40	35.95
PA1	146.41	111.40	35.01

Table 7a.—RUG-53 Case-Mix Adjusted Federal Rates for Rural SNFs by Labor and Non-Labor Component

RUG-53 category	Total rate	Labor portion	Non-labor portion
RUX	575.20	437.65	137.55
RUL	513.49	390.70	122.79
RVX	420.73	320.12	100.61
RVL	394.47	300.14	94.33
RHX	378.71	288.15	90.56
RHL	373.46	284.15	89.31
RMX	434.69	330.74	103.95
RML	404.49	307.76	96.73
RLX	329.89	251.00	78.89
RUC	497.73	378.71	119.02
RUB	462.28	351.73	110.55
RUA	442.59	336.75	105.84
RVC	381.34	290.15	91.19
RVB	362.96	276.17	86.79
RVA	332.76	253.19	79.57
RHC	353.77	269.17	84.60
RHB	340.64	259.18	81.46
RHA	319.63	243.20	76.43
RMC	337.53	256.82	80.71
RMB	328.34	249.82	78.52
RMA	324.40	246.83	77.57
RLB	307.56	234.01	73.55
RLA	270.80	206.04	64.76
SE3	317.10	241.27	75.83
SE2	271.14	206.30	64.84
SE1	242.26	184.33	57.93
SSC	238.32	181.33	56.99
SSB	226.50	172.34	54.16
SSA	221.25	168.34	52.91
CC2	237.01	180.33	56.68
CC1	218.62	166.34	52.28
CB2	208.12	158.35	49.77
CB1	198.93	151.36	47.57
CA2	197.62	150.36	47.26
CA1	187.11	142.37	44.74
IB2	177.92	135.37	42.55
IB1	175.29	133.37	41.92
IA2	163.48	124.39	39.09
IA1	156.91	119.39	37.52
BB2	176.61	134.38	42.23
BB1	172.67	131.38	41.29
BA2	160.85	122.39	38.46
BA1	150.35	114.40	35.95
PE2	191.05	145.36	45.69
PE1	188.42	143.36	45.06
PD2	183.17	139.37	43.80
PD1	180.55	137.38	43.17
PC2	173.98	132.38	41.60
PC1	171.36	130.38	40.98
PB2	154.29	117.39	36.90
PB1	152.97	116.39	36.58
PA2	151.66	115.39	36.27
PA1	149.03	113.39	35.64

Section 1888(e)(4)(G)(ii) of the Act also requires that we apply this wage index in a manner that does not result in aggregate payments that are greater or lesser than would otherwise be made in the absence of the wage adjustment. For FY 2006 (Federal rates effective October 1, 2005), we would apply the most recent wage index using the hospital wage data, and apply an adjustment to fulfill the budget neutrality requirement. This requirement would be met by multiplying each of the components of the unadjusted Federal rates by a factor equal to the ratio of the volume weighted mean wage adjustment factor (using the wage index from the previous year) to the volume weighted mean wage adjustment factor, using the wage index for the FY beginning October 1, 2005. The same volume weights are used in both the numerator and denominator and will be derived from 1997 Medicare Provider Analysis and Review File (MEDPAR) data. The wage adjustment factor used in this calculation is defined as the labor share of the rate component multiplied by the wage index plus the non-labor share. The proposed budget neutrality factor for this year is 1.0011. However, this may change in the final rule. In order to give the public a sense of the magnitude of this adjustment, last year's factor was 1.0011.

D. Proposed Area Wage Index

Section 1888(e)(4)(G)(ii) of the Act requires that we adjust the Federal rates to account for differences in area wage levels, using a wage index that we find appropriate. Since the inception of a PPS for SNFs, we have used hospital wage data in developing a wage index to be applied to SNFs. As noted previously, we are proposing to continue that practice for FY 2006.

In our July 30, 2004 update notice, we acknowledged that on June 6, 2003, the Office of Management and Budget (OMB) issued “OMB Bulletin No.03-04,” which announced revised definitions for Metropolitan Statistical Areas, and new definitions of Micropolitan Statistical Areas and Combined Statistical Areas. A copy of the Bulletin may be obtained at the following Internet address: http://www.whitehouse.gov/​omb/​bulletins/​b03-04.html. At that time, we did not propose to apply these new definitions known as the Core-Based Statistical Areas (CBSAs). After further analysis, we are proposing to use the OMB-revised definitions to adjust the FY 2006 SNF PPS payment rates. The Hospital Inpatient PPS (IPPS) is applying these revised definitions as discussed in the August 11, 2004 IPPS final rule (69 FR 49207).

1. Proposed Revision of SNF PPS Geographic Classifications

As discussed in the May 12, 1998 SNF PPS interim final rule, which implemented the SNF PPS (63 FR 26252), in establishing an adjustment for area wage levels under § 413.337(a)(ii), the labor-related portion of a SNF's Federal prospective payment is adjusted by using an appropriate wage index. As set forth in § 413.337(a)(ii), a SNF's wage index is determined based on the location of the SNF in an urban or rural area as defined in § 412.62(f)(1)(ii) and (f)(1)(iii), respectively. In general, an urban area is defined as a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA) as defined by OMB. Under § 412.62(f)(1)(iii), a rural area is defined as any area outside of an urban area. The urban and rural area geographic classifications defined in § 412.62(f)(1)(ii) and (f)(1)(iii), respectively, were used under the IPPS from FYs 1985 through 2004 (§ 412.63(b)), and have been used under the SNF PPS since it was implemented for cost reporting periods beginning on or after July 1, 1998. The wage index used for the SNF PPS is calculated using the IPPS wage index data on the basis of the labor market area in which the acute care hospital is located, but without taking into account geographic reclassification under sections 1886(d)(8) and (d)(10) of the Act. The applicable SNF wage index value is assigned to a SNF on the basis of the labor market area in which the SNF is geographically located.

Section 4410 of the BBA provides that for the purposes of section 1886(d)(3)(E) of the Act, the area wage index applicable to hospitals located in an urban area of a State may not be less than the area wage index applicable to hospitals located in rural areas in the State. Consistent with past SNF policy, we treat this provision, commonly referred to as the “rural floor,” as applicable to acute inpatient hospitals and not SNFs. Therefore, the hospital wage index used for SNFs is commonly referred to as “pre-floor,” indicating that the “rural floor” provision is not applied.

The current SNF PPS labor market areas are defined based on the definitions of MSAs, Primary MSAs (PMSAs), and NECMAs issued by the OMB (commonly referred to collectively as “MSAs”). These MSA definitions, which are discussed in greater detail below, are currently used under the SNF PPS and other prospective payment systems such as the long-term care hospital PPS (LTCH PPS), the inpatient psychiatric facility PPS (IPF PPS), the home health agency PPS (HHA PPS), and the inpatient rehabilitation facility PPS (IRF PPS). In the August 11, 2004 IPPS final rule (67 FR 49026 through 49034), revised labor market area definitions were adopted under § 412.64(b), which were effective October 1, 2004 for acute care hospitals. The new standards, CBSAs, were announced by OMB in late 2000 and are discussed in greater detail below.

2. Current SNF PPS Labor Market Areas Based on MSAs

As noted above, we currently define labor market areas based on the definitions of MSAs, PMSAs, and NECMAs issued by the OMB. The 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 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, providers are assigned to either an MSA, PMSA, or NECMA based on whether the county in which the provider is located is part of that area. All of the counties in a State outside a designated MSA, PMSA, or NECMA are designated as rural. For the purposes of calculating the wage index, we combine all of the counties in a State outside a designated MSA, PMSA, or NECMA together to calculate the statewide rural wage index for each State.

3. Core-Based Statistical Areas

The OMB reviews its Metropolitan Area (MA) definitions preceding each decennial census. As discussed in the August 11, 2004 IPPS final rule (69 FR 49207), in the fall of 1998, the OMB chartered the Metropolitan Area Standards Review Committee to examine the MA standards and develop recommendations for possible changes to those standards. Three notices related to the review of the standards, providing an opportunity for public comment on the recommendations of the Committee, were published in the Federal Register on the following dates: December 21, 1998 (63 FR 70526); October 20, 1999 (64 FR 56628); and August 22, 2000 (65 FR 51060).

In the December 27, 2000 Federal Register (65 FR 82228 through 82238), the OMB announced its new standards. In that notice, the OMB defines 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 the OMB, MSAs are based on urbanized areas of 50,000 or more population, and Micropolitan Statistical Areas (referred to in this 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 CBSAs (either MSAs or Micropolitan Areas) are deemed “Outside CBSAs.” In the past, the OMB defined MSAs around areas with a minimum core population of 50,000, and smaller areas were “Outside MSAs.” On June 6, 2003, the OMB announced the new CBSAs, comprised of MSAs and the new Micropolitan Areas based on Census 2000 data. (A copy of the announcement may be obtained at the following Internet address: http://www.whitehouse.gov/​omb/​bulletins/​fy04/​b04-03.html.)

The new CBSA designations recognize 49 new (urban) MSAs and 565 new Micropolitan Areas, and revise the composition of many of the existing (urban) MSAs. There are 1,090 counties in MSAs under the new CBSA designations (previously, there were 848 counties in MSAs). Of these 1,090 counties, 737 are in the same MSA as they were before the change in designations, 65 are in a different MSA, 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. There are five counties that previously were designated to an MSA but are no longer designated to either an MSA or a new Micropolitan Area: Carter County, KY; St. James Parish, LA; Kane County, UT; Culpepper County, VA; and King George County, VA. For a more detailed discussion of the conceptual basis of the new CBSAs, refer to the August 11, 2004 IPPS final rule (67 FR 49026 through 49034).

4. Proposed Revisions to the SNF PPS Labor Market Areas

[If you choose to comment on issues in this section, please include the caption “Proposed Revisions to the SNF PPS Labor Market Areas” at the beginning of your comments.]

In its June 6, 2003 announcement, the OMB cautioned that these new definitions “should not be used to develop and implement Federal, State, and local nonstatistical programs and policies without full consideration of the effects of using these definitions for such purposes. These areas should not serve as a general-purpose geographic framework for nonstatistical activities, and they may or may not be suitable for use in program funding formulas.”

In the SNF PPS update notice for FY 2005 (69 FR 45786, July 30, 2004), we noted that the recently-published IPPS proposed rule for FY 2005 had discussed some of the problems and concerns associated with using these new definitions, and had invited public comment on them. Accordingly, we decided to defer proposing any new labor market definitions in the SNF context at that time, in order to allow the public sufficient time and opportunity to consider and provide comments on this issue. Although the June 30, 2004 update notice also invited comments on the possible application of the new definitions to the SNF PPS, we received no written comments on the use of the new definitions specifically in the SNF context; however, we did receive a few phone calls inquiring about the methodology applied in the August 11, 2004 IPPS final rule (69 FR 49207). We believe that sufficient time has now elapsed for interested parties to consider and react to the new OMB definitions and, accordingly, we are now proposing to make the changes discussed below.

We have continued to use MSAs to define labor market areas for purposes of the wage index. For the SNF prospective payment system, the statute provides the Secretary with broad authority to use an “appropriate wage index as determined by the Secretary.” We believe MSAs are a reasonable and appropriate proxy for developing geographic areas for purposes of adjusting for wage differences in SNF PPS and for many of the same reasons stated in the various IPPS rules over the years where this issue has been exhaustively examined. 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, IRF PPS, HHA PPS, and IPF PPS).

First, historically, Medicare prospective payment systems have utilized MA definitions developed by OMB. For example, in discussing the adoption of the MSA designation for the IPPS area labor adjustment, the IPPS proposed rule for FY 1985 (49 FR 27426, July 3, 1984) 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 as consistent as possible for all MSAs nationwide.

In 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 sections, 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” (section 1886(d)(2)(D) of the Act). Similarly, in the sections of the statute governing the guidelines to be used by the Medicare Geographic Classification Review Board for purposes of reclassification, the Congress directed the Secretary to create guidelines for “determining whether the county in which the hospital is located should be treated as being a part of a particular [MSA]” (sections 1886(d)(10)(A) and 1886(d)(10)(D)(i)(II) of the Act). 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 based upon characteristics that 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. The 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 IPPS, CMS has reviewed alternative methods for determining geographic areas for purposes of the wage index, and in each case, has decided to retain the OMB designations rather than replace these designations with alternatives.

Because we believe that we have broad authority to create labor market areas, and because we also believe that the OMB's latest MA designations accurately reflect the local economies and wage levels of the areas in which hospitals are currently located, we are proposing to adopt the revised labor market area designations based on the OMB's CBSA designations.

When we implemented the wage index adjustment at § 413.337(a)(ii) under the SNF PPS in the May 12, 1998 SNF PPS interim final rule (63 FR 26252), we explained that the SNF PPS wage index adjustment was intended to reflect the relative hospital wage levels in the geographic area of the hospital as compared to the national average hospital wage level. Because we believe that the OMB's CBSA designations based on Census 2000 data reflect the most recent available geographic classifications (MA definitions), we are proposing to revise the labor market area definitions used under the SNF PPS. Specifically, we are proposing to revise the SNF PPS labor market definitions based on the OMB's new CBSA designations (as discussed in greater detail below) effective for SNF PPS services occurring on or after October 1, 2005. Accordingly, we are proposing to revise § 413.337(a)(ii) to specify that for services furnished on or after October 1, 2005, the application of the wage index under the SNF PPS would be made on the basis of the location of the facility in an urban or rural area as defined in § 412.64(b)(1)(ii)(A) through (C).

We note that the OMB's new CBSA designations are the same labor market area definitions implemented under the IPPS at § 412.64(b), which were effective for those hospitals beginning October 1, 2004, as discussed in the August 11, 2004 IPPS final rule (69 FR 49026 through 49034). The similarity between the IPPS and the SNF PPS includes the adoption in the initial implementation of the SNF PPS of the same labor market area definitions under the SNF PPS that existed under the IPPS at that time, as well as the use of acute care hospitals' wage data in calculating the SNF PPS wage index. Therefore, we believe that proposing to revise the SNF PPS labor market area definitions based on OMB's CBSA designations is consistent with our historical practice of generally modeling SNF PPS wage index policy after IPPS wage index policy.

Below, we discuss the composition of the proposed SNF PPS labor market areas based on the OMB's new CBSA designations.

a. New England MSAs

As stated above, under the SNF PPS, we currently use NECMAs to define labor market 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 current MSA definitions, NECMAs provided more consistency in labor market definitions for New England compared with the rest of the country, where MSAs are county-based. Under the new CBSAs, the OMB has now defined the MSAs and Micropolitan Areas in New England on the basis of counties. The OMB also established New England City and Town Areas, which are similar to the previous New England MSAs.

In order to create consistency among all labor market areas and to maintain these areas on the basis of counties, we are proposing to use the county-based areas for all MSAs in the nation, including those in New England. Census 2000 has now defined the New England area based on counties, creating a city- and town-based system as an alternative. We believe that adopting county-based labor market areas for the entire country except those in New England would lead to inconsistencies in our designations. Adopting county-based labor market areas for the entire country provides consistency and stability in Medicare SNF PPS program payment because all of the labor market areas throughout the country, including New England, would be defined using the same system (that is, counties) rather than different systems in different areas of the country, thus minimizing programmatic complexity.

In addition, we have consistently employed a county-based system for New England for precisely that reason: To maintain consistency with the labor market definitions used throughout the country. We note that this is consistent with the implementation of the CBSA designations under the IPPS for New England (see August 11, 2004 (69 FR 49028)). Accordingly, under the SNF PPS we are proposing to use the New England MSAs as determined under the proposed new CBSA-based labor market area definitions in defining the proposed revised SNF PPS labor market areas.

b. Metropolitan Divisions

Under the 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 ties. A county qualifies as a main county if 65 percent or more of its employed residents work within the county and the ratio of the number of jobs located in the county to the number of employed residents is at least 0.75 percent. A county qualifies as a secondary county if 50 percent or more, but less than 65 percent, of its employed residents work within the county and the ratio of the number of jobs located in the county to the number of employed residents is at least 0.75 percent. After all the main and secondary counties are identified and grouped, each additional county that already has qualified for inclusion in the MSA falls within the Metropolitan Division associated with the main/secondary county or counties with which the county at issue has the highest employment interchange measure. Counties in a Metropolitan Division must be contiguous (see 65 FR 82236).

As noted above, in the past, the OMB designated CMSAs as Metropolitan Areas with a population of one million or more and comprised of two or more PMSAs. Under the SNF PPS, we currently use the PMSAs rather than CMSAs to define labor market areas because they comprise a smaller geographic area with potentially varying labor costs due to different local economies. We believe that CMSAs may be too large an area to reflect accurately the local labor costs of all of the individual SNFs included in that relatively “large” area. Similarly, we believe that Metropolitan Divisions under the CBSA designations may be too large an area to reflect accurately the local labor costs of all of the individual SNFs included in that relatively “large” area. Further, Metropolitan Divisions represent the closest approximation to PMSAs and, therefore, would most accurately maintain our current structuring of the SNF PPS labor market areas. Therefore, as implemented under the IPPS (69 FR 49029), we are proposing to use the Metropolitan Divisions where applicable (as described below) under the proposed new CBSA-based labor market area definitions.

In addition to being comparable to the organization of the labor market areas under current MSA designations, we believe that proposing to use Metropolitan Divisions where applicable (as described below) under the SNF PPS would result in a more accurate adjustment for the variation in local labor market areas for SNFs. Specifically, if we recognize the relatively “larger” CBSA that comprises two or more Metropolitan Divisions as an independent labor market area for purposes of the wage index, it would be too large and would include the data from too many hospitals to compute a wage index that would accurately reflect the various local labor costs of all of the individual hospitals included in that relatively “large” CBSA. By proposing to recognize Metropolitan Divisions where applicable (as described below) under the proposed new CBSA-based labor market area definitions under the SNF PPS, we believe that the local labor costs would be more accurately reflected, thereby resulting in a wage index adjustment that better reflects the variation in the local labor costs of the local economies of the SNFs located in those relatively “smaller” areas.

Under the CBSA designations, there are 11 MSAs containing Metropolitan Divisions: Boston; Chicago; Dallas; Detroit; Los Angeles; Miami; New York; Philadelphia; San Francisco; Seattle; and Washington, D.C. Although these MSAs were also CMSAs under the prior definitions, in some cases their areas have been altered. Under the current SNF PPS MSA designations, Boston was a single NECMA. Under the proposed CBSA-based labor market area designations, it would be comprised of 4 Metropolitan Divisions. Los Angeles would go from 4 PMSAs under the current SNF PPS MSA designations to 2 Metropolitan Divisions under the proposed CBSA-based labor market area designations. The New York CMSA would go from 15 PMSAs under the current SNF PPS MSA designations to only 4 Metropolitan Divisions under the proposed CBSA-based labor market area designations. Five PMSAs in Connecticut under the current SNF PPS MSA designations would become separate MSAs under the proposed CBSA-based labor market area designations. The number of PMSAs in New Jersey, under the current SNF PPS MSA designations would go from 5 to 2, with the consolidation of 2 New Jersey PMSAs (Bergen-Passaic and Jersey City) into the New York-Wayne-White Plains, NY-NJ Division, under the proposed CBSA-based labor market area designations. In San Francisco, under the proposed CBSA-based labor market area designations there are only 2 Divisions. Currently, there are 6 PMSAs, some of which are now separate MSAs under the current SNF PPS labor market area designations.

Under the current SNF PPS labor market area designations, Cincinnati, Cleveland, Denver, Houston, Milwaukee, Portland, Sacramento, and San Juan are all designated as CMSAs, but would no longer be designated as CMSAs under the proposed CBSA-based labor market area designations. As noted previously, the population threshold to be designated a CMSA under the current SNF PPS labor market area designations is one million. In most of these cases, counties currently in a PMSA would become a separate, independent MSA under the proposed CBSA-based labor market area designations, leaving only the MSA for the core area under the proposed CBSA-based labor market area designations.

c. Micropolitan Areas

Under the OMB's new CBSA designations, Micropolitan Areas are essentially a third area definition consisting primarily of areas that are currently rural, but also include some or all of areas that are currently designated as urban MSAs. As discussed in greater detail in the August 11, 2004 IPPS final rule (69 FR 49029 through 49032), how these areas are treated would have significant impacts on the calculation and application of the wage index. Specifically, whether or not Micropolitan Areas are included as part of the respective statewide rural wage indexes would affect the value of the Statewide rural wage index of any State that contains a Micropolitan Area. A hospital's classification as urban or rural affects which hospitals' wage data are included in the statewide rural wage index. As discussed above in section II.D.3, we combine all of the counties in a State outside a designated urban area to calculate the statewide rural wage index for each State.

Micropolitan Areas included as part of the statewide rural labor market area would result in an increase to the statewide rural wage index because hospitals located in those Micropolitan Areas typically have higher labor costs than other rural hospitals in the State. Alternatively, as discussed in greater detail below, if Micropolitan Areas would be recognized as independent labor market areas, because there would be so few hospitals in those areas to complete a wage index, the wage indexes for SNFs in those areas could become relatively unstable as they would change considerably from year to year.

We currently use MSAs to define urban labor market areas and group all of the hospitals in counties within each State that are not assigned to an MSA into a statewide rural labor market area. Therefore, we used the terms “urban” and “rural” wage indexes in the past for ease of reference. However, the introduction of Micropolitan Areas by the OMB potentially complicates this terminology because these areas include many hospitals that are currently included in the statewide rural labor market areas.

We are proposing to treat Micropolitan Areas as rural labor market areas under the SNF PPS for the reasons outlined below. That is, counties that are assigned to a Micropolitan area under the CBSA designations would be treated the same as other “rural” counties that are not assigned to either an MSA (Metropolitan Area) or a Micropolitan Area. Therefore, in determining an SNF's applicable wage index (based on IPPS hospital wage index data, as discussed in greater detail below in section II.D.6 of this preamble), we propose that a SNF in a Micropolitan Area under the OMB's CBSA designations would be classified as “rural” and would be assigned the statewide rural wage index for the State in which it resides.

In the August 11, 2004 IPPS final rule (69 FR 49029 through 49032), we discussed the impact of treating Micropolitan areas as part of the statewide rural labor market area instead of treating Micropolitan Areas as independent labor market areas for hospitals paid under the IPPS. As discussed in greater detail in that same final rule, Micropolitan Areas encompass smaller populations than MSAs and tend to include fewer hospitals per Micropolitan Area.

Thus, since Micropolitan Areas tend to include fewer hospitals, recognizing Micropolitan Areas as independent labor market areas would generally increase the potential for dramatic shifts in those areas' wage indexes from one year to the next, because a single hospital (or group of hospitals) could have a disproportionate effect on the wage index of the area. Dramatic shifts in an area's wage index from year to year are problematic and create instability in the payment levels from year to year, which could make fiscal planning for SNFs difficult if we adopted this approach. Therefore, in order to minimize the potential instability in payment levels from year to year, we believe it would be appropriate to treat Micropolitan Areas as part of the statewide rural labor market area under the SNF PPS.

Consistent with the treatment of these areas under the IPPS, we are proposing that Micropolitan Areas be considered a part of the Statewide rural labor market area. Accordingly, we are proposing that the SNF PPS Statewide rural wage index would be determined using acute-care IPPS hospital wage data from hospitals located in non-MSA areas and that the Statewide rural wage index would be assigned to SNFs located in those areas.

When the revised labor market areas based on the OMB's new CBSA designations were adopted under the IPPS beginning on October 1, 2004, a transition to the new designations was established due to the scope and magnitude of the change, in order to mitigate the resulting adverse impact on certain hospitals. As discussed in the August 11, 2004 IPPS final rule (69 FR 49032), during FY 2005, a blend of wage indexes is calculated for those acute care IPPS hospitals experiencing a drop in their wage indexes because of the adoption of the new labor market areas. Also, as described in that same final rule (69 FR 49032), under the IPPS, hospitals that previously had been located in an urban MSA but became rural under the new CBSA definitions are assigned the wage index value of the urban area to which they belonged previously, for 3 years (FYs 2005 through FYs 2007).

We recognize that SNFs will be subject to the same impact as hospitals, and that some SNFs may experience decreases in their wage index as a result of the proposed labor market area changes. At the same time, a significant number of SNFs will benefit from these proposed changes. However, as explained below, we are not proposing a transition period in this proposed rule.

5. Implementation of the Revised Labor Market Areas

Under section 1888(e)(4)(G)(ii) of the Act, the Secretary has the authority to adjust for geographic variations in labor costs by using an appropriate wage index. Moreover, the adjustment must be made in a manner such that aggregate payments would not change if such adjustment were not made.

To facilitate an understanding of the proposed policies related to the proposed change to the SNF PPS labor market areas discussed above, in Table A (MSA/CBSA Crosswalk) of the Addendum of this proposed rule, we are providing a listing of each Social Security Administration (SSA) State and county location code; State and county name; existing MSA-based labor market area designation; MSA-based wage index value; CBSA-based labor market area; and the new CBSA-based wage index value.

When the revised labor market areas based on OMB's new CBSA designations were adopted under the IPPS beginning on October 1, 2004, a transition to the new designations was established due to the scope and fiscal impact of these new boundaries. As discussed in the IPPS final rule (69 FR 49032), during FY 2005, a blend of wage indexes is calculated for those acute care IPPS hospitals experiencing a drop in their wage indexes because of the adoption of the new labor market areas. The most significant impacts will generally be for MSA-based urban hospitals that were designated as rural under the CBSA-based designations.

Because the former MSA-based labor market areas used under the IPPS had been used for payment for over 10 years, we believed it was necessary to provide additional protection, given the scope and potentially significant implications (and the subsequent adverse impact) of these new labor market areas on numerous acute-care hospitals. Therefore, we implemented a transition under the IPPS from the former MSA-based labor market area designation to the new CBSA-based labor market area designation for acute-care hospitals that would receive a lower wage index as a result of the change in the labor market area designations.

As we recognize that SNFs may experience similar changes in their wage indexes as a result of the proposed labor market area changes, we carefully evaluated the impact of the conversion to the proposed wage index structure. During our analysis, we found that a majority of SNFs (61 percent) either maintained the same wage index or would get an increased wage index based on CBSA definitions. Only a very small number of SNFs (4 percent) would experience a decline of 5 percent or more in the wage index based on CBSA designations. We also found that only a very small number of SNFs would experience a change in either rural or urban designation under the CBSA based definitions. Furthermore, we believe the new CBSA definitions may have a positive impact on many counties. For example, most counties which had been included in the rural definitions under the MSA designations but are now designated as urban areas under CBSAs will generally receive an increase in their wage index.

Although a majority of SNFs would not be significantly affected, and we believe that it is not appropriate or necessary to propose a transition to the proposed new CBSA-based labor market areas for the purpose of the SNF PPS wage index, we recognize that there are many options in efficiently implementing the new CBSA geographic designations. Thus, we considered several budget neutral options that would most effectively implement the adoption of the proposed CBSA designations as discussed below.

One option we considered institutes a one-year transition with a blended wage index for all providers. The wage index for each provider would consist of a blend of 50 percent of the FY 2006 MSA-based wage index and 50 percent of the FY 2006 CBSA-based wage index (both based on the FY 2002 hospital wage data). However, we found that while this would help some SNFs that would be adversely affected by the proposed changes to the MSAs, it would also reduce the wage index values (compared to fully adopting the CBSA wage index value) for those SNFs that would be positively affected by the changes. In addition, the budget neutrality factor calculated based on the blended wage index for all SNFs would slightly reduce the unadjusted payment rate for all providers.

A second option we considered was a one-year transition with a blended wage index limited to providers that would experience a decrease due solely to the changes in the labor market definitions. Providers that experience a decrease in their FY 2006 wage index under the CBSA-based definitions compared to the wage index they would have received under the MSA-based definitions (in both cases using FY 2002 hospital wage data) would receive a blended wage index. The wage index for these providers would consist of a blend of 50 percent of the FY 2006 MSA wage index and 50 percent of the FY 2006 CBSA wage index (both based on the FY 2002 hospital wage data). Providers that would experience a decrease due to changes in the labor market definitions would receive the full FY 2006 CBSA wage index.

When we performed our analysis, we found that the unadjusted payment amounts decreased substantially more under this option than they did either by using the first option discussed above or by fully adopting the CBSA designations. As with the first option, the positive impact of blending in order to decrease the impacts for a relatively small number of SNFs would require reduced payment rates for all providers, including the SNFs receiving a blended wage index.

We also recognize that during FY 2005, as discussed in the August 11, 2004 IPPS final rule (69 FR 49032), a hold harmless policy under IPPS was implemented to minimize the overall impact on hospitals that are currently designated as urban under the MSA designations, but would become rural under the CBSA designations. We considered adopting a hold harmless policy for SNFs, to allow facilities that are currently urban under the MSA definitions (but become rural under the CBSA definitions) to maintain their urban status under the CBSA definitions for one year. However, our analysis shows that only an extremely small number of SNFs would qualify for such a hold harmless policy. As any adjustment requires payments to be made in a budget neutral manner, all providers would have the payment rates reduced for the benefit of that small number of SNFs (1.4 percent) which lose their urban designations. Accordingly, we do not believe it is appropriate or necessary to adopt a hold harmless policy under the SNF PPS for facilities that will experience a change in designation under the CBSA definitions.

We are proposing to adopt for the SNF PPS the new CBSA-based labor market area definitions beginning with the 2006 SNF PPS rate year without a transition period and without a hold harmless policy. We also note that OMB in the past has announced MSA changes on an annual basis due to population changes and we have not transitioned these changes under the SNF PPS.

As noted previously, our data analysis shows that a minimal number of SNFs would experience a decrease of more than 5 percent in the wage index. In addition, under the CBSA designation, an even smaller number of SNFs would experience a change from their current urban or rural designation. Therefore, the aggregate impact on SNFs under the MSA-based designations as compared to the CBSA-based designations does not result in a dramatic change overall.

As explained above, we believe that it is not appropriate or necessary to propose a transition to the proposed new CBSA-based labor market area for the SNF PPS wage index adjustment. In addition, as noted above, we believe the data suggest that the potential benefit of a hold harmless policy for an extremely small number of providers would be outweighed by the resulting decrease in payment rates for all providers. However, we specifically invite public comments on our proposed approach, as well as on the various transition options discussed above.

Finally, we note that section 505 of the MMA established new section 1886(d)(13) of the Act. The new section 1886(d)(13) requires that the Secretary establish a process to make adjustments to the hospital wage index based on commuting patterns of hospital employees. We believe that this requirement for an “out-commuting” or “out-migration” adjustment applies specifically to the Hospital Inpatient Prospective Payment System. Therefore, we will not be establishing such an adjustment for the SNF PPS.

6. Wage Index Data

[If you choose to comment on issues in this section, please include the caption “Wage Index Data” at the beginning of your comments.]

In the FY 2005 SNF PPS update notice (69 FR 45775, July 30, 2004), we established SNF PPS wage index values for the 2005 SNF PPS rate year calculated from the same data (generated in cost reporting periods beginning during FY 2001) used to compute the FY 2005 acute care hospital inpatient wage index data, without taking into account geographic reclassification under sections 1886(d)(8) and 1886(d)(10) of the Act and without applying the “rural floor” under section 4410 of the BBA. We subsequently published correction notices to update the wage index values. The SNF wage index values applicable for services furnished on or after October 1, 2004 through August 31, 2005 are shown in Table 8 (for urban areas) and Table 9 (for rural areas) in the December 30, 2004 correction notice (69 FR 78445).

Acute care hospital inpatient wage index data is also used to establish the wage index adjustment used in the LTCH PPS, IPF PPS, HHA PPS, and IRF PPS. As we discussed in the May 12, 1998 SNF PPS interim final rule (63 FR 26252), as hospitals that are excluded from the IPPS are not required to provide wage-related information on the Medicare cost report, and because we would need to establish instructions for the collection of these SNF data in order to establish a geographic reclassification adjustment under the SNF PPS, the wage adjustment established under the SNF PPS is based on a SNF's actual location without regard to the urban or rural designation of any related or affiliated provider.

In this proposed rule, for the FY 2006 SNF PPS rate year, we propose to use acute care hospital inpatient wage index data generated from cost reporting periods beginning during FY 2002 (without taking into account geographic reclassification under sections 1886(d)(8) and 1886(d)(10) of the Act and without applying the “rural floor” under section 4410 of the BBA) to determine the applicable wage index values under the SNF PPS, because these data (FY 2002) are the most recent complete data. We realize that there has been some interest in developing a SNF-specific wage index. However, considering the impact of converting to the new OMB classification methodology discussed above, we believe a second major change would be inappropriate at this time. In making this decision, one of our primary concerns is that the combined effect of changing both the wage area categories and the actual wage index could result in an inaccurate impact assessment for one or both of these changes. As discussed in several of the previous SNF PPS rules, we also remain concerned about the potential volatility and unreliability of unaudited data (see, for example, the final rule for FY 2002 (66 FR 39579 through 39596, July 31, 2001), and the final rule for FY 2004 (68 FR 46045 through 46046, August 3, 2003)).

We are proposing to adopt OMB's new labor market designations for CY 2006, effective January 1, 2006. In adopting the CBSA designations, we identified some geographic areas where there were no hospitals, and thus no hospital wage index data on which to base the calculation of the FY 2006 SNF PPS proposed wage index. In addressing this situation, we are proposing approaches that we believe serve as proxies for hospital wage data and would provide an appropriate standard that accounts for geographic variation in labor costs.

The first situation involves rural locations in Massachusetts and Puerto Rico. Under these labor market areas, there are no rural hospitals in those locations. Because there is no reasonable proxy for more recent rural data within those areas, we are proposing to use last year's wage index value for rural Massachusetts and rural Puerto Rico.

The second situation has to do with the urban areas of Hinesville, GA (CBSA 25980) and Mansfield, OH (CBSA 31900). Again, under the proposed new labor market areas there are no urban hospitals within those areas. We propose to use all of the urban areas within the State to serve as a reasonable proxy for the urban areas without specific hospital wage index data in determining the SNF PPS wage index. Therefore, in this proposed rule, we calculated the urban wage index value for purposes of the wage index for these areas without urban hospital data as the average wage index for all urban areas within the State. We note that we could not apply a similar averaging in rural areas, because in the rural areas there are no State rural hospital wage data available for averaging on a State-wide basis. We solicit comments on these approaches to calculating the wage index values for areas without hospitals for FY 2006 and subsequent years.

The proposed wage index values that would be applicable for SNF PPS services furnished on or after October 1, 2005 through August 31, 2006 are shown in Tables 8 and 9 in the Addendum of this proposed rule.

E. Updates to the Federal Rates

In accordance with section 1888(e)(4)(E) of the Act and section 311 of the BIPA, the proposed payment rates listed here reflect a proposed update equal to the full SNF market basket, estimated at 3.0 percentage points. We will continue to disseminate the rates, wage index, and case-mix classification methodology through the Federal Register before August 1 preceding the start of each succeeding fiscal year. We discuss the Federal rate update factor in greater detail in section III.C of this preamble.

F. Relationship of RUG-III Classification System to Existing Skilled Nursing Facility Level-of-Care Criteria

As discussed in § 413.345, we include in each update of the Federal payment rates in the Federal Register the designation of those specific RUGs under the classification system that represent the required SNF level of care, as provided in § 409.30. This designation reflects an administrative presumption under the current 44-group RUG-III classification system. Our presumption is that any beneficiary who is correctly assigned to one of the upper 26 RUG-III groups in the initial 5-day, Medicare-required assessment is automatically classified as meeting the SNF level of care definition up to the assessment reference date for that assessment.

Any beneficiary assigned to any of the lower 18 groups is not automatically classified as either meeting or not meeting the definition, but instead receives an individual level of care determination using the existing administrative criteria. This presumption recognizes the strong likelihood that beneficiaries assigned to one of the upper 26 groups during the immediate post-hospital period require a covered level of care, which would be significantly less likely for those beneficiaries assigned to one of the lower 18 groups.

As discussed in section II.B of this preamble, we propose to refine the existing 44-group RUG-III classification system by adding an additional 9 groups, comprising a new Rehabilitation plus Extensive Services category. In effect, the groups in this new category would encompass care that is at least as intensive as that identified by any of the upper 26 RUG-III groups under the original, 44-group RUG-III classification system. Accordingly, for purposes of the administrative presumption, we propose to designate the upper 35 groups of the proposed 53-group refined case-mix classification system (including the upper 26 groups that we have identified as representing a covered level of care under the existing 44-group system, plus the additional 9 groups set forth in this proposed rule), consisting of the following RUG classifications: All groups within the proposed new Rehabilitation plus Extensive Services category; all groups within the Ultra High Rehabilitation category; all groups within the Very High Rehabilitation category; all groups within the High Rehabilitation category; all groups within the Medium Rehabilitation category; all groups within the Low Rehabilitation category; all groups within the Extensive Services category; all groups within the Special Care category; and, all groups within the Clinically Complex category.

G. Initial 3-Year Transition Period From Facility Specific to Federal Rates

As noted previously in section I.A and section I.F.2 of this proposed rule, the PPS is no longer operating under the initial 3-year transition period from facility-specific to Federal rates. Therefore, payment now equals the adjusted Federal per diem rate.

H. Example of Computation of Adjusted PPS Rates and SNF Payment

As explained in section II.B of this proposed rule, from October 1, 2005, through December 31, 2005, we propose to make payment based entirely on the existing 44-group RUG-III classification system (including any associated add-on payments). Using the model SNF (XYZ) described in Table 10, the following shows the adjustments made to the Federal per diem rate to compute the provider's actual per diem PPS for the time period mentioned above using the existing 44 group RUG-III classification system.

Table 10.—RUG-44, SNF XYZ: Located in State College, PA, Wage Index: 0.8364

RUG group	Labor	Wage index	Adjustment labor	Non-labor	Adjustment rate	Percent adjustment	Medicare days	Payment
RVC	$282.62	0.8364	$236.38	$88.82	$325.20	* $346.99	14	$4,858
RHA	218.40	0.8364	182.67	68.64	251.31	* 268.15	16	4,290
CC2	180.87	0.8364	151.28	56.84	208.12	** 474.51	10	4,745
SE3	241.52	0.8364	202.01	75.91	277.92	*** 333.50	30	10,005
IA2	123.35	0.8364	103.17	38.77	141.94	141.94	30	4,258
Total							100	28,156
* Reflects a 6.7 percent adjustment from section 314 of the BIPA.
** Reflects a 128 percent adjustment from section 511 of the MMA. Section 101(a) of the BBRA no longer applies because of the MMA section 511 adjustment.
*** Reflects a 20 percent adjustment from section 101(a) of the BBRA.

Beginning January 1, 2006, we propose to make payment based on the proposed new RUG-53 classification system (and, thus, would not include the add-on payments). Table 10a shows an example of the actual per diem PPS payments under the RUG-53 classification system.

Table 10a.—RUG-53, SNF XYZ: Located in State College, PA, Wage Index: 0.8364

RUG group	Labor	Wage index	Adjustment labor	Non-labor	Adjustment rate	Percent adjustment	Medicare days	Payment
RVX	$310.03	0.8364	$259.31	$97.44	$356.75	$356.75	14	$4,994
RHA	233.09	0.8364	194.96	73.26	268.22	268.22	16	4,291
CC2	184.01	0.8364	153.91	57.83	211.74	* 482.76	10	4,828
RLX	246.32	0.8364	206.02	77.42	283.44	283.44	30	8,503
IA2	125.44	0.8364	104.92	39.43	144.35	144.35	30	4,330
Total							100	26,946
* Reflects a 128 percent adjustment from section 511 of the MMA.

III. The Skilled Nursing Facility Market Basket Index

Section 1888(e)(5)(A) of the Act requires us to establish a SNF market basket index (input price index) that reflects changes over time in the prices of an appropriate mix of goods and services included in the SNF PPS. This proposed rule incorporates the latest available projections of the SNF market basket index. The final rule will incorporate updated projections based on the latest available projections at that time. Accordingly, we have developed a SNF market basket index that encompasses the most commonly used cost categories for SNF routine services, ancillary services, and capital-related expenses. In the July 31, 2001 Federal Register (66 FR 39562), we included a complete discussion on the rebasing of the SNF market basket to FY 1997. There are 21 separate cost categories and respective price proxies. These cost categories were illustrated in Table 10.A, Table 10.B, and Appendix A, along with other relevant information, in the July 31, 2001 Federal Register.

Each year, we calculate a revised labor-related share based on the relative importance of labor-related cost categories in the input price index. Table 11 summarizes the proposed updated labor-related share for FY 2006.

Table 11.—FY 2006 Labor-Related Share

	Relative importance, labor-related, FY 2005 (97 index)	Relative importance, labor-related, FY 2006 (97 index)
Wages and salaries	54.720	54.572
Employee benefits	11.595	11.691
Nonmedical professional fees	2.688	2.702
Labor-intensive services	4.125	4.116
Capital-related	3.094	3.006
Total	76.222	76.087

A. Use of the Skilled Nursing Facility Market Basket Percentage

Section 1888(e)(5)(B) of the Act defines the SNF market basket percentage as the percentage change in the SNF market basket index, as described in the previous section, from the average index level of the prior fiscal year to the average index level of the current fiscal year. For the Federal rates established in this proposed rule, this percentage increase in the SNF market basket index would be used to compute the update factor occurring between FY 2005 and FY 2006. We used the Global Insight, Inc. (formerly DRI-WEFA), 1st quarter 2005 forecasted percentage increase in the FY 1997-based SNF market basket index for routine, ancillary, and capital-related expenses, described in the previous section, to compute the update factor. Finally, we no longer compute update factors to adjust a facility-specific portion of the SNF PPS rates, because the 3-year transition period from facility-specific to full Federal rates that started with cost reporting periods beginning in July 1998 has expired.

B. Market Basket Forecast Error Adjustment

As discussed in the June 10, 2003, supplemental proposed rule (68 FR 34768) and finalized in the August 4, 2003, final rule (68 FR 46067), the regulations at § 413.337(d)(2) provide for an adjustment to account for market basket forecast error. The initial adjustment applied to the update of the FY 2003 rate that occurred in FY 2004, and took into account the cumulative forecast error for the period from FY 2000 through FY 2002. Subsequent adjustments in succeeding FYs take into account the forecast error from the most recently available fiscal year for which there are final data, and are applied whenever the difference between the forecasted and actual change in the market basket exceeds a 0.25 percentage point threshold. As discussed previously in section I.G of this proposed rule, as the difference between the estimated and actual amounts of increase in the market basket index for FY 2004 (the most recently available fiscal year for which there are final data) did not exceed the 0.25 percentage point threshold, the payment rates for FY 2006 do not include a forecast error adjustment.

C. Federal Rate Update Factor

Section 1888(e)(4)(E)(ii)(IV) of the Act requires that the update factor used to establish the FY 2006 Federal rates be at a level equal to the full market basket percentage change. Accordingly, to establish the update factor, we determined the total growth from the average market basket level for the period of October 1, 2004 through September 30, 2005 to the average market basket level for the period of October 1, 2005 through September 30, 2006. Using this process, the proposed update factor for FY 2006 SNF Federal rates is 3.0 percentage points. We used this revised proposed update factor to compute the proposed Federal portion of the SNF PPS rate shown in Tables 2 and 3.

IV. Consolidated Billing

As established by section 4432(b) of the BBA, the consolidated billing requirement places with the SNF the Medicare billing responsibility for virtually all of the services that the SNF's residents receive, except for a small number of services that the statute specifically identifies as being excluded from this provision. Section 103 of the BBRA amended this provision by further excluding a number of high-cost, low probability services (identified by Healthcare Common Procedure Coding System (HCPCS) codes) within several broader categories that otherwise remained subject to the provision. Section 313 of the BIPA further amended this provision by repealing its Part B aspect; that is, its applicability to services furnished to a resident during a SNF stay that Medicare does not cover. (However, physical, occupational, and speech-language therapy remain subject to consolidated billing, regardless of whether the resident who receives these services is in a covered Part A stay.)

