[Federal Register: May 5, 2000 (Volume 65, Number 88)] [Proposed Rules] [Page 26331-26380] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr05my00-32] [[pp. 26331-26380]] Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2001 Rates [[Continued from page 26330]] [[Page 26331]] rate and elects rebasing, 25 percent of its updated hospital-specific rate based on FY 1996 cost per discharge plus 75 percent of the updated FY 1982 or FY 1987 hospital-specific rate. Section 1886(d)(5)(G) of the Act, as amended by section 404 of Public Law 106-113, provides that Medicare-dependent, small rural hospitals are paid based on whichever of the following rates yields the greatest aggregate payment: the Federal rate or the Federal rate plus 50 percent of the difference between the Federal rate and the greater of the updated hospital-specific rate based on FY 1982 and FY 1987 cost per discharge. Hospital-specific rates have been determined for each of these hospitals based on either the FY 1982 cost per discharge, the FY 1987 cost per discharge or, for qualifying sole community hospitals, the FY 1996 cost per discharge. For a more detailed discussion of the calculation of the hospital-specific rates, we refer the reader to the September 1, 1983 interim final rule (48 FR 39772); the April 20, 1990 final rule with comment (55 FR 15150); and the September 4, 1990 final rule (55 FR 35994). a. Updating the FY 1982 and FY 1987 Hospital-Specific Rates for FY 2001 We are proposing to increase the hospital-specific rates by 3.1 percent (the hospital market basket rate of increase) for sole community hospitals and by 2.0 percent (the hospital market basket percentage increase minus 1.1 percentage points) for Medicare- dependent, small rural hospitals for FY 2001. Section 1886(b)(3)(C)(iv) of the Act provides that the update factor applicable to the hospital- specific rates for sole community hospitals equal the update factor provided under section 1886(b)(3)(B)(iv) of the Act, which, for sole community hospitals in FY 2001, is the market basket rate of increase. Section 1886(b)(3)(D) of the Act provides that the update factor applicable to the hospital-specific rates for Medicare-dependent, small rural hospitals equal the update factor provided under section 1886(b)(3)(B)(iv) of the Act, which, for FY 2001, is the market basket rate of increase minus 1.1 percentage points. b. Calculation of Hospital-Specific Rate For sole community hospitals, the applicable FY 2001 hospital- specific rate would be the greater of the following: the hospital- specific rate for the preceding fiscal year, increased by the applicable update factor (3.1 percent); or, if the hospital qualifies to rebase its hospital-specific rate based on cost per case in FY 1996 and elects rebasing, 75 percent of the hospital-specific rate for the preceding fiscal year, increased by the applicable update factor, plus 25 percent of its rebased FY 1996 hospital-specific rate updated through FY 2001. For Medicare-dependent, small rural hospitals, the applicable FY 2001 hospital-specific rate would be calculated by increasing the hospital's hospital-specific rate for the preceding fiscal year by the applicable update factor (2.0 percent), which is the same as the update for all prospective payment hospitals, except sole community hospitals. In addition, the hospital-specific rate would be adjusted by the budget neutrality adjustment factor (that is, 0.996506) as discussed in section II.A.4.a. of this Addendum. The resulting rate is used in determining under which rate a sole community hospital or Medicare-dependent, small rural hospital is paid for its discharges beginning on or after October 1, 2000, based on the formula set forth above. 3. General Formula for Calculation of Prospective Payment Rates for Hospitals Located in Puerto Rico Beginning On or After October 1, 2000 and Before October 1, 2001 a. Puerto Rico Rate The Puerto Rico prospective payment rate is determined as follows: Step 1--Select the appropriate adjusted average standardized amount considering the large urban or other designation of the hospital (see Table 1C of section VI of the Addendum). Step 2--Multiply the labor-related portion of the standardized amount by the appropriate Puerto Rico-specific wage index (see Table 4F of section VI of the Addendum). Step 3--Add the amount from Step 2 and the nonlabor-related portion of the standardized amount. Step 4--Multiply the result in Step 3 by 50 percent. Step 5--Multiply the amount from Step 4 by the appropriate DRG relative weight (see Table 5 of section VI of the Addendum). b. National Rate The national prospective