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Start Preamble
Start Printed Page 49454
AGENCY:
Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION:
Notice.
SUMMARY:
This notice announces the annual update to the hospice wage index as required by statute. This update is effective October 1, 2001 through September 30, 2002. The wage index is used to reflect local differences in wage levels. The hospice wage index methodology and values are based on recommendations of a negotiated rulemaking advisory committee and were originally published in the Federal Register on August 8, 1997.
EFFECTIVE DATE:
October 1, 2001.
Start Further InfoFOR FURTHER INFORMATION CONTACT:
Lynn Riley, (410) 786-1286
Carol Blackford, (410) 786-5909
End Further Info End Preamble Start Supplemental InformationSUPPLEMENTARY INFORMATION
I. Background
A. Statute and Regulations
Hospice Care is an approach to treatment that recognizes that the impending death of an individual warrants a change in the focus from curative care to palliative care (relief of pain and other uncomfortable symptoms). The goal of hospice care is to help terminally ill individuals continue life with minimal disruption to normal activities while remaining primarily in the home environment. A hospice uses an interdisciplinary approach to deliver medical, social, psychological, emotional, and spiritual services through use of a broad spectrum of professional and other caregivers, with the goal of making the individual as physically and emotionally comfortable as possible. Counseling and inpatient respite services are available to the family of the hospice patient. Hospice programs consider both the patient and the family as a unit of care.
Section 1861(dd) of the Social Security Act (the Act) provides for coverage of hospice care for terminally ill Medicare beneficiaries who elect to receive care from a participating hospice. The statutory authority for payment to hospices participating in the Medicare program is contained in section 1814(i) of the Act.
Our existing regulations under 42 CFR Part 418 establish eligibility requirements and payment standards and procedures, define covered services, and delineate the conditions a hospice must meet to be approved for participation in the Medicare program. Subpart G of Part 418 provides for payment to hospices based on one of four prospectively determined rates for each day in which a qualified Medicare beneficiary is under the care of a hospice. The four rate categories are routine home care, continuous home care, inpatient respite care, and general inpatient care. Payment rates are established for each category.
The regulations at § 418.306(c), which require the rates to be adjusted by a wage index, were revised in the August 8, 1997 final rule published in the Federal Register (62 FR 42860). This rule implemented a new methodology for calculating the hospice wage index based on the recommendations of a negotiated rulemaking committee. The committee reached consensus on the methodology. We included the resulting committee statement, describing that consensus, as an appendix to the August 8, 1997 final rule (62 FR 42883). The provisions of the final hospice wage index rule are as follows:
- The revised hospice wage index will be calculated using the most current available hospital wage data.
- The revised hospice wage index was phased in over a 3-year transition period. For the first year of the transition period, October 1, 1997 through September 30, 1998, a blended index was calculated by adding two-thirds of the 1983 index value for an area to one-third of the revised wage index value for that area. During the second year of the transition period, October 1, 1998 through September 30, 1999, the calculation was similar, except that the blend was one-third of the 1983 index value and two-thirds of the revised wage index value for that area. We fully implemented the revised wage index during the third transition period, October 1, 1999 through September 30, 2000.
- All hospice wage index values of 0.8 or greater are subject to a budget-neutrality adjustment to ensure that we do not pay more in the aggregate than we would have paid under the original 1983 wage index. The budget-neutrality adjustment is calculated by multiplying the hospice wage index for a given area by the budget-neutrality adjustment factor. The budget-neutrality adjustment is to be applied annually, both during and after the transition period.
- All hospice wage index values below 0.8 receive the greater of the following adjustments: the wage index floor, a 15 percent increase, subject to a maximum wage index value of 0.8; or, the budget-neutrality adjustment.
- The wage index is to be updated annually, in the Federal Register, based on the most current available hospital wage data. These data will include any changes to the definitions of Metropolitan Statistical Areas (MSA).
Section 4441(a) of the Balanced Budget Act of 1997 (BBA) amended section 1814(i)(1)(C)(ii) of the Act to establish updates to hospice rates for fiscal years (FYs) 1998 through 2002. Hospice rates were to be updated by a factor equal to the market basket index, minus 1 percentage point. However, section 131(a) of the Balanced Budget Refinement Act of 1999 (BBRA) changed the payment rates for FYs 2001 and 2002 by increasing the FY 2001 rate by 0.5 percent and the FY 2002 rate by 0.75 percent. Section 131(b) of the BBRA states that any additional payments made under section 131(a) of the BBRA shall not be included in updating the hospice rates after those 2 years.
Section 321(a) of the Medicare, Medicaid and State Child Health Insurance Program (SCHIP) Benefits Improvement and Protection Act (BIPA) amended section 814(i)(1)(C)(ii)(VI) of the Act by increasing Medicare hospice rates for FY 2001 by 5 percentage points. This amendment was applicable to hospice care furnished on or after April 1, 2001. Section 321(b) of BIPA further stipulated that the 5 percent increase in Medicare hospice rates during the period beginning on April 1, 2001 through September 30, 2001 will be treated as the payment rates in effect during the FY 2001. This means that the 5 percent increase was made to the base that is updated annually according to a statutorily dictated percentage of the market basket update, as provided in section 1814(i) of the Act. The new Medicare rates for this time period were announced through HCFA Program Memorandum A-01-04 on January 16, 2001.
