[Federal Register Volume 64, Number 149 (Wednesday, August 4, 1999)]
[Notices]
[Pages 42393-42403]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 99-20013]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Care Financing Administration
[HCFA-1054-N]
RIN 0938-AJ62
Medicare Program; Hospice Wage Index
AGENCY: Health Care Financing Administration (HCFA), HHS.
ACTION: Notice.
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SUMMARY: This notice announces the annual update to the hospice wage
index as required by statute. This update is effective October 1, 1999.
The wage index is used to reflect local differences in wage levels. The
hospice wage index methodology and values are based on recommendations
of a negotiated rulemaking advisory committee and were originally
published in the Federal Register on August 8, 1997. This update is the
third year of a 3-year transition period. The third transition year
begins October 1, 1999 and ends September 30, 2000.
EFFECTIVE DATE: This notice is effective on October 1, 1999.
FOR FURTHER INFORMATION CONTACT: Carol Blackford, (410) 786-5909
SUPPLEMENTARY INFORMATION:
I. Background
A. Statute and Regulations
Hospice Care is an approach to treatment that recognizes that the
impending death of an individual warrants a change in the focus from
curative care to palliative care (relief of pain and other
uncomfortable symptoms). The goal of hospice care is to help terminally
ill individuals continue life with minimal disruption to normal
activities while remaining primarily in the home environment. A hospice
uses an interdisciplinary approach to deliver medical, social,
psychological, emotional, and spiritual services through use of a broad
spectrum of professional and other caregivers, with the goal of making
the individual as physically and emotionally comfortable as possible.
Counseling and respite services are available to the family of the
hospice patient. Hospice programs consider both the patient and the
family as a unit of care.
Section 1861(dd) of the Social Security Act (the Act) provides for
coverage of hospice care for terminally ill Medicare beneficiaries who
elect to receive care from a participating hospice. The statutory
authority for payment to hospices participating in the Medicare program
is contained in section 1814(i) of the Act.
Our regulations at 42 CFR part 418 (issued on December 16, 1983,
effective for hospice services furnished on or after November 1, 1983)
established eligibility requirements and payment standards and
procedures, defined covered services, and delineated the conditions a
hospice must meet to be approved for participation in the Medicare
program. Subpart G of part 418 provides for payment to hospices based
on one of four prospectively determined rates for each day in which a
qualified Medicare beneficiary is under the care of a hospice. The four
rate categories are routine home care, continuous home care, inpatient
respite care, and general inpatient care. Payment rates are established
for each category.
Section 4442 of the Balanced Budget Act of 1997, Public Law 105-C3,
amended section 1814 (i)(2) of the Act to require payment for routine
and continuous home care to be made based on the geographic location at
which the service is furnished. The site of service provision was
effective October 1, 1997 and was implemented through a Program
Memorandum (transmittal A-97-11) issued in September of 1997.
Section 418.306(c), that requires the rates to be adjusted by a
wage index, was revised on August 8, 1997, through publication of a
final rule in the Federal Register (62 FR 42860). This rule implemented
a new methodology for calculating the hospice wage index that was based
on the recommendations of a negotiated rulemaking committee. The
committee reached consensus on a methodology and the resulting
committee statement, describing that consensus, was included as an
attachment to the August 8, 1997 hospice wage index final rule. The
provisions of the final hospice wage index rule are as follows:
The revised hospice wage index will be phased in over a 3-
year transition period. For the first year of the transition period, a
blended index was calculated by adding two-thirds of the 1983 index
value for an area to one-third of the revised wage index value for that
area. During the second year of the transition period, the calculation
was similar, except that the blend was one-third of the 1983 index
value and two-thirds of the revised wage index value for that area.
During the third transition year, the revised wage index will be fully
implemented. The first transition year occurred October 1, 1997 through
September 30, 1998. The second transition year occurred October 1, 1998
through September 30, 1999.
All hospice wage index values of 0.8 or greater are
subject to a budget neutrality adjustment to ensure that Medicare does
not pay any more in the aggregate than it would have paid with the
previous wage index. The budget neutrality adjustment is calculated by
multiplying the hospice wage index for a given area by the budget
neutrality adjustment factor. The budget neutrality adjustment is to be
applied annually, both during and after the transition period.
All hospice wage index values below 0.8 receive the
greater of the following adjustments--the wage index floor, a 15
percent increase, subject to a maximum wage index value of 0.8; or, the
budget neutrality adjustment.
The wage index is to be updated annually, in the Federal
Register, based on the most current available hospital wage data.
B. Update to the Hospice Wage Index
The third year of the 3-year transition period begins October 1,
1999 and ends September 30, 2000. In accordance with the agreement
signed by members of the Hospice Wage Index Negotiated Rulemaking
Committee, we are using 1998 hospital area wage index data, including
any changes to the definitions of Metropolitan Statistical Areas
[[Page 42394]]
(MSAs), that allow us to publish this notice at least 4 months in
advance of the October 1, 1999 effective date.
Additionally, the wage index value for hospices in counties that
are no longer in the same MSA as they were in 1983 will no longer be
blended with the wage index for the original MSA designation. These
hospices will receive the full wage index for their current MSA
designation. All wage index values are adjusted by a budget neutrality
factor of 1.065982 and are subject to the wage index floor adjustment,
if applicable. All of the calculations described above have been
completed by us and are built into the wage index values reflected in
both Tables A and B below. A detailed description of the method used to
compute the hospice wage index is contained in both the September 4,
1996 (61 FR 46579) hospice wage index proposed rule and the August 8,
1997 (62 FR 42860) hospice wage index final rule.
Because the hospice wage index is calculated using the pre-
reclassified hospital wage index, it is important to note that the
method for calculating the Puerto Rico hospital wage index was changed
with the publication of the Hospital Inpatient Prospective Payment
System (PPS) and Fiscal Year 1998 Rates final rule in August 29, 1997
(62 FR 45984 and 45986). The Puerto Rico hospital wage index is
calculated in the same manner as the national wage index, but is based
solely on Puerto Rico's wage data. As explained in the PPS final rule,
the total adjusted salaries are added to fringe benefits for all
hospitals in Puerto Rico and then divided by the sum by the total hours
for Puerto Rico to arrive at an overall average hourly wage. For each
labor market area in Puerto Rico, the hospital wage index is calculated
by dividing the area average hourly wage by the overall Puerto Rico
average hourly wage.