payment rate is determined as follows: Step 1--Multiply the labor-related portion of the national average standardized amount (see Table 1C of section VI of the Addendum) by the appropriate national wage index (see Tables 4A and 4B of section VI of the Addendum). Step 2--Add the amount from Step 1 and the nonlabor-related portion of the national average standardized amount. Step 3--Multiply the result in Step 2 by 50 percent. Step 4--Multiply the amount from Step 3 by the appropriate DRG relative weight (see Table 5 of section VI of the Addendum). The sum of the Puerto Rico rate and the national rate computed above equals the prospective payment for a given discharge for a hospital located in Puerto Rico. III. Changes to the Payment Rates for Blood Clotting Factor for Hemophilia Inpatients For the past 2 years in the Federal Register (63 FR 41010 and 64 FR 41549), we have discussed section 4452 of Public Law 105-33, which amended section 6011(d) of Public Law 101-239 to reinstate the add-on payment for the costs of administering blood clotting factor to Medicare beneficiaries who have hemophilia and who are hospital inpatients for discharges occurring on or after October 1, 1997. In these prior rules, we have described the payment policy and specifically listed the updated add-on payment amounts for each clotting factor, as described by HCFA's Common Procedure Coding System (HCPCS). Because we are not changing the policy established 2 years ago, we are proposing to discontinue listing these amounts in the annual proposed and final rules. Instead, the program manuals will instruct fiscal intermediaries to follow this policy and obtain the average wholesale price (AWP) for each relevant HCPCS from either their corresponding local carrier or the Medicare durable medical equipment regional carrier (DMERC) that has jurisdiction in their area. Carriers already calculate the AWP based on the median AWP of the several products available in each category of factor. The payment amount for clotting factors covered by this inpatient benefit is equal to 85 percent of the AWP, subject to the Part A deductible and coinsurance requirements. The payment amounts will be determined using the most recent AWP data available to the carrier at the time the intermediary performs these annual update calculations. These amounts are updated annually and are effective for discharges beginning on or after October 1 of the current year through September 30 of the following year. Payment will be made for blood clotting factor only if there is an ICD-9-CM diagnosis code for hemophilia included on the bill. [[Page 26332]] IV. Proposed Changes to Payment Rates for Inpatient Capital-Related Costs for FY 2001 The prospective payment system for hospital inpatient capital- related costs was implemented for cost reporting periods beginning on or after October 1, 1991. Effective with that cost reporting period and during a 10-year transition period extending through FY 2001, hospital inpatient capital-related costs are paid on the basis of an increasing proportion of the capital prospective payment system Federal rate and a decreasing proportion of a hospital's historical costs for capital. The basic methodology for determining Federal capital prospective rates is set forth at Secs. 412.308 through 412.352. Below we discuss the factors that we used to determine the proposed Federal rate and the hospital-specific rates for FY 2001. The rates will be effective for discharges occurring on or after October 1, 2000. For FY 1992, we computed the standard Federal payment rate for capital-related costs under the prospective payment system by updating the FY 1989 Medicare inpatient capital cost per case by an actuarial estimate of the increase in Medicare inpatient capital costs per case. Each year after FY 1992, we update the standard Federal rate, as provided in Sec. 412.308(c)(1), to account for capital input price increases and other factors. Also, Sec. 412.308(c)(2) provides that the Federal rate is adjusted annually by a factor equal to the estimated proportion of outlier payments under the Federal rate to total capital payments under the Federal rate. In addition, Sec. 412.308(c)(3) requires that the Federal rate be reduced by an adjustment factor equal to the estimated proportion of payments for exceptions under Sec. 412.348. Furthermore, Sec. 412.308(c)(4)(ii) requires that the Federal rate be adjusted so that the annual DRG reclassification and the recalibration of DRG weights and changes in the geographic adjustment factor are budget neutral. For FYs 1992 through 1995, Sec. 412.352 required that the