Further, while the services of rural health clinics (RHCs) and Federally Qualified Health Centers (FQHCs) generally are subject to SNF consolidated billing, section 410 of the MMA provided that when an RHC or FQHC furnishes the services of a physician (or another type of service that section 1888(e)(2)(A)(ii) of the Act identifies as being excluded from SNF consolidated billing), those services do not become subject to consolidated billing merely by virtue of being furnished under the auspices of the RHC or FQHC. In effect, this provision (which applies to services furnished on or after January 1, 2005) enables those services to retain their separate identity as excluded “practitioner” services in this context, rather than being treated as bundled “RHC” or “FQHC” services. As such, these services would remain separately billable to Part B when furnished to a resident of the SNF during a covered Part A stay.

To date, the Congress has enacted no further legislation affecting the consolidated billing provision. However, as we noted in the proposed rule of April 10, 2000 (65 FR 19232), section 1888(e)(2)(A)(iii) of the Act, as added by section 103 of the BBRA, not only identified for exclusion from this provision a number of particular service codes within four specified categories (that is, chemotherapy items, chemotherapy administration services, radioisotope services, and customized prosthetic devices), but “ * * * also gives the Secretary the authority to designate additional, individual services for exclusion within each of the specified service categories.” In that proposed rule, we also noted that the BBRA Conference report (H.R. Conf. Rep. No. 106-479 at 854) characterizes the individual services that this legislation targets for exclusion as “* * * high-cost, low probability events that could have devastating financial impacts because their costs far exceed the payment [SNFs] receive under the prospective payment system * * *” According to the conferees, section 103(a) “is an attempt to exclude from the PPS certain services and costly items that are provided infrequently in SNFs * * *.” By contrast, we noted that the Congress declined to designate for exclusion any of the remaining services within those four categories (thus leaving all of those services subject to SNF consolidated billing), because they are relatively inexpensive and are furnished routinely in SNFs.

As we further explained in the final rule of July 31, 2000 (65 FR 46790), any additional service codes that we might designate for exclusion under our discretionary authority must meet the same criteria that the Congress used in identifying the original codes excluded from consolidated billing under section 103(a) of the BBRA: They must fall within one of the four service categories specified in the BBRA, and they also must meet the same standards of high cost and low probability in the SNF setting. Accordingly, we characterized this statutory authority to identify additional service codes for exclusion “* * * as essentially affording the flexibility to revise the list of excluded codes in response to changes of major significance that may occur over time (for example, the development of new medical technologies or other advances in the state of medical practice)” (65 FR 46791). In view of the amount of time that has elapsed since we last invited comments on this issue, we believe it is appropriate at this point once again to invite public comments that identify codes in any of these four service categories representing recent medical advances that might meet the BBRA criteria for exclusion from SNF consolidated billing.

We note that the original BBRA legislation (as well as the implementing regulations) identified a set of excluded services by means of specifying HCPCS codes that were in effect as of a particular date (for example July 1, 1999). Identifying the excluded services in this manner made it possible for us to utilize a Program Memorandum as the vehicle for accomplishing routine updates of the excluded codes, in order to reflect any minor revisions that might subsequently occur in the coding system itself (for example, the assignment of a different code number to the same service). Accordingly, for any new services that would actually represent a substantive change in the scope of services that are excluded from the SNF consolidated billing provision, we would identify these additional excluded services by means of the HCPCS codes that are in effect as of a specific date (in this case, October 1, 2005). By making any new exclusions in this manner, we could similarly accomplish routine future updates of these additional codes through the issuance of program instructions.

V. Application of the SNF PPS to SNF Services Furnished by Swing-Bed Hospitals

In accordance with section 1888(e)(7) of the Act (as amended by section 203 of the BIPA), Part A pays critical access hospitals (CAHs) on a reasonable cost basis for SNF services furnished under a swing-bed agreement. However, as noted previously in section I.A of this notice, the services furnished by non-CAH rural hospitals are paid under the SNF PPS. In the July 31, 2001 final rule (66 FR 39562), we announced the conversion of swing-bed rural hospitals to the SNF PPS, effective with the start of the provider's first cost reporting period beginning on or after July 1, 2002. We selected this date consistent with the statutory provision to integrate swing-bed rural hospitals into the SNF PPS by the end of the SNF transition period, June 30, 2002.

As of June 30, 2003, all swing-bed rural hospitals have come under the SNF PPS. Therefore, all rates and wage indexes outlined in earlier sections of this notice for SNF PPS also apply to all swing-bed rural hospitals. A complete discussion of assessment schedules, the MDS, and the transmission software (Raven-SB for Swing Beds) can be found in the July 31, 2001 final rule (66 FR 39562). The latest changes in the MDS for swing-bed rural hospitals are listed on our SNF PPS Web site, http://www.cms.hhs.gov/​providers/​snfpps/​default.asp.

VI. Qualifying Three-Day Inpatient Hospital Stay Requirement

As indicated in section I.A of this proposed rule, the SNF benefit includes not only level of care requirements, but also a set of technical, or “posthospital” eligibility requirements as well. These requirements date back to the original Medicare legislation (section 102(a) of the Social Security Amendments of 1965, Public Law 89-97), when the Congress defined the intended scope of this benefit. The SNF benefit was never intended to cover long-term, relatively low-level “custodial” care; rather, the Congress envisioned this benefit more narrowly, in terms of serving as a less expensive alternative to what would otherwise be the final, convalescent portion of an acute care stay of several days as an inpatient at a hospital. In order to target the SNF benefit more effectively at the limited segment of the nursing home population that the benefit was actually designed to cover (that is, those beneficiaries requiring a short-term, fairly intensive stay in a SNF as a continuation of an acute hospital stay of several days), the Congress established as a prerequisite for SNF coverage a requirement that a beneficiary must first be a hospital inpatient for “not less than 3 consecutive days before his discharge from the hospital” (section 1861(i) of the Act). From the very inception of the Medicare program, in determining the three-day inpatient requirement for purposes of triggering the SNF benefit, “inpatient” status has been determined as commencing with “the calendar day of admission” to the hospital (see 20 CFR § 405.120 (1966)). The current guidelines in the CMS Internet Online Manual (IOM) at Publication 100-02 (Medicare Benefit Policy Manual), Chapter 8 (Coverage of Extended Care (SNF) Services Under Hospital Insurance), § 20.1 (Three-Day Prior Hospitalization) reflect this determination.

More recently, it has been suggested that because of changes in hospital admission practices that have occurred since the Congress enacted this provision in 1965, some patients who at that time would have been a hospital inpatient for at least 3 days are instead now placed in observation status initially, before being formally admitted as a hospital inpatient. Observation status is a distinct service that is discussed in the IOM in Publication 100-02 (Medicare Benefit Policy Manual), Chapter 6 (Hospital Services Covered Under Part B), § 70.4 (Outpatient Observation Services), in which a patient who needs more care than can be provided in an emergency room is moved from the emergency room, placed in a hospital bed in the appropriate hospital unit, and monitored by the unit nursing and physician staff. We recognize that coverage of observation services under the outpatient prospective payment system is connected to patients with three specific diagnoses: chest pain, asthma, and congestive heart failure.

However, as we noted previously, the longstanding policy interpretation of the SNF benefit's prior hospital stay requirement does not count hospital observation time that immediately precedes an inpatient admission toward meeting the requirement. We have received occasional inquiries about the effect of this policy on those beneficiaries who would be able to satisfy the SNF benefit's 3-day hospital stay requirement only if time spent in observation status immediately prior to the formal inpatient admission were counted. These inquiries assert that in such situations, the care furnished during observation may be indistinguishable from the inpatient care that follows the formal admission, so that the beneficiaries themselves often learn of the difference only after they were transferred to the SNF and failed to meet the SNF benefit's prior hospital stay requirement. The inquirers argue that it is unfair to deny SNF coverage to such a beneficiary based solely on what they characterize as a mere recordkeeping convention on the part of the hospital rather than a substantive change in the actual care that the beneficiary receives there.

We note that the current SNF benefit policy (which counts only time following the formal inpatient admission to the hospital toward meeting the qualifying hospital stay requirement) is based directly on the applicable portion of the Medicare law at section 1861(i) of the Act, which defines the SNF benefit's qualifying hospital stay as one in which the beneficiary “* * * was an inpatient for not less than 3 consecutive days * * *” (emphasis added). An inpatient is a person who has been admitted to a hospital for bed occupancy for purposes of receiving inpatient hospital services as defined in section 1861 of the Act. Moreover, although at the time that this provision was enacted, the concept of observation status itself was not yet even envisioned, to date, the Congress has not chosen to amend section 1861(i) of the Act specifically to reflect use of observation time as triggering the SNF benefit. However, we are aware that over time, practice and treatment of observation time may have changed; thus, the effect of not counting this observation time under the existing policy ultimately might be to restrict SNF coverage to a narrower segment of the beneficiary population than the Congress originally intended.

Accordingly, with regard to those beneficiaries whose formal admission to the hospital as an inpatient is immediately preceded by time spent in hospital observation status, we invite comments on whether we should consider the possibility of counting the time spent in observation status toward meeting the SNF benefit's qualifying 3-day hospital stay requirement. We note that in evaluating the potential impact of such a change, it is necessary not only to consider its effect on those beneficiaries who might not otherwise be able to meet the SNF benefit's prior qualifying hospital stay requirement, but also to assess potential negative consequences. Possible examples could include altering the nature of the SNF benefit in a manner that is inconsistent with Congressional intent in establishing this requirement, or creating a “woodwork effect” of unanticipated consequences, such as routine placement of patients in observation status prior to formal admission, even in situations where observation is not appropriate.

In soliciting these comments, moreover, we wish to distinguish the possible use of observation time from time spent in the hospital's emergency room. Although both observation services and emergency room services are directed at patients who are expected to spend only a short period of time in that service area, they are in many other ways dissimilar. Other than for patients with scheduled admissions, the emergency room generally serves as the hospital's overall point of entry, irrespective of the degree of severity of a particular patient's condition; thus, many hospital patients typically would commence their hospital encounter by spending at least some time initially in the emergency room. However, the time in the emergency room is not considered a substitute for or equivalent to inpatient hospital care. Clearly, many visits to the ER are for treatment of problems requiring no inpatient hospitalization (for example, most wounds, broken or sprained limbs, or minor respiratory illnesses) and often patients come to the ER because their regular physician is unavailable. Situations involving observation status, however, tend to be relatively infrequent compared to the care of all patients that present to the hospital (for example, excessive bleeding or complications during surgery necessitating a longer-than-normal recovery period, or non-specific significant abdominal pain). Further, as emergency room services typically represent the patient's initial medical encounter for new or worsening symptoms, such services focus on identifying, managing, and stabilizing the patient's acute condition. By contrast, observation services are furnished to a patient for whom there is already at least a working diagnosis, and involve ongoing assessment and short-term treatment that is specifically directed at that condition so that a subsequent determination about hospital admission or discharge can be made. (With respect to continuing assessment and treatment, observation services would appear to share some common elements with inpatient care, although the latter involves a condition that is expected to require care for a significantly longer duration, and that also may well require medical intervention at a level of complexity that does not occur on an outpatient basis.)

We recognize that, under section 1886(a) of the Act, the statute defines “operating costs of inpatient hospital services” as including the costs of certain services furnished prior to a patient's admission to the hospital. That is, the costs of certain services furnished prior to an individual's admission as an inpatient are deemed by statute to be operating costs of inpatient hospital services. However, it is worth noting that section 1886(a) addresses costs, and neither section 1886(a) nor section 1861(i) provides that a patient be deemed an inpatient during the time prior to admission for purposes of the 3-day requirement for SNF coverage. Moreover, the deeming requirement in section 1886(a) and the 3-day requirement for SNF coverage in section 1861(i) serve different purposes. The deeming requirement in section 1886(a) was intended to prevent hospitals from “unbundling” services from the inpatient stay and inappropriately seeking separate payment. See 59 FR 1654, 1656 (Jan. 12, 1994). That consideration does not apply in the context of SNF coverage. As discussed above, the purpose of the 3-day inpatient stay requirement for SNF coverage is to target SNF coverage to individuals requiring a short-term, fairly intensive stay in a SNF as a continuation of an acute hospital stay. The Congress chose to target SNF coverage to individuals who had been inpatients for at least 3 consecutive days; the Congress could have chosen a shorter time, or it could have specified that certain time before admission must be counted for purposes of the 3-day requirement, but it did not. Given the differences in statutory language and statutory purpose, we believe the requirement in section 1886(a) of the Act (to treat certain preadmission costs as inpatient costs) is consistent with not counting time spent in the hospital prior to an individual's inpatient admission as inpatient time, for purposes of the 3-day requirement for SNF coverage under section 1861(i) of the Act.

VII. Provisions of the Proposed Rule

In this proposed rule, we propose to make the following revision to the existing text of the regulations:

• We would revise the regulations at § 424.20(e)(2), regarding the performance of SNF certifications and recertifications by NPs and CNSs, to clarify the distinction between “direct” and “indirect” employment relationships. We would also make a minor technical correction in the definition of “HCPCS” that appears in § 424.3.

VIII. Collection of Information Requirements

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

IX. Regulatory Impact Analysis

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 16, 1980, Pub. L. 96-354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.

Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). This proposed rule is major, as defined in Title 5, United States Code, section 804(2), because we estimate the impact to the Medicare program, and the annual effects to the overall economy, would be more than $100 million.

The 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 SNFs and most other providers and suppliers are small entities, either by their nonprofit status or by having revenues of $11.5 million or less in any 1 year. For purposes of the RFA, approximately 53 percent of SNFs are considered small businesses according to the Small Business Administration's latest size standards, with total revenues of $11.5 million or less in any 1 year (for further information, see 65 FR 69432, November 17, 2000). Individuals and States are not included in the definition of a small entity. In addition, approximately 29 percent of SNFs are nonprofit organizations.

This proposed rule proposes to update the SNF PPS rates published in the FY 2005 update notice on July 30, 2004 (69 FR 45775) and the associated correction notices published on October 7, 2004 (69 FR 60158), and December 30, 2004 (69 FR 78445).

In addition, section 1102(b) of the Act requires us to prepare a regulatory impact analysis if a rule may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside of a Metropolitan Statistical Area and has fewer than 100 beds. We anticipate that the impact on swing-bed facilities will be similar to the impact on rural hospital-based facilities, which benefit from the case-mix refinement (see Table 12 below).

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, or tribal governments, in the aggregate, or by the private sector, of $110 million or more. This proposed rule would not have a substantial effect on the governments mentioned, or on private sector costs.

Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule that impose substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. As stated above, this proposed rule would not have a substantial effect on State and local governments.

B. Anticipated Effects

This proposed rule sets forth updates of the SNF PPS rates contained in the FY 2005 update notice (69 FR 45775), and the associated correction notices (69 FR 60158 and 69 FR 78445) and presents a refinement to the RUG-III case-mix classification system to be incorporated into the Medicare SNF PPS effective January 1, 2006. As described in Section II.B.4, providers would continue to be paid under the current 44 group RUG-III system from October 1, 2005 through December 31, 2005. Beginning January 1, 2006, we propose that providers would be paid the proposed new RUG-53 payment.

Based on the above, we estimate the FY 2006 impact to be a net impact of $0 million on payments (this reflects a $1.02 billion reduction from the expiration of temporary payment increases, offset by a $510 million increase from the proposed refined case-mix classification system and a $510 million increase from the update to the payment rates, as explained in greater detail later in this section). The impact analysis in Table 12 of this proposed rule represents the projected effects of the proposed policy changes in the SNF PPS from FY 2005 to FY 2006. We estimate the effects by estimating payments while holding all other payment variables constant. We use the best data available, but we do not attempt to predict behavioral responses to these changes, and we do not make adjustments for future changes in such variables as days or case-mix.

We note that certain events may combine to limit the scope or accuracy of our impact analysis, because such an analysis is future-oriented and, thus, susceptible to forecasting errors due to other changes in the forecasted impact time period. Some examples are newly-legislated general Medicare program funding changes by the Congress, or changes specifically related to SNFs. In addition, changes to the Medicare program may continue to be made as a result of the BBA, the BBRA, the BIPA, the MMA, or new statutory provisions. Although these changes may not be specific to the SNF PPS, the nature of the Medicare program is such that the changes may interact, and the complexity of the interaction of these changes could make it difficult to predict accurately the full scope of the impact upon SNFs.

In accordance with section 1888(e)(4)(E) of the Act, we are updating the payment rates for FY 2006. The BBRA, BIPA, and MMA provided for several temporary adjustments to the SNF PPS payment rates that together, using the most recent data available, accounted for an estimated $1.4 billion per year in payments to the nursing home industry.

We note that in accordance with section 101(a) of the BBRA and section 314 of the BIPA, the existing, temporary increase in the per diem adjusted payment rates of 20 percent for certain specified clinically complex RUGs (and 6.7 percent for other, rehabilitation RUGs) would expire with the implementation of the proposed case-mix refinements in the SNF PPS. As explained in section II.B.3 of this proposed rule, section 511 of the MMA, which provides for a 128 percent increase in the PPS per diem payment for any SNF resident with Acquired Immune Deficiency Syndrome (AIDS), remains in effect. However, we have not provided a separate impact analysis for the MMA provision. Our latest estimates indicate that there are less than 2,000 beneficiaries who qualify for this add-on payment. The impact to Medicare is included in the “total” column of Table 12.

In proposing to update the rates for FY 2006, we made a number of standard annual revisions and clarifications mentioned elsewhere in this proposed rule (for example, the update to the wage and market basket indexes used for adjusting the Federal rates). These revisions would increase payments to SNFs by approximately $510 million.

The aggregate change in payments associated with this proposed rule is estimated to be $0 million for FY 2006. The decrease of $1.02 billion due to the elimination of the temporary add-ons as of January 1, 2006, together with the additional payment due to the proposed refined case-mix classification system of $510 million and the market basket increase of $510 million, results in a net change in payments of $0 million. There are two areas of change that produce this impact on SNFs:

1. The implementation of a refined case-mix classification system under section 1888(e)(4)(G)(i) of the Act and, consequently, the reduction of the temporary 20 percent/6.7 percent add-ons to the Federal rates for the specified RUG groups.

2. The total change in payments from FY 2005 levels to FY 2006 levels. This includes all of the previously noted changes in addition to the effect of the update to the rates.

The impacts are shown in Table 12. The breakdown of the various categories of data in the table follows.

The first column shows the breakdown of all SNFs by urban or rural status, hospital-based or freestanding status, and census region.

The first row of figures in the first column describes the estimated effects of the various changes on all facilities. The next 6 rows show the effects on facilities split by hospital-based, freestanding, urban, and rural categories. The next 20 rows show the effects on urban versus rural status by census region.

The second column in the table shows the number of facilities in the impact database.

The third column of the table shows the effect of the annual update to the wage index. This represents the effect of using the most recent wage data available. The total impact of this change is zero percent; however, there are distributional effects of the change.

The fourth column of the table shows the effect of using the new OMB geographic designations based on CBSAs.

The fifth column of the table shows the effect of the elimination of the add-on for specified RUG groups. As expected, this results in a decrease in payments for all providers.

The sixth column of the table shows the effect of the proposed refinements to the case-mix classification system. Table 12 shows that there is a positive three percent overall impact from the proposed case-mix refinements. Distributional effects are noted for specific providers. For example, hospital-based facilities are expected to receive greater than a 5.6 percent increase in payment, compared with freestanding facilities that show an increase in payments of between 2.4 and 2.9 percent. Additionally, rural Census regions show increases in payments of 3.4 percent.

The seventh column of the table shows the effect of all of the changes on the FY 2006 payments. As the market basket increase of 3.0 percentage points is constant for all providers, it is not shown individually; however, we note that the “Total FY 2006 change” column does incorporate this increase. It is projected that aggregate payments would not change in total, assuming facilities do not change their care delivery and billing practices in response.

As can be seen from this table, the combined effects of all of the changes would vary by specific types of providers and by location. For example, though facilities in the rural South Atlantic and rural Mountain region experience payment decreases of 2.3 and 1.8 percent respectively, some providers such as the rural Pacific and rural New England show increases of 4.1 and 2.6 percent respectively. Payment increases for facilities in the Rural Pacific area of the country are the highest for any provider type.

Table 12.—Projected Impact to the SNF PPS for FY 2006

	Number of facilities	Update wage data (percent)	MSA to CBSA (percent)	Eliminate add-on to certain RUGs (percent)	Case-mix refinements (percent)	Total FY 2006 change (percent)
Total	15,675	0.0	0.0	−6.0	3.0	0.0
Urban	10,599	0.0	0.2	−6.0	2.9	0.1
Rural	5,076	0.1	−0.8	−6.0	3.4	−0.3
Hospital based urban	1,097	0.0	0.2	−6.3	5.6	2.5
Freestanding urban	8,693	0.0	0.2	−5.9	2.4	−0.3
Hospital based rural	1,160	0.0	−0.7	−6.8	5.9	1.3
Freestanding rural	3,372	0.2	−1.0	−5.9	2.9	−0.8
Urban by region:
New England	917	−0.4	−0.4	−6.4	3.0	−1.2
Middle Atlantic	1,499	0.2	0.3	−6.1	3.4	0.8
South Atlantic	1,739	−0.3	0.3	−5.9	2.6	−0.3
East North Central	2,009	−0.3	0.0	−5.7	2.8	−0.2
East South Central	531	0.4	0.7	−6.0	2.7	0.8
West North Central	836	−0.4	0.4	−5.9	3.7	0.8
West South Central	1,093	−0.1	0.5	−5.8	2.7	0.3
Mountain	467	−0.2	0.5	−5.6	3.0	0.7
Pacific	1,501	1.2	0.0	−6.2	2.7	0.7
Rural by region:
New England	139	1.9	−0.1	−5.7	3.5	2.6
Middle Atlantic	283	0.0	−0.8	−6.0	3.7	−0.1
South Atlantic	612	−0.3	−1.7	−6.2	2.9	−2.3
East North Central	947	0.2	−0.8	−5.9	3.5	0.1
East South Central	571	0.4	−0.6	−6.3	2.9	−0.6
West North Central	1,219	−0.4	−0.3	−6.2	4.0	0.1
West South Central	823	0.3	−0.8	−6.2	2.9	−0.7
Mountain	298	0.8	−3.4	−5.9	3.8	−1.8
Pacific	182	1.3	0.5	−4.2	3.5	4.1
Ownership:
Government	693	0.1	0.3	−6.5	3.2	0.0
Proprietary	9,317	0.0	0.0	−5.9	2.9	0.0
Voluntary	3,493	−0.1	−0.1	−6.0	3.1	−0.1

C. Accounting Statement

As required by OMB Circular A-4 (available at http://www.whitehouse.gov/​omb/​circulars/​a004/​a-4.pdf), in Table 13 below, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this proposed rule. This table provides our best estimate of the change in Medicare payments under the SNF PPS as a result of the proposals presented in this proposed rule based on the data for 15,675 SNFs in our database. All expenditures are classified as transfers to Medicare providers (that is, SNFs).

Table 13.—Accounting Statement: Classification of Estimated Expenditures, from the 2005 SNF PPS Rate Year to the 2006 SNF PPS Rate Year (in Millions)

Category	Transfers
Annualized Monetized Transfers	$0 million.
From Whom To Whom?	No Transfer.

D. Alternatives Considered

Section 1888(e) of the Act establishes the SNF PPS for the payment of Medicare SNF services for cost reporting periods beginning on or after July 1, 1998. This section of the statute prescribes a detailed formula for calculating payment rates under the SNF PPS, and does not provide for the use of any alternative methodology. It specifies that the base year cost data to be used for computing the RUG-III payment rates must be from FY 1995 (October 1, 1994, through September 30, 1995.) In accordance with the statute, we also incorporated a number of elements into the SNF PPS, such as case-mix classification methodology, the MDS assessment schedule, a market basket index, a wage index, and the urban and rural distinction used in the development or adjustment of the Federal rates. Further, section 1888(e)(4)(H) of the Act specifically requires us to disseminate the payment rates for each new fiscal year through the Federal Register, and to do so before the August 1 that precedes the start of the new fiscal year.

As discussed previously in section II.B of this proposed rule, we propose to implement refinements to the RUG-III case-mix classification system under section 1888(e)(4)(G)(i) of the Act. At the same time, we continue to evaluate longer-range, more comprehensive changes in the case-mix classification system. One alternative that we considered was to defer proposing refinements at this time until our evaluation of longer-range, more comprehensive changes is complete. However, we believe that the refinements that we are proposing would serve to improve the distribution of payments under the PPS, in a manner that more accurately accounts for the care needs of the most medically complex patients. As noted in section II of this preamble, a number of analyses have demonstrated an increase in the explanatory power (R-square) of the proposed refined case-mix classification system model, compared to the 44-group model that is currently in use. While our additional research may identify more comprehensive modifications, it is not currently known when the results of this research would become available. Therefore, we have decided to propose the refinements discussed elsewhere in this proposed rule. In addition, as noted previously, we specifically solicit comments on the economic impact of the payment changes discussed in this proposed rule, as well as their potential impact on beneficiaries' access to quality SNF care.

We considered other options intended to help ensure more accurate allocation of payments specifically with regard to non-therapy ancillaries. One of these options included moving the non-therapy ancillary costs used in establishing the nursing case-mix component of the payment rates to a separate, newly created “medically ancillary” component (65 FR 19192, April 10, 2000). In addition, we looked at a number of possible models, both weighted and unweighted, for a new non-therapy ancillary index (65 FR 19248ff.). Finally, we also researched the application of models such as Diagnosis-Related Groups (DRGs) and All Patient Refined DRGs (APR-DRGs). However, at this stage in our analysis, none of these alternatives offered a significant improvement over the RUG-53 model in accounting for the variability of non-therapy ancillary costs.

In accordance with the provisions of Executive Order 12866, this regulation was reviewed by the Office of Management and Budget.

List of Subjects in 42 CFR Part 424

• Emergency medical services
• Health facilities
• Health professions
• Medicare

For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services proposes to amend 42 CFR chapter IV as follows:

PART 424—CONDITIONS FOR MEDICARE PAYMENT

1. The authority citation for part 424 continues to read as follows:

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

Subpart A—General Provisions

§ 424.3

[Amended]

2. In § 424.3, in the definition of “HCPCS” remove the word “CMS” and add the word “Healthcare” in its place.

Subpart B—Certification and Plan of Treatment Requirements

3. In § 424.20, paragraph (e)(2) is revised to read as follows:

§ 424.20

Requirements for posthospital SNF care.

* * * * *

(e) * * *

(2) A nurse practitioner or clinical nurse specialist, neither of whom has a direct or indirect employment relationship with the facility but who is working in collaboration with a physician. For purposes of this section—

(i) Collaboration means a process whereby a nurse practitioner or clinical nurse specialist works with a doctor of medicine or osteopathy to deliver health care services. The services are delivered within the scope of the nurse's professional expertise, with medical direction and appropriate supervision as provided for in guidelines jointly developed by the nurse and the physician or other mechanisms defined by Federal regulations and the law of the State in which the services are performed.

(ii) A direct employment relationship with the facility is one meeting the common law test specified in 20 CFR 404.1005, 404.1007, and 404.1009. When this test is not met, the facility is considered to have an indirect employment relationship with any nurse practitioner or clinical nurse specialist who performs nursing services for the facility under § 409.21 of this subchapter (however, the performance of only delegated physician tasks under § 483.40(e) of this chapter does not, in itself, establish the existence of an indirect employment relationship).

* * * * *

(Catalog of Federal Domestic Assistance Program No. 93.773, Medicare-Hospital Insurance Program; and No. 93.774, Medicare-Supplementary Medical Insurance Program)

Dated: March 31, 2005.

Mark B. McClellan,

Administrator, Centers for Medicare & Medicaid Services.

Dated: May 13, 2005.

Michael O. Leavitt,

Secretary.

VI. Addendum

This section contains the tables referred to throughout the preamble to this proposed rule. Tables 8 “Proposed Wage Index For Urban Areas Based On CBSA Labor Market Areas,” Table 9 “Proposed Wage Index Based On CBSA Labor Market Areas For Rural Areas” and Table A “MSA/CBSA Crosswalk” are presented below.