C. Tables
Table A--Hospice Wage Index for Urban Areas
------------------------------------------------------------------------
Urban area (constituent
MSA code No. counties or county Wage index \2\
equivalents) \1\
------------------------------------------------------------------------
0040.................... Abilene, TX................... 0.8508
Taylor, TX
0060.................... Aguadilla, PR................. 0.5436
Aguada, PR
Aguadilla, PR
Moca, PR
0080.................... Akron, OH..................... 1.0553
Portage, OH
Summit, OH
0120.................... Albany, GA.................... 0.8501
Dougherty, GA
Lee, GA
0160.................... Albany-Schenectady-Troy, NY 0.9178
Albany, NY
Montgomery, NY
Rensselaer, NY
Saratoga, NY
Schenectady, NY
Schoharie, NY
0200.................... Albuquerque, NM............... 0.9181
Bernalillo, NM Sandoval, NM
Valencia, NM
0220.................... Alexandria, LA................ 0.9089
Rapides, LA
0240.................... Allentown-Bethlehem-Easton, PA 1.0877
Carbon, PA
Lehigh, PA
Northampton, PA
0280.................... Altoona, PA................... 0.9951
Blair, PA
0320.................... Amarillo, TX.................. 0.9033
Potter, TX
Randall, TX
0380.................... Anchorage, AK................. 1.3664
Anchorage, AK
0440.................... Ann Arbor, MI................. 1.1761
Lenawee, MI
Livingston, MI
Washtenaw, MI
0450.................... Anniston, AL.................. 0.9229
Calhoun, AL
0460.................... Appleton-Oshkosh-Neenah, WI 0.9407
Calumet, WI
Outagamie, WI
Winnebago, WI
0470.................... Arecibo, PR................... 0.5597
Arecibo, PR
Camuy, PR
Hatillo, PR
0480.................... Asheville, NC................. 0.9530
Buncombe, NC
Madison, NC
0500.................... Athens, GA.................... 0.9245
Clarke, GA
Madison, GA
Oconee, GA
0520.................. Atlanta, GA................... 1.0569
Barrow, GA
Bartow, GA
Carroll, GA
Cherokee, GA
Clayton, GA
Cobb, GA
Coweta, GA
DeKalb, GA
Douglas, GA
Fayette, GA
Forsyth, GA
Fulton, GA
Gwinnett, GA
Henry, GA
Newton, GA
Paulding, GA
Pickens, GA
Rockdale, GA
Spalding, GA
Walton, GA
0560.................... Atlantic-Cape May, NJ 1.2297
Atlantic, NJ
Cape May, NJ
0600.................... Augusta-Aiken, GA-SC ......... 0.9842
Columbia, GA
McDuffie, GA
Richmond, GA
Aiken, SC
Edgefield, SC
0640.................... Austin-San Marcos, TX 0.9361
Bastrop, TX
Caldwell, TX
Hays, TX
Travis, TX
Williamson, TX
0680.................... Bakersfield, CA .............. 1.0160
Kern, CA
0720.................... Baltimore, MD ................ 1.0278
Anne Arundel, MD
Baltimore, MD
Baltimore City, MD
Carroll, MD
Harford, MD
Howard, MD
Queen Anne's, MD
0733.................... Bangor, ME ................... 1.0099
Penobscot, ME
0743.................... Barnstable-Yarmouth, MA 1.6397
Barnstable, MA
0760.................... Baton Rouge, LA............... 0.9457
Ascension, LA
East Baton Rouge, LA
Livingston, LA
West Baton Rouge, LA
0840.................... Beaumont-Port Arthur, TX 0.9230
Hardin, TX
Jefferson, TX
Orange, TX
0860.................... Bellingham, WA................ 1.2188
Whatcom, WA
0870.................... Benton Harbor, MI............. 0.9094
Berrien, MI
0875.................... Bergen-Passaic, NJ............ 1.2990
Bergen, NJ
Passaic, NJ
0880.................... Billings, MT.................. 0.9746
Yellowstone, MT
0920.................... Biloxi-Gulfport-Pascagoula, MS 0.8822
Hancock, MS
Harrison, MS
Jackson, MS
0960.................... Binghamton, NY................ 0.9657
Broome, NY
Tioga, NY
1000.................... Birmingham, AL................ 0.9672
Blount, AL
[[Page 42395]]
Jefferson, AL
St. Clair, AL
Shelby, AL
1010.................... Bismarck, ND.................. 0.8555
Burleigh, ND
Morton, ND
1020.................... Bloomington, IN 0.9557
Monroe, IN
1040.................... Bloomington-Normal, IL 0.9435
McLean, IL
1080.................... Boise City, ID................ 0.9764
Ada, ID
Canyon, ID
1123.................... Boston-Worcester-Lawrence- 1.2013
Lowell-Brockton, MA-NH
Bristol, MA
Essex, MA
Middlesex, MA
Norfolk, MA
Plymouth, MA
Suffolk, MA
Worcester, MA
Hillsborough, NH
Merrimack, NH
Rockingham, NH
Strafford, NH
1125.................... Boulder-Longmont, CO 1.0700
Boulder, CO
1145.................... Brazoria, TX.................. 0.9494
Brazoria, TX
1150.................... Bremerton, WA................. 1.1784
Kitsap, WA
1240.................... Brownsville-Harlingen-San 0.8780
Benito, TX
Cameron, TX
1260.................... Bryan-College Station, TX 0.8336
Brazos, TX
1280.................... Buffalo-Niagara Falls, NY 1.0220
Erie, NY
Niagara, NY
1303.................... Burlington, VT................ 1.0209
Chittenden, VT
Franklin, VT
Grand Isle, VT
1310.................... Caguas, PR.................... 0.5060
Caguas, PR
Cayey, PR
Cidra, PR
Gurabo, PR
San Lorenzo, PR
1320.................... Canton-Massillon, OH 0.9394
Carroll, OH
Stark, OH
1350.................... Casper, WY.................... 0.9275
Natrona, WY
1360.................... Cedar Rapids, IA.............. 0.9396
Linn, IA
1400.................... Champaign-Urbana, IL 0.9299
Champaign, IL
1440.................... Charleston-North Charleston, 0.9715
SC
Berkeley, SC
Charleston, SC
Dorchester, SC
1480.................... Charleston, WV................ 0.9583
Kanawha, WV
Putnam, WV
1520.................... Charlotte-Gastonia-Rock Hill, 1.0325
NC-SC
Cabarrus, NC
Gaston, NC
Lincoln, NC
Mecklenburg, NC
Rowan, NC
Stanly, NC
Union, NC
York, SC
1540.................... Charlottesville, VA........... 1.0950
Albemarle, VA
Charlottesville City, VA
Fluvanna, VA
Greene, VA
1560.................... Chattanooga, TN-GA 0.9673
Catoosa, GA
Dade, GA
Walker, GA
Hamilton, TN
Marion, TN
1580.................... Cheyenne, WY.................. 0.8687
Laramie, WY
1600.................... Chicago, IL................... 1.1151
Cook, IL
DeKalb, IL
Du Page, IL
Grundy, IL
Kane, IL
Kendall, IL
Lake, IL
McHenry, IL
Will, IL
1620.................... Chico-Paradise, CA 1.0814
Butte, CA
1640.................... Cincinnati, OH-KY-IN 1.0228
Brown, OH
Clermont, OH
Hamilton, OH
Warren, OH
Boone, KY
Campbell, KY
Gallatin, KY
Grant, KY
Kenton, KY
Pendleton, KY
Dearborn, IN
Ohio, IN
1660.................... Clarksville-Hopkinsville, TN- 0.8570
KY
Christian, KY
Montgomery, TN
1680.................... Cleveland-Lorain-Elyria, OH 1.0538
Ashtabula, OH
Cuyahoga, OH
Geauga, OH
Lake, OH
Lorain, OH
Medina, OH
1720.................... Colorado Springs, CO 1.0010
El Paso, CO
1740.................... Columbia, MO.................. 0.9532
Boone, MO
1760.................... Columbia, SC.................. 0.9903
Lexington, SC
Richland, SC