Federal rate also be adjusted by a budget neutrality factor so that aggregate payments for inpatient hospital capital costs were projected to equal 90 percent of the payments that would have been made for capital-related costs on a reasonable cost basis during the fiscal year. That provision expired in FY 1996. Section 412.308(b)(2) describes the 7.4 percent reduction to the rate that was made in FY 1994, and Sec. 412.308(b)(3) describes the 0.28 percent reduction to the rate made in FY 1996 as a result of the revised policy of paying for transfers. In the FY 1998 final rule with comment period (62 FR 45966), we implemented section 4402 of Public Law 105-33, which requires that for discharges occurring on or after October 1, 1997, and before October 1, 2002, the unadjusted standard Federal rate is reduced by 17.78 percent. A small part of that reduction will be restored effective October 1, 2002. For each hospital, the hospital-specific rate was calculated by dividing the hospital's Medicare inpatient capital-related costs for a specified base year by its Medicare discharges (adjusted for transfers), and dividing the result by the hospital's case mix index (also adjusted for transfers). The resulting case-mix adjusted average cost per discharge was then updated to FY 1992 based on the national average increase in Medicare's inpatient capital cost per discharge and adjusted by the exceptions payment adjustment factor and the budget neutrality adjustment factor to yield the FY 1992 hospital-specific rate. Since FY 1992, the hospital-specific rate has been updated annually for inflation and for changes in the exceptions payment adjustment factor. For FYs 1992 through 1995, the hospital-specific rate was also adjusted by a budget neutrality adjustment factor. For discharges occurring on or after October 1, 1997, and before October 1, 2002, the unadjusted hospital-specific rate is reduced by 17.78 percent. A small part of this reduction will be restored effective October 1, 2002. To determine the appropriate budget neutrality adjustment factor and the exceptions payment adjustment factor, we developed a dynamic model of Medicare inpatient capital-related costs, that is, a model that projects changes in Medicare inpatient capital-related costs over time. With the expiration of the budget neutrality provision, the model is still used to estimate the exceptions payment adjustment and other factors. The model and its application are described in greater detail in Appendix B of this proposed rule. In accordance with section 1886(d)(9)(A) of the Act, under the prospective payment system for inpatient operating costs, hospitals located in Puerto Rico are paid for operating costs under a special payment formula. Prior to FY 1998, hospitals in Puerto Rico were paid a blended rate that consisted of 75 percent of the applicable standardized amount specific to Puerto Rico hospitals and 25 percent of the applicable national average standardized amount. However, effective October 1, 1997, as a result of section 4406 of Public Law 105-33, operating payments to hospitals in Puerto Rico are based on a blend of 50 percent of the applicable standardized amount specific to Puerto Rico hospitals and 50 percent of the applicable national average standardized amount. In conjunction with this change to the operating blend percentage, effective with discharges on or after October 1, 1997, we compute capital payments to hospitals in Puerto Rico based on a blend of 50 percent of the Puerto Rico rate and 50 percent of the Federal rate. Section 412.374 provides for the use of this blended payment system for payments to Puerto Rico hospitals under the prospective payment system for inpatient capital-related costs. Accordingly, for capital- related costs, we compute a separate payment rate specific to Puerto Rico hospitals using the same methodology used to compute the national Federal rate for capital. A. Determination of Federal Inpatient Capital-Related Prospective Payment Rate Update In the July 30, 1999 final rule (64 FR 41551), we established a Federal rate of $377.03 for FY 2000. As a result of the changes we are proposing to the factors used to establish the Federal rate in this addendum, the proposed FY 2001 Federal rate is $383.06. In the discussion that follows, we explain the factors that were used to determine the proposed FY 2001 Federal rate. In particular, we explain why the proposed FY 2001 Federal rate has increased 1.60 percent compared to the FY 2000 Federal rate. We also estimate aggregate capital payments will increase by 5.89 percent during this same period. This increase is primarily due to the increase in the number of hospital admissions, the increase in case-mix, and the increase in the Federal blend percentage from 90 to 100 percent for fully prospective payment hospitals. Total payments to hospitals under the prospective payment system are relatively unaffected by changes in the capital prospective payments. Since capital payments constitute about 10 percent of hospital payments, a 1 percent change in the capital Federal rate yields only about 0.1 percent change in actual payments to hospitals. Aggregate payments under the capital prospective payment transition system are estimated to increase in FY 2001 compared to FY 2000. 