Table 8.—Proposed Wage Index For Urban Areas Based On CBSA Labor Market Areas

CBSA Code	Urban Area (Constituent Counties)	Wage Index
10180	Abilene, TX	0.7904
	Callahan County, TX
	Jones County, TX
	Taylor County, TX
10380	Aguadilla-Isabela-San Sebastian, PR	0.4743
	Aguada Municipio, PR
	Aguadilla Municipio, PR
	Añasco Municipio, PR
	Isabela Municipio, PR
	Lares Municipio, PR
	Moca Municipio, PR
	Rincón Municipio, PR
	San Sebastian Municipio, PR
10420	Akron, OH	0.8991
	Portage County, OH
	Summit County, OH
10500	Albany, GA	0.8636
	Baker County, GA
	Dougherty County, GA
	Lee County, GA
	Terrell County, GA
	Worth County, GA
10580	Albany-Schenectady-Troy, NY	0.8545
	Albany County, NY
	Rensselaer County, NY
	Saratoga County, NY
	Schenectady County, NY
	Schoharie County, NY
10740	Albuquerque, NM	0.9693
	Bernalillo County, NM
	Sandoval County, NM
	Torrance County, NM
	Valencia County, NM
10780	Alexandria, LA	0.8041
	Grant Parish, LA
	Rapides Parish, LA
10900	Allentown-Bethlehem-Easton, PA-NJ	0.9828
	Warren County, NJ
	Carbon County, PA
	Lehigh County, PA
	Northampton County, PA
11020	Altoona, PA	0.8953
	Blair County, PA
11100	Amarillo, TX	0.9166
	Armstrong County, TX
	Carson County, TX
	Potter County, TX
	Randall County, TX
11180	Ames, IA	0.9545
	Story County, IA
11260	Anchorage, AK	1.2110
	Anchorage Municipality, AK
	Matanuska-Susitna Borough, AK
11300	Anderson, IN	0.8595
	Madison County, IN
11340	Anderson, SC	0.8897
	Anderson County, SC
11460	Ann Arbor, MI	1.0870
	Washtenaw County, MI
11500	Anniston-Oxford, AL	0.7659
	Calhoun County, AL
11540	Appleton, WI	0.9298
	Calumet County, WI
	Outagamie County, WI
11700	Asheville, NC	0.9294
	Buncombe County, NC
	Haywood County, NC
	Henderson County, NC
	Madison County, NC
12020	Athens-Clarke County, GA	0.9843
	Clarke County, GA
	Madison County, GA
	Oconee County, GA
	Oglethorpe County, GA
12060	Atlanta-Sandy Springs-Marietta, GA	0.9648
	Barrow County, GA
	Bartow County, GA
	Butts County, GA
	Carroll County, GA
	Cherokee County, GA
	Clayton County, GA
	Cobb County, GA
	Coweta County, GA
	Dawson County, GA
	DeKalb County, GA
	Douglas County, GA
	Fayette County, GA
	Forsyth County, GA
	Fulton County, GA
	Gwinnett County, GA
	Haralson County, GA
	Heard County, GA
	Henry County, GA
	Jasper County, GA
	Lamar County, GA
	Meriwether County, GA
	Newton County, GA
	Paulding County, GA
	Pickens County, GA
	Pike County, GA
	Rockdale County, GA
	Spalding County, GA
	Walton County, GA
12100	Atlantic City, NJ	1.1633
	Atlantic County, NJ
12220	Auburn-Opelika, AL	0.8108
	Lee County, AL
12260	Augusta-Richmond County, GA-SC	0.9565
	Burke County, GA
	Columbia County, GA
	McDuffie County, GA
	Richmond County, GA
	Aiken County, SC
	Edgefield County, SC
12420	Austin-Round Rock, TX	0.9450
	Bastrop County, TX
	Caldwell County, TX
	Hays County, TX
	Travis County, TX
	Williamson County, TX
12540	Bakersfield, CA	1.0344
	Kern County, CA
12580	Baltimore-Towson, MD	0.9907
	Anne Arundel County, MD
	Baltimore County, MD
	Carroll County, MD
	Harford County, MD
	Howard County, MD
	Queen Anne's County, MD
	Baltimore City, MD
12620	Bangor, ME	1.0003
	Penobscot County, ME
12700	Barnstable Town, MA	1.2527
	Barnstable County, MA
12940	Baton Rouge, LA	0.8601
	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	0.9510
	Calhoun County, MI
13020	Bay City, MI	0.9352
	Bay County, MI
13140	Beaumont-Port Arthur, TX	0.8421
	Hardin County, TX
	Jefferson County, TX
	Orange County, TX
13380	Bellingham, WA	1.1743
	Whatcom County, WA
13460	Bend, OR	1.0796
	Deschutes County, OR
13644	Bethesda-Frederick-Gaithersburg, MD	1.1495
	Frederick County, MD
	Montgomery County, MD
13740	Billings, MT	0.8843
	Carbon County, MT
	Yellowstone County, MT
13780	Binghamton, NY	0.8571
	Broome County, NY
	Tioga County, NY
13820	Birmingham-Hoover, AL	0.8979
	Bibb County, AL
	Blount County, AL
	Chilton County, AL
	Jefferson County, AL
	St. Clair County, AL
	Shelby County, AL
	Walker County, AL
13900	Bismarck, ND	0.7519
	Burleigh County, ND
	Morton County, ND
13980	Blacksburg-Christiansburg-Radford, VA	0.7962
	Giles County, VA
	Montgomery County, VA
	Pulaski County, VA
	Radford City, VA
14020	Bloomington, IN	0.8456
	Greene County, IN
	Monroe County, IN
	Owen County, IN
14060	Bloomington-Normal, IL	0.9084
	McLean County, IL
14260	Boise City-Nampa, ID	0.9061
	Ada County, ID
	Boise County, ID
	Canyon County, ID
	Gem County, ID
	Owyhee County, ID
14484	Boston-Quincy, MA	1.1543
	Norfolk County, MA
	Plymouth County, MA
	Suffolk County, MA
14500	Boulder, CO	0.9744
	Boulder County, CO
14540	Bowling Green, KY	0.8220
	Edmonson County, KY
	Warren County, KY
14740	Bremerton-Silverdale, WA	1.0686
	Kitsap County, WA
14860	Bridgeport-Stamford-Norwalk, CT	1.2598
	Fairfield County, CT
15180	Brownsville-Harlingen, TX	0.9822
	Cameron County, TX
15260	Brunswick, GA	0.9320
	Brantley County, GA
	Glynn County, GA
	McIntosh County, GA
15380	Buffalo-Niagara Falls, NY	0.8889
	Erie County, NY
	Niagara County, NY
15500	Burlington, NC	0.8914
	Alamance County, NC
15540	Burlington-South Burlington, VT	0.9446
	Chittenden County, VT
	Franklin County, VT
	Grand Isle County, VT
15764	Cambridge-Newton-Framingham, MA	1.1084
	Middlesex County, MA
15804	Camden, NJ	1.0528
	Burlington County, NJ
	Camden County, NJ
	Gloucester County, NJ
15940	Canton-Massillon, OH	0.8944
	Carroll County, OH
	Stark County, OH
15980	Cape Coral-Fort Myers, FL	0.9366
	Lee County, FL
16180	Carson City, NV	1.0244
16220	Casper, WY	0.9035
	Natrona County, WY
16300	Cedar Rapids, IA	0.8617
	Benton County, IA
	Jones County, IA
	Linn County, IA
16580	Champaign-Urbana, IL	0.9604
	Champaign County, IL
	Ford County, IL
	Piatt County, IL
16620	Charleston, WV	0.8428
	Boone County, WV
	Clay County, WV
	Kanawha County, WV
	Lincoln County, WV
	Putnam County, WV
16700	Charleston-North Charleston, SC	0.9438
	Berkeley County, SC
	Charleston County, SC
	Dorchester County, SC
16740	Charlotte-Gastonia-Concord, NC-SC	0.9760
	Anson County, NC
	Cabarrus County, NC
	Gaston County, NC
	Mecklenburg County, NC
	Union County, NC
	York County, SC
16820	Charlottesville, VA	1.0234
	Albemarle County, VA
	Fluvanna County, VA
	Greene County, VA
	Nelson County, VA
	Charlottesville City, VA
16860	Chattanooga, TN-GA	0.9098
	Catoosa County, GA
	Dade County, GA
	Walker County, GA
	Hamilton County, TN
	Marion County, TN
	Sequatchie County, TN
16940	Cheyenne, WY	0.8784
	Laramie County, WY
16974	Chicago-Naperville-Joliet, IL	1.0848
	Cook County, IL
	DeKalb County, IL
	DuPage County, IL
	Grundy County, IL
	Kane County, IL
	Kendall County, IL
	McHenry County, IL
	Will County, IL
17020	Chico, CA	1.0522
	Butte County, CA
17140	Cincinnati-Middletown, OH-KY-IN	0.9623
	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	0.8292
	Christian County, KY
	Trigg County, KY
	Montgomery County, TN
	Stewart County, TN
17420	Cleveland, TN	0.8141
	Bradley County, TN
	Polk County, TN
17460	Cleveland-Elyria-Mentor, OH	0.9204
	Cuyahoga County, OH
	Geauga County, OH
	Lake County, OH
	Lorain County, OH
	Medina County, OH
17660	Coeur d'Alene, ID	0.9657
	Kootenai County, ID
17780	College Station-Bryan, TX	0.8909
	Brazos County, TX
	Burleson County, TX
	Robertson County, TX
17820	Colorado Springs, CO	0.9478
	El Paso County, CO
	Teller County, CO
17860	Columbia, MO	0.8354
	Boone County, MO
	Howard County, MO
17900	Columbia, SC	0.9047
	Calhoun County, SC
	Fairfield County, SC
	Kershaw County, SC
	Lexington County, SC
	Richland County, SC
	Saluda County, SC
17980	Columbus, GA-AL	0.8568
	Russell County, AL
	Chattahoochee County, GA
	Harris County, GA
	Marion County, GA
	Muscogee County, GA
18020	Columbus, IN	0.9598
	Bartholomew County, IN
18140	Columbus, OH	0.9850
	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	0.8559
	Aransas County, TX
	Nueces County, TX
	San Patricio County, TX
18700	Corvallis, OR	1.0739
	Benton County, OR
19060	Cumberland, MD-WV	0.9326
	Allegany County, MD
	Mineral County, WV
19124	Dallas-Plano-Irving, TX	1.0233
	Collin County, TX
	Dallas County, TX
	Delta County, TX
	Denton County, TX
	Ellis County, TX
	Hunt County, TX
	Kaufman County, TX
	Rockwall County, TX
19140	Dalton, GA	0.9044
	Murray County, GA
	Whitfield County, GA
19180	Danville, IL	0.9037
	Vermilion County, IL
19260	Danville, VA	0.8497
	Pittsylvania County, VA
	Danville City, VA
19340	Davenport-Moline-Rock Island, IA-IL	0.8731
	Henry County, IL
	Mercer County, IL
	Rock Island County, IL
	Scott County, IA
19380	Dayton, OH	0.9073
	Greene County, OH
	Miami County, OH
	Montgomery County, OH
	Preble County, OH
19460	Decatur, AL	0.8478
	Lawrence County, AL
	Morgan County, AL
19500	Decatur, IL	0.8076
	Macon County, IL
19660	Deltona-Daytona Beach-Ormond Beach, FL	0.9308
	Volusia County, FL
19740	Denver-Aurora, CO	1.0733
	Adams County, CO
	Arapahoe County, CO
	Broomfield County, CO
	Clear Creek County, CO
	Denver County, CO
	Douglas County, CO
	Elbert County, CO
	Gilpin County, CO
	Jefferson County, CO
	Park County, CO
19780	Des Moines, IA	0.9651
	Dallas County, IA
	Guthrie County, IA
	Madison County, IA
	Polk County, IA
	Warren County, IA
19804	Detroit-Livonia-Dearborn, MI	1.0441
	Wayne County, MI
20020	Dothan, AL	0.7707
	Geneva County, AL
	Henry County, AL
	Houston County, AL
20100	Dover, DE	0.9779
	Kent County, DE
20220	Dubuque, IA	0.9135
	Dubuque County, IA
20260	Duluth, MN-WI	1.0209
	Carlton County, MN
	St. Louis County, MN
	Douglas County, WI
20500	Durham, NC	1.0303
	Chatham County, NC
	Durham County, NC
	Orange County, NC
	Person County, NC
20740	Eau Claire, WI	0.9210
	Chippewa County, WI
	Eau Claire County, WI
20764	Edison, NJ	1.1260
	Middlesex County, NJ
	Monmouth County, NJ
	Ocean County, NJ
	Somerset County, NJ
20940	El Centro, CA	0.8915
	Imperial County, CA
21060	Elizabethtown, KY	0.8810
	Hardin County, KY
	Larue County, KY
21140	Elkhart-Goshen, IN	0.9637
	Elkhart County, IN
21300	Elmira, NY	0.8259
	Chemung County, NY
21340	El Paso, TX	0.8924
	El Paso County, TX
21500	Erie, PA	0.8746
	Erie County, PA
21604	Essex County, MA	1.0533
	Essex County, MA
21660	Eugene-Springfield, OR	1.0829
	Lane County, OR
21780	Evansville, IN-KY	0.8721
	Gibson County, IN
	Posey County, IN
	Vanderburgh County, IN
	Warrick County, IN
	Henderson County, KY
	Webster County, KY
21820	Fairbanks, AK	1.1419
	Fairbanks North Star Borough, AK
21940	Fajardo, PR	0.4157
	Ceiba Municipio, PR
	Fajardo Municipio, PR
	Luquillo Municipio, PR
22020	Fargo, ND-MN	0.8495
	Cass County, ND
	Clay County, MN
22140	Farmington, NM	0.8518
	San Juan County, NM
22180	Fayetteville, NC	0.9426
	Cumberland County, NC
	Hoke County, NC
22220	Fayetteville-Springdale-Rogers, AR-MO	0.8563
	Benton County, AR
	Madison County, AR
	Washington County, AR
	McDonald County, MO
22380	Flagstaff, AZ	1.2105
	Coconino County, AZ
22420	Flint, MI	1.0663
	Genesee County, MI
22500	Florence, SC	0.8964
	Darlington County, SC
	Florence County, SC
22520	Florence-Muscle Shoals, AL	0.8280
	Colbert County, AL
	Lauderdale County, AL
22540	Fond du Lac, WI	0.9650
	Fond du Lac County, WI
22660	Fort Collins-Loveland, CO	1.0132
	Larimer County, CO
22744	Fort Lauderdale-Pompano Beach-Deerfield Beach, FL	1.0442
	Broward County, FL
22900	Fort Smith, AR-OK	0.8214
	Crawford County, AR
	Franklin County, AR
	Sebastian County, AR
	Le Flore County, OK
	Sequoyah County, OK
23020	Fort Walton Beach-Crestview-Destin, FL	0.8881
	Okaloosa County, FL
23060	Fort Wayne, IN	0.9803
	Allen County, IN
	Wells County, IN
	Whitley County, IN
23104	Fort Worth-Arlington, TX	0.9510
	Johnson County, TX
	Parker County, TX
	Tarrant County, TX
	Wise County, TX
23420	Fresno, CA	1.0541
	Fresno County, CA
23460	Gadsden, AL	0.7946
	Etowah County, AL
23540	Gainesville, FL	0.9474
	Alachua County, FL
	Gilchrist County, FL
23580	Gainesville, GA	0.8883
	Hall County, GA
23844	Gary, IN	0.9369
	Jasper County, IN
	Lake County, IN
	Newton County, IN
	Porter County, IN
24020	Glens Falls, NY	0.8567
	Warren County, NY
	Washington County, NY
24140	Goldsboro, NC	0.8784
	Wayne County, NC
24220	Grand Forks, ND-MN	1.1516
	Polk County, MN
	Grand Forks County, ND
24300	Grand Junction, CO	0.9560
	Mesa County, CO
24340	Grand Rapids-Wyoming, MI	0.9400
	Barry County, MI
	Ionia County, MI
	Kent County, MI
	Newaygo County, MI
24500	Great Falls, MT	0.9061
	Cascade County, MT
24540	Greeley, CO	0.9580
	Weld County, CO
24580	Green Bay, WI	0.9452
	Brown County, WI
	Kewaunee County, WI
	Oconto County, WI
24660	Greensboro-High Point, NC	0.9113
	Guilford County, NC
	Randolph County, NC
	Rockingham County, NC
24780	Greenville, NC	0.9434
	Greene County, NC
	Pitt County, NC
24860	Greenville, SC	1.0165
	Greenville County, SC
	Laurens County, SC
	Pickens County, SC
25020	Guayama, PR	0.3184
	Arroyo Municipio, PR
	Guayama Municipio, PR
	Patillas Municipio, PR
25060	Gulfport-Biloxi, MS	0.8938
	Hancock County, MS
	Harrison County, MS
	Stone County, MS
25180	Hagerstown-Martinsburg, MD-WV	0.9499
	Washington County, MD
	Berkeley County, WV
	Morgan County, WV
25260	Hanford-Corcoran, CA	1.0046
	Kings County, CA
25420	Harrisburg-Carlisle, PA	0.9322
	Cumberland County, PA
	Dauphin County, PA
	Perry County, PA
25500	Harrisonburg, VA	0.9098
	Rockingham County, VA
	Harrisonburg City, VA
25540	Hartford-West Hartford-East Hartford, CT	1.1084
	Hartford County, CT
	Litchfield County, CT
	Middlesex County, CT
	Tolland County, CT
25620	Hattiesburg, MS	0.7609
	Forrest County, MS
	Lamar County, MS
	Perry County, MS
25860	Hickory-Lenoir-Morganton, NC	0.8922
	Alexander County, NC
	Burke County, NC
	Caldwell County, NC
	Catawba County, NC
25980	Hinesville-Fort Stewart, GA 1	0.9178
	Liberty County, GA
	Long County, GA
26100	Holland-Grand Haven, MI	0.9064
	Ottawa County, MI
26180	Honolulu, HI	1.1208
	Honolulu County, HI
26300	Hot Springs, AR	0.9053
	Garland County, AR
26380	Houma-Bayou Cane-Thibodaux, LA	0.7902
	Lafourche Parish, LA
	Terrebonne Parish, LA
26420	Houston-Baytown-Sugar Land, TX	1.0005
	Austin County, TX
	Brazoria County, TX
	Chambers County, TX
	Fort Bend County, TX
	Galveston County, TX
	Harris County, TX
	Liberty County, TX
	Montgomery County, TX
	San Jacinto County, TX
	Waller County, TX
26580	Huntington-Ashland, WV-KY-OH	0.9486
	Boyd County, KY
	Greenup County, KY
	Lawrence County, OH
	Cabell County, WV
	Wayne County, WV
26620	Huntsville, AL	0.9149
	Limestone County, AL
	Madison County, AL
26820	Idaho Falls, ID	0.9429
	Bonneville County, ID
	Jefferson County, ID
26900	Indianapolis, IN	0.9930
	Boone County, IN
	Brown County, IN
	Hamilton County, IN
	Hancock County, IN
	Hendricks County, IN
	Johnson County, IN
	Marion County, IN
	Morgan County, IN
	Putnam County, IN
	Shelby County, IN
26980	Iowa City, IA	0.9756
	Johnson County, IA
	Washington County, IA
27060	Ithaca, NY	0.9803
	Tompkins County, NY
27100	Jackson, MI	0.9313
	Jackson County, MI
27140	Jackson, MS	0.8319
	Copiah County, MS
	Hinds County, MS
	Madison County, MS
	Rankin County, MS
	Simpson County, MS
27180	Jackson, TN	0.8973
	Chester County, TN
	Madison County, TN
27260	Jacksonville, FL	0.9299
	Baker County, FL
	Clay County, FL
	Duval County, FL
	Nassau County, FL
	St. Johns County, FL
27340	Jacksonville, NC	0.8244
	Onslow County, NC
27500	Janesville, WI	0.9547
	Rock County, WI
27620	Jefferson City, MO	0.8396
	Callaway County, MO
	Cole County, MO
	Moniteau County, MO
	Osage County, MO
27740	Johnson City, TN	0.7945
	Carter County, TN
	Unicoi County, TN
	Washington County, TN
27780	Johnstown, PA	0.8362
	Cambria County, PA
27860	Jonesboro, AR	0.7919
	Craighead County, AR
	Poinsett County, AR
27900	Joplin, MO	0.8590
	Jasper County, MO
	Newton County, MO
28020	Kalamazoo-Portage, MI	1.0391
	Kalamazoo County, MI
	Van Buren County, MI
28100	Kankakee-Bradley, IL	1.0974
	Kankakee County, IL
28140	Kansas City, MO-KS	0.9467
	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	1.0630
	Benton County, WA
	Franklin County, WA
28660	Killeen-Temple-Fort Hood, TX	0.8535
	Bell County, TX
	Coryell County, TX
	Lampasas County, TX
28700	Kingsport-Bristol-Bristol, TN-VA	0.8062
	Hawkins County, TN
	Sullivan County, TN
	Bristol City, VA
	Scott County, VA
	Washington County, VA
28740	Kingston, NY	0.9257
	Ulster County, NY
28940	Knoxville, TN	0.8454
	Anderson County, TN
	Blount County, TN
	Knox County, TN
	Loudon County, TN
	Union County, TN
29020	Kokomo, IN	0.9517
	Howard County, IN
	Tipton County, IN
29100	La Crosse, WI-MN	0.9573
	Houston County, MN
	La Crosse County, WI
29140	Lafayette, IN	0.8745
	Benton County, IN
	Carroll County, IN
	Tippecanoe County, IN
29180	Lafayette, LA	0.8436
	Lafayette Parish, LA
	St. Martin Parish, LA
29340	Lake Charles, LA	0.7841
	Calcasieu Parish, LA
	Cameron Parish, LA
29404	Lake County-Kenosha County, IL-WI	1.0440
	Lake County, IL
	Kenosha County, WI
29460	Lakeland, FL	0.8921
	Polk County, FL
29540	Lancaster, PA	0.9704
	Lancaster County, PA
29620	Lansing-East Lansing, MI	0.9792
	Clinton County, MI
	Eaton County, MI
	Ingham County, MI
29700	Laredo, TX	0.8076
	Webb County, TX
29740	Las Cruces, NM	0.8475
	Dona Ana County, NM
29820	Las Vegas-Paradise, NV	1.1449
	Clark County, NV
29940	Lawrence, KS	0.8546
	Douglas County, KS
30020	Lawton, OK	0.7880
	Comanche County, OK
30140	Lebanon, PA	0.8468
	Lebanon County, PA
30300	Lewiston, ID-WA	0.9896
	Nez Perce County, ID
	Asotin County, WA
30340	Lewiston-Auburn, ME	0.9341
	Androscoggin County, ME
30460	Lexington-Fayette, KY	0.9084
	Bourbon County, KY
	Clark County, KY
	Fayette County, KY
	Jessamine County, KY
	Scott County, KY
	Woodford County, KY
30620	Lima, OH	0.9234
	Allen County, OH
30700	Lincoln, NE	1.0225
	Lancaster County, NE
	Seward County, NE
30780	Little Rock-North Little Rock, AR	0.8756
	Faulkner County, AR
	Grant County, AR
	Lonoke County, AR
	Perry County, AR
	Pulaski County, AR
	Saline County, AR
30860	Logan, UT-ID	0.9173
	Franklin County, ID
	Cache County, UT
30980	Longview, TX	0.8739
	Gregg County, TX
	Rusk County, TX
	Upshur County, TX
31020	Longview, WA	0.9523
	Cowlitz County, WA
31084	Los Angeles-Long Beach-Glendale, CA	1.1752
	Los Angeles County, CA
31140	Louisville, KY-IN	0.9261
	Clark County, IN
	Floyd County, IN
	Harrison County, IN
	Washington County, IN
	Bullitt County, KY
	Henry County, KY
	Jefferson County, KY
	Meade County, KY
	Nelson County, KY
	Oldham County, KY
	Shelby County, KY
	Spencer County, KY
	Trimble County, KY
31180	Lubbock, TX	0.8792
	Crosby County, TX
	Lubbock County, TX
31340	Lynchburg, VA	0.8700
	Amherst County, VA
	Appomattox County, VA
	Bedford County, VA
	Campbell County, VA
	Bedford City, VA
	Lynchburg City, VA
31420	Macon, GA	0.9453
	Bibb County, GA
	Crawford County, GA
	Jones County, GA
	Monroe County, GA
	Twiggs County, GA
31460	Madera, CA	0.8721
	Madera County, CA
31540	Madison, WI	1.0635
	Columbia County, WI
	Dane County, WI
	Iowa County, WI
31700	Manchester-Nashua, NH	1.0335
	Hillsborough County, NH
	Merrimack County, NH
31900	Mansfield, OH 1	0.8887
	Richland County, OH
32420	Mayagüez, PR	0.4017
	Hormigueros Municipio, PR
	Mayagüez Municipio, PR
32580	McAllen-Edinburg-Pharr, TX	0.8943
	Hidalgo County, TX
32780	Medford, OR	1.0235
	Jackson County, OR
32820	Memphis, TN-MS-AR	0.9341
	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	1.1120
	Merced County, CA
33124	Miami-Miami Beach-Kendall, FL	0.9759
	Miami-Dade County, FL
33140	Michigan City-La Porte, IN	0.9409
	LaPorte County, IN
33260	Midland, TX	0.9523
	Midland County, TX
33340	Milwaukee-Waukesha-West Allis, WI	1.0106
	Milwaukee County, WI
	Ozaukee County, WI
	Washington County, WI
	Waukesha County, WI
33460	Minneapolis-St. Paul-Bloomington, MN-WI	1.1078
	Anoka County, MN
	Carver County, MN
	Chisago County, MN
	Dakota County, MN
	Hennepin County, MN
	Isanti County, MN
	Ramsey County, MN
	Scott County, MN
	Sherburne County, MN
	Washington County, MN
	Wright County, MN
	Pierce County, WI
	St. Croix County, WI
33540	Missoula, MT	0.9482
	Missoula County, MT
33660	Mobile, AL	0.7895
	Mobile County, AL
33700	Modesto, CA	1.1804
	Stanislaus County, CA
33740	Monroe, LA	0.8040
	Ouachita Parish, LA
	Union Parish, LA
33780	Monroe, MI	0.9478
	Monroe County, MI
33860	Montgomery, AL	0.8588
	Autauga County, AL
	Elmore County, AL
	Lowndes County, AL
	Montgomery County, AL
34060	Morgantown, WV	0.8428
	Monongalia County, WV
	Preston County, WV
34100	Morristown, TN	0.8753
	Grainger County, TN
	Hamblen County, TN
	Jefferson County, TN
34580	Mount Vernon-Anacortes, WA	1.0465
	Skagit County, WA
34620	Muncie, IN	0.8939
	Delaware County, IN
34740	Muskegon-Norton Shores, MI	0.9673
	Muskegon County, MI
34820	Myrtle Beach-Conway-North Myrtle Beach, SC	0.8873
	Horry County, SC
34900	Napa, CA	1.2656
	Napa County, CA
34940	Naples-Marco Island, FL	1.0140
	Collier County, FL
34980	Nashville-Davidson—Murfreesboro, TN	0.9769
	Cannon County, TN
	Cheatham County, TN
	Davidson County, TN
	Dickson County, TN
	Hickman County, TN
	Macon County, TN
	Robertson County, TN
	Rutherford County, TN
	Smith County, TN
	Sumner County, TN
	Trousdale County, TN
	Williamson County, TN
	Wilson County, TN
35004	Nassau-Suffolk, NY	1.2760
	Nassau County, NY
	Suffolk County, NY
35084	Newark-Union, NJ-PA	1.2195
	Essex County, NJ
	Hunterdon County, NJ
	Morris County, NJ
	Sussex County, NJ
	Union County, NJ
	Pike County, PA
35300	New Haven-Milford, CT	1.1702
	New Haven County, CT
35380	New Orleans-Metairie-Kenner, LA	0.9005
	Jefferson Parish, LA
	Orleans Parish, LA
	Plaquemines Parish, LA
	St. Bernard Parish, LA
	St. Charles Parish, LA
	St. John the Baptist Parish, LA
	St. Tammany Parish, LA
35644	New York-Wayne-White Plains, NY-NJ	1.3185
	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	0.8888
	Berrien County, MI
35980	Norwich-New London, CT	1.1356
	New London County, CT
36084	Oakland-Fremont-Hayward, CA	1.5346
	Alameda County, CA
	Contra Costa County, CA
36100	Ocala, FL	0.8934
	Marion County, FL
36140	Ocean City, NJ	1.1022
	Cape May County, NJ
36220	Odessa, TX	0.9894
	Ector County, TX
36260	Ogden-Clearfield, UT	0.9038
	Davis County, UT
	Morgan County, UT
	Weber County, UT
36420	Oklahoma City, OK	0.9040
	Canadian County, OK
	Cleveland County, OK
	Grady County, OK
	Lincoln County, OK
	Logan County, OK
	McClain County, OK
	Oklahoma County, OK
36500	Olympia, WA	1.0938
	Thurston County, WA
36540	Omaha-Council Bluffs, NE-IA	0.9569
	Harrison County, IA
	Mills County, IA
	Pottawattamie County, IA
	Cass County, NE
	Douglas County, NE
	Sarpy County, NE
	Saunders County, NE
	Washington County, NE
36740	Orlando, FL	0.9459
	Lake County, FL
	Orange County, FL
	Osceola County, FL
	Seminole County, FL
36780	Oshkosh-Neenah, WI	0.9192
	Winnebago County, WI
36980	Owensboro, KY	0.8789
	Daviess County, KY
	Hancock County, KY
	McLean County, KY
37100	Oxnard-Thousand Oaks-Ventura, CA	1.1613
	Ventura County, CA
37340	Palm Bay-Melbourne-Titusville, FL	0.9835
	Brevard County, FL
37460	Panama City-Lynn Haven, FL	0.7989
	Bay County, FL
37620	Parkersburg-Marietta, WV-OH	0.8278
	Washington County, OH
	Pleasants County, WV
	Wirt County, WV
	Wood County, WV
37700	Pascagoula, MS	0.8165
	George County, MS
	Jackson County, MS
37860	Pensacola-Ferry Pass-Brent, FL	0.8104
	Escambia County, FL
	Santa Rosa County, FL
37900	Peoria, IL	0.8868
	Marshall County, IL
	Peoria County, IL
	Stark County, IL
	Tazewell County, IL
	Woodford County, IL
37964	Philadelphia, PA	1.1040
	Bucks County, PA
	Chester County, PA
	Delaware County, PA
	Montgomery County, PA
	Philadelphia County, PA
38060	Phoenix-Mesa-Scottsdale, AZ	1.0138
	Maricopa County, AZ
	Pinal County, AZ
38220	Pine Bluff, AR	0.8689
	Cleveland County, AR
	Jefferson County, AR
	Lincoln County, AR
38300	Pittsburgh, PA	0.8853
	Allegheny County, PA
	Armstrong County, PA
	Beaver County, PA
	Butler County, PA
	Fayette County, PA
	Washington County, PA
	Westmoreland County, PA
38340	Pittsfield, MA	1.0191
	Berkshire County, MA
38540	Pocatello, ID	0.9360
	Bannock County, ID
	Power County, ID
38660	Ponce, PR	0.5177
	Juana Díaz Municipio, PR
	Ponce Municipio, PR
	Villalba Municipio, PR
38860	Portland-South Portland-Biddeford, ME	1.0392
	Cumberland County, ME
	Sagadahoc County, ME
	York County, ME
38900	Portland-Vancouver-Beaverton, OR-WA	1.1260
	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	1.0133
	Martin County, FL
	St. Lucie County, FL
39100	Poughkeepsie-Newburgh-Middletown, NY	1.0766
	Dutchess County, NY
	Orange County, NY
39140	Prescott, AZ	0.9879
	Yavapai County, AZ
39300	Providence-New Bedford-Fall River, RI-MA	1.0966
	Bristol County, MA
	Bristol County, RI
	Kent County, RI
	Newport County, RI
	Providence County, RI
	Washington County, RI
39340	Provo-Orem, UT	0.9510
	Juab County, UT
	Utah County, UT
39380	Pueblo, CO	0.8632
	Pueblo County, CO
39460	Punta Gorda, FL	0.9264
	Charlotte County, FL
39540	Racine, WI	0.9006
	Racine County, WI
39580	Raleigh-Cary, NC	0.9733
	Franklin County, NC
	Johnston County, NC
	Wake County, NC
39660	Rapid City, SD	0.9021
	Meade County, SD
	Pennington County, SD
39740	Reading, PA	0.9696
	Berks County, PA
39820	Redding, CA	1.2215
	Shasta County, CA
39900	Reno-Sparks, NV	1.0993
	Storey County, NV
	Washoe County, NV
40060	Richmond, VA	0.9338
	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	1.1022
	Riverside County, CA
	San Bernardino County, CA
40220	Roanoke, VA	0.8383
	Botetourt County, VA
	Craig County, VA
	Franklin County, VA
	Roanoke County, VA
	Roanoke City, VA
	Salem City, VA
40340	Rochester, MN	1.1142
	Dodge County, MN
	Olmsted County, MN
	Wabasha County, MN
40380	Rochester, NY	0.9115
	Livingston County, NY
	Monroe County, NY
	Ontario County, NY
	Orleans County, NY
	Wayne County, NY
40420	Rockford, IL	0.9994
	Boone County, IL
	Winnebago County, IL
40484	Rockingham County-Strafford County, NH	1.0385
	Rockingham County, NH
	Strafford County, NH
40580	Rocky Mount, NC	0.8924
	Edgecombe County, NC
	Nash County, NC
40660	Rome, GA	0.9424
	Floyd County, GA
40900	Sacramento—Arden-Arcade—Roseville, CA	1.2973
	El Dorado County, CA
	Placer County, CA
	Sacramento County, CA
	Yolo County, CA
40980	Saginaw-Saginaw Township North, MI	0.9420
	Saginaw County, MI
41060	St. Cloud, MN	0.9975
	Benton County, MN
	Stearns County, MN
41100	St. George, UT	0.9402
	Washington County, UT
41140	St. Joseph, MO-KS	0.9529
	Doniphan County, KS
	Andrew County, MO
	Buchanan County, MO
	DeKalb County, MO
41180	St. Louis, MO-IL	0.8949
	Bond County, IL
	Calhoun County, IL
	Clinton County, IL
	Jersey County, IL
	Macoupin County, IL
	Madison County, IL
	Monroe County, IL
	St. Clair County, IL
	Crawford County, MO
	Franklin County, MO
	Jefferson County, MO
	Lincoln County, MO
	St. Charles County, MO
	St. Louis County, MO
	Warren County, MO
	Washington County, MO
	St. Louis City, MO
41420	Salem, OR	1.0452
	Marion County, OR
	Polk County, OR
41500	Salinas, CA	1.4142
	Monterey County, CA
41540	Salisbury, MD	0.9073
	Somerset County, MD
	Wicomico County, MD
41620	Salt Lake City, UT	0.9433
	Salt Lake County, UT
	Summit County, UT
	Tooele County, UT
41660	San Angelo, TX	0.8280
	Irion County, TX
	Tom Green County, TX
41700	San Antonio, TX	0.8989
	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	1.1424
	San Diego County, CA
41780	Sandusky, OH	0.9025
	Erie County, OH
41884	San Francisco-San Mateo-Redwood City, CA	1.4990
	Marin County, CA
	San Francisco County, CA
	San Mateo County, CA
41900	San Germán-Cabo Rojo, PR	0.4655
	Cabo Rojo Municipio, PR
	Lajas Municipio, PR
	Sabana Grande Municipio, PR
	San Germán Municipio, PR
41940	San Jose-Sunnyvale-Santa Clara, CA	1.5125
	San Benito County, CA
	Santa Clara County, CA
41980	San Juan-Caguas-Guaynabo, PR	0.4686
	Aguas Buenas Municipio, PR
	Aibonito Municipio, PR
	Arecibo Municipio, PR
	Barceloneta Municipio, PR
	Barranquitas Municipio, PR
	Bayamón Municipio, PR
	Caguas Municipio, PR
	Camuy Municipio, PR
	Canóvanas Municipio, PR
	Carolina Municipio, PR
	Cataño Municipio, PR
	Cayey Municipio, PR
	Ciales Municipio, PR
	Cidra Municipio, PR
	Comerío Municipio, PR
	Corozal Municipio, PR
	Dorado Municipio, PR
	Florida Municipio, PR
	Guaynabo Municipio, PR
	Gurabo Municipio, PR
	Hatillo Municipio, PR
	Humacao Municipio, PR
	Juncos Municipio, PR
	Las Piedras Municipio, PR
	Loíza Municipio, PR
	Manatí Municipio, PR
	Maunabo Municipio, PR
	Morovis Municipio, PR
	Naguabo Municipio, PR
	Naranjito Municipio, PR
	Orocovis Municipio, PR
	Quebradillas Municipio, PR
	Río Grande Municipio, PR
	San Juan Municipio, PR
	San Lorenzo Municipio, PR
	Toa Alta Municipio, PR
	Toa Baja Municipio, PR
	Trujillo Alto Municipio, PR
	Vega Alta Municipio, PR
	Vega Baja Municipio, PR
	Yabucoa Municipio, PR
42020	San Luis Obispo-Paso Robles, CA	1.1360
	San Luis Obispo County, CA
42044	Santa Ana-Anaheim-Irvine, CA	1.1576
	Orange County, CA
42060	Santa Barbara-Santa Maria-Goleta, CA	1.1538
	Santa Barbara County, CA
42100	Santa Cruz-Watsonville, CA	1.5182
	Santa Cruz County, CA
42140	Santa Fe, NM	1.0931
	Santa Fe County, NM
42220	Santa Rosa-Petaluma, CA	1.3506
	Sonoma County, CA
42260	Sarasota-Bradenton-Venice, FL	0.9555
	Manatee County, FL
	Sarasota County, FL
42340	Savannah, GA	0.9480
	Bryan County, GA
	Chatham County, GA
	Effingham County, GA
42540	Scranton—Wilkes-Barre, PA	0.8548
	Lackawanna County, PA
	Luzerne County, PA
	Wyoming County, PA
42644	Seattle-Bellevue-Everett, WA	1.1589
	King County, WA
	Snohomish County, WA
43100	Sheboygan, WI	0.8920
	Sheboygan County, WI
43300	Sherman-Denison, TX	0.9516
	Grayson County, TX
43340	Shreveport-Bossier City, LA	0.8769
	Bossier Parish, LA
	Caddo Parish, LA
	De Soto Parish, LA
43580	Sioux City, IA-NE-SD	0.9376
	Woodbury County, IA
	Dakota County, NE
	Dixon County, NE
	Union County, SD
43620	Sioux Falls, SD	0.9645
	Lincoln County, SD
	McCook County, SD
	Minnehaha County, SD
	Turner County, SD
43780	South Bend-Mishawaka, IN-MI	0.9798
	St. Joseph County, IN
	Cass County, MI
43900	Spartanburg, SC	0.9181
	Spartanburg County, SC
44060	Spokane, WA	1.0916
	Spokane County, WA
44100	Springfield, IL	0.8885
	Menard County, IL
	Sangamon County, IL
44140	Springfield, MA	1.0259
	Franklin County, MA
	Hampden County, MA
	Hampshire County, MA
44180	Springfield, MO	0.8246
	Christian County, MO
	Dallas County, MO
	Greene County, MO
	Polk County, MO
	Webster County, MO
44220	Springfield, OH	0.8404
	Clark County, OH
44300	State College, PA	0.8364
	Centre County, PA
44700	Stockton, CA	1.1311
	San Joaquin County, CA
44940	Sumter, SC	0.8386
	Sumter County, SC
45060	Syracuse, NY	0.9581
	Madison County, NY
	Onondaga County, NY
	Oswego County, NY
45104	Tacoma, WA	1.0753
	Pierce County, WA
45220	Tallahassee, FL	0.8697
	Gadsden County, FL
	Jefferson County, FL
	Leon County, FL
	Wakulla County, FL
45300	Tampa-St. Petersburg-Clearwater, FL	0.9193
	Hernando County, FL
	Hillsborough County, FL
	Pasco County, FL
	Pinellas County, FL
45460	Terre Haute, IN	0.8313
	Clay County, IN
	Sullivan County, IN
	Vermillion County, IN
	Vigo County, IN
45500	Texarkana, TX-Texarkana, AR	0.8291
	Miller County, AR
	Bowie County, TX
45780	Toledo, OH	0.9584
	Fulton County, OH
	Lucas County, OH
	Ottawa County, OH
	Wood County, OH
45820	Topeka, KS	0.8929
	Jackson County, KS
	Jefferson County, KS
	Osage County, KS
	Shawnee County, KS
	Wabaunsee County, KS
45940	Trenton-Ewing, NJ	1.0845
	Mercer County, NJ
46060	Tucson, AZ	0.8987
	Pima County, AZ
46140	Tulsa, OK	0.8286
	Creek County, OK
	Okmulgee County, OK
	Osage County, OK
	Pawnee County, OK
	Rogers County, OK
	Tulsa County, OK
	Wagoner County, OK
46220	Tuscaloosa, AL	0.8721
	Greene County, AL
	Hale County, AL
	Tuscaloosa County, AL
46340	Tyler, TX	0.9307
	Smith County, TX
46540	Utica-Rome, NY	0.8293
	Herkimer County, NY
	Oneida County, NY
46660	Valdosta, GA	0.8875
	Brooks County, GA
	Echols County, GA
	Lanier County, GA
	Lowndes County, GA
46700	Vallejo-Fairfield, CA	1.4899
	Solano County, CA
46940	Vero Beach, FL	0.9444
	Indian River County, FL
47020	Victoria, TX	0.8168
	Calhoun County, TX
	Goliad County, TX
	Victoria County, TX
47220	Vineland-Millville-Bridgeton, NJ	0.9837
	Cumberland County, NJ
47260	Virginia Beach-Norfolk-Newport News, VA-NC	0.8808
	Currituck County, NC
	Gloucester County, VA
	Isle of Wight County, VA
	James City County, VA
	Mathews County, VA
	Surry County, VA
	York County, VA
	Chesapeake City, VA
	Hampton City, VA
	Newport News City, VA
	Norfolk City, VA
	Poquoson City, VA
	Portsmouth City, VA
	Suffolk City, VA
	Virginia Beach City, VA
	Williamsburg City, VA
47300	Visalia-Porterville, CA	1.0074
	Tulare County, CA
47380	Waco, TX	0.8527
	McLennan County, TX
47580	Warner Robins, GA	0.8654
	Houston County, GA
47644	Warren-Farmington Hills-Troy, MI	0.9861
	Lapeer County, MI
	Livingston County, MI
	Macomb County, MI
	Oakland County, MI
	St. Clair County, MI
47894	Washington-Arlington-Alexandria, DC-VA-MD-WV	1.0932
	District of Columbia, DC
	Calvert County, MD
	Charles County, MD
	Prince George's County, MD
	Arlington County, VA
	Clarke County, VA
	Fairfax County, VA
	Fauquier County, VA
	Loudoun County, VA
	Prince William County, VA
	Spotsylvania County, VA
	Stafford County, VA
	Warren County, VA
	Alexandria City, VA
	Fairfax City, VA
	Falls Church City, VA
	Fredericksburg City, VA
	Manassas City, VA
	Manassas Park City, VA
	Jefferson County, WV
47940	Waterloo-Cedar Falls, IA	0.8566
	Black Hawk County, IA
	Bremer County, IA
	Grundy County, IA
48140	Wausau, WI	0.9600
	Marathon County, WI
48260	Weirton-Steubenville, WV-OH	0.7827
	Jefferson County, OH
	Brooke County, WV
	Hancock County, WV
48300	Wenatchee, WA	1.0080
	Chelan County, WA
	Douglas County, WA
48424	West Palm Beach-Boca Raton-Boynton Beach, FL	1.0077
	Palm Beach County, FL
48540	Wheeling, WV-OH	0.7168
	Belmont County, OH
	Marshall County, WV
	Ohio County, WV
48620	Wichita, KS	0.9141
	Butler County, KS
	Harvey County, KS
	Sedgwick County, KS
	Sumner County, KS
48660	Wichita Falls, TX	0.8294
	Archer County, TX
	Clay County, TX
	Wichita County, TX
48700	Williamsport, PA	0.8377
	Lycoming County, PA
48864	Wilmington, DE-MD-NJ	1.0482
	New Castle County, DE
	Cecil County, MD
	Salem County, NJ
48900	Wilmington, NC	0.9592
	Brunswick County, NC
	New Hanover County, NC
	Pender County, NC
49020	Winchester, VA-WV	1.0224
	Frederick County, VA
	Winchester City, VA
	Hampshire County, WV
49180	Winston-Salem, NC	0.8953
	Davie County, NC
	Forsyth County, NC
	Stokes County, NC
	Yadkin County, NC
49340	Worcester, MA	1.1039
	Worcester County, MA
49420	Yakima, WA	1.0165
	Yakima County, WA
49500	Yauco, PR	0.4413
	Guánica Municipio, PR
	Guayanilla Municipio, PR
	Peñuelas Municipio, PR
	Yauco Municipio, PR
49620	York-Hanover, PA	0.9420
	York County, PA
49660	Youngstown-Warren-Boardman, OH-PA	0.8611
	Mahoning County, OH
	Trumbull County, OH
	Mercer County, PA
49700	Yuba City, CA	1.0932
	Sutter County, CA
	Yuba County, CA
49740	Yuma, AZ	0.9135
	Yuma County, AZ
1 At this time, there are no hospitals located in these urban areas on which to base a wage index. Therefore, the urban wage index value is based on the average wage index for all urban areas within the state.

Table 9.—Proposed Wage Index Based On CBSA Labor Market Areas For Rural Areas

CBSA Code	Nonurban Area	Wage Index
01	Alabama	0.7477
02	Alaska	1.1990
03	Arizona	0.8777
04	Arkansas	0.7451
05	California	1.0857
06	Colorado	0.9389
07	Connecticut	1.1794
08	Delaware	0.9606
10	Florida	0.8598
11	Georgia	0.7666
12	Hawaii	1.0562
13	Idaho	0.8045
14	Illinois	0.8279
15	Indiana	0.8630
16	Iowa	0.8502
17	Kansas	0.7987
18	Kentucky	0.7774
19	Louisiana	0.7418
20	Maine	0.8852
21	Maryland	0.9095
22	Massachusetts 2	1.0216
23	Michigan	0.8870
24	Minnesota	0.9183
25	Mississippi	0.7671
26	Missouri	0.7909
27	Montana	0.8833
28	Nebraska	0.8665
29	Nevada	0.9074
30	New Hampshire	1.0677
31	New Jersey 2
32	New Mexico	0.8644
33	New York	0.8157
34	North Carolina	0.8567
35	North Dakota	0.7268
36	Ohio	0.8786
37	Oklahoma	0.7589
38	Oregon	0.9830
39	Pennsylvania	0.8302
40	Puerto Rico 2	0.4047
41	Rhode Island 2
42	South Carolina	0.8641
43	South Dakota	0.8484
44	Tennessee	0.7888
45	Texas	0.8007
46	Utah	0.8126
47	Vermont	0.9840
48	Virgin Islands	0.7026
49	Virginia	0.8012
50	Washington	1.0458
51	West Virginia	0.7725
52	Wisconsin	0.9480
53	Wyoming	0.9214
65	Guam	0.9611
2 All counties within the State are classified as urban, with the exception of Massachusetts and Puerto Rico. Massachusetts and Puerto Rico have 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.