Also, section 321(d) of BIPA specified that the Secretary of Health and Human Services use 1.0043 as the hospice wage index value for the Wichita, Kansas MSA in calculating payments for a hospice program providing hospice care in this MSA during FY 2000. CMS's Regional Home Health Intermediaries were instructed, through HCFA Program Memorandum A-01-07, to re-calculate the payment for Medicare hospice services provided during FY 2000 by Medicare hospice providers in the Wichita, Kansas MSA using the new wage index value of 1.0043, and to disburse a lump sum payment reflecting Start Printed Page 49455the difference in the two values that fiscal year.
B. Update to the Hospice Wage Index
This annual update is effective October 1, 2001 through September 30, 2002. In accordance with the agreement signed by the Centers for Medicaid & Medicare Services (CMS) and all other members of the Hospice Wage Index Negotiated Rulemaking Committee, we are using the most current CMS hospital data available, including any changes to the definitions of MSAs. The FY 2001 hospital wage index was the most current hospital wage data available when the FY 2002 wage index values were calculated. We used the pre-reclassified and pre-floor hospital area wage index data.
All wage index values are adjusted by a budget-neutrality factor of 1.064726 and are subject to the wage index floor adjustment, if applicable. We have completed all of the calculations described above and included them in the wage index values reflected in both Tables A and B below. A detailed description of the method used to compute the hospice wage index is contained in both the September 4, 1996 proposed rule published in the Federal Register (61 FR 46579) and the August 8, 1997 final rule published in the Federal Register (62 FR 42860).
1. Metropolitan Statistical Areas
As explained in the September 4, 1996 hospice wage index proposed rule, each hospice's labor market area would be established by the MSA definitions issued by the Office of Management and Budget (OMB) on December 28, 1992 based on the 1990 census, and updated periodically by OMB. Any changes to the MSA definitions would be effective annually and announced in the final rule updating the hospice wage index.
2. MSA Wage Index Values Lower than Rural Values
As explained above, any area not included in an MSA is considered to be nonurban and receives the statewide rural rate. We are aware that in the past, a number of MSAs have had wage index values that were lower than their rural statewide value. This difference is due to variations in local wage data as compared to national wage data. The hospice wage index is computed by dividing the hourly wage rate for an MSA or nonurban area by a national hourly wage rate. Nonurban areas could receive a higher wage index value than urban areas in the same State if the hourly wage rate in the nonurban area increased at a greater rate.
C. Tables
Table A.—Hospice Wage Index for Urban Areas
MSA Code No. Urban area (constituent counties or county equivalents) 1 Wage index 2 0040 Abilene, TX 0.8773 Taylor, TX 0060 Aguadilla, PR 0.5050 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH 1.0366 Portage, OH Summit, OH 0120 Albany, GA 1.0576 Dougherty, GA Lee, GA 0160 Albany-Schenectady-Troy, NY 0.9102 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM 0.9727 Bernalillo, NM Sandoval, NM Valencia, NM 0220 Alexandria, LA 0.8649 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA 1.0567 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA 0.9951 Blair, PA 0320 Amarillo, TX 0.9279 Potter, TX Randall, TX 0380 Anchorage, AK 1.3621 Anchorage, AK 0440 Ann Arbor, MI 1.1982 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL 0.8820 Calhoun, AL 0460 Appleton-Oshkosh-Neenah, WI 0.9638 Calumet, WI Start Printed Page 49456 Outagamie, WI Winnebago, WI 0470 Arecibo, PR 0.8518 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC 1.0132 Buncombe, NC Madison, NC 0500 Athens, GA 1.0369 Clarke, GA Madison, GA Oconee, GA 0520 Atlanta, GA 1.0749 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 1.1906 Atlantic, NJ Cape May, NJ 0580 Aubrn-Opelika, AL 0.8631 Lee, AL 0600 Augusta-Aiken, GA-SC 0.9753 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 Austin-San Marcos, TX 1.0197 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 Bakersfield, CA 1.0304 Kern, CA 0720 Baltimore, MD 0.9971 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME 1.0180 Penobscot, ME 0743 Barnstable-Yarmouth, MA 1.4735 Barnstable, MA 0760 Baton Rouge, LA 0.9414 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX 0.9310 Start Printed Page 49457 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA 1.2179 Whatcom, WA 0870 Benton Harbor, MI 0.9232 Berrien, MI 0875 Bergen-Passaic, NJ 1.2615 Bergen, NJ Passaic, NJ 0880 Billings, MT 1.0205 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS 0.8769 Hancock, MS Harrison, MS Jackson, MS 0960 Binghamton, NY 0.9252 Broome, NY Tioga, NY 1000 Birmingham, AL 0.8999 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND 0.8204 Burleigh, ND Morton, ND 