1. Standard Federal Rate Update a. Description of the Update Framework Under Sec. 412.308(c)(1), the standard Federal rate is updated on the basis of [[Page 26333]] an analytical framework that takes into account changes in a capital input price index and other factors. The update framework consists of a capital input price index (CIPI) and several policy adjustment factors. Specifically, we have adjusted the projected CIPI rate of increase as appropriate each year for case-mix index-related changes, for intensity, and for errors in previous CIPI forecasts. The proposed update factor for FY 2001 under that framework is 0.9 percent. This proposal is based on a projected 0.9 percent increase in the CIPI, a 0.0 percent adjustment for intensity, a 0.0 percent adjustment for case-mix, a 0.0 percent adjustment for the FY 1999 DRG reclassification and recalibration, and a forecast error correction of 0.0 percent. We explain the basis for the FY 2001 CIPI projection in section II.D of this Addendum. In this section IV of the Addendum, we describe the policy adjustments that have been applied. The case-mix index is the measure of the average DRG weight for cases paid under the prospective payment system. Because the DRG weight determines the prospective payment for each case, any percentage increase in the case-mix index corresponds to an equal percentage increase in hospital payments. The case-mix index can change for any of several reasons:The average resource use of Medicare patients changes ("real" case-mix change); Changes in hospital coding of patient records result in higher weight DRG assignments ("coding effects"); and The annual DRG reclassification and recalibration changes may not be budget neutral ("reclassification effect"). We define real case-mix change as actual changes in the mix (and resource requirements) of Medicare patients as opposed to changes in coding behavior that result in assignment of cases to higher weighted DRGs but do not reflect higher resource requirements. In the update framework for the prospective payment system for operating costs, we adjust the update upwards to allow for real case-mix change, but remove the effects of coding changes on the case-mix index. We also remove the effect on total payments of prior changes to the DRG classifications and relative weights, in order to retain budget neutrality for all case-mix index-related changes other than patient severity. (For example, we adjusted for the effects of the FY 1999 DRG reclassification and recalibration as part of our FY 2001 update recommendation.) We have adopted this case-mix index adjustment in the capital update framework as well. For FY 2001, we are projecting a 0.5 percent increase in the case- mix index. We estimate that real case-mix increase will equal 0.5 percent in FY 2001. Therefore, the proposed net adjustment for case-mix change in FY 2001 is 0.0 percentage points. We estimate that FY 1999 DRG reclassification and recalibration will result in a 0.0 percent change in the case-mix when compared with the case-mix index that would have resulted if we had not made the reclassification and recalibration changes to the DRGs. Therefore, we are making a 0.0 percent adjustment for DRG reclassification and recalibration in the update recommendation for FY 2001. The capital update framework contains an adjustment for forecast error. The input price index forecast is based on historical trends and relationships ascertainable at the time the update factor is established for the upcoming year. In any given year there may be unanticipated price fluctuations that may result in differences between the actual increase in prices and the forecast used in calculating the update factors. In setting a prospective payment rate under the framework, we make an adjustment for forecast error only if our estimate of the change in the capital input price index for any year is off by 0.25 percentage points or more. There is a 2-year lag