Table A.—MSA/CBSA Crosswalk

SSA State/County Code	County and State Name	MSA Number	2006 MSA- based WI	2006 CBSA- based WI	CBSA Number
01000	Autauga County, Alabama	5240	0.8588	0.8588	33860
01010	Baldwin County, Alabama	5160	0.7866	0.7477	99901
01020	Barbour County, Alabama	01	0.7463	0.7477	99901
01030	Bibb County, Alabama	01	0.7463	0.8979	13820
01040	Blount County, Alabama	1000	0.9021	0.8979	13820
01050	Bullock County, Alabama	01	0.7463	0.7477	99901
01060	Butler County, Alabama	01	0.7463	0.7477	99901
01070	Calhoun County, Alabama	0450	0.7659	0.7659	11500
01080	Chambers County, Alabama	01	0.7463	0.7477	99901
01090	Cherokee County, Alabama	01	0.7463	0.7477	99901
01100	Chilton County, Alabama	01	0.7463	0.8979	13820
01110	Choctaw County, Alabama	01	0.7463	0.7477	99901
01120	Clarke County, Alabama	01	0.7463	0.7477	99901
01130	Clay County, Alabama	01	0.7463	0.7477	99901
01140	Cleburne County, Alabama	01	0.7463	0.7477	99901
01150	Coffee County, Alabama	01	0.7463	0.7477	99901
01160	Colbert County, Alabama	2650	0.8280	0.8280	22520
01170	Conecuh County, Alabama	01	0.7463	0.7477	99901
01180	Coosa County, Alabama	01	0.7463	0.7477	99901
01190	Covington County, Alabama	01	0.7463	0.7477	99901
01200	Crenshaw County, Alabama	01	0.7463	0.7477	99901
01210	Cullman County, Alabama	01	0.7463	0.7477	99901
01220	Dale County, Alabama	2180	0.7687	0.7477	99901
01230	Dallas County, Alabama	01	0.7463	0.7477	99901
01240	De Kalb County, Alabama	01	0.7463	0.7477	99901
01250	Elmore County, Alabama	5240	0.8588	0.8588	33860
01260	Escambia County, Alabama	01	0.7463	0.7477	99901
01270	Etowah County, Alabama	2880	0.7946	0.7946	23460
01280	Fayette County, Alabama	01	0.7463	0.7477	99901
01290	Franklin County, Alabama	01	0.7463	0.7477	99901
01300	Geneva County, Alabama	01	0.7463	0.7707	20020
01310	Greene County, Alabama	01	0.7463	0.8721	46220
01320	Hale County, Alabama	01	0.7463	0.8721	46220
01330	Henry County, Alabama	01	0.7463	0.7707	20020
01340	Houston County, Alabama	2180	0.7687	0.7707	20020
01350	Jackson County, Alabama	01	0.7463	0.7477	99901
01360	Jefferson County, Alabama	1000	0.9021	0.8979	13820
01370	Lamar County, Alabama	01	0.7463	0.7477	99901
01380	Lauderdale County, Alabama	2650	0.8280	0.8280	22520
01390	Lawrence County, Alabama	2030	0.8478	0.8478	19460
01400	Lee County, Alabama	0580	0.8108	0.8108	12220
01410	Limestone County, Alabama	3440	0.9149	0.9149	26620
01420	Lowndes County, Alabama	01	0.7463	0.8588	33860
01430	Macon County, Alabama	01	0.7463	0.7477	99901
01440	Madison County, Alabama	3440	0.9149	0.9149	26620
01450	Marengo County, Alabama	01	0.7463	0.7477	99901
01460	Marion County, Alabama	01	0.7463	0.7477	99901
01470	Marshall County, Alabama	01	0.7463	0.7477	99901
01480	Mobile County, Alabama	5160	0.7866	0.7895	33660
01490	Monroe County, Alabama	01	0.7463	0.7477	99901
01500	Montgomery County, Alabama	5240	0.8588	0.8588	33860
01510	Morgan County, Alabama	2030	0.8478	0.8478	19460
01520	Perry County, Alabama	01	0.7463	0.7477	99901
01530	Pickens County, Alabama	01	0.7463	0.7477	99901
01540	Pike County, Alabama	01	0.7463	0.7477	99901
01550	Randolph County, Alabama	01	0.7463	0.7477	99901
01560	Russell County, Alabama	1800	0.8568	0.8568	17980
01570	St Clair County, Alabama	1000	0.9021	0.8979	13820
01580	Shelby County, Alabama	1000	0.9021	0.8979	13820
01590	Sumter County, Alabama	01	0.7463	0.7477	99901
01600	Talladega County, Alabama	01	0.7463	0.7477	99901
01610	Tallapoosa County, Alabama	01	0.7463	0.7477	99901
01620	Tuscaloosa County, Alabama	8600	0.8842	0.8721	46220
01630	Walker County, Alabama	01	0.7463	0.8979	13820
01640	Washington County, Alabama	01	0.7463	0.7477	99901
01650	Wilcox County, Alabama	01	0.7463	0.7477	99901
01660	Winston County, Alabama	01	0.7463	0.7477	99901
02013	Aleutians County East, Alaska	02	1.1900	1.1990	99902
02016	Aleutians County West, Alaska	02	1.1900	1.1990	99902
02020	Anchorage County, Alaska	0380	1.2022	1.2110	11260
02030	Angoon County, Alaska	02	1.1900	1.1990	99902
02040	Barrow-North Slope County, Alaska	02	1.1900	1.1990	99902
02050	Bethel County, Alaska	02	1.1900	1.1990	99902
02060	Bristol Bay Borough County, Alaska	02	1.1900	1.1990	99902
02068	Denali County, Alaska	02	1.1900	1.1990	99902
02070	Bristol Bay County, Alaska	02	1.1900	1.1990	99902
02080	Cordova-Mc Carthy County, Alaska	02	1.1900	1.1990	99902
02090	Fairbanks County, Alaska	02	1.1900	1.1419	21820
02100	Haines County, Alaska	02	1.1900	1.1990	99902
02110	Juneau County, Alaska	02	1.1900	1.1990	99902
02120	Kenai-Cook Inlet County, Alaska	02	1.1900	1.1990	99902
02122	Kenai Peninsula Borough, Alaska	02	1.1900	1.1990	99902
02130	Ketchikan County, Alaska	02	1.1900	1.1990	99902
02140	Kobuk County, Alaska	02	1.1900	1.1990	99902
02150	Kodiak County, Alaska	02	1.1900	1.1990	99902
02160	Kuskokwin County, Alaska	02	1.1900	1.1990	99902
02164	Lake and Peninsula Borough, Alaska	02	1.1900	1.1990	99902
02170	Matanuska County, Alaska	02	1.1900	1.2110	11260
02180	Nome County, Alaska	02	1.1900	1.1990	99902
02185	North Slope Borough, Alaska	02	1.1900	1.1990	99902
02188	Northwest Arctic Borough, Alaska	02	1.1900	1.1990	99902
02190	Outer Ketchikan County, Alaska	02	1.1900	1.1990	99902
02200	Prince Of Wales County, Alaska	02	1.1900	1.1990	99902
02201	Prince of Wales-Outer Ketchikan Census Area, Alaska	02	1.1900	1.1990	99902
02210	Seward County, Alaska	02	1.1900	1.1990	99902
02220	Sitka County, Alaska	02	1.1900	1.1990	99902
02230	Skagway-Yakutat County, Alaska	02	1.1900	1.1990	99902
02231	Skagway-Yakutat-Angoon Census Area, Alaska	02	1.1900	1.1990	99902
02232	Skagway-Hoonah-Angoon Census Area, Alaska	02	1.1900	1.1990	99902
02240	Southeast Fairbanks County, Alaska	02	1.1900	1.1990	99902
02250	Upper Yukon County, Alaska	02	1.1900	1.1990	99902
02260	Valdz-Chitna-Whitier County, Alaska	02	1.1900	1.1990	99902
02261	Valdex-Cordove Census Area, Alaska	02	1.1900	1.1990	99902
02270	Wade Hampton County, Alaska	02	1.1900	1.1990	99902
02280	Wrangell-Petersburg County, Alaska	02	1.1900	1.1990	99902
02282	Yakutat Borough, Alaska	02	1.1900	1.1990	99902
02290	Yukon-Koyukuk County, Alaska	02	1.1900	1.1990	99902
03000	Apache County, Arizona	03	0.9054	0.8777	99903
03010	Cochise County, Arizona	03	0.9054	0.8777	99903
03020	Coconino County, Arizona	2620	1.1857	1.2105	22380
03030	Gila County, Arizona	03	0.9054	0.8777	99903
03040	Graham County, Arizona	03	0.9054	0.8777	99903
03050	Greenlee County, Arizona	03	0.9054	0.8777	99903
03055	La Paz County, Arizona	03	0.9054	0.8777	99903
03060	Maricopa County, Arizona	6200	1.0138	1.0138	38060
03070	Mohave County, Arizona	4120	1.1166	0.8777	99903
03080	Navajo County, Arizona	03	0.9054	0.8777	99903
03090	Pima County, Arizona	8520	0.8987	0.8987	46060
03100	Pinal County, Arizona	6200	1.0138	1.0138	38060
03110	Santa Cruz County, Arizona	03	0.9054	0.8777	99903
03120	Yavapai County, Arizona	03	0.9054	0.9879	39140
03130	Yuma County, Arizona	9360	0.9135	0.9135	49740
04000	Arkansas County, Arkansas	04	0.7744	0.7451	99904
04010	Ashley County, Arkansas	04	0.7744	0.7451	99904
04020	Baxter County, Arkansas	04	0.7744	0.7451	99904
04030	Benton County, Arkansas	2580	0.8563	0.8563	22220
04040	Boone County, Arkansas	04	0.7744	0.7451	99904
04050	Bradley County, Arkansas	04	0.7744	0.7451	99904
04060	Calhoun County, Arkansas	04	0.7744	0.7451	99904
04070	Carroll County, Arkansas	04	0.7744	0.7451	99904
04080	Chicot County, Arkansas	04	0.7744	0.7451	99904
04090	Clark County, Arkansas	04	0.7744	0.7451	99904
04100	Clay County, Arkansas	04	0.7744	0.7451	99904
04110	Cleburne County, Arkansas	04	0.7744	0.7451	99904
04120	Cleveland County, Arkansas	04	0.7744	0.8689	38220
04130	Columbia County, Arkansas	04	0.7744	0.7451	99904
04140	Conway County, Arkansas	04	0.7744	0.7451	99904
04150	Craighead County, Arkansas	3700	0.7919	0.7919	27860
04160	Crawford County, Arkansas	2720	0.8229	0.8214	22900
04170	Crittenden County, Arkansas	4920	0.9360	0.9341	32820
04180	Cross County, Arkansas	04	0.7744	0.7451	99904
04190	Dallas County, Arkansas	04	0.7744	0.7451	99904
04200	Desha County, Arkansas	04	0.7744	0.7451	99904
04210	Drew County, Arkansas	04	0.7744	0.7451	99904
04220	Faulkner County, Arkansas	4400	0.8756	0.8756	30780
04230	Franklin County, Arkansas	04	0.7744	0.8214	22900
04240	Fulton County, Arkansas	04	0.7744	0.7451	99904
04250	Garland County, Arkansas	04	0.7744	0.9053	26300
04260	Grant County, Arkansas	04	0.7744	0.8756	30780
04270	Greene County, Arkansas	04	0.7744	0.7451	99904
04280	Hempstead County, Arkansas	04	0.7744	0.7451	99904
04290	Hot Spring County, Arkansas	04	0.7744	0.7451	99904
04300	Howard County, Arkansas	04	0.7744	0.7451	99904
04310	Independence County, Arkansas	04	0.7744	0.7451	99904
04320	Izard County, Arkansas	04	0.7744	0.7451	99904
04330	Jackson County, Arkansas	04	0.7744	0.7451	99904
04340	Jefferson County, Arkansas	6240	0.8689	0.8689	38220
04350	Johnson County, Arkansas	04	0.7744	0.7451	99904
04360	Lafayette County, Arkansas	04	0.7744	0.7451	99904
04370	Lawrence County, Arkansas	04	0.7744	0.7451	99904
04380	Lee County, Arkansas	04	0.7744	0.7451	99904
04390	Lincoln County, Arkansas	04	0.7744	0.8689	38220
04400	Little River County, Arkansas	04	0.7744	0.7451	99904
04410	Logan County, Arkansas	04	0.7744	0.7451	99904
04420	Lonoke County, Arkansas	4400	0.8756	0.8756	30780
04430	Madison County, Arkansas	04	0.7744	0.8563	22220
04440	Marion County, Arkansas	04	0.7744	0.7451	99904
04450	Miller County, Arkansas	8360	0.8291	0.8291	45500
04460	Mississippi County, Arkansas	04	0.7744	0.7451	99904
04470	Monroe County, Arkansas	04	0.7744	0.7451	99904
04480	Montgomery County, Arkansas	04	0.7744	0.7451	99904
04490	Nevada County, Arkansas	04	0.7744	0.7451	99904
04500	Newton County, Arkansas	04	0.7744	0.7451	99904
04510	Ouachita County, Arkansas	04	0.7744	0.7451	99904
04520	Perry County, Arkansas	04	0.7744	0.8756	30780
04530	Phillips County, Arkansas	04	0.7744	0.7451	99904
04540	Pike County, Arkansas	04	0.7744	0.7451	99904
04550	Poinsett County, Arkansas	04	0.7744	0.7919	27860
04560	Polk County, Arkansas	04	0.7744	0.7451	99904
04570	Pope County, Arkansas	04	0.7744	0.7451	99904
04580	Prairie County, Arkansas	04	0.7744	0.7451	99904
04590	Pulaski County, Arkansas	4400	0.8756	0.8756	30780
04600	Randolph County, Arkansas	04	0.7744	0.7451	99904
04610	St Francis County, Arkansas	04	0.7744	0.7451	99904
04620	Saline County, Arkansas	4400	0.8756	0.8756	30780
04630	Scott County, Arkansas	04	0.7744	0.7451	99904
04640	Searcy County, Arkansas	04	0.7744	0.7451	99904
04650	Sebastian County, Arkansas	2720	0.8229	0.8214	22900
04660	Sevier County, Arkansas	04	0.7744	0.7451	99904
04670	Sharp County, Arkansas	04	0.7744	0.7451	99904
04680	Stone County, Arkansas	04	0.7744	0.7451	99904
04690	Union County, Arkansas	04	0.7744	0.7451	99904
04700	Van Buren County, Arkansas	04	0.7744	0.7451	99904
04710	Washington County, Arkansas	2580	0.8563	0.8563	22220
04720	White County, Arkansas	04	0.7744	0.7451	99904
04730	Woodruff County, Arkansas	04	0.7744	0.7451	99904
04740	Yell County, Arkansas	04	0.7744	0.7451	99904
05000	Alameda County, California	5775	1.5346	1.5346	36084
05010	Alpine County, California	05	1.0639	1.0857	99905
05020	Amador County, California	05	1.0639	1.0857	99905
05030	Butte County, California	1620	1.0522	1.0522	17020
05040	Calaveras County, California	05	1.0639	1.0857	99905
05050	Colusa County, California	05	1.0639	1.0857	99905
05060	Contra Costa County, California	5775	1.5346	1.5346	36084
05070	Del Norte County, California	05	1.0639	1.0857	99905
05080	Eldorado County, California	6920	1.3148	1.2973	40900
05090	Fresno County, California	2840	1.0432	1.0541	23420
05100	Glenn County, California	05	1.0639	1.0857	99905
05110	Humboldt County, California	05	1.0639	1.0857	99905
05120	Imperial County, California	05	1.0639	0.8915	20940
05130	Inyo County, California	05	1.0639	1.0857	99905
05140	Kern County, California	0680	1.0344	1.0344	12540
05150	Kings County, California	05	1.0639	1.0046	25260
05160	Lake County, California	05	1.0639	1.0857	99905
05170	Lassen County, California	05	1.0639	1.0857	99905
05200	Los Angeles County, California	4480	1.1752	1.1752	31084
05210	Los Angeles County, California	4480	1.1752	1.1752	31084
05300	Madera County, California	2840	1.0432	0.8721	31460
05310	Marin County, California	7360	1.4990	1.4990	41884
05320	Mariposa County, California	05	1.0639	1.0857	99905
05330	Mendocino County, California	05	1.0639	1.0857	99905
05340	Merced County, California	4940	1.1120	1.1120	32900
05350	Modoc County, California	05	1.0639	1.0857	99905
05360	Mono County, California	05	1.0639	1.0857	99905
05370	Monterey County, California	7120	1.4142	1.4142	41500
05380	Napa County, California	8720	1.3966	1.2656	34900
05390	Nevada County, California	05	1.0639	1.0857	99905
05400	Orange County, California	5945	1.1576	1.1576	42044
05410	Placer County, California	6920	1.3148	1.2973	40900
05420	Plumas County, California	05	1.0639	1.0857	99905
05430	Riverside County, California	6780	1.1022	1.1022	40140
05440	Sacramento County, California	6920	1.3148	1.2973	40900
05450	San Benito County, California	05	1.0639	1.5125	41940
05460	San Bernardino County, California	6780	1.1022	1.1022	40140
05470	San Diego County, California	7320	1.1424	1.1424	41740
05480	San Francisco County, California	7360	1.4990	1.4990	41884
05490	San Joaquin County, California	8120	1.1311	1.1311	44700
05500	San Luis Obispo County, California	7460	1.1360	1.1360	42020
05510	San Mateo County, California	7360	1.4990	1.4990	41884
05520	Santa Barbara County, California	7480	1.1538	1.1538	42060
05530	Santa Clara County, California	7400	1.5144	1.5125	41940
05540	Santa Cruz County, California	7485	1.5182	1.5182	42100
05550	Shasta County, California	6690	1.2215	1.2215	39820
05560	Sierra County, California	05	1.0639	1.0857	99905
05570	Siskiyou County, California	05	1.0639	1.0857	99905
05580	Solano County, California	8720	1.3966	1.4899	46700
05590	Sonoma County, California	7500	1.3506	1.3506	42220
05600	Stanislaus County, California	5170	1.1804	1.1804	33700
05610	Sutter County, California	9340	1.0932	1.0932	49700
05620	Tehama County, California	05	1.0639	1.0857	99905
05630	Trinity County, California	05	1.0639	1.0857	99905
05640	Tulare County, California	8780	1.0074	1.0074	47300
05650	Tuolumne County, California	05	1.0639	1.0857	99905
05660	Ventura County, California	8735	1.1613	1.1613	37100
05670	Yolo County, California	9270	0.9949	1.2973	40900
05680	Yuba County, California	9340	1.0932	1.0932	49700
06000	Adams County, Colorado	2080	1.0733	1.0733	19740
06010	Alamosa County, Colorado	06	0.9389	0.9389	99906
06020	Arapahoe County, Colorado	2080	1.0733	1.0733	19740
06030	Archuleta County, Colorado	06	0.9389	0.9389	99906
06040	Baca County, Colorado	06	0.9389	0.9389	99906
06050	Bent County, Colorado	06	0.9389	0.9389	99906
06060	Boulder County, Colorado	1125	0.9744	0.9744	14500
06070	Chaffee County, Colorado	06	0.9389	0.9389	99906
06080	Cheyenne County, Colorado	06	0.9389	0.9389	99906
06090	Clear Creek County, Colorado	06	0.9389	1.0733	19740
06100	Conejos County, Colorado	06	0.9389	0.9389	99906
06110	Costilla County, Colorado	06	0.9389	0.9389	99906
06120	Crowley County, Colorado	06	0.9389	0.9389	99906
06130	Custer County, Colorado	06	0.9389	0.9389	99906
06140	Delta County, Colorado	06	0.9389	0.9389	99906
06150	Denver County, Colorado	2080	1.0733	1.0733	19740
06160	Dolores County, Colorado	06	0.9389	0.9389	99906
06170	Douglas County, Colorado	2080	1.0733	1.0733	19740
06180	Eagle County, Colorado	06	0.9389	0.9389	99906
06190	Elbert County, Colorado	06	0.9389	1.0733	19740
06200	El Paso County, Colorado	1720	0.9478	0.9478	17820
06210	Fremont County, Colorado	06	0.9389	0.9389	99906
06220	Garfield County, Colorado	06	0.9389	0.9389	99906
06230	Gilpin County, Colorado	06	0.9389	1.0733	19740
06240	Grand County, Colorado	06	0.9389	0.9389	99906
06250	Gunnison County, Colorado	06	0.9389	0.9389	99906
06260	Hinsdale County, Colorado	06	0.9389	0.9389	99906
06270	Huerfano County, Colorado	06	0.9389	0.9389	99906
06280	Jackson County, Colorado	06	0.9389	0.9389	99906
06290	Jefferson County, Colorado	2080	1.0733	1.0733	19740
06300	Kiowa County, Colorado	06	0.9389	0.9389	99906
06310	Kit Carson County, Colorado	06	0.9389	0.9389	99906
06320	Lake County, Colorado	06	0.9389	0.9389	99906
06330	La Plata County, Colorado	06	0.9389	0.9389	99906
06340	Larimer County, Colorado	2670	1.0132	1.0132	22660
06350	Las Animas County, Colorado	06	0.9389	0.9389	99906
06360	Lincoln County, Colorado	06	0.9389	0.9389	99906
06370	Logan County, Colorado	06	0.9389	0.9389	99906
06380	Mesa County, Colorado	2995	0.9560	0.9560	24300
06390	Mineral County, Colorado	06	0.9389	0.9389	99906
06400	Moffat County, Colorado	06	0.9389	0.9389	99906
06410	Montezuma County, Colorado	06	0.9389	0.9389	99906
06420	Montrose County, Colorado	06	0.9389	0.9389	99906
06430	Morgan County, Colorado	06	0.9389	0.9389	99906
06440	Otero County, Colorado	06	0.9389	0.9389	99906
06450	Ouray County, Colorado	06	0.9389	0.9389	99906
06460	Park County, Colorado	06	0.9389	1.0733	19740
06470	Phillips County, Colorado	06	0.9389	0.9389	99906
06480	Pitkin County, Colorado	06	0.9389	0.9389	99906
06490	Prowers County, Colorado	06	0.9389	0.9389	99906
06500	Pueblo County, Colorado	6560	0.8632	0.8632	39380
06510	Rio Blanco County, Colorado	06	0.9389	0.9389	99906
06520	Rio Grande County, Colorado	06	0.9389	0.9389	99906
06530	Routt County, Colorado	06	0.9389	0.9389	99906
06540	Saguache County, Colorado	06	0.9389	0.9389	99906
06550	San Juan County, Colorado	06	0.9389	0.9389	99906
06560	San Miguel County, Colorado	06	0.9389	0.9389	99906
06570	Sedgwick County, Colorado	06	0.9389	0.9389	99906
06580	Summit County, Colorado	06	0.9389	0.9389	99906
06590	Teller County, Colorado	06	0.9389	0.9478	17820
06600	Washington County, Colorado	06	0.9389	0.9389	99906
06610	Weld County, Colorado	3060	0.9580	0.9580	24540
06620	Yuma County, Colorado	06	0.9389	0.9389	99906
06630	Broomfield County, Colorado	2080	1.0733	1.0733	19740
07000	Fairfield County, Connecticut	5483	1.2096	1.2598	14860
07010	Hartford County, Connecticut	3283	1.1084	1.1084	25540
07020	Litchfield County, Connecticut	3283	1.1084	1.1084	25540
07030	Middlesex County, Connecticut	3283	1.1084	1.1084	25540
07040	New Haven County, Connecticut	5483	1.2096	1.1702	35300
07050	New London County, Connecticut	5523	1.1356	1.1356	35980
07060	Tolland County, Connecticut	3283	1.1084	1.1084	25540
07070	Windham County, Connecticut	07	1.1794	1.1794	99907
08000	Kent County, Delaware	2190	0.9779	0.9779	20100
08010	New Castle County, Delaware	9160	1.0537	1.0482	48864
08020	Sussex County, Delaware	08	0.9606	0.9606	99908
09000	Washington Dc County, Dist Of Col	8840	1.0983	1.0932	47894
10000	Alachua County, Florida	2900	0.9474	0.9474	23540
10010	Baker County, Florida	10	0.8698	0.9299	27260
10020	Bay County, Florida	6015	0.7989	0.7989	37460
10030	Bradford County, Florida	10	0.8698	0.8598	99910
10040	Brevard County, Florida	4900	0.9835	0.9835	37340
10050	Broward County, Florida	2680	1.0442	1.0442	22744
10060	Calhoun County, Florida	10	0.8698	0.8598	99910
10070	Charlotte County, Florida	6580	0.9264	0.9264	39460
10080	Citrus County, Florida	10	0.8698	0.8598	99910
10090	Clay County, Florida	3600	0.9308	0.9299	27260
10100	Collier County, Florida	5345	1.0140	1.0140	34940
10110	Columbia County, Florida	10	0.8698	0.8598	99910
10120	Dade County, Florida	5000	0.9759	0.9759	33124
10130	De Soto County, Florida	10	0.8698	0.8598	99910
10140	Dixie County, Florida	10	0.8698	0.8598	99910
10150	Duval County, Florida	3600	0.9308	0.9299	27260
10160	Escambia County, Florida	6080	0.8104	0.8104	37860
10170	Flagler County, Florida	2020	0.9334	0.8598	99910
10180	Franklin County, Florida	10	0.8698	0.8598	99910
10190	Gadsden County, Florida	8240	0.8697	0.8697	45220
10200	Gilchrist County, Florida	10	0.8698	0.9474	23540
10210	Glades County, Florida	10	0.8698	0.8598	99910
10220	Gulf County, Florida	10	0.8698	0.8598	99910
10230	Hamilton County, Florida	10	0.8698	0.8598	99910
10240	Hardee County, Florida	10	0.8698	0.8598	99910
10250	Hendry County, Florida	10	0.8698	0.8598	99910
10260	Hernando County, Florida	8280	0.9193	0.9193	45300
10270	Highlands County, Florida	10	0.8698	0.8598	99910
10280	Hillsborough County, Florida	8280	0.9193	0.9193	45300
10290	Holmes County, Florida	10	0.8698	0.8598	99910
10300	Indian River County, Florida	10	0.8698	0.9444	46940
10310	Jackson County, Florida	10	0.8698	0.8598	99910
10320	Jefferson County, Florida	10	0.8698	0.8697	45220
10330	Lafayette County, Florida	10	0.8698	0.8598	99910
10340	Lake County, Florida	5960	0.9459	0.9459	36740
10350	Lee County, Florida	2700	0.9366	0.9366	15980
10360	Leon County, Florida	8240	0.8697	0.8697	45220
10370	Levy County, Florida	10	0.8698	0.8598	99910
10380	Liberty County, Florida	10	0.8698	0.8598	99910
10390	Madison County, Florida	10	0.8698	0.8598	99910
10400	Manatee County, Florida	7510	0.9555	0.9555	42260
10410	Marion County, Florida	5790	0.8934	0.8934	36100
10420	Martin County, Florida	2710	1.0133	1.0133	38940
10430	Monroe County, Florida	10	0.8698	0.8598	99910
10440	Nassau County, Florida	3600	0.9308	0.9299	27260
10450	Okaloosa County, Florida	2750	0.8881	0.8881	23020
10460	Okeechobee County, Florida	10	0.8698	0.8598	99910
10470	Orange County, Florida	5960	0.9459	0.9459	36740
10480	Osceola County, Florida	5960	0.9459	0.9459	36740
10490	Palm Beach County, Florida	8960	1.0077	1.0077	48424
10500	Pasco County, Florida	8280	0.9193	0.9193	45300
10510	Pinellas County, Florida	8280	0.9193	0.9193	45300
10520	Polk County, Florida	3980	0.8921	0.8921	29460
10530	Putnam County, Florida	10	0.8698	0.8598	99910
10540	Johns County, Florida	3600	0.9308	0.9299	27260
10550	St Lucie County, Florida	2710	1.0133	1.0133	38940
10560	Santa Rosa County, Florida	6080	0.8104	0.8104	37860
10570	Sarasota County, Florida	7510	0.9555	0.9555	42260
10580	Seminole County, Florida	5960	0.9459	0.9459	36740
10590	Sumter County, Florida	10	0.8698	0.8598	99910
10600	Suwannee County, Florida	10	0.8698	0.8598	99910
10610	Taylor County, Florida	10	0.8698	0.8598	99910
10620	Union County, Florida	10	0.8698	0.8598	99910
10630	Volusia County, Florida	2020	0.9334	0.9308	19660
10640	Wakulla County, Florida	10	0.8698	0.8697	45220
10650	Walton County, Florida	10	0.8698	0.8598	99910
10660	Washington County, Florida	10	0.8698	0.8598	99910
11000	Appling County, Georgia	11	0.8165	0.7666	99911
11010	Atkinson County, Georgia	11	0.8165	0.7666	99911
11011	Bacon County, Georgia	11	0.8165	0.7666	99911
11020	Baker County, Georgia	11	0.8165	0.8636	10500
11030	Baldwin County, Georgia	11	0.8165	0.7666	99911
11040	Banks County, Georgia	11	0.8165	0.7666	99911
11050	Barrow County, Georgia	0520	0.9648	0.9648	12060
11060	Bartow County, Georgia	0520	0.9648	0.9648	12060
11070	Ben Hill County, Georgia	11	0.8165	0.7666	99911
11080	Berrien County, Georgia	11	0.8165	0.7666	99911
11090	Bibb County, Georgia	4680	0.9286	0.9453	31420
11100	Bleckley County, Georgia	11	0.8165	0.7666	99911
11110	Brantley County, Georgia	11	0.8165	0.9320	15260
11120	Brooks County, Georgia	11	0.8165	0.8875	46660
11130	Bryan County, Georgia	7520	0.9480	0.9480	42340
11140	Bulloch County, Georgia	11	0.8165	0.7666	99911
11150	Burke County, Georgia	11	0.8165	0.9565	12260
11160	Butts County, Georgia	11	0.8165	0.9648	12060
11161	Calhoun County, Georgia	11	0.8165	0.7666	99911
11170	Camden County, Georgia	11	0.8165	0.7666	99911
11180	Candler County, Georgia	11	0.8165	0.7666	99911
11190	Carroll County, Georgia	0520	0.9648	0.9648	12060
11200	Catoosa County, Georgia	1560	0.9098	0.9098	16860
11210	Charlton County, Georgia	11	0.8165	0.7666	99911
11220	Chatham County, Georgia	7520	0.9480	0.9480	42340
11230	Chattahoochee County, Georgia	1800	0.8568	0.8568	17980
11240	Chattooga County, Georgia	11	0.8165	0.7666	99911
11250	Cherokee County, Georgia	0520	0.9648	0.9648	12060
11260	Clarke County, Georgia	0500	0.9843	0.9843	12020
11270	Clay County, Georgia	11	0.8165	0.7666	99911
11280	Clayton County, Georgia	0520	0.9648	0.9648	12060
11281	Clinch County, Georgia	11	0.8165	0.7666	99911
11290	Cobb County, Georgia	0520	0.9648	0.9648	12060
11291	Coffee County, Georgia	11	0.8165	0.7666	99911
11300	Colquitt County, Georgia	11	0.8165	0.7666	99911
11310	Columbia County, Georgia	0600	0.9619	0.9565	12260
11311	Cook County, Georgia	11	0.8165	0.7666	99911
11320	Coweta County, Georgia	0520	0.9648	0.9648	12060
11330	Crawford County, Georgia	11	0.8165	0.9453	31420
11340	Crisp County, Georgia	11	0.8165	0.7666	99911
11341	Dade County, Georgia	1560	0.9098	0.9098	16860
11350	Dawson County, Georgia	11	0.8165	0.9648	12060
11360	Decatur County, Georgia	11	0.8165	0.7666	99911
11370	De Kalb County, Georgia	0520	0.9648	0.9648	12060
11380	Dodge County, Georgia	11	0.8165	0.7666	99911
11381	Dooly County, Georgia	11	0.8165	0.7666	99911
11390	Dougherty County, Georgia	0120	0.8636	0.8636	10500
11400	Douglas County, Georgia	0520	0.9648	0.9648	12060
11410	Early County, Georgia	11	0.8165	0.7666	99911
11420	Echols County, Georgia	11	0.8165	0.8875	46660
11421	Effingham County, Georgia	7520	0.9480	0.9480	42340
11430	Elbert County, Georgia	11	0.8165	0.7666	99911
11440	Emanuel County, Georgia	11	0.8165	0.7666	99911
11441	Evans County, Georgia	11	0.8165	0.7666	99911
11450	Fannin County, Georgia	11	0.8165	0.7666	99911
11451	Fayette County, Georgia	0520	0.9648	0.9648	12060
11460	Floyd County, Georgia	11	0.8165	0.9424	40660
11461	Forsyth County, Georgia	0520	0.9648	0.9648	12060
11462	Franklin County, Georgia	11	0.8165	0.7666	99911
11470	Fulton County, Georgia	0520	0.9648	0.9648	12060
11471	Gilmer County, Georgia	11	0.8165	0.7666	99911
11480	Glascock County, Georgia	11	0.8165	0.7666	99911
11490	Glynn County, Georgia	11	0.8165	0.9320	15260
11500	Gordon County, Georgia	11	0.8165	0.7666	99911
11510	Grady County, Georgia	11	0.8165	0.7666	99911
11520	Greene County, Georgia	11	0.8165	0.7666	99911
11530	Gwinnett County, Georgia	0520	0.9648	0.9648	12060
11540	Habersham County, Georgia	11	0.8165	0.7666	99911
11550	Hall County, Georgia	11	0.8165	0.8883	23580
11560	Hancock County, Georgia	11	0.8165	0.7666	99911
11570	Haralson County, Georgia	11	0.8165	0.9648	12060
11580	Harris County, Georgia	1800	0.8568	0.8568	17980
11581	Hart County, Georgia	11	0.8165	0.7666	99911
11590	Heard County, Georgia	11	0.8165	0.9648	12060
11591	Henry County, Georgia	0520	0.9648	0.9648	12060
11600	Houston County, Georgia	4680	0.9286	0.8654	47580
11601	Irwin County, Georgia	11	0.8165	0.7666	99911
11610	Jackson County, Georgia	11	0.8165	0.7666	99911
11611	Jasper County, Georgia	11	0.8165	0.9648	12060
11612	Jeff Davis County, Georgia	11	0.8165	0.7666	99911
11620	Jefferson County, Georgia	11	0.8165	0.7666	99911
11630	Jenkins County, Georgia	11	0.8165	0.7666	99911
11640	Johnson County, Georgia	11	0.8165	0.7666	99911
11650	Jones County, Georgia	4680	0.9286	0.9453	31420
11651	Lamar County, Georgia	11	0.8165	0.9648	12060
11652	Lanier County, Georgia	11	0.8165	0.8875	46660
11660	Laurens County, Georgia	11	0.8165	0.7666	99911
11670	Lee County, Georgia	0120	0.8636	0.8636	10500
11680	Liberty County, Georgia	11	0.8165	0.9178	25980
11690	Lincoln County, Georgia	11	0.8165	0.7666	99911
11691	Long County, Georgia	11	0.8165	0.9178	25980
11700	Lowndes County, Georgia	11	0.8165	0.8875	46660
11701	Lumpkin County, Georgia	11	0.8165	0.7666	99911
11702	Mc Duffie County, Georgia	0600	0.9619	0.9565	12260
11703	Mc Intosh County, Georgia	11	0.8165	0.9320	15260
11710	Macon County, Georgia	11	0.8165	0.7666	99911
11720	Madison County, Georgia	0500	0.9843	0.9843	12020
11730	Marion County, Georgia	11	0.8165	0.8568	17980
11740	Meriwether County, Georgia	11	0.8165	0.9648	12060
11741	Miller County, Georgia	11	0.8165	0.7666	99911
11750	Mitchell County, Georgia	11	0.8165	0.7666	99911
11760	Monroe County, Georgia	11	0.8165	0.9453	31420
11770	Montgomery County, Georgia	11	0.8165	0.7666	99911
11771	Morgan County, Georgia	11	0.8165	0.7666	99911
11772	Murray County, Georgia	11	0.8165	0.9044	19140
11780	Muscogee County, Georgia	1800	0.8568	0.8568	17980
11790	Newton County, Georgia	0520	0.9648	0.9648	12060
11800	Oconee County, Georgia	0500	0.9843	0.9843	12020
11801	Oglethorpe County, Georgia	11	0.8165	0.9843	12020
11810	Paulding County, Georgia	0520	0.9648	0.9648	12060
11811	Peach County, Georgia	4680	0.9286	0.7666	99911
11812	Pickens County, Georgia	0520	0.9648	0.9648	12060
11820	Pierce County, Georgia	11	0.8165	0.7666	99911
11821	Pike County, Georgia	11	0.8165	0.9648	12060
11830	Polk County, Georgia	11	0.8165	0.7666	99911
11831	Pulaski County, Georgia	11	0.8165	0.7666	99911
11832	Putnam County, Georgia	11	0.8165	0.7666	99911
11833	Quitman County, Georgia	11	0.8165	0.7666	99911
11834	Rabun County, Georgia	11	0.8165	0.7666	99911
11835	Randolph County, Georgia	11	0.8165	0.7666	99911
11840	Richmond County, Georgia	0600	0.9619	0.9565	12260
11841	Rockdale County, Georgia	0520	0.9648	0.9648	12060
11842	Schley County, Georgia	11	0.8165	0.7666	99911
11850	Screven County, Georgia	11	0.8165	0.7666	99911
11851	Seminole County, Georgia	11	0.8165	0.7666	99911
11860	Spalding County, Georgia	0520	0.9648	0.9648	12060
11861	Stephens County, Georgia	11	0.8165	0.7666	99911
11862	Stewart County, Georgia	11	0.8165	0.7666	99911
11870	Sumter County, Georgia	11	0.8165	0.7666	99911
11880	Talbot County, Georgia	11	0.8165	0.7666	99911
11881	Taliaferro County, Georgia	11	0.8165	0.7666	99911
11882	Tattnall County, Georgia	11	0.8165	0.7666	99911
11883	Taylor County, Georgia	11	0.8165	0.7666	99911
11884	Telfair County, Georgia	11	0.8165	0.7666	99911
11885	Terrell County, Georgia	11	0.8165	0.8636	10500
11890	Thomas County, Georgia	11	0.8165	0.7666	99911
11900	Tift County, Georgia	11	0.8165	0.7666	99911
11901	Toombs County, Georgia	11	0.8165	0.7666	99911
11902	Towns County, Georgia	11	0.8165	0.7666	99911
11903	Treutlen County, Georgia	11	0.8165	0.7666	99911
11910	Troup County, Georgia	11	0.8165	0.7666	99911
11911	Turner County, Georgia	11	0.8165	0.7666	99911
11912	Twiggs County, Georgia	4680	0.9286	0.9453	31420
11913	Union County, Georgia	11	0.8165	0.7666	99911
11920	Upson County, Georgia	11	0.8165	0.7666	99911
11921	Walker County, Georgia	1560	0.9098	0.9098	16860
11930	Walton County, Georgia	0520	0.9648	0.9648	12060
11940	Ware County, Georgia	11	0.8165	0.7666	99911
11941	Warren County, Georgia	11	0.8165	0.7666	99911
11950	Washington County, Georgia	11	0.8165	0.7666	99911
11960	Wayne County, Georgia	11	0.8165	0.7666	99911
11961	Webster County, Georgia	11	0.8165	0.7666	99911
11962	Wheeler County, Georgia	11	0.8165	0.7666	99911
11963	White County, Georgia	11	0.8165	0.7666	99911
11970	Whitfield County, Georgia	11	0.8165	0.9044	19140
11971	Wilcox County, Georgia	11	0.8165	0.7666	99911
11972	Wilkes County, Georgia	11	0.8165	0.7666	99911
11973	Wilkinson County, Georgia	11	0.8165	0.7666	99911
11980	Worth County, Georgia	11	0.8165	0.8636	10500
12005	Kalawao County, Hawaii	12	1.0562	1.0562	99912
12010	Hawaii County, Hawaii	12	1.0562	1.0562	99912
12020	Honolulu County, Hawaii	3320	1.1208	1.1208	26180
12040	Kauai County, Hawaii	12	1.0562	1.0562	99912
12050	Maui County, Hawaii	12	1.0562	1.0562	99912
13000	Ada County, Idaho	1080	0.9061	0.9061	14260
13010	Adams County, Idaho	13	0.9106	0.8045	99913
13020	Bannock County, Idaho	6340	0.9360	0.9360	38540
13030	Bear Lake County, Idaho	13	0.9106	0.8045	99913
13040	Benewah County, Idaho	13	0.9106	0.8045	99913
13050	Bingham County, Idaho	13	0.9106	0.8045	99913
13060	Blaine County, Idaho	13	0.9106	0.8045	99913
13070	Boise County, Idaho	13	0.9106	0.9061	14260
13080	Bonner County, Idaho	13	0.9106	0.8045	99913
13090	Bonneville County, Idaho	13	0.9106	0.9429	26820
13100	Boundary County, Idaho	13	0.9106	0.8045	99913
13110	Butte County, Idaho	13	0.9106	0.8045	99913
13120	Camas County, Idaho	13	0.9106	0.8045	99913
13130	Canyon County, Idaho	1080	0.9061	0.9061	14260
13140	Caribou County, Idaho	13	0.9106	0.8045	99913
13150	Cassia County, Idaho	13	0.9106	0.8045	99913
13160	Clark County, Idaho	13	0.9106	0.8045	99913
13170	Clearwater County, Idaho	13	0.9106	0.8045	99913
13180	Custer County, Idaho	13	0.9106	0.8045	99913
13190	Elmore County, Idaho	13	0.9106	0.8045	99913
13200	Franklin County, Idaho	13	0.9106	0.9173	30860
13210	Fremont County, Idaho	13	0.9106	0.8045	99913
13220	Gem County, Idaho	13	0.9106	0.9061	14260
13230	Gooding County, Idaho	13	0.9106	0.8045	99913
13240	Idaho County, Idaho	13	0.9106	0.8045	99913
13250	Jefferson County, Idaho	13	0.9106	0.9429	26820
13260	Jerome County, Idaho	13	0.9106	0.8045	99913
13270	Kootenai County, Idaho	13	0.9106	0.9657	17660
13280	Latah County, Idaho	13	0.9106	0.8045	99913
13290	Lemhi County, Idaho	13	0.9106	0.8045	99913
13300	Lewis County, Idaho	13	0.9106	0.8045	99913
13310	Lincoln County, Idaho	13	0.9106	0.8045	99913
13320	Madison County, Idaho	13	0.9106	0.8045	99913
13330	Minidoka County, Idaho	13	0.9106	0.8045	99913
13340	Nez Perce County, Idaho	13	0.9106	0.9896	30300
13350	Oneida County, Idaho	13	0.9106	0.8045	99913
13360	Owyhee County, Idaho	13	0.9106	0.9061	14260
13370	Payette County, Idaho	13	0.9106	0.8045	99913
13380	Power County, Idaho	13	0.9106	0.9360	38540
13390	Shoshone County, Idaho	13	0.9106	0.8045	99913
13390	Teton County, Idaho	13	0.9106	0.8045	99913
13410	Twin Falls County, Idaho	13	0.9106	0.8045	99913
13420	Valley County, Idaho	13	0.9106	0.8045	99913
13430	Washington County, Idaho	13	0.9106	0.8045	99913
14000	Adams County, Illinois	14	0.8309	0.8279	99914
14010	Alexander County, Illinois	14	0.8309	0.8279	99914
14020	Bond County, Illinois	14	0.8309	0.8949	41180
14030	Boone County, Illinois	6880	0.9994	0.9994	40420
14040	Brown County, Illinois	14	0.8309	0.8279	99914
14050	Bureau County, Illinois	14	0.8309	0.8279	99914
14060	Calhoun County, Illinois	14	0.8309	0.8949	41180
14070	Carroll County, Illinois	14	0.8309	0.8279	99914
14080	Cass County, Illinois	14	0.8309	0.8279	99914
14090	Champaign County, Illinois	1400	0.9604	0.9604	16580
14100	Christian County, Illinois	14	0.8309	0.8279	99914
14110	Clark County, Illinois	14	0.8309	0.8279	99914
14120	Clay County, Illinois	14	0.8309	0.8279	99914
14130	Clinton County, Illinois	7040	0.8957	0.8949	41180
14140	Coles County, Illinois	14	0.8309	0.8279	99914
14141	Cook County, Illinois	1600	1.0838	1.0848	16974
14150	Crawford County, Illinois	14	0.8309	0.8279	99914
14160	Cumberland County, Illinois	14	0.8309	0.8279	99914
14170	De Kalb County, Illinois	1600	1.0838	1.0848	16974
14180	De Witt County, Illinois	14	0.8309	0.8279	99914
14190	Douglas County, Illinois	14	0.8309	0.8279	99914
14250	Du Page County, Illinois	1600	1.0838	1.0848	16974
14310	Edgar County, Illinois	14	0.8309	0.8279	99914
14320	Edwards County, Illinois	14	0.8309	0.8279	99914
14330	Effingham County, Illinois	14	0.8309	0.8279	99914
14340	Fayette County, Illinois	14	0.8309	0.8279	99914
14350	Ford County, Illinois	14	0.8309	0.9604	16580
14360	Franklin County, Illinois	14	0.8309	0.8279	99914
14370	Fulton County, Illinois	14	0.8309	0.8279	99914
14380	Gallatin County, Illinois	14	0.8309	0.8279	99914
14390	Greene County, Illinois	14	0.8309	0.8279	99914
14400	Grundy County, Illinois	1600	1.0838	1.0848	16974
14410	Hamilton County, Illinois	14	0.8309	0.8279	99914
14420	Hancock County, Illinois	14	0.8309	0.8279	99914
14421	Hardin County, Illinois	14	0.8309	0.8279	99914
14440	Henderson County, Illinois	14	0.8309	0.8279	99914
14450	Henry County, Illinois	1960	0.8731	0.8731	19340
14460	Iroquois County, Illinois	14	0.8309	0.8279	99914
14470	Jackson County, Illinois	14	0.8309	0.8279	99914
14480	Jasper County, Illinois	14	0.8309	0.8279	99914
14490	Jefferson County, Illinois	14	0.8309	0.8279	99914
14500	Jersey County, Illinois	7040	0.8957	0.8949	41180