1800.................... Columbus, GA-AL............... 0.9073
Chattahochee, GA
Harris, GA
Muscogee, GA
Russell, AL
1840.................... Columbus, OH.................. 1.0426
Delaware, OH
Fairfield, OH
Franklin, OH
Licking, OH
Madison, OH
Pickaway, OH
1880.................... Corpus Christi, TX............ 0.9075
Nueces, TX
San Patricio, TX
1900.................... Cumberland, MD-WV 0.8786
Allegany, MD
Mineral, WV
1920.................... Dallas, TX.................... 0.9987
Collin, TX
Dallas, TX
Denton, TX
Ellis, TX
Henderson, TX
Hunt, TX
Kaufman, TX
Rockwall, TX
1950.................... Danville, VA.................. 0.9641
Danville City, VA
Pittsylvania, VA
1960.................... Davenport-Moline-Rock Island, 0.8968
IA-IL
Scott, IA
Henry, IL
Rock Island, IL
2000.................... Dayton-Springfield, OH 1.0239
Clark, OH
Greene, OH
Miami, OH
Montgomery, OH
2020.................... Daytona Beach, FL 0.9737
Flagler, FL
Volusia, FL
2030.................... Decatur, AL................... 0.8776
Lawrence, AL
Morgan, AL
2040.................... Decatur, IL................... 0.8565
Macon, IL
2080.................... Denver, CO.................... 1.1013
Adams, CO
Arapahoe, CO
[[Page 42396]]
Denver, CO
Douglas, CO
Jefferson, CO
2120.................... Des Moines, IA................ 0.9005
Dallas, IA
Polk, IA
Warren, IA
2160.................... Detroit, MI................... 1.1240
Lapeer, MI
Macomb, MI
Monroe, MI
Oakland, MI
St. Clair, MI
Wayne, MI
2180.................... Dothan, AL.................... 0.8413
Dale, AL
Houston, AL
2190.................... Dover, DE..................... 0.9981
Kent, DE
2200.................... Dubuque, IA................... 0.8765
Dubuque, IA
2240.................... Duluth-Superior, MN-WI 1.0619
St. Louis, MN
Douglas, WI
2281.................... Dutchess County, NY 1.1225
Dutchess, NY
2290.................... Eau Claire, WI................ 0.9139
Chippewa, WI
Eau Claire, WI
2320.................... El Paso, TX................... 0.9823
El Paso, TX
2330.................... Elkhart-Goshen, IN............ 0.9919
Elkhart, IN
2335.................... Elmira, NY.................... 0.8997
Chemung, NY
2340.................... Enid, OK...................... 0.8510
Garfield, OK
2360.................... Erie, PA...................... 0.9883
Erie, PA
2400.................... Eugene-Springfield, OR 1.1932
Lane, OR
2440.................... Evansville-Henderson, IN-KY 0.9091
Posey, IN
Vanderburgh, IN
Warrick, IN
Henderson, KY
2520.................... Fargo-Moorhead, ND-MN 1.0148
Clay, MN
Cass, ND
2560.................... Fayetteville, NC 0.8943
Cumberland, NC
2580.................... Fayetteville-Springdale- 0.9182
Rogers, AR.
Benton, AR
Washington, AR
2620.................... Flagstaff, AZ-UT.............. 1.0109
Coconino, AZ
Kane, UT
2640.................... Flint, MI..................... 1.1759
Genesee, MI
2650.................... Florence, AL.................. 0.8182
Colbert, AL
Lauderdale, AL
2655.................... Florence, SC.................. 0.9062
Florence, SC
2670.................... Fort Collins-Loveland, CO 1.1481
Larimer, CO
2680.................... Ft. Lauderdale, FL............ 1.0454
Broward, FL
2700.................... Fort Myers-Cape Coral, FL 0.9532
Lee, FL
2710.................... Fort Pierce-Port St. Lucie, FL 1.0917
Martin, FL
St. Lucie, FL
2720.................... Fort Smith, AR-OK 0.8126
Crawford, AR
Sebastian, AR
Sequoyah, OK
2750.................... Fort Walton Beach, FL 0.9183
Okaloosa, FL
2760.................... Fort Wayne, IN................ 0.9644
Adams, IN
Allen, IN
De Kalb, IN
Huntington, IN
Wells, IN
Whitley, IN
2800.................... Fort Worth-Arlington, TX 1.0360
Hood, TX
Johnson, TX
Parker, TX
Tarrant, TX
2840.................... Fresno, CA.................... 1.1406
Fresno, CA
Madera, CA
2880.................... Gadsden, AL................... 0.9358
Etowah, AL
2900.................... Gainesville, FL............... 1.0077
Alachua, FL
2920.................... Galveston-Texas City, TX 1.1613
Galveston, TX
2960.................... Gary, IN...................... 1.0058
Lake, IN
Porter, IN
2975.................... Glens Falls, NY............... 0.9050
Warren, NY
Washington, NY
2980.................... Goldsboro, NC................. 0.9093
Wayne, NC
2985.................... Grand Forks, ND-MN 0.9419
Grand Forks, ND
Polk, MN
2995.................... Grand Junction, CO 0.8825
Mesa, CO
3000.................... Grand Rapids-Muskegon-Holland, 1.0629
MI
Allegan, MI
Kent, MI
Muskegon, MI
Ottawa, MI
3040.................... Great Falls, MT............... 0.9457
Cascade, MT
3060.................... Greeley, CO................... 1.0081
Weld, CO
3080.................... Green Bay, WI................. 0.9760
Brown, WI
3120.................... Greensboro-Winston-Salem-High 1.0177
Point, NC
Alamance, NC
Davidson, NC
Davie, NC
Forsyth, NC
Guilford, NC
Randolph, NC
Stokes, NC
Yadkin, NC
3150.................... Greenville, NC................ 1.0056
Pitt, NC
3160.................... Greenville-Spartanburg- 0.9830
Anderson, SC
Anderson, SC
Cherokee, SC
Greenville, SC
Pickens, SC
Spartanburg, SC
3180.................... Hagerstown, MD................ 1.0855
Washington, MD
3200.................... Hamilton-Middletown, OH 0.9842
Butler, OH
3240.................... Harrisburg-Lebanon-Carlisle, 1.0724
PA
Cumberland, PA
Dauphin, PA
Lebanon, PA
Perry, PA
3283.................... Hartford, CT.................. 1.2612
Hartford, CT
Litchfield, CT
Middlesex, CT
Tolland, CT
3285.................... Hattiesburg, MS............... 0.8000
Forrest, MS
Lamar, MS
3290.................... Hickory-Morganton-Lenoir, NC 0.9492
Alexander, NC
Burke, NC
Caldwell, NC
Catawba, NC
3320.................... Honolulu, HI.................. 1.2269
Honolulu, HI
3350.................... Houma, LA..................... 0.8738
Lafourche, LA
Terrebonne, LA
3360.................... Houston, TX................... 1.0541
Chambers, TX
Fort Bend, TX
Harris, TX
Liberty, TX
Montgomery, TX
Waller, TX
[[Page 42397]]
3400.................... Huntington-Ashland, WV-KY-OH 1.0284
Boyd, KY
Carter, KY
Greenup, KY
Lawrence, OH
Cabell, WV
Wayne, WV
3440.................... Huntsville, AL................ 0.8938
Limestone, AL
Madison, AL
3480.................... Indianapolis, IN.............. 1.0480
Boone, IN
Hamilton, IN
Hancock, IN
Hendricks, IN
Johnson, IN
Madison, IN
Marion, IN
Morgan, IN
Shelby, IN
3500.................... Iowa City, IA................. 1.0107
Johnson, IA
3520.................... Jackson, MI................... 0.9833
Jackson, MI
3560.................... Jackson, MS................... 0.8839
Hinds, MS
Madison, MS
Rankin, MS
3580.................... Jackson, TN................... 0.9125