between the forecast and the measurement of the forecast error. A forecast error of 0.0 percentage points was calculated for the FY 1999 update. That is, current historical data indicate that the FY 1999 CIPI used in calculating the forecasted FY 1999 update factor did not overstate or understate realized price increases. Therefore, we are making a 0.0 percent adjustment for forecast error in the update for FY 2001. Under the capital prospective payment system framework, we also make an adjustment for changes in intensity. We calculate this adjustment using the same methodology and data as in the framework for the operating prospective payment system. The intensity factor for the operating update framework reflects how hospital services are utilized to produce the final product, that is, the discharge. This component accounts for changes in the use of quality-enhancing services, changes in within-DRG severity, and expected modification of practice patterns to remove cost-ineffective services. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level changes (the CPI for hospital and related services), and changes in real case-mix. The use of total charges in the calculation of the proposed intensity factor makes it a total intensity factor, that is, charges for capital services are already built into the calculation of the factor. Therefore, we have incorporated the intensity adjustment from the operating update framework into the capital update framework. Without reliable estimates of the proportions of the overall annual intensity increases that are due, respectively, to ineffective practice patterns and to the combination of quality-enhancing new technologies and within-DRG complexity, we assume, as in the revised operating update framework, that one-half of the annual increase is due to each of these factors. The capital update framework thus provides an add-on to the input price index rate of increase of one-half of the estimated annual increase in intensity to allow for within-DRG severity increases and the adoption of quality-enhancing technology. For FY 2001, we have developed a Medicare-specific intensity measure based on a 5-year average using FY 1995 through 1999 data. In determining case-mix constant intensity, we found that observed case- mix increase was 1.7 percent in FY 1995, 1.6 percent in FY 1996, 0.3 percent in FY 1997,-0.4 percent in FY 1998, and -0.3 in FY 1999. For FY 1995 and FY 1996, we estimate that real case-mix increase was 1.0 to 1.4 percent each year. The estimate for those years is supported by past studies of case-mix change by the RAND Corporation. The most recent study was "Has DRG Creep Crept Up? Decomposing the Case Mix Index Change Between 1987 and 1988" by G.M. Carter, J.P. Newhouse, and D.A. Relles, R-4098-HCFA/ProPAC (1991). The study suggested that real case-mix change was not dependent on total change, but was usually a fairly steady 1.0 to 1.5 percent per year. We use 1.4 percent as the upper bound because the RAND study did not take into account that hospitals may have induced doctors to document medical records more completely in order to improve payment. Following that study, we consider up to 1.4 percent of observed case-mix change as real for FY 1995 through FY 1999. Based on this analysis, we believe that all of the observed case-mix increase for FY 1997, FY 1998, and FY 1999 is real. The increases for FY 1995 and FY 1996 were in excess of our estimate of real case-mix increase. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level [[Page 26334]] changes (the CPI for hospital and related services), and changes in real case-mix. Given estimates of real case-mix of 1.0 percent for FY 1995, 1.0 percent for FY 1996, 0.3 percent for FY 1997, -0.4 for FY 1998, and -0.3 for FY 1999, we estimate that case-mix constant intensity declined by an average 0.7 percent during FYs 1995 through 1999, for a cumulative decrease of 3.6 percent. If we assume that real case-mix increase was 1.4 percent for FY 1995, 1.4 percent for FY 1996, 0.3 percent for FY 1997, -0.4 for FY 1998, and -0.3 for FY 1999, we estimate that case-mix constant intensity declined by an average 0.9 percent during FYs 1995 through 1999, for a cumulative decrease of 4.5 percent. Since we estimate that intensity has declined during that period, we are recommending a 0.0 percent intensity adjustment for FY 2001. We note that the operating recommendation addressed in Appendix D of this proposed rule reflects the possible range that a negative adjustment could span (-0.6 percent to 0.0 percent adjustment) based on our analyses that intensity has declined during that 