14510	Jo Daviess County, Illinois	14	0.8309	0.8279	99914
14520	Johnson County, Illinois	14	0.8309	0.8279	99914
14530	Kane County, Illinois	1600	1.0838	1.0848	16974
14540	Kankakee County, Illinois	3740	1.0974	1.0974	28100
14550	Kendall County, Illinois	1600	1.0838	1.0848	16974
14560	Knox County, Illinois	14	0.8309	0.8279	99914
14570	Lake County, Illinois	1600	1.0838	1.0440	29404
14580	La Salle County, Illinois	14	0.8309	0.8279	99914
14590	Lawrence County, Illinois	14	0.8309	0.8279	99914
14600	Lee County, Illinois	14	0.8309	0.8279	99914
14610	Livingston County, Illinois	14	0.8309	0.8279	99914
14620	Logan County, Illinois	14	0.8309	0.8279	99914
14630	Mc Donough County, Illinois	14	0.8309	0.8279	99914
14640	Mc Henry County, Illinois	1600	1.0838	1.0848	16974
14650	Mclean County, Illinois	1040	0.9084	0.9084	14060
14660	Macon County, Illinois	2040	0.8076	0.8076	19500
14670	Macoupin County, Illinois	14	0.8309	0.8949	41180
14680	Madison County, Illinois	7040	0.8957	0.8949	41180
14690	Marion County, Illinois	14	0.8309	0.8279	99914
14700	Marshall County, Illinois	14	0.8309	0.8868	37900
14710	Mason County, Illinois	14	0.8309	0.8279	99914
14720	Massac County, Illinois	14	0.8309	0.8279	99914
14730	Menard County, Illinois	7880	0.8885	0.8885	44100
14740	Mercer County, Illinois	14	0.8309	0.8731	19340
14750	Monroe County, Illinois	7040	0.8957	0.8949	41180
14760	Montgomery County, Illinois	14	0.8309	0.8279	99914
14770	Morgan County, Illinois	14	0.8309	0.8279	99914
14780	Moultrie County, Illinois	14	0.8309	0.8279	99914
14790	Ogle County, Illinois	6880	0.9994	0.8279	99914
14800	Peoria County, Illinois	6120	0.8868	0.8868	37900
14810	Perry County, Illinois	14	0.8309	0.8279	99914
14820	Piatt County, Illinois	14	0.8309	0.9604	16580
14830	Pike County, Illinois	14	0.8309	0.8279	99914
14831	Pope County, Illinois	14	0.8309	0.8279	99914
14850	Pulaski County, Illinois	14	0.8309	0.8279	99914
14860	Putnam County, Illinois	14	0.8309	0.8279	99914
14870	Randolph County, Illinois	14	0.8309	0.8279	99914
14880	Richland County, Illinois	14	0.8309	0.8279	99914
14890	Rock Island County, Illinois	1960	0.8731	0.8731	19340
14900	St Clair County, Illinois	7040	0.8957	0.8949	41180
14910	Saline County, Illinois	14	0.8309	0.8279	99914
14920	Sangamon County, Illinois	7880	0.8885	0.8885	44100
14921	Schuyler County, Illinois	14	0.8309	0.8279	99914
14940	Scott County, Illinois	14	0.8309	0.8279	99914
14950	Shelby County, Illinois	14	0.8309	0.8279	99914
14960	Stark County, Illinois	14	0.8309	0.8868	37900
14970	Stephenson County, Illinois	14	0.8309	0.8279	99914
14980	Tazewell County, Illinois	6120	0.8868	0.8868	37900
14981	Union County, Illinois	14	0.8309	0.8279	99914
14982	Vermilion County, Illinois	14	0.8309	0.9037	19180
14983	Wabash County, Illinois	14	0.8309	0.8279	99914
14984	Warren County, Illinois	14	0.8309	0.8279	99914
14985	Washington County, Illinois	14	0.8309	0.8279	99914
14986	Wayne County, Illinois	14	0.8309	0.8279	99914
14987	White County, Illinois	14	0.8309	0.8279	99914
14988	Whiteside County, Illinois	14	0.8309	0.8279	99914
14989	Will County, Illinois	1600	1.0838	1.0848	16974
14990	Williamson County, Illinois	14	0.8309	0.8279	99914
14991	Winnebago County, Illinois	6880	0.9994	0.9994	40420
14992	Woodford County, Illinois	6120	0.8868	0.8868	37900
15000	Adams County, Indiana	2760	0.9716	0.8630	99915
15010	Allen County, Indiana	2760	0.9716	0.9803	23060
15020	Bartholomew County, Indiana	15	0.8727	0.9598	18020
15030	Benton County, Indiana	15	0.8727	0.8745	29140
15040	Blackford County, Indiana	15	0.8727	0.8630	99915
15050	Boone County, Indiana	3480	0.9875	0.9930	26900
15060	Brown County, Indiana	15	0.8727	0.9930	26900
15070	Carroll County, Indiana	15	0.8727	0.8745	29140
15080	Cass County, Indiana	15	0.8727	0.8630	99915
15090	Clark County, Indiana	4520	0.9302	0.9261	31140
15100	Clay County, Indiana	8320	0.8345	0.8313	45460
15110	Clinton County, Indiana	3920	0.8745	0.8630	99915
15120	Crawford County, Indiana	15	0.8727	0.8630	99915
15130	Daviess County, Indiana	15	0.8727	0.8630	99915
15140	Dearborn County, Indiana	1640	0.9742	0.9623	17140
15150	Decatur County, Indiana	15	0.8727	0.8630	99915
15160	De Kalb County, Indiana	2760	0.9716	0.8630	99915
15170	Delaware County, Indiana	5280	0.8939	0.8939	34620
15180	Dubois County, Indiana	15	0.8727	0.8630	99915
15190	Elkhart County, Indiana	2330	0.9637	0.9637	21140
15200	Fayette County, Indiana	15	0.8727	0.8630	99915
15210	Floyd County, Indiana	4520	0.9302	0.9261	31140
15220	Fountain County, Indiana	15	0.8727	0.8630	99915
15230	Franklin County, Indiana	15	0.8727	0.9623	17140
15240	Fulton County, Indiana	15	0.8727	0.8630	99915
15250	Gibson County, Indiana	15	0.8727	0.8721	21780
15260	Grant County, Indiana	15	0.8727	0.8630	99915
15270	Greene County, Indiana	15	0.8727	0.8456	14020
15280	Hamilton County, Indiana	3480	0.9875	0.9930	26900
15290	Hancock County, Indiana	3480	0.9875	0.9930	26900
15300	Harrison County, Indiana	4520	0.9302	0.9261	31140
15310	Hendricks County, Indiana	3480	0.9875	0.9930	26900
15320	Henry County, Indiana	15	0.8727	0.8630	99915
15330	Howard County, Indiana	3850	0.9517	0.9517	29020
15340	Huntington County, Indiana	2760	0.9716	0.8630	99915
15350	Jackson County, Indiana	15	0.8727	0.8630	99915
15360	Jasper County, Indiana	15	0.8727	0.9369	23844
15370	Jay County, Indiana	15	0.8727	0.8630	99915
15380	Jefferson County, Indiana	15	0.8727	0.8630	99915
15390	Jennings County, Indiana	15	0.8727	0.8630	99915
15400	Johnson County, Indiana	3480	0.9875	0.9930	26900
15410	Knox County, Indiana	15	0.8727	0.8630	99915
15420	Kosciusko County, Indiana	15	0.8727	0.8630	99915
15430	Lagrange County, Indiana	15	0.8727	0.8630	99915
15440	Lake County, Indiana	2960	0.9404	0.9369	23844
15450	La Porte County, Indiana	15	0.8727	0.9409	33140
15460	Lawrence County, Indiana	15	0.8727	0.8630	99915
15470	Madison County, Indiana	3480	0.9875	0.8595	11300
15480	Marion County, Indiana	3480	0.9875	0.9930	26900
15490	Marshall County, Indiana	15	0.8727	0.8630	99915
15500	Martin County, Indiana	15	0.8727	0.8630	99915
15510	Miami County, Indiana	15	0.8727	0.8630	99915
15520	Monroe County, Indiana	1020	0.8456	0.8456	14020
15530	Montgomery County, Indiana	15	0.8727	0.8630	99915
15540	Morgan County, Indiana	3480	0.9875	0.9930	26900
15550	Newton County, Indiana	15	0.8727	0.9369	23844
15560	Noble County, Indiana	15	0.8727	0.8630	99915
15570	Ohio County, Indiana	1640	0.9742	0.9623	17140
15580	Orange County, Indiana	15	0.8727	0.8630	99915
15590	Owen County, Indiana	15	0.8727	0.8456	14020
15600	Parke County, Indiana	15	0.8727	0.8630	99915
15610	Perry County, Indiana	15	0.8727	0.8630	99915
15620	Pike County, Indiana	15	0.8727	0.8630	99915
15630	Porter County, Indiana	2960	0.9404	0.9369	23844
15640	Posey County, Indiana	2440	0.8721	0.8721	21780
15650	Pulaski County, Indiana	15	0.8727	0.8630	99915
15660	Putnam County, Indiana	15	0.8727	0.9930	26900
15670	Randolph County, Indiana	15	0.8727	0.8630	99915
15680	Ripley County, Indiana	15	0.8727	0.8630	99915
15690	Rush County, Indiana	15	0.8727	0.8630	99915
15700	St Joseph County, Indiana	7800	0.9798	0.9798	43780
15710	Scott County, Indiana	4520	0.9302	0.8630	99915
15720	Shelby County, Indiana	3480	0.9875	0.9930	26900
15730	Spencer County, Indiana	15	0.8727	0.8630	99915
15740	Starke County, Indiana	15	0.8727	0.8630	99915
15750	Steuben County, Indiana	15	0.8727	0.8630	99915
15760	Sullivan County, Indiana	15	0.8727	0.8313	45460
15770	Switzerland County, Indiana	15	0.8727	0.8630	99915
15780	Tippecanoe County, Indiana	3920	0.8745	0.8745	29140
15790	Tipton County, Indiana	3850	0.9517	0.9517	29020
15800	Union County, Indiana	15	0.8727	0.8630	99915
15810	Vanderburgh County, Indiana	2440	0.8721	0.8721	21780
15820	Vermillion County, Indiana	8320	0.8345	0.8313	45460
15830	Vigo County, Indiana	8320	0.8345	0.8313	45460
15840	Wabash County, Indiana	15	0.8727	0.8630	99915
15840	Warren County, Indiana	15	0.8727	0.8630	99915
15860	Warrick County, Indiana	2440	0.8721	0.8721	21780
15870	Washington County, Indiana	15	0.8727	0.9261	31140
15880	Wayne County, Indiana	15	0.8727	0.8630	99915
15890	Wells County, Indiana	2760	0.9716	0.9803	23060
15900	White County, Indiana	15	0.8727	0.8630	99915
15910	Whitley County, Indiana	2760	0.9716	0.9803	23060
16000	Adair County, Iowa	16	0.8588	0.8502	99916
16010	Adams County, Iowa	16	0.8588	0.8502	99916
16020	Allamakee County, Iowa	16	0.8588	0.8502	99916
16030	Appanoose County, Iowa	16	0.8588	0.8502	99916
16040	Audubon County, Iowa	16	0.8588	0.8502	99916
16050	Benton County, Iowa	16	0.8588	0.8617	16300
16060	Black Hawk County, Iowa	8920	0.8566	0.8566	47940
16070	Boone County, Iowa	16	0.8588	0.8502	99916
16080	Bremer County, Iowa	16	0.8588	0.8566	47940
16090	Buchanan County, Iowa	16	0.8588	0.8502	99916
16100	Buena Vista County, Iowa	16	0.8588	0.8502	99916
16110	Butler County, Iowa	16	0.8588	0.8502	99916
16120	Calhoun County, Iowa	16	0.8588	0.8502	99916
16130	Carroll County, Iowa	16	0.8588	0.8502	99916
16140	Cass County, Iowa	16	0.8588	0.8502	99916
16150	Cedar County, Iowa	16	0.8588	0.8502	99916
16160	Cerro Gordo County, Iowa	16	0.8588	0.8502	99916
16170	Cherokee County, Iowa	16	0.8588	0.8502	99916
16180	Chickasaw County, Iowa	16	0.8588	0.8502	99916
16190	Clarke County, Iowa	16	0.8588	0.8502	99916
16200	Clay County, Iowa	16	0.8588	0.8502	99916
16210	Clayton County, Iowa	16	0.8588	0.8502	99916
16220	Clinton County, Iowa	16	0.8588	0.8502	99916
16230	Crawford County, Iowa	16	0.8588	0.8502	99916
16240	Dallas County, Iowa	2120	0.9651	0.9651	19780
16250	Davis County, Iowa	16	0.8588	0.8502	99916
16260	Decatur County, Iowa	16	0.8588	0.8502	99916
16270	Delaware County, Iowa	16	0.8588	0.8502	99916
16280	Des Moines County, Iowa	16	0.8588	0.8502	99916
16290	Dickinson County, Iowa	16	0.8588	0.8502	99916
16300	Dubuque County, Iowa	2200	0.9135	0.9135	20220
16310	Emmet County, Iowa	16	0.8588	0.8502	99916
16320	Fayette County, Iowa	16	0.8588	0.8502	99916
16330	Floyd County, Iowa	16	0.8588	0.8502	99916
16340	Franklin County, Iowa	16	0.8588	0.8502	99916
16350	Fremont County, Iowa	16	0.8588	0.8502	99916
16360	Greene County, Iowa	16	0.8588	0.8502	99916
16370	Grundy County, Iowa	16	0.8588	0.8566	47940
16380	Guthrie County, Iowa	16	0.8588	0.9651	19780
16390	Hamilton County, Iowa	16	0.8588	0.8502	99916
16400	Hancock County, Iowa	16	0.8588	0.8502	99916
16410	Hardin County, Iowa	16	0.8588	0.8502	99916
16420	Harrison County, Iowa	16	0.8588	0.9569	36540
16430	Henry County, Iowa	16	0.8588	0.8502	99916
16440	Howard County, Iowa	16	0.8588	0.8502	99916
16450	Humboldt County, Iowa	16	0.8588	0.8502	99916
16460	Ida County, Iowa	16	0.8588	0.8502	99916
16470	Iowa County, Iowa	16	0.8588	0.8502	99916
16480	Jackson County, Iowa	16	0.8588	0.8502	99916
16490	Jasper County, Iowa	16	0.8588	0.8502	99916
16500	Jefferson County, Iowa	16	0.8588	0.8502	99916
16510	Johnson County, Iowa	3500	0.9756	0.9756	26980
16520	Jones County, Iowa	16	0.8588	0.8617	16300
16530	Keokuk County, Iowa	16	0.8588	0.8502	99916
16540	Kossuth County, Iowa	16	0.8588	0.8502	99916
16550	Lee County, Iowa	16	0.8588	0.8502	99916
16560	Linn County, Iowa	1360	0.8617	0.8617	16300
16570	Louisa County, Iowa	16	0.8588	0.8502	99916
16580	Lucas County, Iowa	16	0.8588	0.8502	99916
16590	Lyon County, Iowa	16	0.8588	0.8502	99916
16600	Madison County, Iowa	16	0.8588	0.9651	19780
16610	Mahaska County, Iowa	16	0.8588	0.8502	99916
16620	Marion County, Iowa	16	0.8588	0.8502	99916
16630	Marshall County, Iowa	16	0.8588	0.8502	99916
16640	Mills County, Iowa	16	0.8588	0.9569	36540
16650	Mitchell County, Iowa	16	0.8588	0.8502	99916
16660	Monona County, Iowa	16	0.8588	0.8502	99916
16670	Monroe County, Iowa	16	0.8588	0.8502	99916
16680	Montgomery County, Iowa	16	0.8588	0.8502	99916
16690	Muscatine County, Iowa	16	0.8588	0.8502	99916
16700	OBrien County, Iowa	16	0.8588	0.8502	99916
16710	Osceola County, Iowa	16	0.8588	0.8502	99916
16720	Page County, Iowa	16	0.8588	0.8502	99916
16730	Palo Alto County, Iowa	16	0.8588	0.8502	99916
16740	Plymouth County, Iowa	16	0.8588	0.8502	99916
16750	Pocahontas County, Iowa	16	0.8588	0.8502	99916
16760	Polk County, Iowa	2120	0.9651	0.9651	19780
16770	Pottawattamie County, Iowa	5920	0.9569	0.9569	36540
16780	Poweshiek County, Iowa	16	0.8588	0.8502	99916
16790	Ringgold County, Iowa	16	0.8588	0.8502	99916
16800	Sac County, Iowa	16	0.8588	0.8502	99916
16810	Scott County, Iowa	1960	0.8731	0.8731	19340
16820	Shelby County, Iowa	16	0.8588	0.8502	99916
16830	Sioux County, Iowa	16	0.8588	0.8502	99916
16840	Story County, Iowa	16	0.8588	0.9545	11180
16850	Tama County, Iowa	16	0.8588	0.8502	99916
16860	Taylor County, Iowa	16	0.8588	0.8502	99916
16870	Union County, Iowa	16	0.8588	0.8502	99916
16880	Van Buren County, Iowa	16	0.8588	0.8502	99916
16890	Wapello County, Iowa	16	0.8588	0.8502	99916
16900	Warren County, Iowa	2120	0.9651	0.9651	19780
16910	Washington County, Iowa	16	0.8588	0.9756	26980
16920	Wayne County, Iowa	16	0.8588	0.8502	99916
16930	Webster County, Iowa	16	0.8588	0.8502	99916
16940	Winnebago County, Iowa	16	0.8588	0.8502	99916
16950	Winneshiek County, Iowa	16	0.8588	0.8502	99916
16960	Woodbury County, Iowa	7720	0.9411	0.9376	43580
16970	Worth County, Iowa	16	0.8588	0.8502	99916
16980	Wright County, Iowa	16	0.8588	0.8502	99916
17000	Allen County, Kansas	17	0.7994	0.7987	99917
17010	Anderson County, Kansas	17	0.7994	0.7987	99917
17020	Atchison County, Kansas	17	0.7994	0.7987	99917
17030	Barber County, Kansas	17	0.7994	0.7987	99917
17040	Barton County, Kansas	17	0.7994	0.7987	99917
17050	Bourbon County, Kansas	17	0.7994	0.7987	99917
17060	Brown County, Kansas	17	0.7994	0.7987	99917
17070	Butler County, Kansas	9040	0.9163	0.9141	48620
17080	Chase County, Kansas	17	0.7994	0.7987	99917
17090	Chautauqua County, Kansas	17	0.7994	0.7987	99917
17100	Cherokee County, Kansas	17	0.7994	0.7987	99917
17110	Cheyenne County, Kansas	17	0.7994	0.7987	99917
17120	Clark County, Kansas	17	0.7994	0.7987	99917
17130	Clay County, Kansas	17	0.7994	0.7987	99917
17140	Cloud County, Kansas	17	0.7994	0.7987	99917
17150	Coffey County, Kansas	17	0.7994	0.7987	99917
17160	Comanche County, Kansas	17	0.7994	0.7987	99917
17170	Cowley County, Kansas	17	0.7994	0.7987	99917
17180	Crawford County, Kansas	17	0.7994	0.7987	99917
17190	Decatur County, Kansas	17	0.7994	0.7987	99917
17200	Dickinson County, Kansas	17	0.7994	0.7987	99917
17210	Doniphan County, Kansas	17	0.7994	0.9529	41140
17220	Douglas County, Kansas	4150	0.8546	0.8546	29940
17230	Edwards County, Kansas	17	0.7994	0.7987	99917
17240	Elk County, Kansas	17	0.7994	0.7987	99917
17250	Ellis County, Kansas	17	0.7994	0.7987	99917
17260	Ellsworth County, Kansas	17	0.7994	0.7987	99917
17270	Finney County, Kansas	17	0.7994	0.7987	99917
17280	Ford County, Kansas	17	0.7994	0.7987	99917
17290	Franklin County, Kansas	17	0.7994	0.9467	28140
17300	Geary County, Kansas	17	0.7994	0.7987	99917
17310	Gove County, Kansas	17	0.7994	0.7987	99917
17320	Graham County, Kansas	17	0.7994	0.7987	99917
17330	Grant County, Kansas	17	0.7994	0.7987	99917
17340	Gray County, Kansas	17	0.7994	0.7987	99917
17350	Greeley County, Kansas	17	0.7994	0.7987	99917
17360	Greenwood County, Kansas	17	0.7994	0.7987	99917
17370	Hamilton County, Kansas	17	0.7994	0.7987	99917
17380	Harper County, Kansas	17	0.7994	0.7987	99917
17390	Harvey County, Kansas	9040	0.9163	0.9141	48620
17391	Haskell County, Kansas	17	0.7994	0.7987	99917
17410	Hodgeman County, Kansas	17	0.7994	0.7987	99917
17420	Jackson County, Kansas	17	0.7994	0.8929	45820
17430	Jefferson County, Kansas	17	0.7994	0.8929	45820
17440	Jewell County, Kansas	17	0.7994	0.7987	99917
17450	Johnson County, Kansas	3760	0.9481	0.9467	28140
17451	Kearny County, Kansas	17	0.7994	0.7987	99917
17470	Kingman County, Kansas	17	0.7994	0.7987	99917
17480	Kiowa County, Kansas	17	0.7994	0.7987	99917
17490	Labette County, Kansas	17	0.7994	0.7987	99917
17500	Lane County, Kansas	17	0.7994	0.7987	99917
17510	Leavenworth County, Kansas	3760	0.9481	0.9467	28140
17520	Lincoln County, Kansas	17	0.7994	0.7987	99917
17530	Linn County, Kansas	17	0.7994	0.9467	28140
17540	Logan County, Kansas	17	0.7994	0.7987	99917
17550	Lyon County, Kansas	17	0.7994	0.7987	99917
17560	Mc Pherson County, Kansas	17	0.7994	0.7987	99917
17570	Marion County, Kansas	17	0.7994	0.7987	99917
17580	Marshall County, Kansas	17	0.7994	0.7987	99917
17590	Meade County, Kansas	17	0.7994	0.7987	99917
17600	Miami County, Kansas	3760	0.9481	0.9467	28140
17610	Mitchell County, Kansas	17	0.7994	0.7987	99917
17620	Montgomery County, Kansas	17	0.7994	0.7987	99917
17630	Morris County, Kansas	17	0.7994	0.7987	99917
17640	Morton County, Kansas	17	0.7994	0.7987	99917
17650	Nemaha County, Kansas	17	0.7994	0.7987	99917
17660	Neosho County, Kansas	17	0.7994	0.7987	99917
17670	Ness County, Kansas	17	0.7994	0.7987	99917
17680	Norton County, Kansas	17	0.7994	0.7987	99917
17690	Osage County, Kansas	17	0.7994	0.8929	45820
17700	Osborne County, Kansas	17	0.7994	0.7987	99917
17710	Ottawa County, Kansas	17	0.7994	0.7987	99917
17720	Pawnee County, Kansas	17	0.7994	0.7987	99917
17730	Phillips County, Kansas	17	0.7994	0.7987	99917
17740	Pottawatomie County, Kansas	17	0.7994	0.7987	99917
17750	Pratt County, Kansas	17	0.7994	0.7987	99917
17760	Rawlins County, Kansas	17	0.7994	0.7987	99917
17770	Reno County, Kansas	17	0.7994	0.7987	99917
17780	Republic County, Kansas	17	0.7994	0.7987	99917
17790	Rice County, Kansas	17	0.7994	0.7987	99917
17800	Riley County, Kansas	17	0.7994	0.7987	99917
17810	Rooks County, Kansas	17	0.7994	0.7987	99917
17820	Rush County, Kansas	17	0.7994	0.7987	99917
17830	Russell County, Kansas	17	0.7994	0.7987	99917
17840	Saline County, Kansas	17	0.7994	0.7987	99917
17841	Scott County, Kansas	17	0.7994	0.7987	99917
17860	Sedgwick County, Kansas	9040	0.9163	0.9141	48620
17870	Seward County, Kansas	17	0.7994	0.7987	99917
17880	Shawnee County, Kansas	8440	0.8929	0.8929	45820
17890	Sheridan County, Kansas	17	0.7994	0.7987	99917
17900	Sherman County, Kansas	17	0.7994	0.7987	99917
17910	Smith County, Kansas	17	0.7994	0.7987	99917
17920	Stafford County, Kansas	17	0.7994	0.7987	99917
17921	Stanton County, Kansas	17	0.7994	0.7987	99917
17940	Stevens County, Kansas	17	0.7994	0.7987	99917
17950	Sumner County, Kansas	17	0.7994	0.9141	48620
17960	Thomas County, Kansas	17	0.7994	0.7987	99917
17970	Trego County, Kansas	17	0.7994	0.7987	99917
17980	Wabaunsee County, Kansas	17	0.7994	0.8929	45820
17981	Wallace County, Kansas	17	0.7994	0.7987	99917
17982	Washington County, Kansas	17	0.7994	0.7987	99917
17983	Wichita County, Kansas	17	0.7994	0.7987	99917
17984	Wilson County, Kansas	17	0.7994	0.7987	99917
17985	Woodson County, Kansas	17	0.7994	0.7987	99917
17986	Wyandotte County, Kansas	3760	0.9481	0.9467	28140
18000	Adair County, Kentucky	18	0.7866	0.7774	99918
18010	Allen County, Kentucky	18	0.7866	0.7774	99918
18020	Anderson County, Kentucky	18	0.7866	0.7774	99918
18030	Ballard County, Kentucky	18	0.7866	0.7774	99918
18040	Barren County, Kentucky	18	0.7866	0.7774	99918
18050	Bath County, Kentucky	18	0.7866	0.7774	99918
18060	Bell County, Kentucky	18	0.7866	0.7774	99918
18070	Boone County, Kentucky	1640	0.9742	0.9623	17140
18080	Bourbon County, Kentucky	4280	0.8997	0.9084	30460
18090	Boyd County, Kentucky	3400	0.9486	0.9486	26580
18100	Boyle County, Kentucky	18	0.7866	0.7774	99918
18110	Bracken County, Kentucky	18	0.7866	0.9623	17140
18120	Breathitt County, Kentucky	18	0.7866	0.7774	99918
18130	Breckinridge County, Kentucky	18	0.7866	0.7774	99918
18140	Bullitt County, Kentucky	4520	0.9302	0.9261	31140
18150	Butler County, Kentucky	18	0.7866	0.7774	99918
18160	Caldwell County, Kentucky	18	0.7866	0.7774	99918
18170	Calloway County, Kentucky	18	0.7866	0.7774	99918
18180	Campbell County, Kentucky	1640	0.9742	0.9623	17140
18190	Carlisle County, Kentucky	18	0.7866	0.7774	99918
18191	Carroll County, Kentucky	18	0.7866	0.7774	99918
18210	Carter County, Kentucky	3400	0.9486	0.7774	99918
18220	Casey County, Kentucky	18	0.7866	0.7774	99918
18230	Christian County, Kentucky	1660	0.8292	0.8292	17300
18240	Clark County, Kentucky	4280	0.8997	0.9084	30460
18250	Clay County, Kentucky	18	0.7866	0.7774	99918
18260	Clinton County, Kentucky	18	0.7866	0.7774	99918
18270	Crittenden County, Kentucky	18	0.7866	0.7774	99918
18271	Cumberland County, Kentucky	18	0.7866	0.7774	99918
18290	Daviess County, Kentucky	5990	0.8789	0.8789	36980
18291	Edmonson County, Kentucky	18	0.7866	0.8220	14540
18310	Elliott County, Kentucky	18	0.7866	0.7774	99918
18320	Estill County, Kentucky	18	0.7866	0.7774	99918
18330	Fayette County, Kentucky	4280	0.8997	0.9084	30460
18340	Fleming County, Kentucky	18	0.7866	0.7774	99918
18350	Floyd County, Kentucky	18	0.7866	0.7774	99918
18360	Franklin County, Kentucky	18	0.7866	0.7774	99918
18361	Fulton County, Kentucky	18	0.7866	0.7774	99918
18362	Gallatin County, Kentucky	1640	0.9742	0.9623	17140
18390	Garrard County, Kentucky	18	0.7866	0.7774	99918
18400	Grant County, Kentucky	1640	0.9742	0.9623	17140
18410	Graves County, Kentucky	18	0.7866	0.7774	99918
18420	Grayson County, Kentucky	18	0.7866	0.7774	99918
18421	Green County, Kentucky	18	0.7866	0.7774	99918
18440	Greenup County, Kentucky	3400	0.9486	0.9486	26580
18450	Hancock County, Kentucky	18	0.7866	0.8789	36980
18460	Hardin County, Kentucky	18	0.7866	0.8810	21060
18470	Harlan County, Kentucky	18	0.7866	0.7774	99918
18480	Harrison County, Kentucky	18	0.7866	0.7774	99918
18490	Hart County, Kentucky	18	0.7866	0.7774	99918
18500	Henderson County, Kentucky	2440	0.8721	0.8721	21780
18510	Henry County, Kentucky	18	0.7866	0.9261	31140
18511	Hickman County, Kentucky	18	0.7866	0.7774	99918
18530	Hopkins County, Kentucky	18	0.7866	0.7774	99918
18540	Jackson County, Kentucky	18	0.7866	0.7774	99918
18550	Jefferson County, Kentucky	4520	0.9302	0.9261	31140
18560	Jessamine County, Kentucky	4280	0.8997	0.9084	30460
18570	Johnson County, Kentucky	18	0.7866	0.7774	99918
18580	Kenton County, Kentucky	1640	0.9742	0.9623	17140
18590	Knott County, Kentucky	18	0.7866	0.7774	99918
18600	Knox County, Kentucky	18	0.7866	0.7774	99918
18610	Larue County, Kentucky	18	0.7866	0.8810	21060
18620	Laurel County, Kentucky	18	0.7866	0.7774	99918
18630	Lawrence County, Kentucky	18	0.7866	0.7774	99918
18640	Lee County, Kentucky	18	0.7866	0.7774	99918
18650	Leslie County, Kentucky	18	0.7866	0.7774	99918
18660	Letcher County, Kentucky	18	0.7866	0.7774	99918
18670	Lewis County, Kentucky	18	0.7866	0.7774	99918
18680	Lincoln County, Kentucky	18	0.7866	0.7774	99918
18690	Livingston County, Kentucky	18	0.7866	0.7774	99918
18700	Logan County, Kentucky	18	0.7866	0.7774	99918
18710	Lyon County, Kentucky	18	0.7866	0.7774	99918
18720	Mc Cracken County, Kentucky	18	0.7866	0.7774	99918
18730	Mc Creary County, Kentucky	18	0.7866	0.7774	99918
18740	Mc Lean County, Kentucky	18	0.7866	0.8789	36980
18750	Madison County, Kentucky	4280	0.8997	0.7774	99918
18760	Magoffin County, Kentucky	18	0.7866	0.7774	99918
18770	Marion County, Kentucky	18	0.7866	0.7774	99918
18780	Marshall County, Kentucky	18	0.7866	0.7774	99918
18790	Martin County, Kentucky	18	0.7866	0.7774	99918
18800	Mason County, Kentucky	18	0.7866	0.7774	99918
18801	Meade County, Kentucky	18	0.7866	0.9261	31140
18802	Menifee County, Kentucky	18	0.7866	0.7774	99918
18830	Mercer County, Kentucky	18	0.7866	0.7774	99918
18831	Metcalfe County, Kentucky	18	0.7866	0.7774	99918
18850	Monroe County, Kentucky	18	0.7866	0.7774	99918
18860	Montgomery County, Kentucky	18	0.7866	0.7774	99918
18861	Morgan County, Kentucky	18	0.7866	0.7774	99918
18880	Muhlenberg County, Kentucky	18	0.7866	0.7774	99918
18890	Nelson County, Kentucky	18	0.7866	0.9261	31140
18900	Nicholas County, Kentucky	18	0.7866	0.7774	99918
18910	Ohio County, Kentucky	18	0.7866	0.7774	99918
18920	Oldham County, Kentucky	4520	0.9302	0.9261	31140
18930	Owen County, Kentucky	18	0.7866	0.7774	99918
18931	Owsley County, Kentucky	18	0.7866	0.7774	99918
18932	Pendleton County, Kentucky	1640	0.9742	0.9623	17140
18960	Perry County, Kentucky	18	0.7866	0.7774	99918
18970	Pike County, Kentucky	18	0.7866	0.7774	99918
18971	Powell County, Kentucky	18	0.7866	0.7774	99918
18972	Pulaski County, Kentucky	18	0.7866	0.7774	99918
18973	Robertson County, Kentucky	18	0.7866	0.7774	99918
18974	Rockcastle County, Kentucky	18	0.7866	0.7774	99918
18975	Rowan County, Kentucky	18	0.7866	0.7774	99918
18976	Russell County, Kentucky	18	0.7866	0.7774	99918
18977	Scott County, Kentucky	4280	0.8997	0.9084	30460
18978	Shelby County, Kentucky	18	0.7866	0.9261	31140
18979	Simpson County, Kentucky	18	0.7866	0.7774	99918
18980	Spencer County, Kentucky	18	0.7866	0.9261	31140
18981	Taylor County, Kentucky	18	0.7866	0.7774	99918
18982	Todd County, Kentucky	18	0.7866	0.7774	99918
18983	Trigg County, Kentucky	18	0.7866	0.8292	17300
18984	Trimble County, Kentucky	18	0.7866	0.9261	31140
18985	Union County, Kentucky	18	0.7866	0.7774	99918
18986	Warren County, Kentucky	18	0.7866	0.8220	14540
18987	Washington County, Kentucky	18	0.7866	0.7774	99918
18988	Wayne County, Kentucky	18	0.7866	0.7774	99918
18989	Webster County, Kentucky	18	0.7866	0.8721	21780
18990	Whitley County, Kentucky	18	0.7866	0.7774	99918
18991	Wolfe County, Kentucky	18	0.7866	0.7774	99918
18992	Woodford County, Kentucky	4280	0.8997	0.9084	30460
19000	Acadia County, Louisiana	3880	0.8260	0.7418	99919
19010	Allen County, Louisiana	19	0.7348	0.7418	99919
19020	Ascension County, Louisiana	0760	0.8652	0.8601	12940
19030	Assumption County, Louisiana	19	0.7348	0.7418	99919
19040	Avoyelles County, Louisiana	19	0.7348	0.7418	99919
19050	Beauregard County, Louisiana	19	0.7348	0.7418	99919
19060	Bienville County, Louisiana	19	0.7348	0.7418	99919
19070	Bossier County, Louisiana	7680	0.8746	0.8769	43340
19080	Caddo County, Louisiana	7680	0.8746	0.8769	43340
19090	Calcasieu County, Louisiana	3960	0.7866	0.7841	29340
19100	Caldwell County, Louisiana	19	0.7348	0.7418	99919
19110	Cameron County, Louisiana	19	0.7348	0.7841	29340
19120	Catahoula County, Louisiana	19	0.7348	0.7418	99919
19130	Claiborne County, Louisiana	19	0.7348	0.7418	99919
19140	Concordia County, Louisiana	19	0.7348	0.7418	99919
19150	De Soto County, Louisiana	19	0.7348	0.8769	43340
19160	East Baton Rouge County, Louisiana	0760	0.8652	0.8601	12940
19170	East Carroll County, Louisiana	19	0.7348	0.7418	99919
19180	East Feliciana County, Louisiana	19	0.7348	0.8601	12940
19190	Evangeline County, Louisiana	19	0.7348	0.7418	99919
19200	Franklin County, Louisiana	19	0.7348	0.7418	99919
19210	Grant County, Louisiana	19	0.7348	0.8041	10780
19220	Iberia County, Louisiana	19	0.7348	0.7418	99919
19230	Iberville County, Louisiana	19	0.7348	0.8601	12940
19240	Jackson County, Louisiana	19	0.7348	0.7418	99919
19250	Jefferson County, Louisiana	5560	0.9005	0.9005	35380
19260	Jefferson Davis County, Louisiana	19	0.7348	0.7418	99919
19270	Lafayette County, Louisiana	3880	0.8260	0.8436	29180
19280	Lafourche County, Louisiana	3350	0.7902	0.7902	26380
19290	La Salle County, Louisiana	19	0.7348	0.7418	99919
19300	Lincoln County, Louisiana	19	0.7348	0.7418	99919
19310	Livingston County, Louisiana	0760	0.8652	0.8601	12940
19320	Madison County, Louisiana	19	0.7348	0.7418	99919
19330	Morehouse County, Louisiana	19	0.7348	0.7418	99919
19340	Natchitoches County, Louisiana	19	0.7348	0.7418	99919
19350	Orleans County, Louisiana	5560	0.9005	0.9005	35380
19360	Ouachita County, Louisiana	5200	0.8052	0.8040	33740
19370	Plaquemines County, Louisiana	5560	0.9005	0.9005	35380
19380	Pointe Coupee County, Louisiana	19	0.7348	0.8601	12940
19390	Rapides County, Louisiana	0220	0.8041	0.8041	10780
19400	Red River County, Louisiana	19	0.7348	0.7418	99919
19410	Richland County, Louisiana	19	0.7348	0.7418	99919
19420	Sabine County, Louisiana	19	0.7348	0.7418	99919
19430	St Bernard County, Louisiana	5560	0.9005	0.9005	35380
19440	St Charles County, Louisiana	5560	0.9005	0.9005	35380
19450	St Helena County, Louisiana	19	0.7348	0.8601	12940
19460	St James County, Louisiana	5560	0.9005	0.7418	99919
19470	St John Baptist County, Louisiana	5560	0.9005	0.9005	35380
19480	St Landry County, Louisiana	3880	0.8260	0.7418	99919
19490	St Martin County, Louisiana	3880	0.8260	0.8436	29180
19500	St Mary County, Louisiana	19	0.7348	0.7418	99919
19510	St Tammany County, Louisiana	5560	0.9005	0.9005	35380
19520	Tangipahoa County, Louisiana	19	0.7348	0.7418	99919
19530	Tensas County, Louisiana	19	0.7348	0.7418	99919
19540	Terrebonne County, Louisiana	3350	0.7902	0.7902	26380
19550	Union County, Louisiana	19	0.7348	0.8040	33740
19560	Vermilion County, Louisiana	19	0.7348	0.7418	99919
19570	Vernon County, Louisiana	19	0.7348	0.7418	99919
19580	Washington County, Louisiana	19	0.7348	0.7418	99919
19590	Webster County, Louisiana	7680	0.8746	0.7418	99919
19600	West Baton Rouge County, Louisiana	0760	0.8652	0.8601	12940
19610	West Carroll County, Louisiana	19	0.7348	0.7418	99919
19620	West Feliciana County, Louisiana	19	0.7348	0.8601	12940
19630	Winn County, Louisiana	19	0.7348	0.7418	99919
20000	Androscoggin County, Maine	4243	0.9341	0.9341	30340
20010	Aroostook County, Maine	20	0.8852	0.8852	99920
20020	Cumberland County, Maine	6403	1.0392	1.0392	38860
20030	Franklin County, Maine	20	0.8852	0.8852	99920
20040	Hancock County, Maine	20	0.8852	0.8852	99920
20050	Kennebec County, Maine	20	0.8852	0.8852	99920
20060	Knox County, Maine	20	0.8852	0.8852	99920
20070	Lincoln County, Maine	20	0.8852	0.8852	99920
20080	Oxford County, Maine	20	0.8852	0.8852	99920
20090	Penobscot County, Maine	0733	1.0003	1.0003	12620
20100	Piscataquis County, Maine	20	0.8852	0.8852	99920
20110	Sagadahoc County, Maine	6403	1.0392	1.0392	38860
20120	Somerset County, Maine	20	0.8852	0.8852	99920
20130	Waldo County, Maine	20	0.8852	0.8852	99920
20140	Washington County, Maine	20	0.8852	0.8852	99920
20150	York County, Maine	6403	1.0392	1.0392	38860
21000	Allegany County, Maryland	1900	0.9326	0.9326	19060
21010	Anne Arundel County, Maryland	0720	0.9907	0.9907	12580
21020	Baltimore County, Maryland	0720	0.9907	0.9907	12580
21030	Baltimore City County, Maryland	0720	0.9907	0.9907	12580
21040	Calvert County, Maryland	8840	1.0983	1.0932	47894
21050	Caroline County, Maryland	21	0.9085	0.9095	99921
21060	Carroll County, Maryland	0720	0.9907	0.9907	12580
21070	Cecil County, Maryland	9160	1.0537	1.0482	48864
21080	Charles County, Maryland	8840	1.0983	1.0932	47894
21090	Dorchester County, Maryland	21	0.9085	0.9095	99921
21100	Frederick County, Maryland	8840	1.0983	1.1495	13644
21110	Garrett County, Maryland	21	0.9085	0.9095	99921
21120	Harford County, Maryland	0720	0.9907	0.9907	12580
21130	Howard County, Maryland	0720	0.9907	0.9907	12580
21140	Kent County, Maryland	21	0.9085	0.9095	99921
21150	Montgomery County, Maryland	8840	1.0983	1.1495	13644
21160	Prince Georges County, Maryland	8840	1.0983	1.0932	47894
21170	Queen Annes County, Maryland	0720	0.9907	0.9907	12580
21180	St Marys County, Maryland	21	0.9085	0.9095	99921
21190	Somerset County, Maryland	21	0.9085	0.9073	41540
21200	Talbot County, Maryland	21	0.9085	0.9095	99921
21210	Washington County, Maryland	3180	0.9879	0.9499	25180
21220	Wicomico County, Maryland	21	0.9085	0.9073	41540
21230	Worcester County, Maryland	21	0.9085	0.9095	99921
22000	Barnstable County, Massachusetts	0743	1.2527	1.2527	12700
22010	Berkshire County, Massachusetts	6323	1.0191	1.0191	38340
22020	Bristol County, Massachusetts	1123	1.1152	1.0966	39300
22030	Dukes County, Massachusetts	22	1.0050	1.0216	99922
22040	Essex County, Massachusetts	1123	1.1152	1.0533	21604
22060	Franklin County, Massachusetts	22	1.0050	1.0259	44140
22070	Hampden County, Massachusetts	8003	1.0273	1.0259	44140
22080	Hampshire County, Massachusetts	8003	1.0273	1.0259	44140
22090	Middlesex County, Massachusetts	1123	1.1152	1.1084	15764
22120	Nantucket County, Massachusetts	22	1.0050	1.0216	99922
22130	Norfolk County, Massachusetts	1123	1.1152	1.1543	14484
22150	Plymouth County, Massachusetts	1123	1.1152	1.1543	14484
22160	Suffolk County, Massachusetts	1123	1.1152	1.1543	14484
22170	Worcester County, Massachusetts	1123	1.1152	1.1039	49340
23000	Alcona County, Michigan	23	0.8813	0.8870	99923
23010	Alger County, Michigan	23	0.8813	0.8870	99923
23020	Allegan County, Michigan	3000	0.9455	0.8870	99923
23030	Alpena County, Michigan	23	0.8813	0.8870	99923
23040	Antrim County, Michigan	23	0.8813	0.8870	99923
23050	Arenac County, Michigan	23	0.8813	0.8870	99923
23060	Baraga County, Michigan	23	0.8813	0.8870	99923
23070	Barry County, Michigan	23	0.8813	0.9400	24340
23080	Bay County, Michigan	6960	0.9415	0.9352	13020
23090	Benzie County, Michigan	23	0.8813	0.8870	99923
23100	Berrien County, Michigan	0870	0.8888	0.8888	35660
23110	Branch County, Michigan	23	0.8813	0.8870	99923
23120	Calhoun County, Michigan	3720	1.0151	0.9510	12980
23130	Cass County, Michigan	23	0.8813	0.9798	43780
23140	Charlevoix County, Michigan	23	0.8813	0.8870	99923
23150	Cheboygan County, Michigan	23	0.8813	0.8870	99923
23160	Chippewa County, Michigan	23	0.8813	0.8870	99923
23170	Clare County, Michigan	23	0.8813	0.8870	99923
23180	Clinton County, Michigan	4040	0.9792	0.9792	29620
23190	Crawford County, Michigan	23	0.8813	0.8870	99923
23200	Delta County, Michigan	23	0.8813	0.8870	99923
23210	Dickinson County, Michigan	23	0.8813	0.8870	99923
23220	Eaton County, Michigan	4040	0.9792	0.9792	29620
23230	Emmet County, Michigan	23	0.8813	0.8870	99923
23240	Genesee County, Michigan	2640	1.0663	1.0663	22420
23250	Gladwin County, Michigan	23	0.8813	0.8870	99923
23260	Gogebic County, Michigan	23	0.8813	0.8870	99923
23270	Grand Traverse County, Michigan	23	0.8813	0.8870	99923
23280	Gratiot County, Michigan	23	0.8813	0.8870	99923
23290	Hillsdale County, Michigan	23	0.8813	0.8870	99923
23300	Houghton County, Michigan	23	0.8813	0.8870	99923
23310	Huron County, Michigan	23	0.8813	0.8870	99923
23320	Ingham County, Michigan	4040	0.9792	0.9792	29620
23330	Ionia County, Michigan	23	0.8813	0.9400	24340
23340	Iosco County, Michigan	23	0.8813	0.8870	99923
23350	Iron County, Michigan	23	0.8813	0.8870	99923
23360	Isabella County, Michigan	23	0.8813	0.8870	99923
23370	Jackson County, Michigan	3520	0.9313	0.9313	27100
23380	Kalamazoo County, Michigan	3720	1.0151	1.0391	28020
23390	Kalkaska County, Michigan	23	0.8813	0.8870	99923
23400	Kent County, Michigan	3000	0.9455	0.9400	24340
23410	Keweenaw County, Michigan	23	0.8813	0.8870	99923
23420	Lake County, Michigan	23	0.8813	0.8870	99923
23430	Lapeer County, Michigan	2160	1.0152	0.9861	47644
23440	Leelanau County, Michigan	23	0.8813	0.8870	99923
23450	Lenawee County, Michigan	0440	1.0718	0.8870	99923
23460	Livingston County, Michigan	0440	1.0718	0.9861	47644
23470	Luce County, Michigan	23	0.8813	0.8870	99923
23480	Mackinac County, Michigan	23	0.8813	0.8870	99923
23490	Macomb County, Michigan	2160	1.0152	0.9861	47644
23500	Manistee County, Michigan	23	0.8813	0.8870	99923
23510	Marquette County, Michigan	23	0.8813	0.8870	99923
23520	Mason County, Michigan	23	0.8813	0.8870	99923
23530	Mecosta County, Michigan	23	0.8813	0.8870	99923
23540	Menominee County, Michigan	23	0.8813	0.8870	99923
23550	Midland County, Michigan	6960	0.9415	0.8870	99923
23560	Missaukee County, Michigan	23	0.8813	0.8870	99923
23570	Monroe County, Michigan	2160	1.0152	0.9478	33780
23580	Montcalm County, Michigan	23	0.8813	0.8870	99923
23590	Montmorency County, Michigan	23	0.8813	0.8870	99923
23600	Muskegon County, Michigan	3000	0.9455	0.9673	34740
23610	Newaygo County, Michigan	23	0.8813	0.9400	24340
23620	Oakland County, Michigan	2160	1.0152	0.9861	47644
23630	Oceana County, Michigan	23	0.8813	0.8870	99923