1020 Bloomington, IN 0.9298 Monroe, IN 1040 Bloomington-Normal, IL 0.9684 McLean, IL 1080 Boise City, ID 0.9589 Ada, ID Canyon, ID 1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1882 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 1.0361 Boulder, CO 1145 Brazoria, TX 0.9218 Brazoria, TX 1150 Bremerton, WA 1.1685 Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX 0.9287 Cameron, TX 1260 Bryan-College Station, TX 0.8770 Brazos, TX 1280 Buffalo-Niagara Falls, NY 1.0200 Erie, NY Niagara, NY 1303 Burlington, VT 1.1430 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR 0.5246 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 Canton-Massillon, OH 0.9140 Carroll, OH Start Printed Page 49458 Stark, OH 1350 Casper, WY 0.9289 Natrona, WY 1360 Cedar Rapids, IA 0.9301 Linn, IA 1400 Champaign-Urbana, IL 0.9793 Champaign, IL 1440 Charleston-North Charleston, SC 0.9623 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV 0.9838 Kanawha, WV Putnam, WV 1520 Charlotte-Gastonia-Rock Hill, NC-SC 0.9999 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA 1.1487 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA 1.0469 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 Cheyenne, WY 0.8846 Laramie, WY 1600 Chicago, IL 1.1867 Cook, IL DeKalb, IL Du Page, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA 1.0560 Butte, CA 1640 Cincinnati, OH-KY-IN 1.0024 Brown, OH Clermont, OH Hamilton, OH Warren, OH Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Dearborn, IN Ohio, IN 1660 Clarksville-Hopkinsville, TN-KY 0.8735 Christian, KY Montgomery, TN 1680 Cleveland-Lorain-Elyria, OH 1.0218 Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH Start Printed Page 49459 1720 Colorado Springs, CO 1.0325 El Paso, CO 1740 Columbia, MO 0.9541 Boone, MO 1760 Columbia, SC 1.0172 Lexington, SC Richland, SC 1800 Columbus, GA-AL 0.9123 Chattahochee, GA Harris, GA Muscogee, GA Russell, AL 1840 Columbus, OH 1.0242 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX 0.9291 Nueces, TX San Patricio, TX 1890 Corvallis, Oregon 1.2059 Benton, OR 1900 Cumberland, MD-WV 0.8911 Allegany, MD Mineral, WV 1920 Dallas, TX 1.0555 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA 0.9145 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock Island, IA-IL 0.9474 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH 1.0053 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL 0.9795 Flagler, FL Volusia, FL 2030 Decatur, AL 0.9086 Lawrence, AL Morgan, AL 2040 Decatur, IL 0.8651 Macon, IL 2080 Denver, CO 1.0840 Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA 0.9708 Dallas, IA Polk, IA Warren, IA 2160 Detroit, MI 1.1190 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI Start Printed Page 49460 St. Clair, MI Wayne, MI 2180 Dothan, AL 0.8457 Dale, AL Houston, AL 2190 Dover, DE 1.0730 Kent, DE 2200 Dubuque, IA 0.9312 Dubuque, IA 2240 Duluth-Superior, MN-WI 1.0681 St. Louis, MN Douglas, WI 2281 Dutchess County, NY 1.0912 Dutchess, NY 2290 Eau Claire, WI 0.9359 Chippewa, WI Eau Claire, WI 2320 El Paso, TX 0.9951 El Paso, TX 2330 Elkhart-Goshen, IN 0.9737 Elkhart, IN 2335 Elmira, NY 0.9099 Chemung, NY 2340 Enid, OK 0.9167 Garfield, OK 2360 Erie, PA 0.9567 Erie, PA 2400 Eugene-Springfield, OR 1.1675 Lane, OR 2440 Evansville-Henderson, IN-KY 0.8702 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN 0.9315 Clay, MN Cass, ND 2560 Fayetteville, NC 0.9215 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR 0.8422 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT 1.1378 Coconino, AZ Kane, UT 2640 Flint, MI 1.1930 Genesee, MI 2650 Florence, AL 0.8109 Colbert, AL Lauderdale, AL 2655 Florence, SC 0.9345 Florence, SC 2670 Fort Collins-Loveland, CO 1.1336 Larimer, CO 2680 Ft. Lauderdale, FL 1.0776 Broward, FL 2700 Fort Myers-Cape Coral, FL 0.9846 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL 1.0155 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK 0.8573 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL 1.0229 Okaloosa, FL 2760 Fort Wayne, IN 0.9226 Adams, IN Allen, IN De Kalb, IN Start Printed Page 49461 Huntington, IN Wells, IN Whitley, IN 2800 Forth Worth-Arlington, TX 1.0144 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA 1.0758 Fresno, CA Madera, CA 2880 Gadsden, AL 0.8968 Etowah, AL 2900 Gainesville, FL 1.0726 Alachua, FL 2920 Galveston-Texas City, TX 1.0560 Galveston, TX 2960 Gary, IN 1.0066 Lake, IN Porter, IN 2975 Glens Falls, NY 0.8902 Warren, NY Washington, NY 2980 Goldsboro, NC 0.8968 Wayne, NC 2985 Grand Forks, ND-MN 0.9387 Grand Forks, ND Polk, MN 2995 Grand Junction, CO 0.9699 Mesa, CO 3000 Grand Rapids-Muskegon-Holland, MI 1.0911 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT 0.9652 Cascade, MT 3060 Greeley, CO 1.0449 Weld, CO 3080 Green Bay, WI 0.9822 Brown, WI 3120 Greensboro-Winston-Salem-High Point, NC 0.9722 Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC 0.9991 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC 0.9586 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD 1.0018 Washington, MD 3200 Hamilton-Middletown, OH 0.9648 