Madison, TN
Chester, TN
3600.................... Jacksonville, FL.............. 0.9487
Clay, FL
Duval, FL
Nassau, FL
St. Johns, FL
3605.................... Jacksonville, NC.............. 0.8055
Onslow, NC
3610.................... Jamestown, NY................. 0.8165
Chautauqua, NY
3620.................... Janesville-Beloit, WI 0.9648
Rock, WI
3640.................... Jersey City, NJ............... 1.2363
Hudson, NJ
3660.................... Johnson City-Kingsport- 0.9352
Bristol, TN-VA
Carter, TN
Hawkins, TN
Sullivan, TN
Unicoi, TN
Washington, TN
Bristol City,
VA
Scott, VA
Washington, VA
3680.................... Johnstown, PA................. 0.9188
Cambria, PA
Somerset, PA
3700.................... Jonesboro, AR................. 0.8000
Craighead, AR
3710.................... Joplin, MO.................... 0.8392
Jasper, MO
Newton, MO
3720.................... Kalamazoo-Battlecreek, MI 1.2079
Calhoun, MI
Kalamazoo, MI
Van Buren, MI
3740.................... Kankakee, IL.................. 1.0039
Kankakee, IL
3760.................... Kansas City, KS-MO 1.0281
Johnson, KS
Leavenworth,
KS
Miami, KS
Wyandotte, KS
Cass, MO
Clay, MO
Clinton, MO
Jackson, MO
Lafayette, MO
Platte, MO
Ray, MO
3800.................... Kenosha, WI................... 0.9731
Kenosha, WI
3810.................... Killeen-Temple, TX............ 1.0776
Bell, TX
Coryell, TX
3840.................... Knoxville, TN................. 0.9506
Anderson, TN
Blount, TN
Knox, TN
Loudon, TN
Sevier, TN
Union, TN
3850.................... Kokomo, IN.................... 0.9887
Howard, IN
Tipton, IN
3870.................... La Crosse, WI-MN.............. 0.9501
Houston, MN
La Crosse, WI
3880.................... Lafayette, LA................. 0.8800
Acadia, LA
Lafayette, LA
St. Landry, LA
St. Martin, LA
3920.................... Lafayette, IN................. 0.9424
Clinton, IN
Tippecanoe, IN
3960.................... Lake Charles, LA.............. 0.818
Calcasieu, LA
3980.................... Lakeland-Winter Haven, FL 0.9529
Polk, FL
4000.................... Lancaster, PA................. 1.0192
Lancaster, PA
40...................... Lansing-East Lansing, MI 1.0756
Clinton, MI
Eaton, MI
Ingham, MI
4080.................... Laredo, TX.................... 0.8000
Webb, TX
4100.................... Las Cruces, NM................ 0.9455
Dona Ana, NM
4120.................... Las Vegas, NV-AZ 1.2166
Mohave, AZ
Clarke, NV
Nye, NV
4150.................... Lawrence, KS.................. 0.9226
Douglas, KS
4200.................... Lawton, OK.................... 0.271
Comanche, OK
4243.................... Lewiston-Auburn, ME 0.9753
Androscoggin, ME
4280.................... Lexington, KY................. 0.9067
Bourbon, KY
Clark, KY
Fayette, KY
Jessamine, KY
Madison, KY
Scott, KY
Woodford, KY
4320.................... Lima, OH...................... 0.9539
Allen, OH
Auglaize, OH
4360.................... Lincoln, NE................... 0.9917
Lancaster, NE
4400.................... Little Rock-North Little Rock, 0.9064
AR
Faulkner, AR
Lonoke, AR
Pulaski, AR
Saline, AR
4420.................... Longview-Marshall, TX 0.9272
Gregg, TX
Harrison, TX
Upshur, TX
4480.................... Los Angeles-Long Beach, CA 1.2882
Los Angeles, CA
4520.................... Louisville, KY-IN............. 0.9693
Clark, IN
Floyd, IN
Harrison, IN
Scott, IN
Bullitt, KY
Jefferson, KY
Oldham, KY
4600.................... Lubbock, TX................... 0.9057
Lubbock, TX
4640.................... Lynchburg, VA................. 0.9487
Amherst, VA
Bedford, VA
Bedford City, VA
Campbell, VA
Lynchburg City, VA
4680.................... Macon, GA..................... 0.9573
Bibb, GA
Houston, GA
Jones, GA
Peach, GA
Twiggs, GA
4720.................... Madison, WI................... 1.0679
Dane, WI
4800.................... Mansfield, OH................. 0.9097
Crawford, OH
Richland, OH
4840.................... Mayaguez, PR.................. 0.5061
Anasco, PR
Cabo Rojo, PR
[[Page 42398]]
Hormigueros, PR
Mayaguez, PR
Sabana Grande, PR
San German, PR
4880.................... McAllen-Edinburg-Mission, TX 0.9480
Hidalgo, TX
4890.................... Medford-Ashland, OR 1.0681
Jackson, OR
4900.................... Melbourne-Titusville-Palm Bay, 0.9824
FL
Brevard, Fl
4920.................... Memphis, TN-AR-MS 0.8913
Crittenden, AR
DeSoto, MS
Fayette, TN
Shelby, TN
Tipton, TN
4940.................... Merced, CA.................... 1.0695
Merced, CA
5000.................... Miami, FL..................... 1.0678
Dade, FL
5015.................... Middlesex-Somerset-Hunterdon, 1.1888
NJ
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
5080.................... Milwaukee-Waukesha, WI 0.9973
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120.................... Minneapolis-St. Paul, MN-WI 1.1570
Anoka, MN
Carver, MN
Chisago, MN
Dakota, MN
Hennepin, MN
Isanti, MN
Ramsey, MN
Scott, MN
Sherburne, MN
Washington, MN
Wright, MN
Pierce, WI
St. Croix, WI
5140.................... Missoula, MT.................. 0.9795
Missoula, MT
5160.................... Mobile, AL.................... 0.8930
Baldwin, AL
Mobile, AL
5170.................... Modesto, CA................... 1.1029
Stanislaus, CA
5190.................... Monmouth-Ocean, NJ 1.2064
Monmouth, NJ
Ocean, NJ
5200.................... Monroe, LA.................... 0.8761
Ouachita, LA
5240.................... Montgomery, AL................ 0.8337
Autauga, AL
Elmore, AL
Montgomery, AL
5280.................... Muncie, IN.................... 1.0035
Delaware, IN
5330.................... Myrtle Beach, SC.............. 0.8719
Horry, SC
5345.................... Naples, FL.................... 1.0848
Collier, FL
5360.................... Nashville, TN................. 1.0106
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
Rutherford TN
Sumner, TN
Williamson, TN
Wilson, TN
5380.................... Nassau-Suffolk, NY 1.4490
Nassau, NY
Suffolk, NY
5483.................... New Haven-Bridgeport-Stamford- 1.3141
Waterbury-Danbury, CT
Fairfield, CT
New Haven, CT
5523.................... New London-Norwich, CT 1.2382
New London, CT
5560.................... New Orleans, LA............... 0.9924
Jefferson, LA
Orleans, LA
Plaquemines, LA
St. Bernard, LA
St. Charles, LA
St. James, LA
St. John The Baptist, LA
St. Tammany, LA
5600.................... New York, NY.................. 1.5415
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
Richmond, NY
Rockland, NY
Westchester, NY
5640.................... Newark, NJ.................... 1.2649
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
Warren, NJ
5660.................... Newburgh, NY-PA............... 1.1891
Orange, NY
Pike, PA
5720.................... Norfolk-Virginia Beach-Newport 0.8821
News, VA-NC.