23640	Ogemaw County, Michigan	23	0.8813	0.8870	99923
23650	Ontonagon County, Michigan	23	0.8813	0.8870	99923
23660	Osceola County, Michigan	23	0.8813	0.8870	99923
23670	Oscoda County, Michigan	23	0.8813	0.8870	99923
23680	Otsego County, Michigan	23	0.8813	0.8870	99923
23690	Ottawa County, Michigan	3000	0.9455	0.9064	26100
23700	Presque Isle County, Michigan	23	0.8813	0.8870	99923
23710	Roscommon County, Michigan	23	0.8813	0.8870	99923
23720	Saginaw County, Michigan	6960	0.9415	0.9420	40980
23730	St Clair County, Michigan	12160	1.0152	0.9861	47644
23740	St Joseph County, Michigan	23	0.8813	0.8870	99923
23750	Sanilac County, Michigan	23	0.8813	0.8870	99923
23760	Schoolcraft County, Michigan	23	0.8813	0.8870	99923
23770	Shiawassee County, Michigan	23	0.8813	0.8870	99923
23780	Tuscola County, Michigan	23	0.8813	0.8870	99923
23790	Van Buren County, Michigan	3720	1.0151	1.0391	28020
23800	Washtenaw County, Michigan	0440	1.0718	1.0870	11460
23810	Wayne County, Michigan	2160	1.0152	1.0441	19804
23830	Wexford County, Michigan	23	0.8813	0.8870	99923
24000	Aitkin County, Minnesota	24	0.9193	0.9183	99924
24010	Anoka County, Minnesota	5120	1.1078	1.1078	33460
24020	Becker County, Minnesota	24	0.9193	0.9183	99924
24030	Beltrami County, Minnesota	24	0.9193	0.9183	99924
24040	Benton County, Minnesota	6980	0.9975	0.9975	41060
24050	Big Stone County, Minnesota	24	0.9193	0.9183	99924
24060	Blue Earth County, Minnesota	24	0.9193	0.9183	99924
24070	Brown County, Minnesota	24	0.9193	0.9183	99924
24080	Carlton County, Minnesota	24	0.9193	1.0209	20260
24090	Carver County, Minnesota	5120	1.1078	1.1078	33460
24100	Cass County, Minnesota	24	0.9193	0.9183	99924
24110	Chippewa County, Minnesota	24	0.9193	0.9183	99924
24120	Chisago County, Minnesota	5120	1.1078	1.1078	33460
24130	Clay County, Minnesota	2520	0.8495	0.8495	22020
24140	Clearwater County, Minnesota	24	0.9193	0.9183	99924
24150	Cook County, Minnesota	24	0.9193	0.9183	99924
24160	Cottonwood County, Minnesota	24	0.9193	0.9183	99924
24170	Crow Wing County, Minnesota	24	0.9193	0.9183	99924
24180	Dakota County, Minnesota	5120	1.1078	1.1078	33460
24190	Dodge County, Minnesota	24	0.9193	1.1142	40340
24200	Douglas County, Minnesota	24	0.9193	0.9183	99924
24210	Faribault County, Minnesota	24	0.9193	0.9183	99924
24220	Fillmore County, Minnesota	24	0.9193	0.9183	99924
24230	Freeborn County, Minnesota	24	0.9193	0.9183	99924
24240	Goodhue County, Minnesota	24	0.9193	0.9183	99924
24250	Grant County, Minnesota	24	0.9193	0.9183	99924
24260	Hennepin County, Minnesota	5120	1.1078	1.1078	33460
24270	Houston County, Minnesota	3870	0.9573	0.9573	29100
24280	Hubbard County, Minnesota	24	0.9193	0.9183	99924
24290	Isanti County, Minnesota	5120	1.1078	1.1078	33460
24300	Itasca County, Minnesota	24	0.9193	0.9183	99924
24310	Jackson County, Minnesota	24	0.9193	0.9183	99924
24320	Kanabec County, Minnesota	24	0.9193	0.9183	99924
24330	Kandiyohi County, Minnesota	24	0.9193	0.9183	99924
24340	Kittson County, Minnesota	24	0.9193	0.9183	99924
24350	Koochiching County, Minnesota	24	0.9193	0.9183	99924
24360	Lac Qui Parle County, Minnesota	24	0.9193	0.9183	99924
24370	Lake County, Minnesota	24	0.9193	0.9183	99924
24380	Lake Of Woods County, Minnesota	24	0.9193	0.9183	99924
24390	Le Sueur County, Minnesota	24	0.9193	0.9183	99924
24400	Lincoln County, Minnesota	24	0.9193	0.9183	99924
24410	Lyon County, Minnesota	24	0.9193	0.9183	99924
24420	Mc Leod County, Minnesota	24	0.9193	0.9183	99924
24430	Mahnomen County, Minnesota	24	0.9193	0.9183	99924
24440	Marshall County, Minnesota	24	0.9193	0.9183	99924
24450	Martin County, Minnesota	24	0.9193	0.9183	99924
24460	Meeker County, Minnesota	24	0.9193	0.9183	99924
24470	Mille Lacs County, Minnesota	24	0.9193	0.9183	99924
24480	Morrison County, Minnesota	24	0.9193	0.9183	99924
24490	Mower County, Minnesota	24	0.9193	0.9183	99924
24500	Murray County, Minnesota	24	0.9193	0.9183	99924
24510	Nicollet County, Minnesota	24	0.9193	0.9183	99924
24520	Nobles County, Minnesota	24	0.9193	0.9183	99924
24530	Norman County, Minnesota	24	0.9193	0.9183	99924
24540	Olmsted County, Minnesota	6820	1.1142	1.1142	40340
24550	Otter Tail County, Minnesota	24	0.9193	0.9183	99924
24560	Pennington County, Minnesota	24	0.9193	0.9183	99924
24570	Pine County, Minnesota	24	0.9193	0.9183	99924
24580	Pipestone County, Minnesota	24	0.9193	0.9183	99924
24590	Polk County, Minnesota	2985	1.1516	1.1516	24220
24600	Pope County, Minnesota	24	0.9193	0.9183	99924
24610	Ramsey County, Minnesota	5120	1.1078	1.1078	33460
24620	Red Lake County, Minnesota	24	0.9193	0.9183	99924
24630	Redwood County, Minnesota	24	0.9193	0.9183	99924
24640	Renville County, Minnesota	24	0.9193	0.9183	99924
24650	Rice County, Minnesota	24	0.9193	0.9183	99924
24660	Rock County, Minnesota	24	0.9193	0.9183	99924
24670	Roseau County, Minnesota	24	0.9193	0.9183	99924
24680	St Louis County, Minnesota	2240	1.0223	1.0209	20260
24690	Scott County, Minnesota	5120	1.1078	1.1078	33460
24700	Sherburne County, Minnesota	5120	1.1078	1.1078	33460
24710	Sibley County, Minnesota	24	0.9193	0.9183	99924
24720	Stearns County, Minnesota	6980	0.9975	0.9975	41060
24730	Steele County, Minnesota	24	0.9193	0.9183	99924
24740	Stevens County, Minnesota	24	0.9193	0.9183	99924
24750	Swift County, Minnesota	24	0.9193	0.9183	99924
24760	Todd County, Minnesota	24	0.9193	0.9183	99924
24770	Traverse County, Minnesota	24	0.9193	0.9183	99924
24780	Wabasha County, Minnesota	24	0.9193	1.1142	40340
24790	Wadena County, Minnesota	24	0.9193	0.9183	99924
24800	Waseca County, Minnesota	24	0.9193	0.9183	99924
24810	Washington County, Minnesota	5120	1.1078	1.1078	33460
24820	Watonwan County, Minnesota	24	0.9193	0.9183	99924
24830	Wilkin County, Minnesota	24	0.9193	0.9183	99924
24840	Winona County, Minnesota	24	0.9193	0.9183	99924
24850	Wright County, Minnesota	5120	1.1078	1.1078	33460
24860	Yellow Medicine County, Minnesota	24	0.9193	0.9183	99924
25000	Adams County, Mississippi	25	0.7631	0.7671	99925
25010	Alcorn County, Mississippi	25	0.7631	0.7671	99925
25020	Amite County, Mississippi	25	0.7631	0.7671	99925
25030	Attala County, Mississippi	25	0.7631	0.7671	99925
25040	Benton County, Mississippi	25	0.7631	0.7671	99925
25050	Bolivar County, Mississippi	25	0.7631	0.7671	99925
25060	Calhoun County, Mississippi	25	0.7631	0.7671	99925
25070	Carroll County, Mississippi	25	0.7631	0.7671	99925
25080	Chickasaw County, Mississippi	25	0.7631	0.7671	99925
25090	Choctaw County, Mississippi	25	0.7631	0.7671	99925
25100	Claiborne County, Mississippi	25	0.7631	0.7671	99925
25110	Clarke County, Mississippi	25	0.7631	0.7671	99925
25120	Clay County, Mississippi	25	0.7631	0.7671	99925
25130	Coahoma County, Mississippi	25	0.7631	0.7671	99925
25140	Copiah County, Mississippi	25	0.7631	0.8319	27140
25150	Covington County, Mississippi	25	0.7631	0.7671	99925
25160	Desoto County, Mississippi	4920	0.9360	0.9341	32820
25170	Forrest County, Mississippi	3285	0.7609	0.7609	25620
25180	Franklin County, Mississippi	25	0.7631	0.7671	99925
25190	George County, Mississippi	25	0.7631	0.8165	37700
25200	Greene County, Mississippi	25	0.7631	0.7671	99925
25210	Grenada County, Mississippi	25	0.7631	0.7671	99925
25220	Hancock County, Mississippi	0920	0.8715	0.8938	25060
25230	Harrison County, Mississippi	0920	0.8715	0.8938	25060
25240	Hinds County, Mississippi	3560	0.8391	0.8319	27140
25250	Holmes County, Mississippi	25	0.7631	0.7671	99925
25260	Humphreys County, Mississippi	25	0.7631	0.7671	99925
25270	Issaquena County, Mississippi	25	0.7631	0.7671	99925
25280	Itawamba County, Mississippi	25	0.7631	0.7671	99925
25290	Jackson County, Mississippi	0920	0.8715	0.8165	37700
25300	Jasper County, Mississippi	25	0.7631	0.7671	99925
25310	Jefferson County, Mississippi	25	0.7631	0.7671	99925
25320	Jefferson Davis County, Mississippi	25	0.7631	0.7671	99925
25330	Jones County, Mississippi	25	0.7631	0.7671	99925
25340	Kemper County, Mississippi	25	0.7631	0.7671	99925
25350	Lafayette County, Mississippi	25	0.7631	0.7671	99925
25360	Lamar County, Mississippi	3285	0.7609	0.7609	25620
25370	Lauderdale County, Mississippi	25	0.7631	0.7671	99925
25380	Lawrence County, Mississippi	25	0.7631	0.7671	99925
25390	Leake County, Mississippi	25	0.7631	0.7671	99925
25400	Lee County, Mississippi	25	0.7631	0.7671	99925
25410	Leflore County, Mississippi	25	0.7631	0.7671	99925
25420	Lincoln County, Mississippi	25	0.7631	0.7671	99925
25430	Lowndes County, Mississippi	25	0.7631	0.7671	99925
25440	Madison County, Mississippi	3560	0.8391	0.8319	27140
25450	Marion County, Mississippi	25	0.7631	0.7671	99925
25460	Marshall County, Mississippi	25	0.7631	0.9341	32820
25470	Monroe County, Mississippi	25	0.7631	0.7671	99925
25480	Montgomery County, Mississippi	25	0.7631	0.7671	99925
25490	Neshoba County, Mississippi	25	0.7631	0.7671	99925
25500	Newton County, Mississippi	25	0.7631	0.7671	99925
25510	Noxubee County, Mississippi	25	0.7631	0.7671	99925
25520	Oktibbeha County, Mississippi	25	0.7631	0.7671	99925
25530	Panola County, Mississippi	25	0.7631	0.7671	99925
25540	Pearl River County, Mississippi	25	0.7631	0.7671	99925
25550	Perry County, Mississippi	25	0.7631	0.7609	25620
25560	Pike County, Mississippi	25	0.7631	0.7671	99925
25570	Pontotoc County, Mississippi	25	0.7631	0.7671	99925
25580	Prentiss County, Mississippi	25	0.7631	0.7671	99925
25590	Quitman County, Mississippi	25	0.7631	0.7671	99925
25600	Rankin County, Mississippi	3560	0.8391	0.8319	27140
25610	Scott County, Mississippi	25	0.7631	0.7671	99925
25620	Sharkey County, Mississippi	25	0.7631	0.7671	99925
25630	Simpson County, Mississippi	25	0.7631	0.8319	27140
25640	Smith County, Mississippi	25	0.7631	0.7671	99925
25650	Stone County, Mississippi	25	0.7631	0.8938	25060
25660	Sunflower County, Mississippi	25	0.7631	0.7671	99925
25670	Tallahatchie County, Mississippi	25	0.7631	0.7671	99925
25680	Tate County, Mississippi	25	0.7631	0.9341	32820
25690	Tippah County, Mississippi	25	0.7631	0.7671	99925
25700	Tishomingo County, Mississippi	25	0.7631	0.7671	99925
25710	Tunica County, Mississippi	25	0.7631	0.9341	32820
25720	Union County, Mississippi	25	0.7631	0.7671	99925
25730	Walthall County, Mississippi	25	0.7631	0.7671	99925
25740	Warren County, Mississippi	25	0.7631	0.7671	99925
25750	Washington County, Mississippi	25	0.7631	0.7671	99925
25760	Wayne County, Mississippi	25	0.7631	0.7671	99925
25770	Webster County, Mississippi	25	0.7631	0.7671	99925
25780	Wilkinson County, Mississippi	25	0.7631	0.7671	99925
25790	Winston County, Mississippi	25	0.7631	0.7671	99925
25800	Yalobusha County, Mississippi	25	0.7631	0.7671	99925
25810	Yazoo County, Mississippi	25	0.7631	0.7671	99925
26000	Adair County, Missouri	26	0.7968	0.7909	99926
26010	Andrew County, Missouri	7000	0.9529	0.9529	41140
26020	Atchison County, Missouri	26	0.7968	0.7909	99926
26030	Audrain County, Missouri	26	0.7968	0.7909	99926
26040	Barry County, Missouri	26	0.7968	0.7909	99926
26050	Barton County, Missouri	26	0.7968	0.7909	99926
26060	Bates County, Missouri	26	0.7968	0.9467	28140
26070	Benton County, Missouri	26	0.7968	0.7909	99926
26080	Bollinger County, Missouri	26	0.7968	0.7909	99926
26090	Boone County, Missouri	1740	0.8354	0.8354	17860
26100	Buchanan County, Missouri	7000	0.9529	0.9529	41140
26110	Butler County, Missouri	26	0.7968	0.7909	99926
26120	Caldwell County, Missouri	26	0.7968	0.9467	28140
26130	Callaway County, Missouri	26	0.7968	0.8396	27620
26140	Camden County, Missouri	26	0.7968	0.7909	99926
26150	Cape Girardeau County, Missouri	26	0.7968	0.7909	99926
26160	Carroll County, Missouri	26	0.7968	0.7909	99926
26170	Carter County, Missouri	26	0.7968	0.7909	99926
26180	Cass County, Missouri	3760	0.9481	0.9467	28140
26190	Cedar County, Missouri	26	0.7968	0.7909	99926
26200	Chariton County, Missouri	26	0.7968	0.7909	99926
26210	Christian County, Missouri	7920	0.8259	0.8246	44180
26220	Clark County, Missouri	26	0.7968	0.7909	99926
26230	Clay County, Missouri	3760	0.9481	0.9467	28140
26240	Clinton County, Missouri	3760	0.9481	0.9467	28140
26250	Cole County, Missouri	26	0.7968	0.8396	27620
26260	Cooper County, Missouri	26	0.7968	0.7909	99926
26270	Crawford County, Missouri	26	0.7968	0.8949	41180
26280	Dade County, Missouri	26	0.7968	0.7909	99926
26290	Dallas County, Missouri	26	0.7968	0.8246	44180
26300	Daviess County, Missouri	26	0.7968	0.7909	99926
26310	De Kalb County, Missouri	26	0.7968	0.9529	41140
26320	Dent County, Missouri	26	0.7968	0.7909	99926
26330	Douglas County, Missouri	26	0.7968	0.7909	99926
26340	Dunklin County, Missouri	26	0.7968	0.7909	99926
26350	Franklin County, Missouri	7040	0.8957	0.8949	41180
26360	Gasconade County, Missouri	26	0.7968	0.7909	99926
26370	Gentry County, Missouri	26	0.7968	0.7909	99926
26380	Greene County, Missouri	7920	0.8259	0.8246	44180
26390	Grundy County, Missouri	26	0.7968	0.7909	99926
26400	Harrison County, Missouri	26	0.7968	0.7909	99926
26410	Henry County, Missouri	26	0.7968	0.7909	99926
26411	Hickory County, Missouri	26	0.7968	0.7909	99926
26412	Holt County, Missouri	26	0.7968	0.7909	99926
26440	Howard County, Missouri	26	0.7968	0.8354	17860
26450	Howell County, Missouri	26	0.7968	0.7909	99926
26460	Iron County, Missouri	26	0.7968	0.7909	99926
26470	Jackson County, Missouri	3760	0.9481	0.9467	28140
26480	Jasper County, Missouri	3710	0.8590	0.8590	27900
26490	Jefferson County, Missouri	7040	0.8957	0.8949	41180
26500	Johnson County, Missouri	26	0.7968	0.7909	99926
26510	Knox County, Missouri	26	0.7968	0.7909	99926
26520	Laclede County, Missouri	26	0.7968	0.7909	99926
26530	Lafayette County, Missouri	3760	0.9481	0.9467	28140
26540	Lawrence County, Missouri	26	0.7968	0.7909	99926
26541	Lewis County, Missouri	26	0.7968	0.7909	99926
26560	Lincoln County, Missouri	7040	0.8957	0.8949	41180
26570	Linn County, Missouri	26	0.7968	0.7909	99926
26580	Livingston County, Missouri	26	0.7968	0.7909	99926
26590	Mc Donald County, Missouri	26	0.7968	0.8563	22220
26600	Macon County, Missouri	26	0.7968	0.7909	99926
26601	Madison County, Missouri	26	0.7968	0.7909	99926
26620	Maries County, Missouri	26	0.7968	0.7909	99926
26630	Marion County, Missouri	26	0.7968	0.7909	99926
26631	Mercer County, Missouri	26	0.7968	0.7909	99926
26650	Miller County, Missouri	26	0.7968	0.7909	99926
26660	Mississippi County, Missouri	26	0.7968	0.7909	99926
26670	Moniteau County, Missouri	26	0.7968	0.8396	27620
26680	Monroe County, Missouri	26	0.7968	0.7909	99926
26690	Montgomery County, Missouri	26	0.7968	0.7909	99926
26700	Morgan County, Missouri	26	0.7968	0.7909	99926
26710	New Madrid County, Missouri	26	0.7968	0.7909	99926
26720	Newton County, Missouri	3710	0.8590	0.8590	27900
26730	Nodaway County, Missouri	26	0.7968	0.7909	99926
26740	Oregon County, Missouri	26	0.7968	0.7909	99926
26750	Osage County, Missouri	26	0.7968	0.8396	27620
26751	Ozark County, Missouri	26	0.7968	0.7909	99926
26770	Pemiscot County, Missouri	26	0.7968	0.7909	99926
26780	Perry County, Missouri	26	0.7968	0.7909	99926
26790	Pettis County, Missouri	26	0.7968	0.7909	99926
26800	Phelps County, Missouri	26	0.7968	0.7909	99926
26810	Pike County, Missouri	26	0.7968	0.7909	99926
26820	Platte County, Missouri	3760	0.9481	0.9467	28140
26821	Polk County, Missouri	26	0.7968	0.8246	44180
26840	Pulaski County, Missouri	26	0.7968	0.7909	99926
26850	Putnam County, Missouri	26	0.7968	0.7909	99926
26860	Ralls County, Missouri	26	0.7968	0.7909	99926
26870	Randolph County, Missouri	26	0.7968	0.7909	99926
26880	Ray County, Missouri	3760	0.9481	0.9467	28140
26881	Reynolds County, Missouri	26	0.7968	0.7909	99926
26900	Ripley County, Missouri	26	0.7968	0.7909	99926
26910	St Charles County, Missouri	7040	0.8957	0.8949	41180
26911	St Clair County, Missouri	26	0.7968	0.7909	99926
26930	St Francois County, Missouri	26	0.7968	0.7909	99926
26940	St Louis County, Missouri	7040	0.8957	0.8949	41180
26950	St Louis City County, Missouri	7040	0.8957	0.8949	41180
26960	Ste Genevieve County, Missouri	26	0.7968	0.7909	99926
26970	Saline County, Missouri	26	0.7968	0.7909	99926
26980	Schuyler County, Missouri	26	0.7968	0.7909	99926
26981	Scotland County, Missouri	26	0.7968	0.7909	99926
26982	Scott County, Missouri	26	0.7968	0.7909	99926
26983	Shannon County, Missouri	26	0.7968	0.7909	99926
26984	Shelby County, Missouri	26	0.7968	0.7909	99926
26985	Stoddard County, Missouri	26	0.7968	0.7909	99926
26986	Stone County, Missouri	26	0.7968	0.7909	99926
26987	Sullivan County, Missouri	26	0.7968	0.7909	99926
26988	Taney County, Missouri	26	0.7968	0.7909	99926
26989	Texas County, Missouri	26	0.7968	0.7909	99926
26990	Vernon County, Missouri	26	0.7968	0.7909	99926
26991	Warren County, Missouri	7040	0.8957	0.8949	41180
26992	Washington County, Missouri	26	0.7968	0.8949	41180
26993	Wayne County, Missouri	26	0.7968	0.7909	99926
26994	Webster County, Missouri	7920	0.8259	0.8246	44180
26995	Worth County, Missouri	26	0.7968	0.7909	99926
26996	Wright County, Missouri	26	0.7968	0.7909	99926
27000	Beaverhead County, Montana	27	0.8833	0.8833	99927
27010	Big Horn County, Montana	27	0.8833	0.8833	99927
27020	Blaine County, Montana	27	0.8833	0.8833	99927
27030	Broadwater County, Montana	27	0.8833	0.8833	99927
27040	Carbon County, Montana	27	0.8833	0.8843	13740
27050	Carter County, Montana	27	0.8833	0.8833	99927
27060	Cascade County, Montana	3040	0.9061	0.9061	24500
27070	Chouteau County, Montana	27	0.8833	0.8833	99927
27080	Custer County, Montana	27	0.8833	0.8833	99927
27090	Daniels County, Montana	27	0.8833	0.8833	99927
27100	Dawson County, Montana	27	0.8833	0.8833	99927
27110	Deer Lodge County, Montana	27	0.8833	0.8833	99927
27113	Yellowstone National Park, Montana	27	0.8833	0.8833	99927
27120	Fallon County, Montana	27	0.8833	0.8833	99927
27130	Fergus County, Montana	27	0.8833	0.8833	99927
27140	Flathead County, Montana	27	0.8833	0.8833	99927
27150	Gallatin County, Montana	27	0.8833	0.8833	99927
27160	Garfield County, Montana	27	0.8833	0.8833	99927
27170	Glacier County, Montana	27	0.8833	0.8833	99927
27180	Golden Valley County, Montana	27	0.8833	0.8833	99927
27190	Granite County, Montana	27	0.8833	0.8833	99927
27200	Hill County, Montana	27	0.8833	0.8833	99927
27210	Jefferson County, Montana	27	0.8833	0.8833	99927
27220	Judith Basin County, Montana	27	0.8833	0.8833	99927
27230	Lake County, Montana	27	0.8833	0.8833	99927
27240	Lewis And Clark County, Montana	27	0.8833	0.8833	99927
27250	Liberty County, Montana	27	0.8833	0.8833	99927
27260	Lincoln County, Montana	27	0.8833	0.8833	99927
27270	Mc Cone County, Montana	27	0.8833	0.8833	99927
27280	Madison County, Montana	27	0.8833	0.8833	99927
27290	Meagher County, Montana	27	0.8833	0.8833	99927
27300	Mineral County, Montana	27	0.8833	0.8833	99927
27310	Missoula County, Montana	5140	0.9482	0.9482	33540
27320	Musselshell County, Montana	27	0.8833	0.8833	99927
27330	Park County, Montana	27	0.8833	0.8833	99927
27340	Petroleum County, Montana	27	0.8833	0.8833	99927
27350	Phillips County, Montana	27	0.8833	0.8833	99927
27360	Pondera County, Montana	27	0.8833	0.8833	99927
27370	Powder River County, Montana	27	0.8833	0.8833	99927
27380	Powell County, Montana	27	0.8833	0.8833	99927
27390	Prairie County, Montana	27	0.8833	0.8833	99927
27400	Ravalli County, Montana	27	0.8833	0.8833	99927
27410	Richland County, Montana	27	0.8833	0.8833	99927
27420	Roosevelt County, Montana	27	0.8833	0.8833	99927
27430	Rosebud County, Montana	27	0.8833	0.8833	99927
27440	Sanders County, Montana	27	0.8833	0.8833	99927
27450	Sheridan County, Montana	27	0.8833	0.8833	99927
27460	Silver Bow County, Montana	27	0.8833	0.8833	99927
27470	Stillwater County, Montana	27	0.8833	0.8833	99927
27480	Sweet Grass County, Montana	27	0.8833	0.8833	99927
27490	Teton County, Montana	27	0.8833	0.8833	99927
27500	Toole County, Montana	27	0.8833	0.8833	99927
27510	Treasure County, Montana	27	0.8833	0.8833	99927
27520	Valley County, Montana	27	0.8833	0.8833	99927
27530	Wheatland County, Montana	27	0.8833	0.8833	99927
27540	Wibaux County, Montana	27	0.8833	0.8833	99927
27550	Yellowstone County, Montana	0880	0.8843	0.8843	13740
28000	Adams County, Nebraska	28	0.8665	0.8665	99928
28010	Antelope County, Nebraska	28	0.8665	0.8665	99928
28020	Arthur County, Nebraska	28	0.8665	0.8665	99928
28030	Banner County, Nebraska	28	0.8665	0.8665	99928
28040	Blaine County, Nebraska	28	0.8665	0.8665	99928
28050	Boone County, Nebraska	28	0.8665	0.8665	99928
28060	Box Butte County, Nebraska	28	0.8665	0.8665	99928
28070	Boyd County, Nebraska	28	0.8665	0.8665	99928
28080	Brown County, Nebraska	28	0.8665	0.8665	99928
28090	Buffalo County, Nebraska	28	0.8665	0.8665	99928
28100	Burt County, Nebraska	28	0.8665	0.8665	99928
28110	Butler County, Nebraska	28	0.8665	0.8665	99928
28120	Cass County, Nebraska	5920	0.9569	0.9569	36540
28130	Cedar County, Nebraska	28	0.8665	0.8665	99928
28140	Chase County, Nebraska	28	0.8665	0.8665	99928
28150	Cherry County, Nebraska	28	0.8665	0.8665	99928
28160	Cheyenne County, Nebraska	28	0.8665	0.8665	99928
28170	Clay County, Nebraska	28	0.8665	0.8665	99928
28180	Colfax County, Nebraska	28	0.8665	0.8665	99928
28190	Cuming County, Nebraska	28	0.8665	0.8665	99928
28200	Custer County, Nebraska	28	0.8665	0.8665	99928
28210	Dakota County, Nebraska	7720	0.9411	0.9376	43580
28220	Dawes County, Nebraska	28	0.8665	0.8665	99928
28230	Dawson County, Nebraska	28	0.8665	0.8665	99928
28240	Deuel County, Nebraska	28	0.8665	0.8665	99928
28250	Dixon County, Nebraska	28	0.8665	0.9376	43580
28260	Dodge County, Nebraska	28	0.8665	0.8665	99928
28270	Douglas County, Nebraska	5920	0.9569	0.9569	36540
28280	Dundy County, Nebraska	28	0.8665	0.8665	99928
28290	Fillmore County, Nebraska	28	0.8665	0.8665	99928
28300	Franklin County, Nebraska	28	0.8665	0.8665	99928
28310	Frontier County, Nebraska	28	0.8665	0.8665	99928
28320	Furnas County, Nebraska	28	0.8665	0.8665	99928
28330	Gage County, Nebraska	28	0.8665	0.8665	99928
28340	Garden County, Nebraska	28	0.8665	0.8665	99928
28350	Garfield County, Nebraska	28	0.8665	0.8665	99928
28360	Gosper County, Nebraska	28	0.8665	0.8665	99928
28370	Grant County, Nebraska	28	0.8665	0.8665	99928
28380	Greeley County, Nebraska	28	0.8665	0.8665	99928
28390	Hall County, Nebraska	28	0.8665	0.8665	99928
28400	Hamilton County, Nebraska	28	0.8665	0.8665	99928
28410	Harlan County, Nebraska	28	0.8665	0.8665	99928
28420	Hayes County, Nebraska	28	0.8665	0.8665	99928
28430	Hitchcock County, Nebraska	28	0.8665	0.8665	99928
28440	Holt County, Nebraska	28	0.8665	0.8665	99928
28450	Hooker County, Nebraska	28	0.8665	0.8665	99928
28460	Howard County, Nebraska	28	0.8665	0.8665	99928
28470	Jefferson County, Nebraska	28	0.8665	0.8665	99928
28480	Johnson County, Nebraska	28	0.8665	0.8665	99928
28490	Kearney County, Nebraska	28	0.8665	0.8665	99928
28500	Keith County, Nebraska	28	0.8665	0.8665	99928
28510	Keya Paha County, Nebraska	28	0.8665	0.8665	99928
28520	Kimball County, Nebraska	28	0.8665	0.8665	99928
28530	Knox County, Nebraska	28	0.8665	0.8665	99928
28540	Lancaster County, Nebraska	4360	1.0225	1.0225	30700
28550	Lincoln County, Nebraska	28	0.8665	0.8665	99928
28560	Logan County, Nebraska	28	0.8665	0.8665	99928
28570	Loup County, Nebraska	28	0.8665	0.8665	99928
28580	Mc Pherson County, Nebraska	28	0.8665	0.8665	99928
28590	Madison County, Nebraska	28	0.8665	0.8665	99928
28600	Merrick County, Nebraska	28	0.8665	0.8665	99928
28610	Morrill County, Nebraska	28	0.8665	0.8665	99928
28620	Nance County, Nebraska	28	0.8665	0.8665	99928
28630	Nemaha County, Nebraska	28	0.8665	0.8665	99928
28640	Nuckolls County, Nebraska	28	0.8665	0.8665	99928
28650	Otoe County, Nebraska	28	0.8665	0.8665	99928
28660	Pawnee County, Nebraska	28	0.8665	0.8665	99928
28670	Perkins County, Nebraska	28	0.8665	0.8665	99928
28680	Phelps County, Nebraska	28	0.8665	0.8665	99928
28690	Pierce County, Nebraska	28	0.8665	0.8665	99928
28700	Platte County, Nebraska	28	0.8665	0.8665	99928
28710	Polk County, Nebraska	28	0.8665	0.8665	99928
28720	Redwillow County, Nebraska	28	0.8665	0.8665	99928
28730	Richardson County, Nebraska	28	0.8665	0.8665	99928
28740	Rock County, Nebraska	28	0.8665	0.8665	99928
28750	Saline County, Nebraska	28	0.8665	0.8665	99928
28760	Sarpy County, Nebraska	5920	0.9569	0.9569	36540
28770	Saunders County, Nebraska	28	0.8665	0.9569	36540
28780	Scotts Bluff County, Nebraska	28	0.8665	0.8665	99928
28790	Seward County, Nebraska	28	0.8665	1.0225	30700
28800	Sheridan County, Nebraska	28	0.8665	0.8665	99928
28810	Sherman County, Nebraska	28	0.8665	0.8665	99928
28820	Sioux County, Nebraska	28	0.8665	0.8665	99928
28830	Stanton County, Nebraska	28	0.8665	0.8665	99928
28840	Thayer County, Nebraska	28	0.8665	0.8665	99928
28850	Thomas County, Nebraska	28	0.8665	0.8665	99928
28860	Thurston County, Nebraska	28	0.8665	0.8665	99928
28870	Valley County, Nebraska	28	0.8665	0.8665	99928
28880	Washington County, Nebraska	5920	0.9569	0.9569	36540
28890	Wayne County, Nebraska	28	0.8665	0.8665	99928
28900	Webster County, Nebraska	28	0.8665	0.8665	99928
28910	Wheeler County, Nebraska	28	0.8665	0.8665	99928
28920	York County, Nebraska	28	0.8665	0.8665	99928
29000	Churchill County, Nevada	29	0.9697	0.9074	99929
29010	Clark County, Nevada	4120	1.1166	1.1449	29820
29020	Douglas County, Nevada	29	0.9697	0.9074	99929
29030	Elko County, Nevada	29	0.9697	0.9074	99929
29040	Esmeralda County, Nevada	29	0.9697	0.9074	99929
29050	Eureka County, Nevada	29	0.9697	0.9074	99929
29060	Humboldt County, Nevada	29	0.9697	0.9074	99929
29070	Lander County, Nevada	29	0.9697	0.9074	99929
29080	Lincoln County, Nevada	29	0.9697	0.9074	99929
29090	Lyon County, Nevada	29	0.9697	0.9074	99929
29100	Mineral County, Nevada	29	0.9697	0.9074	99929
29110	Nye County, Nevada	4120	1.1166	0.9074	99929
29120	Carson City County, Nevada	29	0.9697	1.0244	16180
29130	Pershing County, Nevada	29	0.9697	0.9074	99929
29140	Storey County, Nevada	29	0.9697	1.0993	39900
29150	Washoe County, Nevada	6720	1.0993	1.0993	39900
29160	White Pine County, Nevada	29	0.9697	0.9074	99929
30000	Belknap County, New Hampshire	30	1.0677	1.0677	99930
30010	Carroll County, New Hampshire	30	1.0677	1.0677	99930
30020	Cheshire County, New Hampshire	30	1.0677	1.0677	99930
30030	Coos County, New Hampshire	30	1.0677	1.0677	99930
30040	Grafton County, New Hampshire	30	1.0677	1.0677	99930
30050	Hillsboro County, New Hampshire	1123	1.1152	1.0335	31700
30060	Merrimack County, New Hampshire	1123	1.1152	1.0335	31700
30070	Rockingham County, New Hampshire	1123	1.1152	1.0385	40484
30080	Strafford County, New Hampshire	1123	1.1152	1.0385	40484
30090	Sullivan County, New Hampshire	30	1.0677	1.0677	99930
31000	Atlantic County, New Jersey	0560	1.1513	1.1633	12100
31100	Bergen County, New Jersey	0875	1.1660	1.3185	35644
31150	Burlington County, New Jersey	6160	1.0926	1.0528	15804
31160	Camden County, New Jersey	6160	1.0926	1.0528	15804
31180	Cape May County, New Jersey	0560	1.1513	1.1022	36140
31190	Cumberland County, New Jersey	8760	0.9837	0.9837	47220
31200	Essex County, New Jersey	5640	1.2141	1.2195	35084
31220	Gloucester County, New Jersey	6160	1.0926	1.0528	15804
31230	Hudson County, New Jersey	3640	1.1349	1.3185	35644
31250	Hunterdon County, New Jersey	5015	1.1178	1.2195	35084
31260	Mercer County, New Jersey	8480	1.0845	1.0845	45940
31270	Middlesex County, New Jersey	5015	1.1178	1.1260	20764
31290	Monmouth County, New Jersey	5190	1.1271	1.1260	20764
31300	Morris County, New Jersey	5640	1.2141	1.2195	35084
31310	Ocean County, New Jersey	5190	1.1271	1.1260	20764
31320	Passaic County, New Jersey	0875	1.1660	1.3185	35644
31340	Salem County, New Jersey	6160	1.0926	1.0482	48864
31350	Somerset County, New Jersey	5015	1.1178	1.1260	20764
31360	Sussex County, New Jersey	5640	1.2141	1.2195	35084
31370	Union County, New Jersey	5640	1.2141	1.2195	35084
31390	Warren County, New Jersey	5640	1.2141	0.9828	10900
32000	Bernalillo County, New Mexico	0200	0.9693	0.9693	10740
32010	Catron County, New Mexico	32	0.8571	0.8644	99932
32020	Chaves County, New Mexico	32	0.8571	0.8644	99932
32025	Cibola County, New Mexico	32	0.8571	0.8644	99932
32030	Colfax County, New Mexico	32	0.8571	0.8644	99932
32040	Curry County, New Mexico	32	0.8571	0.8644	99932
32050	De Baca County, New Mexico	32	0.8571	0.8644	99932
32060	Dona Ana County, New Mexico	4100	0.8475	0.8475	29740
32070	Eddy County, New Mexico	32	0.8571	0.8644	99932
32080	Grant County, New Mexico	32	0.8571	0.8644	99932
32090	Guadalupe County, New Mexico	32	0.8571	0.8644	99932
32100	Harding County, New Mexico	32	0.8571	0.8644	99932
32110	Hidalgo County, New Mexico	32	0.8571	0.8644	99932
32120	Lea County, New Mexico	32	0.8571	0.8644	99932
32130	Lincoln County, New Mexico	32	0.8571	0.8644	99932
32131	Los Alamos County, New Mexico	7490	1.0759	0.8644	99932
32140	Luna County, New Mexico	32	0.8571	0.8644	99932
32150	Mc Kinley County, New Mexico	32	0.8571	0.8644	99932
32160	Mora County, New Mexico	32	0.8571	0.8644	99932
32170	Otero County, New Mexico	32	0.8571	0.8644	99932
32180	Quay County, New Mexico	32	0.8571	0.8644	99932
32190	Rio Arriba County, New Mexico	32	0.8571	0.8644	99932
32200	Roosevelt County, New Mexico	32	0.8571	0.8644	99932
32210	Sandoval County, New Mexico	0200	0.9693	0.9693	10740
32220	San Juan County, New Mexico	32	0.8571	0.8518	22140
32230	San Miguel County, New Mexico	32	0.8571	0.8644	99932
32240	Santa Fe County, New Mexico	7490	1.0759	1.0931	42140
32250	Sierra County, New Mexico	32	0.8571	0.8644	99932
32260	Socorro County, New Mexico	32	0.8571	0.8644	99932
32270	Taos County, New Mexico	32	0.8571	0.8644	99932
32280	Torrance County, New Mexico	32	0.8571	0.9693	10740
32290	Union County, New Mexico	32	0.8571	0.8644	99932
32300	Valencia County, New Mexico	0200	0.9693	0.9693	10740
33000	Albany County, New York	0160	0.8518	0.8545	10580
33010	Allegany County, New York	33	0.8395	0.8157	99933
33020	Bronx County, New York	5600	1.3465	1.3185	35644
33030	Broome County, New York	0960	0.8571	0.8571	13780
33040	Cattaraugus County, New York	33	0.8395	0.8157	99933
33050	Cayuga County, New York	8160	0.9499	0.8157	99933
33060	Chautauqua County, New York	3610	0.7552	0.8157	99933
33070	Chemung County, New York	2335	0.8259	0.8259	21300
33080	Chenango County, New York	33	0.8395	0.8157	99933
33090	Clinton County, New York	33	0.8395	0.8157	99933
33200	Columbia County, New York	33	0.8395	0.8157	99933
33210	Cortland County, New York	33	0.8395	0.8157	99933
33220	Delaware County, New York	33	0.8395	0.8157	99933
33230	Dutchess County, New York	2281	1.0183	1.0766	39100
33240	Erie County, New York	1280	0.8889	0.8889	15380
33260	Essex County, New York	33	0.8395	0.8157	99933
33270	Franklin County, New York	33	0.8395	0.8157	99933
33280	Fulton County, New York	33	0.8395	0.8157	99933
33290	Genesee County, New York	6840	0.9044	0.8157	99933
33300	Greene County, New York	33	0.8395	0.8157	99933
33310	Hamilton County, New York	33	0.8395	0.8157	99933
33320	Herkimer County, New York	8680	0.8293	0.8293	46540
33330	Jefferson County, New York	33	0.8395	0.8157	99933
33331	Kings County, New York	5600	1.3465	1.3185	35644
33340	Lewis County, New York	33	0.8395	0.8157	99933
33350	Livingston County, New York	6840	0.9044	0.9115	40380
33360	Madison County, New York	8160	0.9499	0.9581	45060
33370	Monroe County, New York	6840	0.9044	0.9115	40380
33380	Montgomery County, New York	0160	0.8518	0.8157	99933
33400	Nassau County, New York	5380	1.2760	1.2760	35004
33420	New York County, New York	5600	1.3465	1.3185	35644
33500	Niagara County, New York	1280	0.8889	0.8889	15380
33510	Oneida County, New York	8680	0.8293	0.8293	46540
33520	Onondaga County, New York	8160	0.9499	0.9581	45060
33530	Ontario County, New York	6840	0.9044	0.9115	40380
33540	Orange County, New York	5660	1.1218	1.0766	39100
33550	Orleans County, New York	6840	0.9044	0.9115	40380
33560	Oswego County, New York	8160	0.9499	0.9581	45060
33570	Otsego County, New York	33	0.8395	0.8157	99933
33580	Putnam County, New York	5600	1.3465	1.3185	35644
33590	Queens County, New York	5600	1.3465	1.3185	35644
33600	Rensselaer County, New York	0160	0.8518	0.8545	10580
33610	Richmond County, New York	5600	1.3465	1.3185	35644
33620	Rockland County, New York	5600	1.3465	1.3185	35644
33630	St Lawrence County, New York	33	0.8395	0.8157	99933
33640	Saratoga County, New York	0160	0.8518	0.8545	10580
33650	Schenectady County, New York	0160	0.8518	0.8545	10580
33660	Schoharie County, New York	0160	0.8518	0.8545	10580
33670	Schuyler County, New York	33	0.8395	0.8157	99933
33680	Seneca County, New York	33	0.8395	0.8157	99933
33690	Steuben County, New York	33	0.8395	0.8157	99933
33700	Suffolk County, New York	5380	1.2760	1.2760	35004
33710	Sullivan County, New York	33	0.8395	0.8157	99933
33720	Tioga County, New York	0960	0.8571	0.8571	13780
33730	Tompkins County, New York	33	0.8395	0.9803	27060
33740	Ulster County, New York	33	0.8395	0.9257	28740
33750	Warren County, New York	2975	0.8567	0.8567	24020
33760	Washington County, New York	2975	0.8567	0.8567	24020
33770	Wayne County, New York	6840	0.9044	0.9115	40380
33800	Westchester County, New York	5600	1.3465	1.3185	35644
33900	Wyoming County, New York	33	0.8395	0.8157	99933
33910	Yates County, New York	33	0.8395	0.8157	99933
34000	Alamance County, N Carolina	3120	0.9027	0.8914	15500
34010	Alexander County, N Carolina	3290	0.8922	0.8922	25860
34020	Alleghany County, N Carolina	34	0.8490	0.8567	99934
34030	Anson County, N Carolina	34	0.8490	0.9760	16740
34040	Ashe County, N Carolina	34	0.8490	0.8567	99934
34050	Avery County, N Carolina	34	0.8490	0.8567	99934
34060	Beaufort County, N Carolina	34	0.8490	0.8567	99934
34070	Bertie County, N Carolina	34	0.8490	0.8567	99934
34080	Bladen County, N Carolina	34	0.8490	0.8567	99934
34090	Brunswick County, N Carolina	9200	0.9592	0.9592	48900
34100	Buncombe County, N Carolina	0480	0.9747	0.9294	11700
34110	Burke County, N Carolina	3290	0.8922	0.8922	25860
34120	Cabarrus County, N Carolina	1520	0.9725	0.9760	16740
34130	Caldwell County, N Carolina	3290	0.8922	0.8922	25860
34140	Camden County, N Carolina	34	0.8490	0.8567	99934
34150	Carteret County, N Carolina	34	0.8490	0.8567	99934
34160	Caswell County, N Carolina	34	0.8490	0.8567	99934
34170	Catawba County, N Carolina	3290	0.8922	0.8922	25860
34180	Chatham County, N Carolina	6640	1.0087	1.0303	20500
34190	Cherokee County, N Carolina	34	0.8490	0.8567	99934
34200	Chowan County, N Carolina	34	0.8490	0.8567	99934
34210	Clay County, N Carolina	34	0.8490	0.8567	99934
34220	Cleveland County, N Carolina	34	0.8490	0.8567	99934
34230	Columbus County, N Carolina	34	0.8490	0.8567	99934
34240	Craven County, N Carolina	34	0.8490	0.8567	99934
34250	Cumberland County, N Carolina	2560	0.9426	0.9426	22180
34251	Currituck County, N Carolina	5720	0.8808	0.8808	47260
34270	Dare County, N Carolina	34	0.8490	0.8567	99934
34280	Davidson County, N Carolina	3120	0.9027	0.8567	99934
34290	Davie County, N Carolina	3120	0.9027	0.8953	49180
34300	Duplin County, N Carolina	34	0.8490	0.8567	99934
34310	Durham County, N Carolina	6640	1.0087	1.0303	20500
34320	Edgecombe County, N Carolina	6895	0.8924	0.8924	40580
34330	Forsyth County, N Carolina	3120	0.9027	0.8953	49180
34340	Franklin County, N Carolina	6640	1.0087	0.9733	39580
34350	Gaston County, N Carolina	1520	0.9725	0.9760	16740
34360	Gates County, N Carolina	34	0.8490	0.8567	99934
34370	Graham County, N Carolina	34	0.8490	0.8567	99934
34380	Granville County, N Carolina	34	0.8490	0.8567	99934
34390	Greene County, N Carolina	34	0.8490	0.9434	24780
34400	Guilford County, N Carolina	3120	0.9027	0.9113	24660
34410	Halifax County, N Carolina	34	0.8490	0.8567	99934
34420	Harnett County, N Carolina	34	0.8490	0.8567	99934