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA 0.9994 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 Hartford, CT 1.2109 Hartford, CT Litchfield, CT Middlesex, CT Start Printed Page 49462 Tolland, CT 3285 Hattiesburg, MS 0.8000 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC 0.9591 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI 1.2631 Honolulu, HI 3350 Houma, LA 0.8609 Lafourche, LA Terrebonne, LA 3360 Houston, TX 1.0362 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH 1.0515 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL 0.9510 Limestone, AL Madison, AL 3480 Indianapolis, IN 1.0420 Boone, IN Hamilton, IN Hancock, IN Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA 1.0282 Johnson, IA 3520 Jackson, MI 0.9725 Jackson, MI 3560 Jackson, MS 0.9382 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN 0.9365 Madison, TN Chester, TN 3600 Jacksonville, FL 0.9804 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 Jacksonville, NC 0.8280 Onslow, NC 3610 Jamestown, NY 0.8324 Chautauqua, NY 3620 Janesville-Beloit, WI 1.0205 Rock, WI 3640 Jersey City, NJ 1.2246 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA 0.8807 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Start Printed Page 49463 Bristol City, VA Scott, VA Washington, VA 3680 Johnstown, PA 0.9419 Cambria, PA Somerset, PA 3700 Jonesboro, AR 0.8339 Craighead, AR 3710 Joplin, MO 0.8675 Jasper, MO Newton, MO 3720 Kalamazoo-Battlecreek, MI 1.1130 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL 1.05423 Kankakee, IL 3760 Kansas City, KS-MO 1.0144 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 1.0233 Kenosha, WI 3810 Kileen-Temple, TX 1.0774 Bell, TX Coryell, TX 3840 Knoxville, TN 0.8880 Anderson, TN Blount, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN 1.0134 Howard, IN Tipton, IN 3870 La Crosse, WI-MN 0.9807 Houston, MN La Crosse, WI 3880 Lafayette, LA 0.9040 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN 0.9406 Clinton, IN Tippecanoe, IN 3960 Lake Charles, LA 0.8000 Calcasieu, LA 3980 Lakeland-Winter Haven, FL 0.9837 Polk, FL 4000 Lancater, PA 0.9858 Lancaster, PA 4040 Lansing-East Lansing, MI 1.0577 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX 0.8697 Webb, TX 4100 Las Cruces, NM 0.9218 Dona Ana, NM 4120 Las Vegas, NV-AZ 1.1495 Mohave, AZ Clarke, NV Start Printed Page 49464 Nye, NV 4150 Lawrence, KS 0.8720 Douglas, KS 4200 Lawton, OK 0.9578 Comanche, OK 4243 Lewiston-Auburn, ME 0.9621 Androscoggin, ME 4280 Lexington, KY 0.9440 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH 0.9923 Allen, OH Auglaize, OH 4360 Lincoln, NE 1.0249 Lancaster, NE 4400 Little Rock-North Little Rock, AR 0.9482 Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX 0.9499 Gregg, TX Harrison, TX Upshur, TX 4480 Los Angeles-Long Beach, CA 1.2772 Los Angeles, CA 4520 Louisville, KY-IN 0.9955 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX 0.9410 Lubbock, TX 4640 Lynchburg, VA 0.9441 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA 0.9555 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI 1.0936 Dane, WI 4800 Mansfield, OH 0.9252 Crawford, OH Richland, OH 4840 Mayaguez, PR 0.5277 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX 0.9120 Hidalgo, TX 4890 Medford-Ashland, OR 1.1014 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL 1.0315 Brevard, FL Start Printed Page 49465 4920 Memphis, TN-AR-MS 0.9288 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 Merced, CA 1.0270 Merced, CA 5000 Miami, FL 1.0710 Dade, FL 5015 Middlesex-Somerset-Hunterdon, NJ 1.1792 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 Milwaukee-Waukesha, WI 1.0399 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 Minneapolis-St. Paul, MN-WI 1.1730 Anoka, MN Carver, MN Chisago, MN Dakota, MN Hennepin, MN Isanti, MN Ramsey, MN Scott, MN Sherbune, MN Washington, MN Wright, MN Pierce, WI St. Croix, WI 5140 Missoula, MT 0.9874 Missoula, MT 5160 Mobile, AL 0.8691 Baldwin, AL Mobile, AL 5170 Modesto, CA 1.1069 Stanislaus, CA 5190 Monmouth-Ocean, NJ 1.2008 Monmouth, NJ Ocean, NJ 5200 Monroe, LA 0.8939 Ouachita, LA 5240 Montgomery, AL 0.8148 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN 1.1679 Delaware, IN 5330 Myrtle Beach, SC 0.8986 Horry, SC 5345 Naples, FL 1.0286 Collier, FL 5360 Nashville, TN 1.0104 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford, TN Sumner, TN Williamson, TN Wilson, TN 5380 Nassau-Suffolk, NY 1.4834 Nassau, NY Suffolk, NY 5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT 1.3093 Fairfield, CT New Haven, CT 5523 New London-Norwich, CT 1.2844 Start Printed Page 49466 New London, CT 5560 New Orleans, LA 0.9897 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 1.5599 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 Newark, NJ 1.2603 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA 1.1549 Orange, NY Pike, PA 5720 Norfolk-Virginia Beach-Newport News, VA-NC 0.8956 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 1.5953 Alameda, CA Contra Costa, CA 5790 Ocala, FL 0.9841 Marion, FL 5800 Odessa-Midland, TX 0.9801 Ector, TX Midland, TX 5880 