Currituck, NC
Chesapeake City, VA
Gloucester, VA
Hampton City, VA
James City, VA
Isle of Wight, VA
Mathews, VA
Newport News City, VA
Norfolk City, VA
Poquoson City, VA
Portsmouth City, VA
Suffolk City, VA
Virginia Beach City VA
Williamsburg City, VA
York, VA
5775.................... Oakland, CA................... 1.5982
Alameda, CA
Contra Costa, CA
5790.................... Ocala, FL..................... 0.9756
Marion, FL
5800.................... Odessa-Midland, TX 0.9227
Ector, TX
Midland, TX
5880.................... Oklahoma City, OK 0.9283
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910.................... Olympia, WA................... 1.2282
Thurston, WA ..............
5920.................... Omaha, NE-IA.................. 1.0630
Pottawattamie, IA
Cass, NE
Douglas, NE
Sarpy, NE
Washington, NE
5945.. Orange County, CA 1.2282
Orange, CA
5960.................... Orlando, FL................... 1.0460
Lake, FL
Orange, FL
Osceola, FL
Seminole, FL
5990.................... Owensboro, KY................. 0.8284
Daviess, KY
6015.................... Panama City, FL............... 0.9068
Bay, FL
6020.................... Parkersburg-Marietta, WV-OH... 0.8545
Washington, OH
Wood, WV
6080.................... Pensacola, FL................. 0.8790
Escambia, FL
Santa Rosa, FL
6120.................... Peoria-Pekin, IL.............. 0.8590
Peoria, IL
Tazewell, IL
Woodford, IL
6160.................... Philadelphia, PA-NJ 1.2120
Burlington, NJ
Camden, NJ
Gloucester, NJ
Salem, NJ
[[Page 42399]]
Bucks, PA
Chester, PA
Delaware, PA
Montgomery, PA
Philadelphia, PA
6200.................... Phoenix-Mesa, AZ.............. 1.0224
Maricopa, AZ
Pinal, AZ
6240.................... Pine Bluff, AR................ 0.8434
Jefferson, AR
6280.................... Pittsburgh, PA................ 1.0435
Allegheny, PA
Beaver, PA
Butler, PA
Fayette, PA
Washington, PA
Westmoreland, PA
6323.................... Pittsfield, MA................ 1.1533
Berkshire, MA
6340.................... Pocatello, ID................. 0.9372
Bannock, ID
6360.................... Ponce, PR..................... 0.5506
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
6403.................... Portland, ME.................. 1.0192
Cumberland, ME
Sagadahoc, ME
York, ME
6440.................... Portland-Vancouver, OR-WA 1.1916
Clackamas, OR
Columbia, OR
Multnomah, OR
Washington, OR
Yamhill, OR
Clark, WA
6483.................... Providence-Warwick-Pawtucket, 1.1514
RI
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520.................... Provo-Orem, UT................ 1.0537
Utah, UT
6560.................... Pueblo, CO.................... 0.9287
Pueblo, CO
6580.................... Punta Gorda, FL............... 0.9627
Charlotte, FL
6600.................... Racine, WI.................... 0.9732
Racine, WI
6640.................... Raleigh-Durham-Chapel Hill, NC 1.0459
Chatham, NC
Durham, NC
Franklin, NC
Johnston, NC
Orange, NC
Wake, NC
6660.................... Rapid City, SD................ 0.8750
Pennington, SD
6680.................... Reading, PA................... 0.9843
Berks, PA
6690.................... Redding, CA................... 1.2640
Shasta, CA
6720.................... Reno, NV...................... 1.1827
Washoe, NV
6740.................... Richland-Kennewick-Pasco, WA 1.0966
Benton, WA
Franklin, WA
6760.................... Richmond-Petersburg, VA 0.9819
Charles City County, VA
Chesterfield, VA
Colonial Heights City, VA
Dinwiddie, VA
Goochland, VA
Hanover, VA
Henrico, VA
Hopewell City, VA
New Kent, VA
Petersburg City, VA
Powhatan, VA
Prince George, VA
Richmond City, VA
6780.................... Rivee-San Bernardino, CA 1.1467
San Bernardino, CA
6800.................... Roanoke, VA................... 0.9070
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820.................... Rochester, MN................. 1.2470
Olmsted, MN
6840.................... Rochester, NY................. 1.0294
Genesee, NY
Livingston, NY
Ontario, NY
Ontario, NY
Orleans, NY
Wayne NY
6880.................... Rockford, IL.................. 0.9183
Boone, IL
Ogle, IL
Winnebago, IL
6895.................... Rocky Mount, NC............... 0.9607
Edgecombe, NC
Nash, NC
6920.................... Sacramento, CA................ 1.2751
El Dorado, CA
Placer, CA
Sacramento, CA
6960.................... Saginaw-Bay City-Midland, MI 1.0113
Bay, MI
Midland, MI
Saginaw, MI
6980.................... St. Cloud, MN................. 1.0219
Benton, MN
Stearns, MN
7000.................... St. Joseph, MO................ 1.0541
Andrew, MO
Buchanan, MO
7040.................... St. Louis, MO-IL.............. 0.9755
Franklin, MO
Jefferson, MO
Lincoln, MO
St. Charles, MO
St. Louis, MO
St. Louis City, MO
Warren, MO
Clinton, IL
Jersey, IL
Madison, IL
Monore, IL
St. Clair, IL
7080.................... Salem, OR..................... 1.0557
Marion, OR
Polk, OR
7120.................... Salinas, CA................... 1.6141
Monterey, CA
7160.................... Salt Lake City-Ogden, UT 1.0018
Davis, UT
Salt Lake, UT
Weber, UT
7200.................... San Angelo, TX................ 0.8150
Tom Green, TX
7240.................... San Antonio, TX............... 0.8634
Bexar, TX
Comal, TX
Guadalupe, TX
Wilson, TX
7320.................... San Diego, CA................. 1.3074
San Diego, CA
7360.................... San Francisco, CA............. 1.4878
Marin, CA
San Francisco, CA
San Mateo, CA
7400.................... San Jose, CA.................. 1.4739
Santa Clara, CA
7440.................... San Juan-Bayamon, PR 0.5316
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
Fajardo, PR
Florida, PR
Guaynabo, PR
Humacao, PR
Juncos, PR
Los Piedras, PR
Loiza, PR
Luguillo, PR
Manati, PR
Morovis, PR
Naguabo, PR
Naranjito, PR
Rio Grande, PR
San Juan, PR
Toa Alta, PR
Toa Baja, PR
Trujillo Alto, PR
Vega Alta, PR
Vega Baja, PR
[[Page 42400]]
Yabucoa, PR
7460.................... San Luis Obispo-Atascadero- 1.2007
Paso Robles, CA
San Luis Obispo, CA
7480.................... Santa Barbara-Santa Maria- 1.1933
Lompoc, CA
Santa Barbara, CA
7485.................... Santa Cruz-Watsonville, CA 1.4903