34430	Haywood County, N Carolina	34	0.8490	0.9294	11700
34440	Henderson County, N Carolina	34	0.8490	0.9294	11700
34450	Hertford County, N Carolina	34	0.8490	0.8567	99934
34460	Hoke County, N Carolina	34	0.8490	0.9426	22180
34470	Hyde County, N Carolina	34	0.8490	0.8567	99934
34480	Iredell County, N Carolina	34	0.8490	0.8567	99934
34490	Jackson County, N Carolina	34	0.8490	0.8567	99934
34500	Johnston County, N Carolina	6640	1.0087	0.9733	39580
34510	Jones County, N Carolina	34	0.8490	0.8567	99934
34520	Lee County, N Carolina	34	0.8490	0.8567	99934
34530	Lenoir County, N Carolina	34	0.8490	0.8567	99934
34540	Lincoln County, N Carolina	1520	0.9725	0.8567	99934
34550	Mc Dowell County, N Carolina	34	0.8490	0.8567	99934
34560	Macon County, N Carolina	34	0.8490	0.8567	99934
34570	Madison County, N Carolina	0480	0.9747	0.9294	11700
34580	Martin County, N Carolina	34	0.8490	0.8567	99934
34590	Mecklenburg County, N Carolina	1520	0.9725	0.9760	16740
34600	Mitchell County, N Carolina	34	0.8490	0.8567	99934
34610	Montgomery County, N Carolina	34	0.8490	0.8567	99934
34620	Moore County, N Carolina	34	0.8490	0.8567	99934
34630	Nash County, N Carolina	6895	0.8924	0.8924	40580
34640	New Hanover County, N Carolina	9200	0.9592	0.9592	48900
34650	Northampton County, N Carolina	34	0.8490	0.8567	99934
34660	Onslow County, N Carolina	3605	0.8244	0.8244	27340
34670	Orange County, N Carolina	6640	1.0087	1.0303	20500
34680	Pamlico County, N Carolina	34	0.8490	0.8567	99934
34690	Pasquotank County, N Carolina	34	0.8490	0.8567	99934
34700	Pender County, N Carolina	34	0.8490	0.9592	48900
34710	Perquimans County, N Carolina	34	0.8490	0.8567	99934
34720	Person County, N Carolina	34	0.8490	1.0303	20500
34730	Pitt County, N Carolina	3150	0.9434	0.9434	24780
34740	Polk County, N Carolina	34	0.8490	0.8567	99934
34750	Randolph County, N Carolina	3120	0.9027	0.9113	24660
34760	Richmond County, N Carolina	34	0.8490	0.8567	99934
34770	Robeson County, N Carolina	34	0.8490	0.8567	99934
34780	Rockingham County, N Carolina	34	0.8490	0.9113	24660
34790	Rowan County, N Carolina	1520	0.9725	0.8567	99934
34800	Rutherford County, N Carolina	34	0.8490	0.8567	99934
34810	Sampson County, N Carolina	34	0.8490	0.8567	99934
34820	Scotland County, N Carolina	34	0.8490	0.8567	99934
34830	Stanly County, N Carolina	1520	0.9725	0.9760	16740
34840	Stokes County, N Carolina	3120	0.9027	0.8953	49180
34850	Surry County, N Carolina	34	0.8490	0.8567	99934
34860	Swain County, N Carolina	34	0.8490	0.8567	99934
34870	Transylvania County, N Carolina	34	0.8490	0.8567	99934
34880	Tyrrell County, N Carolina	34	0.8490	0.8567	99934
34890	Union County, N Carolina	1520	0.9725	0.9760	16740
34900	Vance County, N Carolina	34	0.8490	0.8567	99934
34910	Wake County, N Carolina	6640	1.0087	0.9733	39580
34920	Warren County, N Carolina	34	0.8490	0.8567	99934
34930	Washington County, N Carolina	34	0.8490	0.8567	99934
34940	Watauga County, N Carolina	34	0.8490	0.8567	99934
34950	Wayne County, N Carolina	2980	0.8784	0.8784	24140
34960	Wilkes County, N Carolina	34	0.8490	0.8567	99934
34970	Wilson County, N Carolina	34	0.8490	0.8567	99934
34980	Yadkin County, N Carolina	3120	0.9027	0.8953	49180
34981	Yancey County, N Carolina	34	0.8490	0.8567	99934
35000	Adams County, N Dakota	35	0.7268	0.7268	99935
35010	Barnes County, N Dakota	35	0.7268	0.7268	99935
35020	Benson County, N Dakota	35	0.7268	0.7268	99935
35030	Billings County, N Dakota	35	0.7268	0.7268	99935
35040	Bottineau County, N Dakota	35	0.7268	0.7268	99935
35050	Bowman County, N Dakota	35	0.7268	0.7268	99935
35060	Burke County, N Dakota	35	0.7268	0.7268	99935
35070	Burleigh County, N Dakota	1010	0.7519	0.7519	13900
35080	Cass County, N Dakota	2520	0.8495	0.8495	22020
35090	Cavalier County, N Dakota	35	0.7268	0.7268	99935
35100	Dickey County, N Dakota	35	0.7268	0.7268	99935
35110	Divide County, N Dakota	35	0.7268	0.7268	99935
35120	Dunn County, N Dakota	35	0.7268	0.7268	99935
35130	Eddy County, N Dakota	35	0.7268	0.7268	99935
35140	Emmons County, N Dakota	35	0.7268	0.7268	99935
35150	Foster County, N Dakota	35	0.7268	0.7268	99935
35160	Golden Valley County, N Dakota	35	0.7268	0.7268	99935
35170	Grand Forks County, N Dakota	2985	1.1516	1.1516	24220
35180	Grant County, N Dakota	35	0.7268	0.7268	99935
35190	Griggs County, N Dakota	35	0.7268	0.7268	99935
35200	Hettinger County, N Dakota	35	0.7268	0.7268	99935
35210	Kidder County, N Dakota	35	0.7268	0.7268	99935
35220	La Moure County, N Dakota	35	0.7268	0.7268	99935
35230	Logan County, N Dakota	35	0.7268	0.7268	99935
35240	Mc Henry County, N Dakota	35	0.7268	0.7268	99935
35250	Mc Intosh County, N Dakota	35	0.7268	0.7268	99935
35260	Mc Kenzie County, N Dakota	35	0.7268	0.7268	99935
35270	Mc Lean County, N Dakota	35	0.7268	0.7268	99935
35280	Mercer County, N Dakota	35	0.7268	0.7268	99935
35290	Morton County, N Dakota	1010	0.7519	0.7519	13900
35300	Mountrail County, N Dakota	35	0.7268	0.7268	99935
35310	Nelson County, N Dakota	35	0.7268	0.7268	99935
35320	Oliver County, N Dakota	35	0.7268	0.7268	99935
35330	Pembina County, N Dakota	35	0.7268	0.7268	99935
35340	Pierce County, N Dakota	35	0.7268	0.7268	99935
35350	Ramsey County, N Dakota	35	0.7268	0.7268	99935
35360	Ransom County, N Dakota	35	0.7268	0.7268	99935
35370	Renville County, N Dakota	35	0.7268	0.7268	99935
35380	Richland County, N Dakota	35	0.7268	0.7268	99935
35390	Rolette County, N Dakota	35	0.7268	0.7268	99935
35400	Sargent County, N Dakota	35	0.7268	0.7268	99935
35410	Sheridan County, N Dakota	35	0.7268	0.7268	99935
35420	Sioux County, N Dakota	35	0.7268	0.7268	99935
35430	Slope County, N Dakota	35	0.7268	0.7268	99935
35440	Stark County, N Dakota	35	0.7268	0.7268	99935
35450	Steele County, N Dakota	35	0.7268	0.7268	99935
35460	Stutsman County, N Dakota	35	0.7268	0.7268	99935
35470	Towner County, N Dakota	35	0.7268	0.7268	99935
35480	Traill County, N Dakota	35	0.7268	0.7268	99935
35490	Walsh County, N Dakota	35	0.7268	0.7268	99935
35500	Ward County, N Dakota	35	0.7268	0.7268	99935
35510	Wells County, N Dakota	35	0.7268	0.7268	99935
35520	Williams County, N Dakota	35	0.7268	0.7268	99935
36000	Adams County, Ohio	36	0.8886	0.8786	99936
36010	Allen County, Ohio	4320	0.9128	0.9234	30620
36020	Ashland County, Ohio	36	0.8886	0.8786	99936
36030	Ashtabula County, Ohio	1680	0.9174	0.8786	99936
36040	Athens County, Ohio	36	0.8886	0.8786	99936
36050	Auglaize County, Ohio	4320	0.9128	0.8786	99936
36060	Belmont County, Ohio	9000	0.7168	0.7168	48540
36070	Brown County, Ohio	1640	0.9742	0.9623	17140
36080	Butler County, Ohio	3200	0.8960	0.9623	17140
36090	Carroll County, Ohio	1320	0.8944	0.8944	15940
36100	Champaign County, Ohio	36	0.8886	0.8786	99936
36110	Clark County, Ohio	2000	0.8989	0.8404	44220
36120	Clermont County, Ohio	1640	0.9742	0.9623	17140
36130	Clinton County, Ohio	36	0.8886	0.8786	99936
36140	Columbiana County, Ohio	9320	0.8857	0.8786	99936
36150	Coshocton County, Ohio	36	0.8886	0.8786	99936
36160	Crawford County, Ohio	4800	0.8886	0.8786	99936
36170	Cuyahoga County, Ohio	1680	0.9174	0.9204	17460
36190	Darke County, Ohio	36	0.8886	0.8786	99936
36200	Defiance County, Ohio	36	0.8886	0.8786	99936
36210	Delaware County, Ohio	1840	0.9864	0.9850	18140
36220	Erie County, Ohio	36	0.8886	0.9025	41780
36230	Fairfield County, Ohio	1840	0.9864	0.9850	18140
36240	Fayette County, Ohio	36	0.8886	0.8786	99936
36250	Franklin County, Ohio	1840	0.9864	0.9850	18140
36260	Fulton County, Ohio	8400	0.9584	0.9584	45780
36270	Gallia County, Ohio	36	0.8886	0.8786	99936
36280	Geauga County, Ohio	1680	0.9174	0.9204	17460
36290	Greene County, Ohio	2000	0.8989	0.9073	19380
36300	Guernsey County, Ohio	36	0.8886	0.8786	99936
36310	Hamilton County, Ohio	1640	0.9742	0.9623	17140
36330	Hancock County, Ohio	36	0.8886	0.8786	99936
36340	Hardin County, Ohio	36	0.8886	0.8786	99936
36350	Harrison County, Ohio	36	0.8886	0.8786	99936
36360	Henry County, Ohio	36	0.8886	0.8786	99936
36370	Highland County, Ohio	36	0.8886	0.8786	99936
36380	Hocking County, Ohio	36	0.8886	0.8786	99936
36390	Holmes County, Ohio	36	0.8886	0.8786	99936
36400	Huron County, Ohio	36	0.8886	0.8786	99936
36410	Jackson County, Ohio	36	0.8886	0.8786	99936
36420	Jefferson County, Ohio	8080	0.7827	0.7827	48260
36430	Knox County, Ohio	36	0.8886	0.8786	99936
36440	Lake County, Ohio	1680	0.9174	0.9204	17460
36450	Lawrence County, Ohio	3400	0.9486	0.9486	26580
36460	Licking County, Ohio	1840	0.9864	0.9850	18140
36470	Logan County, Ohio	36	0.8886	0.8786	99936
36480	Lorain County, Ohio	1680	0.9174	0.9204	17460
36490	Lucas County, Ohio	8400	0.9584	0.9584	45780
36500	Madison County, Ohio	1840	0.9864	0.9850	18140
36510	Mahoning County, Ohio	9320	0.8857	0.8611	49660
36520	Marion County, Ohio	36	0.8886	0.8786	99936
36530	Medina County, Ohio	1680	0.9174	0.9204	17460
36540	Meigs County, Ohio	36	0.8886	0.8786	99936
36550	Mercer County, Ohio	36	0.8886	0.8786	99936
36560	Miami County, Ohio	2000	0.8989	0.9073	19380
36570	Monroe County, Ohio	36	0.8886	0.8786	99936
36580	Montgomery County, Ohio	2000	0.8989	0.9073	19380
36590	Morgan County, Ohio	36	0.8886	0.8786	99936
36600	Morrow County, Ohio	36	0.8886	0.9850	18140
36610	Muskingum County, Ohio	36	0.8886	0.8786	99936
36620	Noble County, Ohio	36	0.8886	0.8786	99936
36630	Ottawa County, Ohio	36	0.8886	0.9584	45780
36640	Paulding County, Ohio	36	0.8886	0.8786	99936
36650	Perry County, Ohio	36	0.8886	0.8786	99936
36660	Pickaway County, Ohio	1840	0.9864	0.9850	18140
36670	Pike County, Ohio	36	0.8886	0.8786	99936
36680	Portage County, Ohio	0080	0.8991	0.8991	10420
36690	Preble County, Ohio	36	0.8886	0.9073	19380
36700	Putnam County, Ohio	36	0.8886	0.8786	99936
36710	Richland County, Ohio	4800	0.8886	0.8887	31900
36720	Ross County, Ohio	36	0.8886	0.8786	99936
36730	Sandusky County, Ohio	36	0.8886	0.8786	99936
36740	Scioto County, Ohio	36	0.8886	0.8786	99936
36750	Seneca County, Ohio	36	0.8886	0.8786	99936
36760	Shelby County, Ohio	36	0.8886	0.8786	99936
36770	Stark County, Ohio	1320	0.8944	0.8944	15940
36780	Summit County, Ohio	0080	0.8991	0.8991	10420
36790	Trumbull County, Ohio	9320	0.8857	0.8611	49660
36800	Tuscarawas County, Ohio	36	0.8886	0.8786	99936
36810	Union County, Ohio	36	0.8886	0.9850	18140
36820	Van Wert County, Ohio	36	0.8886	0.8786	99936
36830	Vinton County, Ohio	36	0.8886	0.8786	99936
36840	Warren County, Ohio	1640	0.9742	0.9623	17140
36850	Washington County, Ohio	6020	0.8278	0.8278	37620
36860	Wayne County, Ohio	36	0.8886	0.8786	99936
36870	Williams County, Ohio	36	0.8886	0.8786	99936
36880	Wood County, Ohio	8400	0.9584	0.9584	45780
36890	Wyandot County, Ohio	36	0.8886	0.8786	99936
37000	Adair County, Oklahoma	37	0.7450	0.7589	99937
37010	Alfalfa County, Oklahoma	37	0.7450	0.7589	99937
37020	Atoka County, Oklahoma	37	0.7450	0.7589	99937
37030	Beaver County, Oklahoma	37	0.7450	0.7589	99937
37040	Beckham County, Oklahoma	37	0.7450	0.7589	99937
37050	Blaine County, Oklahoma	37	0.7450	0.7589	99937
37060	Bryan County, Oklahoma	37	0.7450	0.7589	99937
37070	Caddo County, Oklahoma	37	0.7450	0.7589	99937
37080	Canadian County, Oklahoma	5880	0.9034	0.9040	36420
37090	Carter County, Oklahoma	37	0.7450	0.7589	99937
37100	Cherokee County, Oklahoma	37	0.7450	0.7589	99937
37110	Choctaw County, Oklahoma	37	0.7450	0.7589	99937
37120	Cimarron County, Oklahoma	37	0.7450	0.7589	99937
37130	Cleveland County, Oklahoma	5880	0.9034	0.9040	36420
37140	Coal County, Oklahoma	37	0.7450	0.7589	99937
37150	Comanche County, Oklahoma	4200	0.7880	0.7880	30020
37160	Cotton County, Oklahoma	37	0.7450	0.7589	99937
37170	Craig County, Oklahoma	37	0.7450	0.7589	99937
37180	Creek County, Oklahoma	8560	0.8322	0.8286	46140
37190	Custer County, Oklahoma	37	0.7450	0.7589	99937
37200	Delaware County, Oklahoma	37	0.7450	0.7589	99937
37210	Dewey County, Oklahoma	37	0.7450	0.7589	99937
37220	Ellis County, Oklahoma	37	0.7450	0.7589	99937
37230	Garfield County, Oklahoma	2340	0.8675	0.7589	99937
37240	Garvin County, Oklahoma	37	0.7450	0.7589	99937
37250	Grady County, Oklahoma	37	0.7450	0.9040	36420
37260	Grant County, Oklahoma	37	0.7450	0.7589	99937
37270	Greer County, Oklahoma	37	0.7450	0.7589	99937
37280	Harmon County, Oklahoma	37	0.7450	0.7589	99937
37290	Harper County, Oklahoma	37	0.7450	0.7589	99937
37300	Haskell County, Oklahoma	37	0.7450	0.7589	99937
37310	Hughes County, Oklahoma	37	0.7450	0.7589	99937
37320	Jackson County, Oklahoma	37	0.7450	0.7589	99937
37330	Jefferson County, Oklahoma	37	0.7450	0.7589	99937
37340	Johnston County, Oklahoma	37	0.7450	0.7589	99937
37350	Kay County, Oklahoma	37	0.7450	0.7589	99937
37360	Kingfisher County, Oklahoma	37	0.7450	0.7589	99937
37370	Kiowa County, Oklahoma	37	0.7450	0.7589	99937
37380	Latimer County, Oklahoma	37	0.7450	0.7589	99937
37390	Le Flore County, Oklahoma	37	0.7450	0.8214	22900
37400	Lincoln County, Oklahoma	37	0.7450	0.9040	36420
37410	Logan County, Oklahoma	5880	0.9034	0.9040	36420
37420	Love County, Oklahoma	37	0.7450	0.7589	99937
37430	Mc Clain County, Oklahoma	5880	0.9034	0.9040	36420
37440	Mc Curtain County, Oklahoma	37	0.7450	0.7589	99937
37450	Mc Intosh County, Oklahoma	37	0.7450	0.7589	99937
37460	Major County, Oklahoma	37	0.7450	0.7589	99937
37470	Marshall County, Oklahoma	37	0.7450	0.7589	99937
37480	Mayes County, Oklahoma	37	0.7450	0.7589	99937
37490	Murray County, Oklahoma	37	0.7450	0.7589	99937
37500	Muskogee County, Oklahoma	37	0.7450	0.7589	99937
37510	Noble County, Oklahoma	37	0.7450	0.7589	99937
37520	Nowata County, Oklahoma	37	0.7450	0.7589	99937
37530	Okfuskee County, Oklahoma	37	0.7450	0.7589	99937
37540	Oklahoma County, Oklahoma	5880	0.9034	0.9040	36420
37550	Okmulgee County, Oklahoma	37	0.7450	0.8286	46140
37560	Osage County, Oklahoma	8560	0.8322	0.8286	46140
37570	Ottawa County, Oklahoma	37	0.7450	0.7589	99937
37580	Pawnee County, Oklahoma	37	0.7450	0.8286	46140
37590	Payne County, Oklahoma	37	0.7450	0.7589	99937
37600	Pittsburg County, Oklahoma	37	0.7450	0.7589	99937
37610	Pontotoc County, Oklahoma	37	0.7450	0.7589	99937
37620	Pottawatomie County, Oklahoma	5880	0.9034	0.7589	99937
37630	Pushmataha County, Oklahoma	37	0.7450	0.7589	99937
37640	Roger Mills County, Oklahoma	37	0.7450	0.7589	99937
37650	Rogers County, Oklahoma	8560	0.8322	0.8286	46140
37660	Seminole County, Oklahoma	37	0.7450	0.7589	99937
37670	Sequoyah County, Oklahoma	2720	0.8229	0.8214	22900
37680	Stephens County, Oklahoma	37	0.7450	0.7589	99937
37690	Texas County, Oklahoma	37	0.7450	0.7589	99937
37700	Tillman County, Oklahoma	37	0.7450	0.7589	99937
37710	Tulsa County, Oklahoma	8560	0.8322	0.8286	46140
37720	Wagoner County, Oklahoma	8560	0.8322	0.8286	46140
37730	Washington County, Oklahoma	37	0.7450	0.7589	99937
37740	Washita County, Oklahoma	37	0.7450	0.7589	99937
37750	Woods County, Oklahoma	37	0.7450	0.7589	99937
37760	Woodward County, Oklahoma	37	0.7450	0.7589	99937
38000	Baker County, Oregon	38	1.0057	0.9830	99938
38010	Benton County, Oregon	1890	1.0739	1.0739	18700
38020	Clackamas County, Oregon	6440	1.1260	1.1260	38900
38030	Clatsop County, Oregon	38	1.0057	0.9830	99938
38040	Columbia County, Oregon	6440	1.1260	1.1260	38900
38050	Coos County, Oregon	38	1.0057	0.9830	99938
38060	Crook County, Oregon	38	1.0057	0.9830	99938
38070	Curry County, Oregon	38	1.0057	0.9830	99938
38080	Deschutes County, Oregon	38	1.0057	1.0796	13460
38090	Douglas County, Oregon	38	1.0057	0.9830	99938
38100	Gilliam County, Oregon	38	1.0057	0.9830	99938
38110	Grant County, Oregon	38	1.0057	0.9830	99938
38120	Harney County, Oregon	38	1.0057	0.9830	99938
38130	Hood River County, Oregon	38	1.0057	0.9830	99938
38140	Jackson County, Oregon	4890	1.0235	1.0235	32780
38150	Jefferson County, Oregon	38	1.0057	0.9830	99938
38160	Josephine County, Oregon	38	1.0057	0.9830	99938
38170	Klamath County, Oregon	38	1.0057	0.9830	99938
38180	Lake County, Oregon	38	1.0057	0.9830	99938
38190	Lane County, Oregon	2400	1.0829	1.0829	21660
38200	Lincoln County, Oregon	38	1.0057	0.9830	99938
38210	Linn County, Oregon	38	1.0057	0.9830	99938
38220	Malheur County, Oregon	38	1.0057	0.9830	99938
38230	Marion County, Oregon	7080	1.0452	1.0452	41420
38240	Morrow County, Oregon	38	1.0057	0.9830	99938
38250	Multnomah County, Oregon	6440	1.1260	1.1260	38900
38260	Polk County, Oregon	7080	1.0452	1.0452	41420
38270	Sherman County, Oregon	38	1.0057	0.9830	99938
38280	Tillamook County, Oregon	38	1.0057	0.9830	99938
38290	Umatilla County, Oregon	38	1.0057	0.9830	99938
38300	Union County, Oregon	38	1.0057	0.9830	99938
38310	Wallowa County, Oregon	38	1.0057	0.9830	99938
38320	Wasco County, Oregon	38	1.0057	0.9830	99938
38330	Washington County, Oregon	6440	1.1260	1.1260	38900
38340	Wheeler County, Oregon	38	1.0057	0.9830	99938
38350	Yamhill County, Oregon	6440	1.1260	1.1260	38900
39000	Adams County, Pennsylvania	39	0.8331	0.8302	99939
39010	Allegheny County, Pennsylvania	6280	0.8868	0.8853	38300
39070	Armstrong County, Pennsylvania	39	0.8331	0.8853	38300
39080	Beaver County, Pennsylvania	6280	0.8868	0.8853	38300
39100	Bedford County, Pennsylvania	39	0.8331	0.8302	99939
39110	Berks County, Pennsylvania	6680	0.9696	0.9696	39740
39120	Blair County, Pennsylvania	0280	0.8953	0.8953	11020
39130	Bradford County, Pennsylvania	39	0.8331	0.8302	99939
39140	Bucks County, Pennsylvania	6160	1.0926	1.1040	37964
39150	Butler County, Pennsylvania	6280	0.8868	0.8853	38300
39160	Cambria County, Pennsylvania	3680	0.8094	0.8362	27780
39180	Cameron County, Pennsylvania	39	0.8331	0.8302	99939
39190	Carbon County, Pennsylvania	0240	0.9855	0.9828	10900
39200	Centre County, Pennsylvania	8050	0.8364	0.8364	44300
39210	Chester County, Pennsylvania	6160	1.0926	1.1040	37964
39220	Clarion County, Pennsylvania	39	0.8331	0.8302	99939
39230	Clearfield County, Pennsylvania	39	0.8331	0.8302	99939
39240	Clinton County, Pennsylvania	39	0.8331	0.8302	99939
39250	Columbia County, Pennsylvania	7560	0.8533	0.8302	99939
39260	Crawford County, Pennsylvania	39	0.8331	0.8302	99939
39270	Cumberland County, Pennsylvania	3240	0.9242	0.9322	25420
39280	Dauphin County, Pennsylvania	3240	0.9242	0.9322	25420
39290	Delaware County, Pennsylvania	6160	1.0926	1.1040	37964
39310	Elk County, Pennsylvania	39	0.8331	0.8302	99939
39320	Erie County, Pennsylvania	2360	0.8746	0.8746	21500
39330	Fayette County, Pennsylvania	6280	0.8868	0.8853	38300
39340	Forest County, Pennsylvania	39	0.8331	0.8302	99939
39350	Franklin County, Pennsylvania	39	0.8331	0.8302	99939
39360	Fulton County, Pennsylvania	39	0.8331	0.8302	99939
39370	Greene County, Pennsylvania	39	0.8331	0.8302	99939
39380	Huntingdon County, Pennsylvania	39	0.8331	0.8302	99939
39390	Indiana County, Pennsylvania	39	0.8331	0.8302	99939
39400	Jefferson County, Pennsylvania	39	0.8331	0.8302	99939
39410	Juniata County, Pennsylvania	39	0.8331	0.8302	99939
39420	Lackawanna County, Pennsylvania	7560	0.8533	0.8548	42540
39440	Lancaster County, Pennsylvania	4000	0.9704	0.9704	29540
39450	Lawrence County, Pennsylvania	39	0.8331	0.8302	99939
39460	Lebanon County, Pennsylvania	3240	0.9242	0.8468	30140
39470	Lehigh County, Pennsylvania	0240	0.9855	0.9828	10900
39480	Luzerne County, Pennsylvania	7560	0.8533	0.8548	42540
39510	Lycoming County, Pennsylvania	9140	0.8377	0.8377	48700
39520	Mc Kean County, Pennsylvania	39	0.8331	0.8302	99939
39530	Mercer County, Pennsylvania	7610	0.7801	0.8611	49660
39540	Mifflin County, Pennsylvania	39	0.8331	0.8302	99939
39550	Monroe County, Pennsylvania	39	0.8331	0.8302	99939
39560	Montgomery County, Pennsylvania	6160	1.0926	1.1040	37964
39580	Montour County, Pennsylvania	39	0.8331	0.8302	99939
39590	Northampton County, Pennsylvania	0240	0.9855	0.9828	10900
39600	Northumberland County, Pennsylvania	39	0.8331	0.8302	99939
39610	Perry County, Pennsylvania	3240	0.9242	0.9322	25420
39620	Philadelphia County, Pennsylvania	6160	1.0926	1.1040	37964
39630	Pike County, Pennsylvania	5660	1.1218	1.2195	35084
39640	Potter County, Pennsylvania	39	0.8331	0.8302	99939
39650	Schuylkill County, Pennsylvania	39	0.8331	0.8302	99939
39670	Snyder County, Pennsylvania	39	0.8331	0.8302	99939
39680	Somerset County, Pennsylvania	3680	0.8094	0.8302	99939
39690	Sullivan County, Pennsylvania	39	0.8331	0.8302	99939
39700	Susquehanna County, Pennsylvania	39	0.8331	0.8302	99939
39710	Tioga County, Pennsylvania	39	0.8331	0.8302	99939
39720	Union County, Pennsylvania	39	0.8331	0.8302	99939
39730	Venango County, Pennsylvania	39	0.8331	0.8302	99939
39740	Warren County, Pennsylvania	39	0.8331	0.8302	99939
39750	Washington County, Pennsylvania	6280	0.8868	0.8853	38300
39760	Wayne County, Pennsylvania	39	0.8331	0.8302	99939
39770	Westmoreland County, Pennsylvania	6280	0.8868	0.8853	38300
39790	Wyoming County, Pennsylvania	7560	0.8533	0.8548	42540
39800	York County, Pennsylvania	9280	0.9420	0.9420	49620
40010	Adjuntas County, Puerto Rico	40	0.3608	0.4047	99940
40020	Aguada County, Puerto Rico	0060	0.4881	0.4743	10380
40030	Aguadilla County, Puerto Rico	0060	0.4881	0.4743	10380
40040	Aguas Buenas County, Puerto Rico	7440	0.4855	0.4686	41980
40050	Aibonito County, Puerto Rico	40	0.3608	0.4686	41980
40060	Anasco County, Puerto Rico	4840	0.4246	0.4743	10380
40070	Arecibo County, Puerto Rico	0470	0.4116	0.4686	41980
40080	Arroyo County, Puerto Rico	40	0.3608	0.3184	25020
40090	Barceloneta County, Puerto Rico	7440	0.4855	0.4686	41980
40100	Barranquitas County, Puerto Rico	40	0.3608	0.4686	41980
40110	Bayamon County, Puerto Rico	7440	0.4855	0.4686	41980
40120	Cabo Rojo County, Puerto Rico	4840	0.4246	0.4655	41900
40130	Caguas County, Puerto Rico	1310	0.4020	0.4686	41980
40140	Camuy County, Puerto Rico	0470	0.4116	0.4686	41980
40145	Canovanas County, Puerto Rico	7440	0.4855	0.4686	41980
40150	Carolina County, Puerto Rico	7440	0.4855	0.4686	41980
40160	Catano County, Puerto Rico	7440	0.4855	0.4686	41980
40170	Cayey County, Puerto Rico	1310	0.4020	0.4686	41980
40180	Ceiba County, Puerto Rico	7440	0.4855	0.4157	21940
40190	Ciales County, Puerto Rico	40	0.3608	0.4686	41980
40200	Cidra County, Puerto Rico	1310	0.4020	0.4686	41980
40210	Coamo County, Puerto Rico	40	0.3608	0.4047	99940
40220	Comerio County, Puerto Rico	7440	0.4855	0.4686	41980
40230	Corozal County, Puerto Rico	7440	0.4855	0.4686	41980
40240	Culebra County, Puerto Rico	40	0.3608	0.4047	99940
40250	Dorado County, Puerto Rico	7440	0.4855	0.4686	41980
40260	Fajardo County, Puerto Rico	7440	0.4855	0.4157	21940
40265	Florida County, Puerto Rico	7440	0.4855	0.4686	41980
40270	Guanica County, Puerto Rico	40	0.3608	0.4413	49500
40280	Guayama County, Puerto Rico	40	0.3608	0.3184	25020
40290	Guayanilla County, Puerto Rico	6360	0.5091	0.4413	49500
40300	Guaynabo County, Puerto Rico	7440	0.4855	0.4686	41980
40310	Gurabo County, Puerto Rico	1310	0.4020	0.4686	41980
40320	Hatillo County, Puerto Rico	0470	0.4116	0.4686	41980
40330	Hormigueros County, Puerto Rico	4840	0.4246	0.4017	32420
40340	Humacao County, Puerto Rico	7440	0.4855	0.4686	41980
40350	Isabela County, Puerto Rico	40	0.3608	0.4743	10380
40360	Jayuya County, Puerto Rico	40	0.3608	0.4047	99940
40370	Juana Diaz County, Puerto Rico	6360	0.5091	0.5177	38660
40380	Juncos County, Puerto Rico	7440	0.4855	0.4686	41980
40390	Lajas County, Puerto Rico	40	0.3608	0.4655	41900
40400	Lares County, Puerto Rico	40	0.3608	0.4743	10380
40410	Las Marias County, Puerto Rico	40	0.3608	0.4047	99940
40420	Las Piedras County, Puerto Rico	7440	0.4855	0.4686	41980
40430	Loiza County, Puerto Rico	7440	0.4855	0.4686	41980
40440	Luquillo County, Puerto Rico	7440	0.4855	0.4157	21940
40450	Manati County, Puerto Rico	7440	0.4855	0.4686	41980
40460	Maricao County, Puerto Rico	40	0.3608	0.4047	99940
40470	Maunabo County, Puerto Rico	40	0.3608	0.4686	41980
40480	Mayaguez County, Puerto Rico	4840	0.4246	0.4017	32420
40490	Moca County, Puerto Rico	0060	0.4881	0.4743	10380
40500	Morovis County, Puerto Rico	7440	0.4855	0.4686	41980
40510	Naguabo County, Puerto Rico	7440	0.4855	0.4686	41980
40520	Naranjito County, Puerto Rico	7440	0.4855	0.4686	41980
40530	Orocovis County, Puerto Rico	40	0.3608	0.4686	41980
40540	Patillas County, Puerto Rico	40	0.3608	0.3184	25020
40550	Penuelas County, Puerto Rico	6360	0.5091	0.4413	49500
40560	Ponce County, Puerto Rico	6360	0.5091	0.5177	38660
40570	Quebradillas County, Puerto Rico	40	0.3608	0.4686	41980
40580	Rincon County, Puerto Rico	40	0.3608	0.4743	10380
40590	Rio Grande County, Puerto Rico	7440	0.4855	0.4686	41980
40610	Sabana Grande County, Puerto Rico	4840	0.4246	0.4655	41900
40620	Salinas County, Puerto Rico	40	0.3608	0.4047	99940
40630	San German County, Puerto Rico	4840	0.4246	0.4655	41900
40640	San Juan County, Puerto Rico	7440	0.4855	0.4686	41980
40650	San Lorenzo County, Puerto Rico	1310	0.4020	0.4686	41980
40660	San Sebastian County, Puerto Rico	40	0.3608	0.4743	10380
40670	Santa Isabel County, Puerto Rico	40	0.3608	0.4047	99940
40680	Toa Alta County, Puerto Rico	7440	0.4855	0.4686	41980
40690	Toa Baja County, Puerto Rico	7440	0.4855	0.4686	41980
40700	Trujillo Alto County, Puerto Rico	7440	0.4855	0.4686	41980
40710	Utuado County, Puerto Rico	40	0.3608	0.4047	99940
40720	Vega Alta County, Puerto Rico	7440	0.4855	0.4686	41980
40730	Vega Baja County, Puerto Rico	7440	0.4855	0.4686	41980
40740	Vieques County, Puerto Rico	40	0.3608	0.4047	99940
40750	Villalba County, Puerto Rico	6360	0.5091	0.5177	38660
40760	Yabucoa County, Puerto Rico	7440	0.4855	0.4686	41980
40770	Yauco County, Puerto Rico	6360	0.5091	0.4413	49500
41000	Bristol County, Rhode Island	6483	1.1060	1.0966	39300
41010	Kent County, Rhode Island	6483	1.1060	1.0966	39300
41020	Newport County, Rhode Island	6483	1.1060	1.0966	39300
41030	Providence County, Rhode Island	6483	1.1060	1.0966	39300
41050	Washington County, Rhode Island	6483	1.1060	1.0966	39300
42000	Abbeville County, S Carolina	42	0.8634	0.8641	99942
42010	Aiken County, S Carolina	0600	0.9619	0.9565	12260
42020	Allendale County, S Carolina	42	0.8634	0.8641	99942
42030	Anderson County, S Carolina	3160	0.9677	0.8897	11340
42040	Bamberg County, S Carolina	42	0.8634	0.8641	99942
42050	Barnwell County, S Carolina	42	0.8634	0.8641	99942
42060	Beaufort County, S Carolina	42	0.8634	0.8641	99942
42070	Berkeley County, S Carolina	1440	0.9438	0.9438	16700
42080	Calhoun County, S Carolina	42	0.8634	0.9047	17900
42090	Charleston County, S Carolina	1440	0.9438	0.9438	16700
42100	Cherokee County, S Carolina	3160	0.9677	0.8641	99942
42110	Chester County, S Carolina	42	0.8634	0.8641	99942
42120	Chesterfield County, S Carolina	42	0.8634	0.8641	99942
42130	Clarendon County, S Carolina	42	0.8634	0.8641	99942
42140	Colleton County, S Carolina	42	0.8634	0.8641	99942
42150	Darlington County, S Carolina	42	0.8634	0.8964	22500
42160	Dillon County, S Carolina	42	0.8634	0.8641	99942
42170	Dorchester County, S Carolina	1440	0.9438	0.9438	16700
42180	Edgefield County, S Carolina	0600	0.9619	0.9565	12260
42190	Fairfield County, S Carolina	42	0.8634	0.9047	17900
42200	Florence County, S Carolina	2655	0.9060	0.8964	22500
42210	Georgetown County, S Carolina	42	0.8634	0.8641	99942
42220	Greenville County, S Carolina	3160	0.9677	1.0165	24860
42230	Greenwood County, S Carolina	42	0.8634	0.8641	99942
42240	Hampton County, S Carolina	42	0.8634	0.8641	99942
42250	Horry County, S Carolina	5330	0.8873	0.8873	34820
42260	Jasper County, S Carolina	42	0.8634	0.8641	99942
42270	Kershaw County, S Carolina	42	0.8634	0.9047	17900
42280	Lancaster County, S Carolina	42	0.8634	0.8641	99942
42290	Laurens County, S Carolina	42	0.8634	1.0165	24860
42300	Lee County, S Carolina	42	0.8634	0.8641	99942
42310	Lexington County, S Carolina	1760	0.9071	0.9047	17900
42320	Mc Cormick County, S Carolina	42	0.8634	0.8641	99942
42330	Marion County, S Carolina	42	0.8634	0.8641	99942
42340	Marlboro County, S Carolina	42	0.8634	0.8641	99942
42350	Newberry County, S Carolina	42	0.8634	0.8641	99942
42360	Oconee County, S Carolina	42	0.8634	0.8641	99942
42370	Orangeburg County, S Carolina	42	0.8634	0.8641	99942
42380	Pickens County, S Carolina	3160	0.9677	1.0165	24860
42390	Richland County, S Carolina	1760	0.9071	0.9047	17900
42400	Saluda County, S Carolina	42	0.8634	0.9047	17900
42410	Spartanburg County, S Carolina	3160	0.9677	0.9181	43900
42420	Sumter County, S Carolina	8140	0.8386	0.8386	44940
42430	Union County, S Carolina	42	0.8634	0.8641	99942
42440	Williamsburg County, S Carolina	42	0.8634	0.8641	99942
42450	York County, S Carolina	1520	0.9725	0.9760	16740
43010	Aurora County, S Dakota	43	0.8476	0.8484	99943
43020	Beadle County, S Dakota	43	0.8476	0.8484	99943
43030	Bennett County, S Dakota	43	0.8476	0.8484	99943
43040	Bon Homme County, S Dakota	43	0.8476	0.8484	99943
43050	Brookings County, S Dakota	43	0.8476	0.8484	99943
43060	Brown County, S Dakota	43	0.8476	0.8484	99943
43070	Brule County, S Dakota	43	0.8476	0.8484	99943
43080	Buffalo County, S Dakota	43	0.8476	0.8484	99943
43090	Butte County, S Dakota	43	0.8476	0.8484	99943
43100	Campbell County, S Dakota	43	0.8476	0.8484	99943
43110	Charles Mix County, S Dakota	43	0.8476	0.8484	99943
43120	Clark County, S Dakota	43	0.8476	0.8484	99943
43130	Clay County, S Dakota	43	0.8476	0.8484	99943
43140	Codington County, S Dakota	43	0.8476	0.8484	99943
43150	Corson County, S Dakota	43	0.8476	0.8484	99943
43160	Custer County, S Dakota	43	0.8476	0.8484	99943
43170	Davison County, S Dakota	43	0.8476	0.8484	99943
43180	Day County, S Dakota	43	0.8476	0.8484	99943
43190	Deuel County, S Dakota	43	0.8476	0.8484	99943
43200	Dewey County, S Dakota	43	0.8476	0.8484	99943
43210	Douglas County, S Dakota	43	0.8476	0.8484	99943
43220	Edmunds County, S Dakota	43	0.8476	0.8484	99943
43230	Fall River County, S Dakota	43	0.8476	0.8484	99943
43240	Faulk County, S Dakota	43	0.8476	0.8484	99943
43250	Grant County, S Dakota	43	0.8476	0.8484	99943
43260	Gregory County, S Dakota	43	0.8476	0.8484	99943
43270	Haakon County, S Dakota	43	0.8476	0.8484	99943
43280	Hamlin County, S Dakota	43	0.8476	0.8484	99943
43290	Hand County, S Dakota	43	0.8476	0.8484	99943
43300	Hanson County, S Dakota	43	0.8476	0.8484	99943
43310	Harding County, S Dakota	43	0.8476	0.8484	99943
43320	Hughes County, S Dakota	43	0.8476	0.8484	99943
43330	Hutchinson County, S Dakota	43	0.8476	0.8484	99943
43340	Hyde County, S Dakota	43	0.8476	0.8484	99943
43350	Jackson County, S Dakota	43	0.8476	0.8484	99943
43360	Jerauld County, S Dakota	43	0.8476	0.8484	99943
43370	Jones County, S Dakota	43	0.8476	0.8484	99943
43380	Kingsbury County, S Dakota	43	0.8476	0.8484	99943
43390	Lake County, S Dakota	43	0.8476	0.8484	99943
43400	Lawrence County, S Dakota	43	0.8476	0.8484	99943
43410	Lincoln County, S Dakota	7760	0.9645	0.9645	43620
43420	Lyman County, S Dakota	43	0.8476	0.8484	99943
43430	Mc Cook County, S Dakota	43	0.8476	0.9645	43620
43440	Mc Pherson County, S Dakota	43	0.8476	0.8484	99943
43450	Marshall County, S Dakota	43	0.8476	0.8484	99943
43460	Meade County, S Dakota	43	0.8476	0.9021	39660
43470	Mellette County, S Dakota	43	0.8476	0.8484	99943
43480	Miner County, S Dakota	43	0.8476	0.8484	99943
43490	Minnehaha County, S Dakota	7760	0.9645	0.9645	43620
43500	Moody County, S Dakota	43	0.8476	0.8484	99943
43510	Pennington County, S Dakota	6660	0.9021	0.9021	39660
43520	Perkins County, S Dakota	43	0.8476	0.8484	99943
43530	Potter County, S Dakota	43	0.8476	0.8484	99943
43540	Roberts County, S Dakota	43	0.8476	0.8484	99943
43550	Sanborn County, S Dakota	43	0.8476	0.8484	99943
43560	Shannon County, S Dakota	43	0.8476	0.8484	99943
43570	Spink County, S Dakota	43	0.8476	0.8484	99943
43580	Stanley County, S Dakota	43	0.8476	0.8484	99943
43590	Sully County, S Dakota	43	0.8476	0.8484	99943
43600	Todd County, S Dakota	43	0.8476	0.8484	99943
43610	Tripp County, S Dakota	43	0.8476	0.8484	99943
43620	Turner County, S Dakota	43	0.8476	0.9645	43620
43630	Union County, S Dakota	43	0.8476	0.9376	43580
43640	Walworth County, S Dakota	43	0.8476	0.8484	99943
43650	Washabaugh County, S Dakota	43	0.8476	0.8484	99943
43670	Yankton County, S Dakota	43	0.8476	0.8484	99943
43680	Ziebach County, S Dakota	43	0.8476	0.8484	99943
44000	Anderson County, Tennessee	3840	0.8411	0.8454	28940
44010	Bedford County, Tennessee	44	0.7988	0.7888	99944
44020	Benton County, Tennessee	44	0.7988	0.7888	99944
44030	Bledsoe County, Tennessee	44	0.7988	0.7888	99944
44040	Blount County, Tennessee	3840	0.8411	0.8454	28940
44050	Bradley County, Tennessee	44	0.7988	0.8141	17420
44060	Campbell County, Tennessee	44	0.7988	0.7888	99944
44070	Cannon County, Tennessee	44	0.7988	0.9769	34980
44080	Carroll County, Tennessee	44	0.7988	0.7888	99944
44090	Carter County, Tennessee	3660	0.8015	0.7945	27740
44100	Cheatham County, Tennessee	5360	0.9787	0.9769	34980
44110	Chester County, Tennessee	3580	0.8973	0.8973	27180
44120	Claiborne County, Tennessee	44	0.7988	0.7888	99944
44130	Clay County, Tennessee	44	0.7988	0.7888	99944
44140	Cocke County, Tennessee	44	0.7988	0.7888	99944
44150	Coffee County, Tennessee	44	0.7988	0.7888	99944
44160	Crockett County, Tennessee	44	0.7988	0.7888	99944
44170	Cumberland County, Tennessee	44	0.7988	0.7888	99944
44180	Davidson County, Tennessee	5360	0.9787	0.9769	34980
44190	Decatur County, Tennessee	44	0.7988	0.7888	99944
44200	De Kalb County, Tennessee	44	0.7988	0.7888	99944
44210	Dickson County, Tennessee	5360	0.9787	0.9769	34980
44220	Dyer County, Tennessee	44	0.7988	0.7888	99944
44230	Fayette County, Tennessee	4920	0.9360	0.9341	32820
44240	Fentress County, Tennessee	44	0.7988	0.7888	99944
44250	Franklin County, Tennessee	44	0.7988	0.7888	99944
44260	Gibson County, Tennessee	44	0.7988	0.7888	99944
44270	Giles County, Tennessee	44	0.7988	0.7888	99944
44280	Grainger County, Tennessee	44	0.7988	0.8753	34100
44290	Greene County, Tennessee	44	0.7988	0.7888	99944
44300	Grundy County, Tennessee	44	0.7988	0.7888	99944
44310	Hamblen County, Tennessee	44	0.7988	0.8753	34100
44320	Hamilton County, Tennessee	1560	0.9098	0.9098	16860
44330	Hancock County, Tennessee	44	0.7988	0.7888	99944
44340	Hardeman County, Tennessee	44	0.7988	0.7888	99944
44350	Hardin County, Tennessee	44	0.7988	0.7888	99944
44360	Hawkins County, Tennessee	3660	0.8015	0.8062	28700
44370	Haywood County, Tennessee	44	0.7988	0.7888	99944
44380	Henderson County, Tennessee	44	0.7988	0.7888	99944
44390	Henry County, Tennessee	44	0.7988	0.7888	99944
44400	Hickman County, Tennessee	44	0.7988	0.9769	34980
44410	Houston County, Tennessee	44	0.7988	0.7888	99944
44420	Humphreys County, Tennessee	44	0.7988	0.7888	99944
44430	Jackson County, Tennessee	44	0.7988	0.7888	99944
44440	Jefferson County, Tennessee	44	0.7988	0.8753	34100
44450	Johnson County, Tennessee	44	0.7988	0.7888	99944
44460	Knox County, Tennessee	3840	0.8411	0.8454	28940
44470	Lake County, Tennessee	44	0.7988	0.7888	99944
44480	Lauderdale County, Tennessee	44	0.7988	0.7888	99944
44490	Lawrence County, Tennessee	44	0.7988	0.7888	99944
44500	Lewis County, Tennessee	44	0.7988	0.7888	99944
44510	Lincoln County, Tennessee	44	0.7988	0.7888	99944
44520	Loudon County, Tennessee	3840	0.8411	0.8454	28940
44530	Mc Minn County, Tennessee	44	0.7988	0.7888	99944
44540	Mc Nairy County, Tennessee	44	0.7988	0.7888	99944
44550	Macon County, Tennessee	44	0.7988	0.9769	34980
44560	Madison County, Tennessee	3580	0.8973	0.8973	27180
44570	Marion County, Tennessee	1560	0.9098	0.9098	16860
44580	Marshall County, Tennessee	44	0.7988	0.7888	99944
44590	Maury County, Tennessee	44	0.7988	0.7888	99944
44600	Meigs County, Tennessee	44	0.7988	0.7888	99944
44610	Monroe County, Tennessee	44	0.7988	0.7888	99944
44620	Montgomery County, Tennessee	1660	0.8292	0.8292	17300
44630	Moore County, Tennessee	44	0.7988	0.7888	99944
44640	Morgan County, Tennessee	44	0.7988	0.7888	99944