5-year period. While the calculation of the adjustment for intensity is identical in both the capital and the operating update frameworks, consistent with past capital update recommendations and the FY 2001 proposed operating recommendation, we are not making a negative adjustment for intensity in the FY 2001 proposed capital update. b. Comparison of HCFA and MedPAC Update Recommendations MedPAC's FY 2001 update recommendation for capital prospective payments was not included in its March 2000 Report to Congress. However, MedPAC did announce at its April 13, 2000 public meeting that it was recommending a combined update of between 3.5 percent and 4.0 percent for operating and capital-related payments for FY 2001. This recommendation is higher than the current law amount as prescribed by Public Law 105-33. Because of the timing of the announcement and our need for ample time to perform a proper analysis of the recommendation, we will address the comparison of HCFA's update recommendation and MedPAC's update recommendation in the FY 2001 final rule in August 2000 when we will have had the opportunity to review the data analyses that substantiate MedPAC's recommendation. In section IV.A.l.a. of this Addendum, we describe the basis of the components used to develop our proposed 0.9 percent FY 2001 capital update factor as shown in Table 1 below. Table 1.--HCFA's Proposed FY 2001 Capital Update Factor ------------------------------------------------------------------------ ------------------------------------------------------------------------ Capital Input Price Index.................................... 0.9 Intensity.................................................... 0.0 Case-Mix Adjustment Factors: Projected Case-Mix Change................................ -0.5 Real Across DRG Change................................... 0.5 ---------- Subtotal............................................. 0.0 Effect of FY 1999 Reclassification and Recalibration......... 0.0 Forecast Error Correction.................................... 0.0 Total Update................................................. 0.9 ------------------------------------------------------------------------ 2. Outlier Payment Adjustment Factor Section 412.312(c) establishes a unified outlier methodology for inpatient operating and inpatient capital-related costs. A single set of thresholds is used to identify outlier cases for both inpatient operating and inpatient capital-related payments. Outlier payments are made only on the portion of the Federal rate that is used to calculate the hospital's inpatient capital-related payments (for example, 100 percent for cost reporting periods beginning in FY 2001 for hospitals paid under the fully prospective payment methodology). Section 412.308(c)(2) provides that the standard Federal rate for inpatient capital-related costs be reduced by an adjustment factor equal to the estimated proportion of outlier payments under the Federal rate to total inpatient capital-related payments under the Federal rate. The outlier thresholds are set so that operating outlier payments are projected to be 5.1 percent of total operating DRG payments. The inpatient capital-related outlier reduction factor reflects the inpatient capital-related outlier payments that would be made if all hospitals were paid 100 percent of the Federal rate. For purposes of calculating the outlier thresholds and the outlier reduction factor, we model payments as if all hospitals were paid 100 percent of the Federal rate because, as explained above, outlier payments are made only on the portion of the Federal rate that is included in the hospital's inpatient capital-related payments. In the July 30, 1999 final rule, we estimated that outlier payments for capital in FY 2000 would equal 5.98 percent of inpatient capital- related payments based on the Federal rate (64 FR 41553). Accordingly, we applied an outlier adjustment factor of 0.9402 to the Federal rate. Based on the thresholds as set forth in section II.A.4.d. of this Addendum, we estimate that outlier payments for capital will equal 5.84 percent of inpatient capital-related payments based on the Federal rate in FY 2001. Therefore, we are proposing an outlier adjustment factor of 0.9416 to the Federal rate. Thus, the projected percentage of capital outlier payments to total capital standard payments for FY 2001 is lower than the percentage for FY 2000. The outlier reduction factors are not built permanently into the rates; that is, they are not applied cumulatively in determining the Federal rate. Therefore, the proposed net change in the outlier adjustment to the Federal rate for FY 2001 is 1.0015 (0.9416/0.9402). The outlier adjustment increases the FY 2001 Federal rate by 0.15 percent compared with the FY 2000 outlier adjustment. 