Oklahoma City, OK 0.9393 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA 1.1368 Thurston, WA 5920 Omaha, NE-IA 1.0192 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 Orange County, CA 1.2209 Orange, CA 5960 Orlando, FL 1.0232 Lake, FL Start Printed Page 49467 Orange, FL Osceola, FL Seminole, FL 5990 Owensboro, KY 0.8687 Daviess, KY 6015 Panama City, FL 0.9593 Bay, FL 6020 Parkersburg-Marietta, WV-OH 0.8810 Washington, OH Wood, WV 6080 Pensacola, FL 0.8705 Escambia, FL Santa Rosa, FL 6120 Peoria-Pekin, IL 0.9205 Peoria, IL Tazewell, IL Woodford, IL 6160 Philadelphia, PA-NJ 1.1645 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 Phoenix-Mesa, AZ 1.0295 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR 0.8295 Jefferson, AR 6280 Pittsburgh, PA 1.0371 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 Pittsfield, MA 1.0954 Berkshire, MA 6340 Pocatello, ID 0.9663 Bannock, ID 6360 Ponce, PR 0.5757 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME 1.0379 Cumberland, ME Sagadahoc, ME York, ME 6440 Portland-Vancouver, OR-WA 1.1616 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 Providence-Warwick-Pawtucket, RI 1.1567 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT 1.0678 Utah, UT 6560 Pueblo, CO 0.9386 Pueblo, CO Start Printed Page 49468 6580 Punta Gorda, FL 1.0235 Charlotte, FL 6600 Racine, WI 0.9845 6640 Raleigh-Durham-Chapel Hill, NC 1.0270 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD 0.9439 Pennington, SD 6680 Reading, PA 0.9744 Berks, PA 6690 Redding, CA 1.2419 Shasta, CA 6720 Reno, NV 1.1233 Washoe, NV 6740 Richland-Kennewick-Pasco, WA 1.2202 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA 1.0239 Charles City County, VA Chesterfield, VA Colonial Heights City, VA Dinwiddie, VA Goochland, VA Hanover, VA Henrico, VA Hopewell City, VA New Kent, VA Petersburg City, VA Powhatan, VA Prince George, VA Richmond City, VA 6780 Riverside-San Bernardino, CA 1.1966 Riverside, CA San Bernardino, CA 6800 Roanoke, VA 0.9316 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN 1.2047 Olmsted, MN 6840 Rochester, NY 0.9776 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL 0.9390 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC 0.9422 Edgecombe, NC Nash, NC 6920 Sacramento, CA 1.2723 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI 1.0195 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN 1.0664 Benton, MN Stearns, MN 7000 St. Joseph, MO 0.9658 Start Printed Page 49469 Andrew, MO Buchanan, MO 7040 St. Louis, MO-IL 0.9635 Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL 7080 Salem, OR 1.0848 Marion, OR Polk, OR 7120 Salinas, CA 1.5441 Monterey, CA 7160 Salt Lake City-Ogden, UT 1.0442 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX 0.8606 Tom Green, TX 7240 San Antonio, TX 0.9135 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320 San Diego, CA 1.2547 San Diego, CA 7360 San Francisco, CA 1.5072 Marin, CA San Francisco, CA San Mateo, CA 7400 San Jose, CA 1.4536 Santa Clara, CA 7440 San Juan-Bayamon, PR 0.5394 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Ceiba, PR Comerio, PR Corozal, PR Dorado, PR Fajardo, PR Florida, PR Guaynabo, PR Humacao, PR Juncos, PR Los Piedras, PR Loiza, PR Luguillo, PR Manati, PR Morovis, PR Naguabo, PR Naranjito, PR Rio Grande, PR San Juan, PR Toa Alta, PR Toa Baja, PR Trujillo Alto, PR Vega Alta, PR Vega Baja, PR Yabucoa, PR 7460 San Luis Obispo-Atascadero-Paso Robles, CA 1.1364 Start Printed Page 49470 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA 1.1283 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA 1.4949 Santa Cruz, CA 7490 Santa Fe, NM 1.1219 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA 1.3465 Sonoma, CA 7510 Sarasota-Bradenton, FL 1.0444 Manatee, FL Sarasota, FL 7520 Savannah, GA 1.0325 Bryan, GA Chatham, GA Effingham, GA 7560 Scranton-Wilkes-Barre-Hazleton, PA 0.8966 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 Seattle-Bellevue-Everett, WA 1.1708 Island, WA King, WA Snohomish, WA 7610 Sharon, PA 0.8441 Mercer, PA 7620 Sheboygan, WI 0.8921 Sheboygan, WI 7640 Sherman-Denison, TX 0.9257 Grayson, TX 7680 Shreveport-Bossier City, LA 0.9316 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE 0.9021 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD 0.9359 Lincoln, SD Minnehaha, SD 7800 South Bend, IN 1.0647 St. Joseph, IN 7840 Spokane, WA 1.1193 Spokane, WA 7880 Springfield, IL 0.9247 Menard, IL Sangamon, IL 7920 Springfield, MO 0.9037 Christian, MO Greene, MO Webster, MO 8003 Springfield, MA 1.1325 Hampden, MA Hampshire, MA 8050 State College, PA 0.9623 Centre, PA 8080 Steubenville-Weirton, OH-WV 0.9101 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA 1.1317 San Joaquin, CA 8140 Sumter, SC 0.8806 Sumter, SC 8160 Syracuse, NY 1.0167 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY Start Printed Page 49471 8200 Tacoma, WA 1.2312 Pierce, WA 8240 Tallahassee, FL 0.9098 Gadsden, FL Leon, FL 8280 Tampa-St. Petersburg-Clearwater, FL 0.9563 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 Terre Haute, IN 0.8841 