44650	Obion County, Tennessee	44	0.7988	0.7888	99944
44660	Overton County, Tennessee	44	0.7988	0.7888	99944
44670	Perry County, Tennessee	44	0.7988	0.7888	99944
44680	Pickett County, Tennessee	44	0.7988	0.7888	99944
44690	Polk County, Tennessee	44	0.7988	0.8141	17420
44700	Putnam County, Tennessee	44	0.7988	0.7888	99944
44710	Rhea County, Tennessee	44	0.7988	0.7888	99944
44720	Roane County, Tennessee	44	0.7988	0.7888	99944
44730	Robertson County, Tennessee	5360	0.9787	0.9769	34980
44740	Rutherford County, Tennessee	5360	0.9787	0.9769	34980
44750	Scott County, Tennessee	44	0.7988	0.7888	99944
44760	Sequatchie County, Tennessee	44	0.7988	0.9098	16860
44770	Sevier County, Tennessee	3840	0.8411	0.7888	99944
44780	Shelby County, Tennessee	4920	0.9360	0.9341	32820
44790	Smith County, Tennessee	44	0.7988	0.9769	34980
44800	Stewart County, Tennessee	44	0.7988	0.8292	17300
44810	Sullivan County, Tennessee	3660	0.8015	0.8062	28700
44820	Sumner County, Tennessee	5360	0.9787	0.9769	34980
44830	Tipton County, Tennessee	4920	0.9360	0.9341	32820
44840	Trousdale County, Tennessee	44	0.7988	0.9769	34980
44850	Unicoi County, Tennessee	3660	0.8015	0.7945	27740
44860	Union County, Tennessee	3840	0.8411	0.8454	28940
44870	Van Buren County, Tennessee	44	0.7988	0.7888	99944
44880	Warren County, Tennessee	44	0.7988	0.7888	99944
44890	Washington County, Tennessee	3660	0.8015	0.7945	27740
44900	Wayne County, Tennessee	44	0.7988	0.7888	99944
44910	Weakley County, Tennessee	44	0.7988	0.7888	99944
44920	White County, Tennessee	44	0.7988	0.7888	99944
44930	Williamson County, Tennessee	5360	0.9787	0.9769	34980
44940	Wilson County, Tennessee	5360	0.9787	0.9769	34980
45000	Anderson County, Texas	45	0.7936	0.8007	99945
45010	Andrews County, Texas	45	0.7936	0.8007	99945
45020	Angelina County, Texas	45	0.7936	0.8007	99945
45030	Aransas County, Texas	45	0.7936	0.8559	18580
45040	Archer County, Texas	9080	0.8373	0.8294	48660
45050	Armstrong County, Texas	45	0.7936	0.9166	11100
45060	Atascosa County, Texas	45	0.7936	0.8989	41700
45070	Austin County, Texas	45	0.7936	1.0005	26420
45080	Bailey County, Texas	45	0.7936	0.8007	99945
45090	Bandera County, Texas	45	0.7936	0.8989	41700
45100	Bastrop County, Texas	0640	0.9450	0.9450	12420
45110	Baylor County, Texas	45	0.7936	0.8007	99945
45113	Bee County, Texas	45	0.7936	0.8007	99945
45120	Bell County, Texas	3810	0.8535	0.8535	28660
45130	Bexar County, Texas	7240	0.8993	0.8989	41700
45140	Blanco County, Texas	45	0.7936	0.8007	99945
45150	Borden County, Texas	45	0.7936	0.8007	99945
45160	Bosque County, Texas	45	0.7936	0.8007	99945
45170	Bowie County, Texas	8360	0.8291	0.8291	45500
45180	Brazoria County, Texas	1145	0.8572	1.0005	26420
45190	Brazos County, Texas	1260	0.8909	0.8909	17780
45200	Brewster County, Texas	45	0.7936	0.8007	99945
45201	Briscoe County, Texas	45	0.7936	0.8007	99945
45210	Brooks County, Texas	45	0.7936	0.8007	99945
45220	Brown County, Texas	45	0.7936	0.8007	99945
45221	Burleson County, Texas	45	0.7936	0.8909	17780
45222	Burnet County, Texas	45	0.7936	0.8007	99945
45223	Caldwell County, Texas	0640	0.9450	0.9450	12420
45224	Calhoun County, Texas	45	0.7936	0.8168	47020
45230	Callahan County, Texas	45	0.7936	0.7904	10180
45240	Cameron County, Texas	1240	0.9822	0.9822	15180
45250	Camp County, Texas	45	0.7936	0.8007	99945
45251	Carson County, Texas	45	0.7936	0.9166	11100
45260	Cass County, Texas	45	0.7936	0.8007	99945
45270	Castro County, Texas	45	0.7936	0.8007	99945
45280	Chambers County, Texas	3360	1.0101	1.0005	26420
45281	Cherokee County, Texas	45	0.7936	0.8007	99945
45290	Childress County, Texas	45	0.7936	0.8007	99945
45291	Clay County, Texas	45	0.7936	0.8294	48660
45292	Cochran County, Texas	45	0.7936	0.8007	99945
45300	Coke County, Texas	45	0.7936	0.8007	99945
45301	Coleman County, Texas	45	0.7936	0.8007	99945
45310	Collin County, Texas	1920	1.0211	1.0233	19124
45311	Collingsworth County, Texas	45	0.7936	0.8007	99945
45312	Colorado County, Texas	45	0.7936	0.8007	99945
45320	Comal County, Texas	7240	0.8993	0.8989	41700
45321	Comanche County, Texas	45	0.7936	0.8007	99945
45330	Concho County, Texas	45	0.7936	0.8007	99945
45340	Cooke County, Texas	45	0.7936	0.8007	99945
45341	Coryell County, Texas	3810	0.8535	0.8535	28660
45350	Cottle County, Texas	45	0.7936	0.8007	99945
45360	Crane County, Texas	45	0.7936	0.8007	99945
45361	Crockett County, Texas	45	0.7936	0.8007	99945
45362	Crosby County, Texas	45	0.7936	0.8792	31180
45370	Culberson County, Texas	45	0.7936	0.8007	99945
45380	Dallam County, Texas	45	0.7936	0.8007	99945
45390	Dallas County, Texas	1920	1.0211	1.0233	19124
45391	Dawson County, Texas	45	0.7936	0.8007	99945
45392	Deaf Smith County, Texas	45	0.7936	0.8007	99945
45400	Delta County, Texas	45	0.7936	1.0233	19124
45410	Denton County, Texas	1920	1.0211	1.0233	19124
45420	De Witt County, Texas	45	0.7936	0.8007	99945
45421	Dickens County, Texas	45	0.7936	0.8007	99945
45430	Dimmit County, Texas	45	0.7936	0.8007	99945
45431	Donley County, Texas	45	0.7936	0.8007	99945
45440	Duval County, Texas	45	0.7936	0.8007	99945
45450	Eastland County, Texas	45	0.7936	0.8007	99945
45451	Ector County, Texas	5800	0.9751	0.9894	36220
45460	Edwards County, Texas	45	0.7936	0.8007	99945
45470	Ellis County, Texas	1920	1.0211	1.0233	19124
45480	El Paso County, Texas	2320	0.8924	0.8924	21340
45490	Erath County, Texas	45	0.7936	0.8007	99945
45500	Falls County, Texas	45	0.7936	0.8007	99945
45510	Fannin County, Texas	45	0.7936	0.8007	99945
45511	Fayette County, Texas	45	0.7936	0.8007	99945
45520	Fisher County, Texas	45	0.7936	0.8007	99945
45521	Floyd County, Texas	45	0.7936	0.8007	99945
45522	Foard County, Texas	45	0.7936	0.8007	99945
45530	Fort Bend County, Texas	3360	1.0101	1.0005	26420
45531	Franklin County, Texas	45	0.7936	0.8007	99945
45540	Freestone County, Texas	45	0.7936	0.8007	99945
45541	Frio County, Texas	45	0.7936	0.8007	99945
45542	Gaines County, Texas	45	0.7936	0.8007	99945
45550	Galveston County, Texas	2920	0.9645	1.0005	26420
45551	Garza County, Texas	45	0.7936	0.8007	99945
45552	Gillespie County, Texas	45	0.7936	0.8007	99945
45560	Glasscock County, Texas	45	0.7936	0.8007	99945
45561	Goliad County, Texas	45	0.7936	0.8168	47020
45562	Gonzales County, Texas	45	0.7936	0.8007	99945
45563	Gray County, Texas	45	0.7936	0.8007	99945
45564	Grayson County, Texas	7640	0.9516	0.9516	43300
45570	Gregg County, Texas	4420	0.8897	0.8739	30980
45580	Grimes County, Texas	45	0.7936	0.8007	99945
45581	Guadaloupe County, Texas	7240	0.8993	0.8989	41700
45582	Hale County, Texas	45	0.7936	0.8007	99945
45583	Hall County, Texas	45	0.7936	0.8007	99945
45590	Hamilton County, Texas	45	0.7936	0.8007	99945
45591	Hansford County, Texas	45	0.7936	0.8007	99945
45592	Hardeman County, Texas	45	0.7936	0.8007	99945
45600	Hardin County, Texas	0840	0.8421	0.8421	13140
45610	Harris County, Texas	3360	1.0101	1.0005	26420
45620	Harrison County, Texas	4420	0.8897	0.8007	99945
45621	Hartley County, Texas	45	0.7936	0.8007	99945
45630	Haskell County, Texas	45	0.7936	0.8007	99945
45631	Hays County, Texas	0640	0.9450	0.9450	12420
45632	Hemphill County, Texas	45	0.7936	0.8007	99945
45640	Henderson County, Texas	1920	1.0211	0.8007	99945
45650	Hidalgo County, Texas	4880	0.8943	0.8943	32580
45651	Hill County, Texas	45	0.7936	0.8007	99945
45652	Hockley County, Texas	45	0.7936	0.8007	99945
45653	Hood County, Texas	2800	0.9545	0.8007	99945
45654	Hopkins County, Texas	45	0.7936	0.8007	99945
45660	Houston County, Texas	45	0.7936	0.8007	99945
45661	Howard County, Texas	45	0.7936	0.8007	99945
45662	Hudspeth County, Texas	45	0.7936	0.8007	99945
45670	Hunt County, Texas	1920	1.0211	1.0233	19124
45671	Hutchinson County, Texas	45	0.7936	0.8007	99945
45672	Irion County, Texas	45	0.7936	0.8280	41660
45680	Jack County, Texas	45	0.7936	0.8007	99945
45681	Jackson County, Texas	45	0.7936	0.8007	99945
45690	Jasper County, Texas	45	0.7936	0.8007	99945
45691	Jeff Davis County, Texas	45	0.7936	0.8007	99945
45700	Jefferson County, Texas	0840	0.8421	0.8421	13140
45710	Jim Hogg County, Texas	45	0.7936	0.8007	99945
45711	Jim Wells County, Texas	45	0.7936	0.8007	99945
45720	Johnson County, Texas	2800	0.9545	0.9510	23104
45721	Jones County, Texas	45	0.7936	0.7904	10180
45722	Karnes County, Texas	45	0.7936	0.8007	99945
45730	Kaufman County, Texas	1920	1.0211	1.0233	19124
45731	Kendall County, Texas	45	0.7936	0.8989	41700
45732	Kenedy County, Texas	45	0.7936	0.8007	99945
45733	Kent County, Texas	45	0.7936	0.8007	99945
45734	Kerr County, Texas	45	0.7936	0.8007	99945
45740	Kimble County, Texas	45	0.7936	0.8007	99945
45741	King County, Texas	45	0.7936	0.8007	99945
45742	Kinney County, Texas	45	0.7936	0.8007	99945
45743	Kleberg County, Texas	45	0.7936	0.8007	99945
45744	Knox County, Texas	45	0.7936	0.8007	99945
45750	Lamar County, Texas	45	0.7936	0.8007	99945
45751	Lamb County, Texas	45	0.7936	0.8007	99945
45752	Lampasas County, Texas	45	0.7936	0.8535	28660
45753	La Salle County, Texas	45	0.7936	0.8007	99945
45754	Lavaca County, Texas	45	0.7936	0.8007	99945
45755	Lee County, Texas	45	0.7936	0.8007	99945
45756	Leon County, Texas	45	0.7936	0.8007	99945
45757	Liberty County, Texas	3360	1.0101	1.0005	26420
45758	Limestone County, Texas	45	0.7936	0.8007	99945
45759	Lipscomb County, Texas	45	0.7936	0.8007	99945
45760	Live Oak County, Texas	45	0.7936	0.8007	99945
45761	Llano County, Texas	45	0.7936	0.8007	99945
45762	Loving County, Texas	45	0.7936	0.8007	99945
45770	Lubbock County, Texas	4600	0.8792	0.8792	31180
45771	Lynn County, Texas	45	0.7936	0.8007	99945
45772	Mc Culloch County, Texas	45	0.7936	0.8007	99945
45780	Mc Lennan County, Texas	8800	0.8527	0.8527	47380
45781	Mc Mullen County, Texas	45	0.7936	0.8007	99945
45782	Madison County, Texas	45	0.7936	0.8007	99945
45783	Marion County, Texas	45	0.7936	0.8007	99945
45784	Martin County, Texas	45	0.7936	0.8007	99945
45785	Mason County, Texas	45	0.7936	0.8007	99945
45790	Matagorda County, Texas	45	0.7936	0.8007	99945
45791	Maverick County, Texas	45	0.7936	0.8007	99945
45792	Medina County, Texas	45	0.7936	0.8989	41700
45793	Menard County, Texas	45	0.7936	0.8007	99945
45794	Midland County, Texas	5800	0.9751	0.9523	33260
45795	Milam County, Texas	45	0.7936	0.8007	99945
45796	Mills County, Texas	45	0.7936	0.8007	99945
45797	Mitchell County, Texas	45	0.7936	0.8007	99945
45800	Montague County, Texas	45	0.7936	0.8007	99945
45801	Montgomery County, Texas	3360	1.0101	1.0005	26420
45802	Moore County, Texas	45	0.7936	0.8007	99945
45803	Morris County, Texas	45	0.7936	0.8007	99945
45804	Motley County, Texas	45	0.7936	0.8007	99945
45810	Nacogdoches County, Texas	45	0.7936	0.8007	99945
45820	Navarro County, Texas	45	0.7936	0.8007	99945
45821	Newton County, Texas	45	0.7936	0.8007	99945
45822	Nolan County, Texas	45	0.7936	0.8007	99945
45830	Nueces County, Texas	1880	0.8559	0.8559	18580
45831	Ochiltree County, Texas	45	0.7936	0.8007	99945
45832	Oldham County, Texas	45	0.7936	0.8007	99945
45840	Orange County, Texas	0840	0.8421	0.8421	13140
45841	Palo Pinto County, Texas	45	0.7936	0.8007	99945
45842	Panola County, Texas	45	0.7936	0.8007	99945
45843	Parker County, Texas	2800	0.9545	0.9510	23104
45844	Parmer County, Texas	45	0.7936	0.8007	99945
45845	Pecos County, Texas	45	0.7936	0.8007	99945
45850	Polk County, Texas	45	0.7936	0.8007	99945
45860	Potter County, Texas	0320	0.9166	0.9166	11100
45861	Presidio County, Texas	45	0.7936	0.8007	99945
45870	Rains County, Texas	45	0.7936	0.8007	99945
45871	Randall County, Texas	0320	0.9166	0.9166	11100
45872	Reagan County, Texas	45	0.7936	0.8007	99945
45873	Real County, Texas	45	0.7936	0.8007	99945
45874	Red River County, Texas	45	0.7936	0.8007	99945
45875	Reeves County, Texas	45	0.7936	0.8007	99945
45876	Refugio County, Texas	45	0.7936	0.8007	99945
45877	Roberts County, Texas	45	0.7936	0.8007	99945
45878	Robertson County, Texas	45	0.7936	0.8909	17780
45879	Rockwall County, Texas	1920	1.0211	1.0233	19124
45880	Runnels County, Texas	45	0.7936	0.8007	99945
45881	Rusk County, Texas	45	0.7936	0.8739	30980
45882	Sabine County, Texas	45	0.7936	0.8007	99945
45883	San Augustine County, Texas	45	0.7936	0.8007	99945
45884	San Jacinto County, Texas	45	0.7936	1.0005	26420
45885	San Patricio County, Texas	1880	0.8559	0.8559	18580
45886	San Saba County, Texas	45	0.7936	0.8007	99945
45887	Schleicher County, Texas	45	0.7936	0.8007	99945
45888	Scurry County, Texas	45	0.7936	0.8007	99945
45889	Shackelford County, Texas	45	0.7936	0.8007	99945
45890	Shelby County, Texas	45	0.7936	0.8007	99945
45891	Sherman County, Texas	45	0.7936	0.8007	99945
45892	Smith County, Texas	8640	0.9307	0.9307	46340
45893	Somervell County, Texas	45	0.7936	0.8007	99945
45900	Starr County, Texas	45	0.7936	0.8007	99945
45901	Stephens County, Texas	45	0.7936	0.8007	99945
45902	Sterling County, Texas	45	0.7936	0.8007	99945
45903	Stonewall County, Texas	45	0.7936	0.8007	99945
45904	Sutton County, Texas	45	0.7936	0.8007	99945
45905	Swisher County, Texas	45	0.7936	0.8007	99945
45910	Tarrant County, Texas	2800	0.9545	0.9510	23104
45911	Taylor County, Texas	0040	0.8062	0.7904	10180
45912	Terrell County, Texas	45	0.7936	0.8007	99945
45913	Terry County, Texas	45	0.7936	0.8007	99945
45920	Throckmorton County, Texas	45	0.7936	0.8007	99945
45921	Titus County, Texas	45	0.7936	0.8007	99945
45930	Tom Green County, Texas	7200	0.8280	0.8280	41660
45940	Travis County, Texas	0640	0.9450	0.9450	12420
45941	Trinity County, Texas	45	0.7936	0.8007	99945
45942	Tyler County, Texas	45	0.7936	0.8007	99945
45943	Upshur County, Texas	4420	0.8897	0.8739	30980
45944	Upton County, Texas	45	0.7936	0.8007	99945
45945	Uvalde County, Texas	45	0.7936	0.8007	99945
45946	Val Verde County, Texas	45	0.7936	0.8007	99945
45947	Van Zandt County, Texas	45	0.7936	0.8007	99945
45948	Victoria County, Texas	8750	0.8168	0.8168	47020
45949	Walker County, Texas	45	0.7936	0.8007	99945
45950	Waller County, Texas	3360	1.0101	1.0005	26420
45951	Ward County, Texas	45	0.7936	0.8007	99945
45952	Washington County, Texas	45	0.7936	0.8007	99945
45953	Webb County, Texas	4080	0.8076	0.8076	29700
45954	Wharton County, Texas	45	0.7936	0.8007	99945
45955	Wheeler County, Texas	45	0.7936	0.8007	99945
45960	Wichita County, Texas	9080	0.8373	0.8294	48660
45961	Wilbarger County, Texas	45	0.7936	0.8007	99945
45962	Willacy County, Texas	45	0.7936	0.8007	99945
45970	Williamson County, Texas	0640	0.9450	0.9450	12420
45971	Wilson County, Texas	7240	0.8993	0.8989	41700
45972	Winkler County, Texas	45	0.7936	0.8007	99945
45973	Wise County, Texas	45	0.7936	0.9510	23104
45974	Wood County, Texas	45	0.7936	0.8007	99945
45980	Yoakum County, Texas	45	0.7936	0.8007	99945
45981	Young County, Texas	45	0.7936	0.8007	99945
45982	Zapata County, Texas	45	0.7936	0.8007	99945
45983	Zavala County, Texas	45	0.7936	0.8007	99945
46000	Beaver County, Utah	46	0.8779	0.8126	99946
46010	Box Elder County, Utah	46	0.8779	0.8126	99946
46020	Cache County, Utah	46	0.8779	0.9173	30860
46030	Carbon County, Utah	46	0.8779	0.8126	99946
46040	Daggett County, Utah	46	0.8779	0.8126	99946
46050	Davis County, Utah	7160	0.9350	0.9038	36260
46060	Duchesne County, Utah	46	0.8779	0.8126	99946
46070	Emery County, Utah	46	0.8779	0.8126	99946
46080	Garfield County, Utah	46	0.8779	0.8126	99946
46090	Grand County, Utah	46	0.8779	0.8126	99946
46100	Iron County, Utah	46	0.8779	0.8126	99946
46110	Juab County, Utah	46	0.8779	0.9510	39340
46120	Kane County, Utah	2620	1.1857	0.8126	99946
46130	Millard County, Utah	46	0.8779	0.8126	99946
46140	Morgan County, Utah	46	0.8779	0.9038	36260
46150	Piute County, Utah	46	0.8779	0.8126	99946
46160	Rich County, Utah	46	0.8779	0.8126	99946
46170	Salt Lake County, Utah	7160	0.9350	0.9433	41620
46180	San Juan County, Utah	46	0.8779	0.8126	99946
46190	Sanpete County, Utah	46	0.8779	0.8126	99946
46200	Sevier County, Utah	46	0.8779	0.8126	99946
46210	Summit County, Utah	46	0.8779	0.9433	41620
46220	Tooele County, Utah	46	0.8779	0.9433	41620
46230	Uintah County, Utah	46	0.8779	0.8126	99946
46240	Utah County, Utah	6520	0.9510	0.9510	39340
46250	Wasatch County, Utah	46	0.8779	0.8126	99946
46260	Washington County, Utah	46	0.8779	0.9402	41100
46270	Wayne County, Utah	46	0.8779	0.8126	99946
46280	Weber County, Utah	7160	0.9350	0.9038	36260
47000	Addison County, Vermont	47	0.9840	0.9840	99947
47010	Bennington County, Vermont	47	0.9840	0.9840	99947
47020	Caledonia County, Vermont	47	0.9840	0.9840	99947
47030	Chittenden County, Vermont	1303	0.9446	0.9446	15540
47040	Essex County, Vermont	47	0.9840	0.9840	99947
47050	Franklin County, Vermont	1303	0.9446	0.9446	15540
47060	Grand Isle County, Vermont	1303	0.9446	0.9446	15540
47070	Lamoille County, Vermont	47	0.9840	0.9840	99947
47080	Orange County, Vermont	47	0.9840	0.9840	99947
47090	Orleans County, Vermont	47	0.9840	0.9840	99947
47100	Rutland County, Vermont	47	0.9840	0.9840	99947
47110	Washington County, Vermont	47	0.9840	0.9840	99947
47120	Windham County, Vermont	47	0.9840	0.9840	99947
47130	Windsor County, Vermont	47	0.9840	0.9840	99947
49000	Accomack County, Virginia	49	0.8420	0.8012	99949
49010	Albemarle County, Virginia	1540	1.0234	1.0234	16820
49011	Alexandria City County, Virginia	8840	1.0983	1.0932	47894
49020	Alleghany County, Virginia	49	0.8420	0.8012	99949
49030	Amelia County, Virginia	49	0.8420	0.9338	40060
49040	Amherst County, Virginia	4640	0.8700	0.8700	31340
49050	Appomattox County, Virginia	49	0.8420	0.8700	31340
49060	Arlington County, Virginia	8840	1.0983	1.0932	47894
49070	Augusta County, Virginia	49	0.8420	0.8012	99949
49080	Bath County, Virginia	49	0.8420	0.8012	99949
49088	Bedford City County, Virginia	4640	0.8700	0.8700	31340
49090	Bedford County, Virginia	4640	0.8700	0.8700	31340
49100	Bland County, Virginia	49	0.8420	0.8012	99949
49110	Botetourt County, Virginia	6800	0.8395	0.8383	40220
49111	Bristol City County, Virginia	3660	0.8015	0.8062	28700
49120	Brunswick County, Virginia	49	0.8420	0.8012	99949
49130	Buchanan County, Virginia	49	0.8420	0.8012	99949
49140	Buckingham County, Virginia	49	0.8420	0.8012	99949
49141	Buena Vista City County, Virginia	49	0.8420	0.8012	99949
49150	Campbell County, Virginia	4640	0.8700	0.8700	31340
49160	Caroline County, Virginia	49	0.8420	0.9338	40060
49170	Carroll County, Virginia	49	0.8420	0.8012	99949
49180	Charles City County, Virginia	6760	0.9338	0.9338	40060
49190	Charlotte County, Virginia	49	0.8420	0.8012	99949
49191	Charlottesville City County, Virginia	1540	1.0234	1.0234	16820
49194	Chesapeake County, Virginia	5720	0.8808	0.8808	47260
49200	Chesterfield County, Virginia	6760	0.9338	0.9338	40060
49210	Clarke County, Virginia	8840	1.0983	1.0932	47894
49211	Clifton Forge City County, Virginia	49	0.8420	0.8012	99949
49212	Colonial Heights County, Virginia	6760	0.9338	0.9338	40060
49213	Covington City County, Virginia	49	0.8420	0.8012	99949
49220	Craig County, Virginia	49	0.8420	0.8383	40220
49230	Culpeper County, Virginia	8840	1.0983	0.8012	99949
49240	Cumberland County, Virginia	49	0.8420	0.9338	40060
49241	Danville City County, Virginia	1950	0.8497	0.8497	19260
49250	Dickenson County, Virginia	49	0.8420	0.8012	99949
49260	Dinniddie County, Virginia	6760	0.9338	0.9338	40060
49270	Emporia County, Virginia	49	0.8420	0.8012	99949
49280	Essex County, Virginia	49	0.8420	0.8012	99949
49288	Fairfax City County, Virginia	8840	1.0983	1.0932	47894
49290	Fairfax County, Virginia	8840	1.0983	1.0932	47894
49291	Falls Church City County, Virginia	8840	1.0983	1.0932	47894
49300	Fauquier County, Virginia	8840	1.0983	1.0932	47894
49310	Floyd County, Virginia	49	0.8420	0.8012	99949
49320	Fluvanna County, Virginia	1540	1.0234	1.0234	16820
49328	Franklin City County, Virginia	49	0.8420	0.8012	99949
49330	Franklin County, Virginia	49	0.8420	0.8383	40220
49340	Frederick County, Virginia	49	0.8420	1.0224	49020
49342	Fredericksburg City County, Virginia	8840	1.0983	1.0932	47894
49343	Galax City County, Virginia	49	0.8420	0.8012	99949
49350	Giles County, Virginia	49	0.8420	0.7962	13980
49360	Gloucester County, Virginia	5720	0.8808	0.8808	47260
49370	Goochland County, Virginia	6760	0.9338	0.9338	40060
49380	Grayson County, Virginia	49	0.8420	0.8012	99949
49390	Greene County, Virginia	1540	1.0234	1.0234	16820
49400	Greensville County, Virginia	49	0.8420	0.8012	99949
49410	Halifax County, Virginia	49	0.8420	0.8012	99949
49411	Hampton City County, Virginia	5720	0.8808	0.8808	47260
49420	Hanover County, Virginia	6760	0.9338	0.9338	40060
49421	Harrisonburg City County, Virginia	49	0.8420	0.9098	25500
49430	Henrico County, Virginia	6760	0.9338	0.9338	40060
49440	Henry County, Virginia	49	0.8420	0.8012	99949
49450	Highland County, Virginia	49	0.8420	0.8012	99949
49451	Hopewell City County, Virginia	6760	0.9338	0.9338	40060
49460	Isle Of Wight County, Virginia	5720	0.8808	0.8808	47260
49470	James City Co County, Virginia	5720	0.8808	0.8808	47260
49480	King And Queen County, Virginia	49	0.8420	0.9338	40060
49490	King George County, Virginia	8840	1.0983	0.8012	99949
49500	King William County, Virginia	49	0.8420	0.9338	40060
49510	Lancaster County, Virginia	49	0.8420	0.8012	99949
49520	Lee County, Virginia	49	0.8420	0.8012	99949
49522	Lexington County, Virginia	49	0.8420	0.8012	99949
49530	Loudoun County, Virginia	8840	1.0983	1.0932	47894
49540	Louisa County, Virginia	49	0.8420	0.9338	40060
49550	Lunenburg County, Virginia	49	0.8420	0.8012	99949
49551	Lynchburg City County, Virginia	4640	0.8700	0.8700	31340
49560	Madison County, Virginia	49	0.8420	0.8012	99949
49561	Martinsville City County, Virginia	49	0.8420	0.8012	99949
49563	Manassas City County, Virginia	8840	1.0983	1.0932	47894
49565	Manassas Park City County, Virginia	8840	1.0983	1.0932	47894
49570	Mathews County, Virginia	5720	0.8808	0.8808	47260
49580	Mecklenburg County, Virginia	49	0.8420	0.8012	99949
49590	Middlesex County, Virginia	49	0.8420	0.8012	99949
49600	Montgomery County, Virginia	49	0.8420	0.7962	13980
49610	Nansemond County, Virginia	49	0.8420	0.8012	99949
49620	Nelson County, Virginia	49	0.8420	1.0234	16820
49621	New Kent County, Virginia	6760	0.9338	0.9338	40060
49622	Newport News City County, Virginia	5720	0.8808	0.8808	47260
49641	Norfolk City County, Virginia	5720	0.8808	0.8808	47260
49650	Northampton County, Virginia	49	0.8420	0.8012	99949
49660	Northumberland County, Virginia	49	0.8420	0.8012	99949
49661	Norton City County, Virginia	49	0.8420	0.8012	99949
49670	Nottoway County, Virginia	49	0.8420	0.8012	99949
49680	Orange County, Virginia	49	0.8420	0.8012	99949
49690	Page County, Virginia	49	0.8420	0.8012	99949
49700	Patrick County, Virginia	49	0.8420	0.8012	99949
49701	Petersburg City County, Virginia	6760	0.9338	0.9338	40060
49710	Pittsylvania County, Virginia	1950	0.8497	0.8497	19260
49711	Portsmouth City County, Virginia	5720	0.8808	0.8808	47260
49712	Poquoson City County, Virginia	5720	0.8808	0.8808	47260
49720	Powhatan County, Virginia	6760	0.9338	0.9338	40060
49730	Prince Edward County, Virginia	49	0.8420	0.8012	99949
49740	Prince George County, Virginia	6760	0.9338	0.9338	40060
49750	Prince William County, Virginia	8840	1.0983	1.0932	47894
49770	Pulaski County, Virginia	49	0.8420	0.7962	13980
49771	Radford City County, Virginia	49	0.8420	0.7962	13980
49780	Rappahannock County, Virginia	49	0.8420	0.8012	99949
49790	Richmond County, Virginia	49	0.8420	0.8012	99949
49791	Richmond City County, Virginia	6760	0.9338	0.9338	40060
49800	Roanoke County, Virginia	6800	0.8395	0.8383	40220
49801	Roanoke City County, Virginia	6800	0.8395	0.8383	40220
49810	Rockbridge County, Virginia	49	0.8420	0.8012	99949
49820	Rockingham County, Virginia	49	0.8420	0.9098	25500
49830	Russell County, Virginia	49	0.8420	0.8012	99949
49838	Salem County, Virginia	6800	0.8395	0.8383	40220
49840	Scott County, Virginia	3660	0.8015	0.8062	28700
49850	Shenandoah County, Virginia	49	0.8420	0.8012	99949
49860	Smyth County, Virginia	49	0.8420	0.8012	99949
49867	South Boston City County, Virginia	49	0.8420	0.8012	99949
49870	Southampton County, Virginia	49	0.8420	0.8012	99949
49880	Spotsylvania County, Virginia	8840	1.0983	1.0932	47894
49890	Stafford County, Virginia	8840	1.0983	1.0932	47894
49891	Staunton City County, Virginia	49	0.8420	0.8012	99949
49892	Suffolk City County, Virginia	5720	0.8808	0.8808	47260
49900	Surry County, Virginia	49	0.8420	0.8808	47260
49910	Sussex County, Virginia	49	0.8420	0.9338	40060
49920	Tazewell County, Virginia	49	0.8420	0.8012	99949
49921	Virginia Beach City County, Virginia	5720	0.8808	0.8808	47260
49930	Warren County, Virginia	8840	1.0983	1.0932	47894
49950	Washington County, Virginia	3660	0.8015	0.8062	28700
49951	Waynesboro City County, Virginia	49	0.8420	0.8012	99949
49960	Westmoreland County, Virginia	49	0.8420	0.8012	99949
49961	Williamsburg City County, Virginia	5720	0.8808	0.8808	47260
49962	Winchester City County, Virginia	49	0.8420	1.0224	49020
49970	Wise County, Virginia	49	0.8420	0.8012	99949
49980	Wythe County, Virginia	49	0.8420	0.8012	99949
49981	York County, Virginia	5720	0.8808	0.8808	47260
50000	Adams County, Washington	50	1.0194	1.0458	99950
50010	Asotin County, Washington	50	1.0194	0.9896	30300
50020	Benton County, Washington	6740	1.0630	1.0630	28420
50030	Chelan County, Washington	50	1.0194	1.0080	48300
50040	Clallam County, Washington	50	1.0194	1.0458	99950
50050	Clark County, Washington	6440	1.1260	1.1260	38900
50060	Columbia County, Washington	50	1.0194	1.0458	99950
50070	Cowlitz County, Washington	50	1.0194	0.9523	31020
50080	Douglas County, Washington	50	1.0194	1.0080	48300
50090	Ferry County, Washington	50	1.0194	1.0458	99950
50100	Franklin County, Washington	6740	1.0630	1.0630	28420
50110	Garfield County, Washington	50	1.0194	1.0458	99950
50120	Grant County, Washington	50	1.0194	1.0458	99950
50130	Grays Harbor County, Washington	50	1.0194	1.0458	99950
50140	Island County, Washington	7600	1.1579	1.0458	99950
50150	Jefferson County, Washington	50	1.0194	1.0458	99950
50160	King County, Washington	7600	1.1579	1.1589	42644
50170	Kitsap County, Washington	1150	1.0686	1.0686	14740
50180	Kittitas County, Washington	50	1.0194	1.0458	99950
50190	Klickitat County, Washington	50	1.0194	1.0458	99950
50200	Lewis County, Washington	50	1.0194	1.0458	99950
50210	Lincoln County, Washington	50	1.0194	1.0458	99950
50220	Mason County, Washington	50	1.0194	1.0458	99950
50230	Okanogan County, Washington	50	1.0194	1.0458	99950
50240	Pacific County, Washington	50	1.0194	1.0458	99950
50250	Pend Oreille County, Washington	50	1.0194	1.0458	99950
50260	Pierce County, Washington	8200	1.0753	1.0753	45104
50270	San Juan County, Washington	50	1.0194	1.0458	99950
50280	Skagit County, Washington	50	1.0194	1.0465	34580
50290	Skamania County, Washington	50	1.0194	1.1260	38900
50300	Snohomish County, Washington	7600	1.1579	1.1589	42644
50310	Spokane County, Washington	7840	1.0916	1.0916	44060
50320	Stevens County, Washington	50	1.0194	1.0458	99950
50330	Thurston County, Washington	5910	1.0938	1.0938	36500
50340	Wahkiakum County, Washington	50	1.0194	1.0458	99950
50350	Walla Walla County, Washington	50	1.0194	1.0458	99950
50360	Whatcom County, Washington	0860	1.1743	1.1743	13380
50370	Whitman County, Washington	50	1.0194	1.0458	99950
50380	Yakima County, Washington	9260	1.0165	1.0165	49420
51000	Barbour County, W Virginia	51	0.7908	0.7725	99951
51010	Berkeley County, W Virginia	8840	1.0983	0.9499	25180
51020	Boone County, W Virginia	51	0.7908	0.8428	16620
51030	Braxton County, W Virginia	51	0.7908	0.7725	99951
51040	Brooke County, W Virginia	8080	0.7827	0.7827	48260
51050	Cabell County, W Virginia	3400	0.9486	0.9486	26580
51060	Calhoun County, W Virginia	51	0.7908	0.7725	99951
51070	Clay County, W Virginia	51	0.7908	0.8428	16620
51080	Doddridge County, W Virginia	51	0.7908	0.7725	99951
51090	Fayette County, W Virginia	51	0.7908	0.7725	99951
51100	Gilmer County, W Virginia	51	0.7908	0.7725	99951
51110	Grant County, W Virginia	51	0.7908	0.7725	99951
51120	Greenbrier County, W Virginia	51	0.7908	0.7725	99951
51130	Hampshire County, W Virginia	51	0.7908	1.0224	49020
51140	Hancock County, W Virginia	8080	0.7827	0.7827	48260
51150	Hardy County, W Virginia	51	0.7908	0.7725	99951
51160	Harrison County, W Virginia	51	0.7908	0.7725	99951
51170	Jackson County, W Virginia	51	0.7908	0.7725	99951
51180	Jefferson County, W Virginia	8840	1.0983	1.0932	47894
51190	Kanawha County, W Virginia	1480	0.8428	0.8428	16620
51200	Lewis County, W Virginia	51	0.7908	0.7725	99951
51210	Lincoln County, W Virginia	51	0.7908	0.8428	16620
51220	Logan County, W Virginia	51	0.7908	0.7725	99951
51230	Mc Dowell County, W Virginia	51	0.7908	0.7725	99951
51240	Marion County, W Virginia	51	0.7908	0.7725	99951
51250	Marshall County, W Virginia	9000	0.7168	0.7168	48540
51260	Mason County, W Virginia	51	0.7908	0.7725	99951
51270	Mercer County, W Virginia	51	0.7908	0.7725	99951
51280	Mineral County, W Virginia	1900	0.9326	0.9326	19060
51290	Mingo County, W Virginia	51	0.7908	0.7725	99951
51300	Monongalia County, W Virginia	51	0.7908	0.8428	34060
51310	Monroe County, W Virginia	51	0.7908	0.7725	99951
51320	Morgan County, W Virginia	51	0.7908	0.9499	25180
51330	Nicholas County, W Virginia	51	0.7908	0.7725	99951
51340	Ohio County, W Virginia	9000	0.7168	0.7168	48540
51350	Pendleton County, W Virginia	51	0.7908	0.7725	99951
51360	Pleasants County, W Virginia	51	0.7908	0.8278	37620
51370	Pocahontas County, W Virginia	51	0.7908	0.7725	99951
51380	Preston County, W Virginia	51	0.7908	0.8428	34060
51390	Putnam County, W Virginia	1480	0.8428	0.8428	16620
51400	Raleigh County, W Virginia	51	0.7908	0.7725	99951
51410	Randolph County, W Virginia	51	0.7908	0.7725	99951
51420	Ritchie County, W Virginia	51	0.7908	0.7725	99951
51430	Roane County, W Virginia	51	0.7908	0.7725	99951
51440	Summers County, W Virginia	51	0.7908	0.7725	99951
51450	Taylor County, W Virginia	51	0.7908	0.7725	99951
51460	Tucker County, W Virginia	51	0.7908	0.7725	99951
51470	Tyler County, W Virginia	51	0.7908	0.7725	99951
51480	Upshur County, W Virginia	51	0.7908	0.7725	99951
51490	Wayne County, W Virginia	3400	0.9486	0.9486	26580
51500	Webster County, W Virginia	51	0.7908	0.7725	99951
51510	Wetzel County, W Virginia	51	0.7908	0.7725	99951
51520	Wirt County, W Virginia	51	0.7908	0.8278	37620
51530	Wood County, W Virginia	6020	0.8278	0.8278	37620
51540	Wyoming County, W Virginia	51	0.7908	0.7725	99951
52000	Adams County, Wisconsin	52	0.9446	0.9480	99952
52010	Ashland County, Wisconsin	52	0.9446	0.9480	99952
52020	Barron County, Wisconsin	52	0.9446	0.9480	99952
52030	Bayfield County, Wisconsin	52	0.9446	0.9480	99952
52040	Brown County, Wisconsin	3080	0.9452	0.9452	24580
52050	Buffalo County, Wisconsin	52	0.9446	0.9480	99952
52060	Burnett County, Wisconsin	52	0.9446	0.9480	99952
52070	Calumet County, Wisconsin	0460	0.9248	0.9298	11540
52080	Chippewa County, Wisconsin	2290	0.9210	0.9210	20740
52090	Clark County, Wisconsin	52	0.9446	0.9480	99952
52100	Columbia County, Wisconsin	52	0.9446	1.0635	31540
52110	Crawford County, Wisconsin	52	0.9446	0.9480	99952
52120	Dane County, Wisconsin	4720	1.0764	1.0635	31540
52130	Dodge County, Wisconsin	52	0.9446	0.9480	99952
52140	Door County, Wisconsin	52	0.9446	0.9480	99952
52150	Douglas County, Wisconsin	2240	1.0223	1.0209	20260
52160	Dunn County, Wisconsin	52	0.9446	0.9480	99952
52170	Eau Claire County, Wisconsin	2290	0.9210	0.9210	20740
52180	Florence County, Wisconsin	52	0.9446	0.9480	99952
52190	Fond Du Lac County, Wisconsin	52	0.9446	0.9650	22540
52200	Forest County, Wisconsin	52	0.9446	0.9480	99952
52210	Grant County, Wisconsin	52	0.9446	0.9480	99952
52220	Green County, Wisconsin	52	0.9446	0.9480	99952
52230	Green Lake County, Wisconsin	52	0.9446	0.9480	99952
52240	Iowa County, Wisconsin	52	0.9446	1.0635	31540
52250	Iron County, Wisconsin	52	0.9446	0.9480	99952
52260	Jackson County, Wisconsin	52	0.9446	0.9480	99952
52270	Jefferson County, Wisconsin	52	0.9446	0.9480	99952
52280	Juneau County, Wisconsin	52	0.9446	0.9480	99952
52290	Kenosha County, Wisconsin	3800	0.9770	1.0440	29404
52300	Kewaunee County, Wisconsin	52	0.9446	0.9452	24580
52310	La Crosse County, Wisconsin	3870	0.9573	0.9573	29100
52320	Lafayette County, Wisconsin	52	0.9446	0.9480	99952
52330	Langlade County, Wisconsin	52	0.9446	0.9480	99952
52340	Lincoln County, Wisconsin	52	0.9446	0.9480	99952
52350	Manitowoc County, Wisconsin	52	0.9446	0.9480	99952
52360	Marathon County, Wisconsin	8940	0.9600	0.9600	48140
52370	Marinette County, Wisconsin	52	0.9446	0.9480	99952
52380	Marquette County, Wisconsin	52	0.9446	0.9480	99952
52381	Menominee County, Wisconsin	52	0.9446	0.9480	99952
52390	Milwaukee County, Wisconsin	5080	1.0106	1.0106	33340
52400	Monroe County, Wisconsin	52	0.9446	0.9480	99952
52410	Oconto County, Wisconsin	52	0.9446	0.9452	24580
52420	Oneida County, Wisconsin	52	0.9446	0.9480	99952
52430	Outagamie County, Wisconsin	0460	0.9248	0.9298	11540
52440	Ozaukee County, Wisconsin	5080	1.0106	1.0106	33340
52450	Pepin County, Wisconsin	52	0.9446	0.9480	99952
52460	Pierce County, Wisconsin	5120	1.1078	1.1078	33460
52470	Polk County, Wisconsin	52	0.9446	0.9480	99952
52480	Portage County, Wisconsin	52	0.9446	0.9480	99952
52490	Price County, Wisconsin	52	0.9446	0.9480	99952
52500	Racine County, Wisconsin	6600	0.9006	0.9006	39540
52510	Richland County, Wisconsin	52	0.9446	0.9480	99952
52520	Rock County, Wisconsin	3620	0.9547	0.9547	27500
52530	Rusk County, Wisconsin	52	0.9446	0.9480	99952
52540	St Croix County, Wisconsin	5120	1.1078	1.1078	33460
52550	Sauk County, Wisconsin	52	0.9446	0.9480	99952
52560	Sawyer County, Wisconsin	52	0.9446	0.9480	99952
52570	Shawano County, Wisconsin	52	0.9446	0.9480	99952
52580	Sheboygan County, Wisconsin	7620	0.8920	0.8920	43100
52590	Taylor County, Wisconsin	52	0.9446	0.9480	99952
52600	Trempealeau County, Wisconsin	52	0.9446	0.9480	99952
52610	Vernon County, Wisconsin	52	0.9446	0.9480	99952
52620	Vilas County, Wisconsin	52	0.9446	0.9480	99952
52630	Walworth County, Wisconsin	52	0.9446	0.9480	99952
52640	Washburn County, Wisconsin	52	0.9446	0.9480	99952
52650	Washington County, Wisconsin	5080	1.0106	1.0106	33340
52660	Waukesha County, Wisconsin	5080	1.0106	1.0106	33340
52670	Waupaca County, Wisconsin	52	0.9446	0.9480	99952
52680	Waushara County, Wisconsin	52	0.9446	0.9480	99952
52690	Winnebago County, Wisconsin	0460	0.9248	0.9192	36780
52700	Wood County, Wisconsin	52	0.9446	0.9480	99952
53000	Albany County, Wyoming	53	0.9214	0.9214	99953
53010	Big Horn County, Wyoming	53	0.9214	0.9214	99953
53020	Campbell County, Wyoming	53	0.9214	0.9214	99953
53030	Carbon County, Wyoming	53	0.9214	0.9214	99953
53040	Converse County, Wyoming	53	0.9214	0.9214	99953
53050	Crook County, Wyoming	53	0.9214	0.9214	99953
53060	Fremont County, Wyoming	53	0.9214	0.9214	99953
53070	Goshen County, Wyoming	53	0.9214	0.9214	99953
53080	Hot Springs County, Wyoming	53	0.9214	0.9214	99953
53090	Johnson County, Wyoming	53	0.9214	0.9214	99953
53100	Laramie County, Wyoming	1580	0.8784	0.8784	16940
53110	Lincoln County, Wyoming	53	0.9214	0.9214	99953
53120	Natrona County, Wyoming	1350	0.9035	0.9035	16220
53130	Niobrara County, Wyoming	53	0.9214	0.9214	99953
53140	Park County, Wyoming	53	0.9214	0.9214	99953
53150	Platte County, Wyoming	53	0.9214	0.9214	99953
53160	Sheridan County, Wyoming	53	0.9214	0.9214	99953
53170	Sublette County, Wyoming	53	0.9214	0.9214	99953
53180	Sweetwater County, Wyoming	53	0.9214	0.9214	99953
53190	Teton County, Wyoming	53	0.9214	0.9214	99953
53200	Uinta County, Wyoming	53	0.9214	0.9214	99953
53210	Washakie County, Wyoming	53	0.9214	0.9214	99953
53220	Weston County, Wyoming	53	0.9214	0.9214	99953