Santa Cruz, CA
7490.................... Santa Fe, NM.................. 1.0289
Los Alamos, NM
Santa Fe, NM
7500.................... Santa Rosa, CA................ 1.4494
Sonoma, CA
7510.................... Sarasota-Bradenton, FL 1.0161
Manatee, FL
Sarasota, FL
7520.................... Savannah, GA.................. 1.0724
Bryan, GA
Chatham, GA
Effingham, GA
7560.................... Scranton--Wilkes-Barre-- 0.8847
Hazleton, PA
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600.................... Seattle-Bellevue-Everett, WA 1.2287
Island, WA
King, WA
Snohomish, WA
7610.................... Sharon, PA.................... 0.9431
Mercer, PA
7620.................... Sheboygan, WI................. 0.8768
Sheboygan, WI
7640.................... Sherman-Denison, TX 0.9135
Grayson, TX
7680.................... Shreveport-Bossier City, LA 1.0005
Bossier, LA
Caddo, LA
Webster, LA
7720.................... Sioux City, IA-NE............. 0.9041
Woodbury, IA
Dakota, NE
7760.................... Sioux Falls, SD............... 0.9500
Lincoln, SD
Minnehaha, SD
7800.................... South Bend, IN................ 1.0510
St. Joseph, IN
7840.................... Spokane, WA................... 1.1649
Spokane, WA
7880.................... Springfield, IL............... 0.9295
Menard, IL
Sangamon, IL
7920.................... Springfield, MO............... 0.8604
Christian, MO
Greene, MO
Webster, MO
8003.................... Springfield, MA............... 1.1715
Hampden, MA
Hampshire, MA
8050.................... State College, PA............. 1.0072
Centre, PA
8080.................... Steubenville-Weirton, OH-WV 0.8984
Jefferson, OH
Brooke, WV
Hancock, WV
8120.................... Stockton-Lodi, CA............. 1.1806
San Joaquin, CA
8140.................... Sumter, SC.................... 0.8663
Sumter, SC
8160.................... Syracuse, NY.................. 1.0020
Cayuga, NY
Madison, NY
Onondaga, NY
Oswego, NY
8200.................... Tacoma, WA.................... 1.1065
Pierce, WA
8240.................... Tallahassee, FL............... 0.9006
Gadsden, FL
Leon, FL
8280.................... Tampa-St. Petersburg- 0.9714
Clearwater, FL.
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320.................... Terre Haute, IN............... 0.9584
Clay, IN
Vermillion, IN
Vigo, IN
8360.................... Texarkana, AR-Texarkana, TX 0.9067
Miller, AR
Bowie, TX
8400.................... Toledo, OH.................... 1.0650
Fulton, OH
Lucas, OH
Wood, OH
8440.................... Topeka, KS.................... 1.0459
Shawnee, KS
8480.................... Trenton, NJ................... 1.1202
Mercer, NJ
8520.................... Tucson, AZ.................... 0.9624
Pima, AZ
8560.................... Tulsa, OK..................... 0.9021
Creek, OK
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600.................... Tuscaloosa, AL................ 0.8145
Tuscaloosa, AL
8640.................... Tyler, TX..................... 0.9400
Smith, TX
8680.................... Utica-Rome, NY................ 0.8973
Herkimer, NY
Oneida, NY
8720.................... Vallejo-Fairfield-Napa, CA 1.4298
Napa, CA
Solano, CA
8735.................... Ventura, CA................... 1.1741
Ventura, CA
8750.................... Victoria, TX.................. 0.8934
Victoria, TX
8760.................... Vineland-Millville-Bridgeton, 1.1129
NJ
Cumberland, NJ
8780.................... Visalia-Tulare-Porterville, CA 1.0748
Tulare, CA
8800.................... Waco, TX...................... 0.8923
McLennan, TX
8840.................... Washington, DC-MD-VA-WV 1.1520
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Clarke, VA
Culpeper, VA
Fairfax, VA
Fairfax City, VA
Falls Church City, VA
Fauquier, VA
Fredericksburg City, VA
King George, VA
Loudoun, VA
Manassas City, VA
Manassas Park City, VA
Prince William, VA
Spotsylvania, VA
Stafford, VA
Warren, VA
Berkeley, WV
Jefferson, WV
8920.................... Waterloo-Cedar Falls, IA 0.8483
Black Hawk, IA
8940.................... Wausau, WI.................... 1.0375
Marathon, WI
8960.................... West Palm Beach-Boca Raton, FL 1.0893
Palm Beach, FL
9000.................... Wheeling, WV-OH............... 0.8130
Belmont, OH
Marshall, WV
Ohio, WV
9040.................... Wichita, KS................... 0.9485
Butler, KS
Harvey, KS
Sedgwick, KS
9080.................... Wichita Falls, TX............. 0.8347
Archer, TX
Wichita, TX
9140.................... Williamsport, PA.............. 0.9121
Lycoming, PA
9160.................... Wilmington-Newark, DE-MD 1.2651
New Castle, DE
[[Page 42401]]
Cecil, MD
9200.................... Wilmington, NC................ 0.9959
Brunswick, NC
New Hanover, NC
9260.................... Yakima, WA.................... 1.0999
Yakima, WA
9270.................... Yolo, CA...................... 1.1974
Yolo, CA
9280.................... York, PA...................... 1.0031
York, PA
9320.................... Youngstown-Warren, OH 1.0463
Columbiana, OH
Mahoning, OH
Trumbull, OH
9340.................... Yuba City, CA................. 1.1582
Sutter, CA
Yuba, CA
9360.................... Yuma, AZ...................... 1.0722
Yuma, AZ
------------------------------------------------------------------------
\1\ This column lists each MSA area name (in italics) and each county ,
or county equivalent, in the MSA area. Counties not listed in this
Table are considered to be Rural Areas. Wage Index values for these
areas are found in Table B.
\2\ Wage index values are based on FY 1998 hospital cost report data
prior to reclassification. This wage index is further adjusted. Wage
index values greater than 0.8 are subject to a budget neutrality
adjustment of 1.065982. Wage index values below 0.8 are adjusted to be
the greater of a 15 percent increase, subject to a maximum wage index
value of 0.8, or an adjustment by multiplying the hospital wage index
value for a given area by the budget neutrality adjustment. All of
these adjustments have been completed by HCFA and are built into the
wage index values reflected in this table.