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR-Texarkana, TX 0.8904 Miller, AR Bowie, TX 8400 Toledo, OH 1.0468 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS 0.9707 Shawnee, KS 8480 Trenton, NJ 1.0793 Mercer, NJ 8520 Tucson, AZ 0.9363 Pima, AZ 8560 Tulsa, OK 0.9001 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 Tuscaloosa, AL 0.8586 Tuscaloosa, AL 8640 Tyler, TX 1.0013 Smith, TX 8680 Utica-Rome, NY 0.9114 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA 1.3679 Napa, CA Solano, CA 8735 Ventura, CA 1.1744 Ventura, CA 8750 Victoria, TX 0.8682 Victoria, TX 8760 Vineland-Millville-Bridgeton, NJ 1.1181 Cumberland, NJ 8780 Visalia-Tulare-Porterville, CA 1.0169 Tulare, CA 8800 Waco, TX 0.8852 McLennan, TX 8840 Washington, DC-MD-VA-WV 1.1451 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 Start Printed Page 49472 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 0.8948 Black Hawk, IA 8940 Wausau, WI 1.0028 Marathon, WI 8960 West Palm Beach-Boca Raton, FL 1.0309 Palm Beach, FL 9000 Wheeling, WV-OH 0.8234 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS 1.0162 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX 0.8164 Archer, TX Wichita, TX 9140 Williamsport, PA 0.8935 Lycoming, PA 9160 Wilmington-Newark, DE-MD 1.1915 New Castle, DE Cecil, MD 9200 Wilmington, NC 1.0011 Brunswick, NC New Hanover, NC 9260 Yakima, WA 1.0548 Yakima, WA 9270 Yolo, CA 1.0859 Yolo, CA 9280 York, PA 0.9864 York, PA 9320 Youngstown-Warren, OH 1.0161 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA 1.1399 Sutter, CA Yuba, CA 9360 Yuma, AZ 1.0146 Yuma, AZ 1 This column lists each MSA area name and each county, or county equivalent, in the MSA area. Counties not listed in this Table are considered to be Rural Areas. Wage Index values for these areas are found in Table B. 2 Wage index values are based on FY 1997 hospital cost report data before reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of 1.064726. Wage index values below 0.8 are adjusted to be the greater of a 15-percent increase, subject to a maximum wage index value of 0.8, or an adjustment by multiplying the hospital wage index value for a given area by the budget-neutrality adjustment. We have completed all of these adjustments and included them in the wage index values reflected in this table. Table B.—Wage Index for Rural Areas
MSA Code No. Nonurban area Wage index 3 9901 Alabama 0.8000 9902 Alaska 1.3194 9903 Arizona 0.8855 9904 Arkansas 0.8000 9905 California 1.0499 9906 Colorado 0.9548 9907 Connecticut 1.2473 9908 Delaware 0.9661 9910 Florida 0.9496 9911 Georgia 0.8868 Start Printed Page 49473 9912 Hawaii 1.1775 9913 Idaho 0.9240 9914 Illinois 0.8688 9915 Indiana 0.9159 9916 Iowa 0.8550 9917 Kansas 0.8097 9918 Kentucky 0.8444 9919 Louisiana 0.8178 9920 Maine 0.9333 9921 Maryland 0.9211 9922 Massachusetts 1.1929 9923 Michigan 0.9569 9924 Minnesota 0.9456 9925 Mississippi 0.8000 9926 Missouri 0.8196 9927 Montana 0.9250 9928 Nebraska 0.8634 9929 Nevada 0.9830 9930 New Hampshire 1.0482 9931 New Jersey 4 9932 New Mexico 0.9047 9933 New York 0.9049 9934 North Carolina 0.8987 9935 North Dakota 0.8215 9936 Ohio 0.9231 9937 Oklahoma 0.8000 9938 Oregon 1.0788 9939 Pennsylvania 0.9133 9940 Puerto Rico 0.4904 9941 Rhode Island 4 9942 South Carolina 0.8912 9943 South Dakota 0.8060 9944 Tennessee 0.8345 9945 Texas 0.8000 9946 Utah 0.9622 9947 Vermont 0.9874 9948 Virgin Islands 0.7252 9949 Virginia 0.8719 9950 Washington 1.1109 9951 West Virginia 0.8764 9952 Wisconsin 0.9455 9953 Wyoming 0.9388 9965 Guam 1.0233 3 Wage index values are based on FY 1997 hospital cost report data before reclassification. This wage index is further adjusted. Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of 1.064726. Wage index values below 0.8 are adjusted to be the greater of a 15-percent increase, subject to a maximum wage index value of 0.8, or an adjustment by multiplying the hospital wage index value for a given area by the budget-neutrality adjustment. We have completed all of these adjustments and have included them in the wage index values reflected in this table. 4 All counties within the State are classified as urban. II. Regulatory Impact Statement
A. Overall Impact
We have examined the impacts of this notice as required by Executive Order 12866 (September 1993, Regulatory Planning & Review) and the Regulatory Flexibility Act (RFA) (September 19, 1980 Pub. L. 96-354). In this notice, we identified an impact on hospices as a result of changes in the way we compute the hospice wage index. The change in the methodology for computing the wage index was determined through a negotiated rulemaking committee and implemented in the August 8, 1997 final rule (62 FR 42860). We recognize that the BIPA adjusted hospice payments upward by 5 percent; however, we did not do a separate analysis of the impact of this payment adjustment. We used the new rates adjusted by the BIPA when estimating the payments to be made under the new wage index and when calculating the budget-neutrality adjustment factor. Overall, we believe the changes included in this notice to be insignificant.