3. Budget Neutrality Adjustment Factor for Changes in DRG Classifications and Weights and the Geographic Adjustment Factor Section 412.308(c)(4)(ii) requires that the Federal rate be adjusted so that aggregate payments for the fiscal year based on the Federal rate after any changes resulting from the annual DRG reclassification and recalibration and changes in the GAF are projected to equal aggregate payments that would have been made on the basis of the Federal rate without such changes. We use the actuarial model, described in Appendix B of this proposed rule, to estimate the aggregate payments that would have been made on the basis of the Federal rate without changes in the DRG classifications and weights and in the GAF. We also use the model to estimate aggregate payments that would be made on the basis of the Federal rate as a result of those changes. We then use these figures to compute the adjustment required to maintain budget neutrality for changes in DRG weights and in the GAF. For FY 2000, we calculated a GAF/DRG budget neutrality factor of 0.9985. For FY 2001, we are proposing a GAF/DRG budget neutrality factor of 0.9986. The GAF/DRG budget neutrality factors are built permanently into the rates; that is, they are applied cumulatively in determining the Federal rate. This follows from the requirement that estimated aggregate payments each year be no more than they would have been in the absence of the annual DRG reclassification and recalibration and changes in the GAF. The proposed incremental change in the adjustment from FY 2000 to FY 2001 is 0.9986. The proposed cumulative change in the rate due to this adjustment is 1.0060 (the product of the incremental factors for FY 1993, FY 1994, FY 1995, FY 1996, [[Page 26335]] FY 1997, FY 1998, FY 1999, FY 2000, and the proposed incremental factor for FY 2001: 0.9980 x 1.0053 x 0.9998 x 0.9994 x 0.9987 x 0.9989 x 1.0028 x 0.9985 x 0.9986 = 1.0000). This proposed factor accounts for DRG reclassifications and recalibration and for changes in the GAF. It also incorporates the effects on the GAF of FY 2001 geographic reclassification decisions made by the MGCRB compared to FY 2000 decisions. However, it does not account for changes in payments due to changes in the DSH and IME adjustment factors or in the large urban add-on. 4. Exceptions Payment Adjustment Factor Section 412.308(c)(3) requires that the standard Federal rate for inpatient capital-related costs be reduced by an adjustment factor equal to the estimated proportion of additional payments for exceptions under Sec. 412.348 relative to total payments under the hospital- specific rate and Federal rate. We use the model originally developed for determining the budget neutrality adjustment factor to determine the exceptions payment adjustment factor. We describe that model in Appendix B to this proposed rule. For FY 2000, we estimated that exceptions payments would equal 2.70 percent of aggregate payments based on the Federal rate and the hospital-specific rate. Therefore, we applied an exceptions reduction factor of 0.9730 (1-0.0270) in determining the Federal rate. For this proposed rule, we estimate that exceptions payments for FY 2001 will equal 2.04 percent of aggregate payments based on the Federal rate and the hospital-specific rate. Therefore, we are proposing an exceptions payment reduction factor of 0.9796 to the Federal rate for FY 2001. The proposed exceptions reduction factor for FY 2001 is 0.68 percent higher than the factor for FY 2000. The exceptions reduction factors are not built permanently into the rates; that is, the factors are not applied cumulatively in determining the Federal rate. Therefore, the proposed net adjustment to the FY 2001 Federal rate is 0.9796/0.9730, or 1.0068. 5. Standard Capital Federal Rate for FY 2001 For FY 2000, the capital Federal rate was $377.03. As a result of changes we are proposing to the factors used to establish the Federal rate, the proposed FY 2001 Federal rate is $383.06. The proposed Federal rate for FY 2001 was calculated as follows: The proposed FY 2001 update factor is 1.0090; that is, the proposed update is 0.90 percent. The proposed FY 2001 budget neutrality adjustment factor that is applied to the standard Federal payment rate for changes in the DRG relative weights and in the GAF is 0.9986. The proposed FY 2001 outlier adjustment factor is 0.9416. The proposed FY 2001 exceptions payments adjustment factor is 0.9796. Since the