Table B.--WAGE INDEX FOR RURAL AREAS
------------------------------------------------------------------------
Wage
MSA code No. Nonurban area Index
-------------------------------------------------------------------\3\--
9901........................ Alabama......................... 0.8000
9902........................ Alaska.......................... 1.3250
9903........................ Arizona......................... 0.8516
9904........................ Arkansas........................ 0.8000
9905........................ California...................... 1.0637
9906........................ Colorado........................ 0.8993
9907........................ Connecticut..................... 1.2871
9908........................ Delaware........................ 0.9388
9910........................ Florida......................... 0.9463
9911........................ Georgia......................... 0.8408
9912........................ Hawaii.......................... 1.1630
9913........................ Idaho........................... 0.9036
9914........................ Illinois........................ 0.8438
9915........................ Indiana......................... 0.8933
9916........................ Iowa............................ 0.8290
9917........................ Kansas.......................... 0.8000
9918........................ Kentucky........................ 0.8362
9919........................ Louisiana....................... 0.8000
9920........................ Maine........................... 0.9026
9921........................ Maryland........................ 0.9119
9922........................ Massachusetts................... 1.1549
9923........................ Michigan........................ 0.9461
9924........................ Minnesota....................... 0.9162
9925........................ Mississippi..................... 0.8000
9926........................ Missouri........................ 0.8000
9927........................ Montana......................... 0.8952
9928........................ Nebraska........................ 0.8180
9929........................ Nevada.......................... 0.9867
9930........................ New Hampshire................... 1.0916
9931........................ New Jersey \4\.................. ........
9932........................ New Mexico...................... 0.8815
9933........................ New York........................ 0.9155
9934........................ North Carolina.................. 0.8647
9935........................ North Dakota.................... 0.8000
9936........................ Ohio............................ 0.9081
9937........................ Oklahoma........................ 0.8000
9938........................ Oregon.......................... 1.0564
9939........................ Pennsylvania.................... 0.9236
9940........................ Puerto Rico..................... 0.4692
9941........................ Rhode Island \4\................ ........
9942........................ South Carolina.................. 0.8577
9943........................ South Dakota.................... 0.8003
9944........................ Tennessee....................... 0.8000
9945........................ Texas........................... 0.8064
9946........................ Utah............................ 0.9444
9947........................ Vermont......................... 1.0037
9948........................ Virgin Islands.................. 0.5276
9949........................ Virginia........................ 0.8375
9950........................ Washington...................... 1.1181
9951........................ West Virginia................... 0.8395
9952........................ Wisconsin....................... 0.9286
9953........................ Wyoming......................... 0.9347
9965........................ Guam............................ 0.9611
------------------------------------------------------------------------
\3\ Wage index values are based on FY 1998 hospital cost report data
prior to reclassification. This wage index is further adjusted. Wage
index values greater than 0.8 are subject to a budget neutrality
adjustment of 1.065982. Wage index values below 0.8 are adjusted to be
the greater of a 15 percent increase, subject to a maximum wage index
value of 0.8, or an adjustment by multiplying the hospital wage index
value for a given area by the budget neutrality adjustment. All of
these adjustments have been completed by HCFA and are built into the
wage index values reflected in this table.
\4\ All counties within the State are classified as urban.
II. Regulatory Impact Statement
A. Background
We have examined the impacts of this notice as required by
Executive Order 12866, the Unfunded Mandate Reform Act, and the
Regulatory Flexibility Act (RFA) (Pub. L. 96-354). In this notice, we
identified an impact on hospices as a result of changes in the way we
compute the hospice wage index. The change in the methodology for
computing the wage index was determined through a negotiated rulemaking
committee and implemented in the August 8, 1997 final rule (62 FR
42860). This notice only describes the effects of those changes in
conjunction with the annual update to the hospice wage index. We
believe these changes to be insignificant.
1. Executive Order 12866 and RFA
Executive Order 12866 directs agencies to assess all costs and
benefits of available regulatory alternatives and, when regulation is
necessary, to select regulatory approaches that maximize net benefits
(including potential economic, environmental, public health and safety
effects; distributive impacts; and equity). We have determined that
this notice is not an economically significant rule under this
Executive Order. The RFA requires agencies to analyze options for
regulatory relief for small businesses. For purposes of the RFA, States
and individuals are not considered small entities. However, most
providers, physicians, and health care suppliers are small entities,
either by nonprofit status or by having revenues of $5 million or less
annually. Approximately 73 percent of Medicare certified hospices are
identified as being voluntary, government, or other agency, and
therefore are considered small entities. Because the National Hospice
Organization estimates that approximately 65 percent of hospice
patients are Medicare beneficiaries, we have not considered other
sources of revenue in this analysis.
As discussed below, both urban and rural areas in Puerto Rico will
experience the most significant decrease, 7.6 and 11.6 percent
respectively, in payments under this wage index. Looking at the effects
of this rule on Puerto Rico, we see that 21 of the 29 hospices in urban
Puerto Rico can be considered small entities that will experience an
7.6 percent decrease in Medicare payments. Therefore, we anticipate
this rule will have a significant impact on a substantial number of
small entities. However, the methodology for the hospice wage index was
previously determined by consensus through a negotiated rulemaking
committee that included representatives of national hospice
associations; rural, urban, large and small hospices; multi-site
hospices; and consumer groups. Based on all of the options considered,
the committee determined that the methodology described in the
committee statement, and adopted into the August 8, 1997 final rule,
was favorable for the hospice community as a whole, as well as for the
beneficiaries that they serve. Therefore, we believe that mitigating
the effects of small entities has been taken into consideration.
[[Page 42402]]
2. Congressional Review
Section 804(2) of Title 5, United States Code (as added by section
251 of Public Law 104-121 rule of the Public Law), specifies that a
``major rule'' is any rule that the Office of Management and Budget
finds is likely to result in--
An annual effect on the economy of $100 million or more;
A major increase in costs or prices for consumers,
individual industries, Federal, State, or local government agencies, or
geographic regions; or
Significant adverse effects on competition, employment,
investment, productivity, innovation, or on the ability of United
States-based enterprises to compete with foreign-based enterprises in
domestic and export markets.
We estimate that the impact of this notice will not be $100 million
or more; therefore, this rule is not a major rule as defined in Title
5, United States Code, section 804(2) and is not being forwarded to
Congress for a 60-day review period.
3. Unfunded Mandate
The Unfunded Mandate Reform Act of 1995 also requires (in section
202) that agencies prepare an assessment of anticipated costs and
benefits for any rule that may result in an annual expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more. The notice has no
consequential effect on State, local, or tribal governments. We believe
the private sector costs of this rule fall below the threshold, as
well.
4. Rural Hospital Impact
Section 1102(b) of the Act requires us to prepare a regulatory
impact analysis for any notice that may have a significant impact on
the operations of a substantial number of small rural hospitals. Such
an analysis must conform to the provisions of section 604 of the RFA.
For purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside a Metropolitan
Statistical Area and has fewer than 50 beds.
Because this notice has no direct impact on small hospitals, in
accordance with 5 U.S.C. 604, the Secretary certifies that this notice
will not have a significant impact on the operations of a substantial
number of small rural hospitals.