Executive Order 12866 directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year). We have determined that this notice is not an economically significant rule under this Executive Order.
The RFA requires agencies to determine whether a rule will have a significant economic impact on a substantial number of small entities. For purposes of the RFA, small entities include small businesses, nonprofit organizations and government agencies. Start Printed Page 49474Most hospital and most other providers and suppliers are small entities, either by nonprofit status or by having revenues of $5 million or less annually. For purposes of the RFA, most hospices are small entities. Approximately 73 percent of Medicare certified hospices are identified as voluntary, government, or other agencies, and, therefore, are considered small entities. Because the National Hospice and Palliative Care Organization estimates that approximately 70 percent of hospice patients are Medicare beneficiaries, we have not considered other sources of revenue in this analysis.
As discussed below, the estimated decreases in payment to hospices overall are very slight. The effects of this notice indicate that on a regional basis, urban hospices in the New England, Middle Atlantic, South Atlantic, East South Central and Pacific regions will experience a slight decrease in payments. The payment decreases range from a minimum of 0.2 percent (East South Central region) to a maximum of 0.7 percent (New England region). The mid-range of the decrease in estimated payments for urban hospices falls within the Middle Atlantic urban region with a 0.4 percent decrease. Rural hospices in the New England and Middle Atlantic regions will also experience a slight decrease in payments, 0.9 and 0.3 percent respectively. Therefore, based on an analysis of the wage index changes for FY 2002, hospices in the urban and rural areas of the New England and Middle Atlantic regions will be impacted the most. This payment decrease to these small entities indicates that this notice will have a significant impact on a substantial number of small entities. However, nationwide, hospices will receive an overall slight increase in estimated payments. We estimate that total hospice payments will increase by 0.5 percent, or $13,632,000. Urban hospices will receive an increase in estimated payments of 0.3 percent and rural hospices will receive an increase in estimated payments of 1.3 percent.
We would like to emphasize that the methodology for the hospice wage index was previously determined by consensus through a negotiated rulemaking committee that included representatives of national hospice associations; rural, urban, large and small hospices; multi-site hospices; and consumer groups. Based on the options considered, the committee agreed on the methodology described in the committee statement, and adopted it into regulation in the August 8, 1997 final rule. The committee also agreed that this was favorable for the hospice community as well as for beneficiaries. Therefore, we believe that mitigating any negative effects on small entities has been taken into consideration.
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 604 of the RFA. For purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital that is located outside an MSA and has fewer than 100 beds.
Section 202 of the Unfunded Mandate Reform Act of 1995 also requires that agencies assess anticipated costs and benefits before issuing any rule that may result in an expenditure in any 1 year by State, local, and tribal governments, in the aggregate, or by the private sector, in any 1 year of $110 million or more. This notice has no consequential effect on State, local, or tribal governments. We believe the private sector costs of this notice fall below the threshold as well.
We have reviewed this notice under the threshold criteria of Executive Order 13132, Federalism, and have determined that this notice will not have any negative impact on the rights, roles, and responsibilities of State, local, or tribal governments.
B. Anticipated Effects
We have compared estimated payments using the FY 1983 hospice wage index to estimated payments using the FY 2002 wage index and determined the current hospice rates to be budget-neutral. This impact analysis compares hospice payments using the FY 2001 hospice wage index to the estimated payments using the FY 2002 wage index. The data used in developing the quantitative analysis for this notice were obtained from the March 2001 update of the national claims history file of all bills submitted during FY 2000. We deleted bills from hospices that have since closed.
Table C demonstrates the results of our analysis. In Column 2 of Table C, we indicate the number of routine home care days that were included in our analysis, although the analysis was performed on all types of hospice care. Column 3 of Table C indicates payments that were made using the FY 2001 wage index. Column 4 of Table C is based on FY 2000 claims and estimates payments to be made to hospices using the FY 2002 wage index. The final column, which compares Columns 3 and 4, shows the percent change in estimated hospice payments made based on the category of the hospice.
Table C categorizes hospices by various geographic and provider characteristics. The first row displays the results of the impact analysis for all Medicare certified hospices. The second and third rows of the table categorize hospices according to their geographic location (urban and rural). Our analysis indicated that there are 1,319 hospices located in urban areas and 824 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 2000. The next grouping shows the impact on hospices by type of ownership. The final grouping shows the impact on hospices defined by whether they are provider-based or freestanding.
The results of our analysis shows that the greatest increases in payment are for urban areas in the East North Central and West South Central Regions, with a 1.8 percent and 1.9 percent increase, respectively. The greatest decreases in payment are for urban and rural areas in the New England and Middle Atlantic regions.
The breakdown by size, type of ownership, and facility base showed an increase in payments to all hospice programs. Small hospice programs showed significant increases of about 5 percent, while larger programs experienced only a negligible increase. In terms of hospice base, freestanding hospices showed the greatest estimated payment increase while hospices affiliated with home health agencies and skilled nursing facilities showed the smallest amount of payment increase.Start Printed Page 49475
Table C.—Impact of Hospice Wage Index Change
Number of hospices (1) Number of routine home care days in thousands (2) Payments using FY 2001 wage index in thousands (3) Estimated payments using FY 2002 wage index in thousands (4) Percent change in hospice payments (5) (By Geographic Location) All Hospices 2,143 23,765 2,995,014 3,008,646 0.5 Urban Hospices 1,319 20,078 2,616,198 2,624,874 0.3 Rural Hospices 824 3,687 378,816 383,772 1.3 By Region—Urban: New England 89 662 98,780 98,045 -0.7 Middle Atlantic 169 2,302 321,614 320,170 -0.4 South Atlantic 184 4,402 618,316 616,008 -0.4 East North Central 225 3,246 408,377 415,850 1.8 East South Central 95 1,312 148,758 148,457 -0.2 West North Central 94 1,220 139,067 139,550 0.3 West South Central 178 2,752 324,985 331,103 1.9 Mountain 87 1,358 186,025 187,093 0.6 Pacific 171 2,553 350,437 348,589 -0.5 Puerto Rico 27 270 19,840 20,010 0.9 By Region—Rural: New England 26 67 7,825 7,752 -0.9 Middle Atlantic 35 182 19,862 19,798 -0.3 South Atlantic 122 763 78,343 80,149 2.3 East North Central 138 595 61,827 62,535 1.1 East South Central 82 649 63,742 64,465 1.1 West North Central 178 439 45,187 45,577 0.9 West South Central 98 479 45,051 45,793 1.6 Mountain 86 240 25,762 26,223 1.8 Pacific 56 251 29,687 29,946 0.9 Puerto Rico 3 22 1,530 1,533 0.2 (Skilled) Routine Home Care Days: 0-1,754 Days 386 347 37,277 39,056 4.8 1,754-4,373 Days 480 1,429 154,353 156,256 1.2 4,373-9,681 Days 540 3,600 412,953 414,477 0.4 9,681 + Days 736 18,044 2,348,755 2,357,398 0.4 Type of Ownership: Voluntary 1,336 15,108 1,904,983 1,913,143 0.4 Proprietary 590 7,958 1,011,373 1,016,757 0.5 Government 183 594 66,782 66,840 0.1 Other 34 105 11,877 11,906 0.2 Hospice Base: Freestanding 910 14,401 1,826,242 1,840,289 0.8 Home Health Agency 680 5,446 688,646 687,239 -0.2 Hospital 536 3,789 460,963 461,980 0.2 Skilled Nursing Facility 17 129 19,163 19,138 -0.1 C. Conclusion
We have determined, and we certify, that this rule will have a significant economic impact on a substantial number of small entities. However, we are not preparing analyses for either the RFA or Section 1102(b) of the Act because the methodology for the hospice wage index was previously determined by consensus through a negotiated rulemaking committee. Based on the options considered, the committee agreed on the methodology described in the committee statement, and adopted it into regulation in the August 8, 1997 final rule. The committee, which included representatives of national hospice associates, rural, urban, large and small hospice, multi-site hospice, and consumer groups, agreed that this was favorable for the hospice community as well as for beneficiaries. Therefore, we believe that mitigating any negative effects on small entities has been taken into consideration.
OMB Review
In accordance with the provisions of Executive Order 12866, the Office of Management and Budget reviewed this regulation.
Start SignatureEnd Signature End Supplemental InformationDated: July 10, 2001.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Dated: August 31, 2001.
Tommy G. Thompson,
Secretary.
[FR Doc. 01-23820 Filed 9-20-01; 9:51 am]
BILLING CODE 4210-01-P
Document Information
- Effective Date:
- 10/1/2001
- Published:
- 09/27/2001
- Department:
- Centers for Medicare & Medicaid Services
- Entry Type:
- Notice
- Action:
- Notice.
- Document Number:
- 01-23820
- Dates:
- October 1, 2001.
- Pages:
- 49453-49475 (23 pages)
- Docket Numbers:
- CMS-1175-N
- RINs:
- 0938-ZA08
- PDF File:
- 01-23820.pdf