B. Anticipated Effects
This impact analysis compares hospice payments under the FY 1999
hospice wage index (Column 3 of the table) to the estimated payments
using the FY 2000 wage index (Column 4). The wage index blend for the
second transition year (FY 1999) was one-third of the 1983 wage index
added to two-thirds of the new wage index. The third transition year
(FY 2000) fully implements the revised wage index. The data used in
developing the quantitative analysis for this notice were obtained from
the December 1998 update of the national claims history file of all
bills submitted during fiscal year 1998. We deleted bills from hospices
that have since closed. In addition to the information contained in
Table C below, we have compared estimated payments using the original
1983 hospice wage index to estimated payments using the FY 2000 wage
index and determined the new wage index methodology to be budget
neutral as required by the negotiated rulemaking committee agreement.
Table C demonstrates the results of our analysis. In Column 2 of
the table (below) we indicate the number of routine home care days that
were included in our analysis, although the analysis was performed on
all types of hospice care. Column 3 of the table indicates payments
that were made using the FY 1999 wage index. Column 4 of Table C is
based on FY 1998 claims and estimates payments to be made to hospices
using the FY 2000 wage index. The final column, which compares Columns
3 and 4, shows the percent change in estimated hospice payments made
based on the category of the hospice.
Table C categorizes hospices by various geographic and provider
characteristics. The first row displays the results of the impact
analysis for all Medicare certified hospices. The second and third rows
of the table categorize hospices according to their geographic location
(urban and rural). There are 1,375 hospices located in urban areas
included in our analysis and 786 hospices located in rural areas. The
next two groupings in the table indicate the number of hospices by
census region, also broken down by urban and rural hospices. The sixth
grouping shows the impact on hospices based on the size of the
hospice's program. We determined that the majority of hospice payments
are made at the routine home care rate. Therefore, we based the size of
each individual hospice's program on the number of routine home care
days provided in 1998. The next grouping shows the impact on hospices
by type of ownership. The final grouping shows the impact on hospices
defined by whether they are provider-based or freestanding.
The results of our analysis show that the greatest increases are
for urban and rural hospices in the New England region, 3.0 percent and
2.7 percent respectively, and for rural hospices in the Pacific region,
with 2.3 percent. The greatest decreases, besides Puerto Rico, are the
urban West South Central and urban East North Central regions with 2.7
percent and 2.0 percent respectively. The most dramatic shift occurs in
Puerto Rico, where urban payments decrease by 7.6 percent and rural
payments decrease by 11.6 percent.
With the FY 99 wage index, Puerto Rico experienced a 11.6 percent
decrease for urban areas and a 12.3 percent decrease for rural areas.
The total percentage decrease in payments Puerto Rico will experience
with the new hospice wage index is 21 percent for urban areas and 26.3
percent for rural areas, which is consistent with the estimated impact
information HCFA provided to the negotiated rulemaking committee during
their deliberations. Since the wage index values for the Puerto Rico
region are more than 15 percent below the 1983 wage index value of 0.8,
this region is most affected by the revision to the wage index floor.
However, as mentioned above, Puerto Rico's hospital wage index is
calculated in the same manner as the national hospital wage index but
is based solely on Puerto Rico's wage data. This has an impact on
Puerto Rico's hospice wage index in that the hospice wage index is
calculated using the pre-reclassified hospital wage index.
Small hospice programs show small increases while larger programs
experience only a negligible decrease. Government-based hospices show
slight increases in payment due to the wage index change while
proprietary hospices show slight decreases. Finally, freestanding
hospices show slight decreases in their wage index values while
provider-based hospice programs show small increases.
We have reviewed this notice under the threshold criteria of
Executive Order 12612. We have determined that it does not
significantly affect the rights, roles, and responsibilities of States.
[[Page 42403]]
Table C.--Impact of Hospice Wage Index Change
----------------------------------------------------------------------------------------------------------------
Estimated
Number of Payments payments Percent
Number of routine using FY using FY change in
hospices home care 1999 wage 2000 wage hospice
days in index in index in payments
thousands thousands thousands
(1) (2) (3) (4) (5)
----------------------------------------------------------------------------------------------------------------
All............................................ 2,161 18,455 2,135,750 2,128,347 -0.3
Urban Hospices................................. 1,375 15,717 1,877,146 1,868,228 -0.5
Rural Hospices................................. 786 2,738 258,604 260,118 0.6
Region (Urban):
New England................................ 98 607 79,780 82,145 3.0
Middle Atlantic............................ 176 1,970 249,012 252,129 1.3
South Atlantic............................. 188 3,509 433,746 433,786 0.0
East North Central......................... 223 2,546 301,352 295,253 -2.0
East South Central......................... 101 890 92,734 91,468 -1.4
West North Central......................... 98 930 97,912 98,233 0.3
West South Central......................... 185 2,090 224,483 218,502 -2.7
Mountain................................... 90 945 125,720 123,558 -1.7
Pacific.................................... 187 2,028 257,817 259,665 0.7
Puerto Rico................................ 29 203 14,592 13,489 -7.6
Region (Rural):
New England................................ 25 69 7,178 7,372 2.7
Middle Atlantic............................ 36 162 16,287 16,306 0.1
South Atlantic............................. 115 601 55,752 55,890 0.2
East North Central......................... 132 490 46,469 46,864 0.9
East South Central......................... 81 376 34,460 34,534 0.2
West North Central......................... 168 358 33,204 33,579 1.1
West South Central......................... 88 279 24,492 24,408 -0.3
Mountain................................... 84 181 17,817 17,872 0.3
Pacific.................................... 54 202 21,593 22,098 2.3
Puerto Rico................................ 3 19 1,352 1,195 -11.6
Size (Routine Home Care Days):
0-1,754 Days............................... 540 457 46,196 46,452 0.6
1,754-4,373 Days........................... 539 1,603 164,904 164,822 0.0
4,372-9,681 Days........................... 541 3,616 385,755 385,020 -0.2
9,681+Days................................. 541 12,778 1,538,895 1,532,054 -0.4
Type of Ownership:
Voluntary.................................. 1,374 12,342 1,427,656 1,427,863 0.0
Proprietary................................ 574 5,535 648,731 640,829 -1.2
Government................................. 180 494 50,974 51,319 0.7
Other...................................... 33 83 8,389 8,335 -0.6
Hospice Base:
Freestanding............................... 841 10,368 1,211,588 1,202,380 -0.8
Home Health Agency......................... 757 4,852 558,520 559,505 0.3
Hospital................................... 542 3,107 349,520 349,793 0.1
Skilled Nursing Facility................... 21 127 16,597 16,669 0.4
----------------------------------------------------------------------------------------------------------------
Authority: Section 1814(I) of the Social Security Act (42 U.S.C.
1395f (I)(1))
(Catalog of Federal Domestic Assistance Program No. 93.743
Medicare--Hospital Insurance Program; and No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: May 27, 1999.
Nancy-Ann Min DeParle,
Administrator.
Dated: July 2, 1999.
Donna E. Shalala,
Secretary.
[FR Doc. 99-20013 Filed 7-30-99; 1:30 pm]
BILLING CODE 4120-01-P