Federal rate has already been adjusted for differences in case-mix, wages, cost-of-living, indirect medical education costs, and payments to hospitals serving a disproportionate share of low-income patients, we propose to make no additional adjustments in the standard Federal rate for these factors other than the budget neutrality factor for changes in the DRG relative weights and the GAF. We are providing a chart that shows how each of the factors and adjustments for FY 2001 affected the computation of the proposed FY 2001 Federal rate in comparison to the FY 2000 Federal rate. The proposed FY 2001 update factor has the effect of increasing the Federal rate by 0.90 percent compared to the rate in FY 2000, while the proposed geographic and DRG budget neutrality factor has the effect of decreasing the Federal rate by 0.14 percent. The proposed FY 2001 outlier adjustment factor has the effect of increasing the Federal rate by 0.15 percent compared to FY 2000. The proposed FY 2001 exceptions reduction factor has the effect of increasing the Federal rate by 0.68 percent compared to the exceptions reduction for FY 2000. The combined effect of all the proposed changes is to increase the proposed Federal rate by 1.60 percent compared to the Federal rate for FY 2000. Comparison of Factors and Adjustments: FY 2000 Federal Rate and Proposed FY 2001 Federal Rate ---------------------------------------------------------------------------------------------------------------- Proposed FY Percent FY 2000 2001 Change change ---------------------------------------------------------------------------------------------------------------- Update factor \1\............................... 1.0030 1.0090 1.0090 0.90 GAF/DRG Adjustment Factor\1\.................... 0.9985 0.9986 0.9986 -0.14 Outlier Adjustment Factor\2\.................... 0.9402 0.9416 1.0015 0.15 Exceptions Adjustment Factor\2\................. 0.9730 0.9796 1.0068 0.68 Federal Rate.................................... $377.03 $383.06 1.0160 1.60 ---------------------------------------------------------------------------------------------------------------- \1\ The update factor and the GAF/DRG budget neutrality factors are built permanently into the rates. Thus, for example, the incremental change from FY 2000 to FY 2001 resulting from the application of the 0.9986 GAF/DRG budget neutrality factor for FY 2001 is 0.9986. \2\ The outlier reduction factor and the exceptions reduction factor are not built permanently into the rates; that is, these factors are not applied cumulatively in determining the rates. Thus, for example, the net change resulting from the application of the FY 2001 outlier reduction factor is 0.9416/0.9402, or 1.0015. 6. Special Rate for Puerto Rico Hospitals As explained at the beginning of section IV of this Addendum, hospitals in Puerto Rico are paid based on 50 percent of the Puerto Rico rate and 50 percent of the Federal rate. The Puerto Rico rate is derived from the costs of Puerto Rico hospitals only, while the Federal rate is derived from the costs of all acute care hospitals participating in the prospective payment system (including Puerto Rico). To adjust hospitals' capital payments for geographic variations in capital costs, we apply a geographic adjustment factor (GAF) to both portions of the blended rate. The GAF is calculated using the operating prospective payment system wage index and varies depending on the MSA or rural area in which the hospital is located. We use the Puerto Rico wage index to determine the GAF for the Puerto Rico part of the capital-blended rate and the national wage index to determine the GAF for the national part of the blended rate. Since we implemented a separate GAF for Puerto Rico in FY 1998, we also apply separate budget neutrality adjustments for the national GAF and for the Puerto Rico GAF. However, we apply the same budget neutrality factor for DRG reclassifications and recalibration nationally and for Puerto Rico. The Puerto Rico GAF budget [[Page 26336]] neutrality factor is 1.0031, while the DRG adjustment is 1.0002, for a combined cumulative adjustment of 1.0033. In computing the payment for a particular Puerto Rico hospital, the Puerto Rico portion of the rate (50 percent) is multiplied by the Puerto Rico-specific GAF for the MSA in which the hospital is located, and the national portion of the rate (50 percent) is multiplied by the national GAF for the MSA in which the hospital is located (which is computed from national data for all hospitals in the United States and Puerto Rico). In FY 1998, we implemented a 17.78 percent reduction to the Puerto Rico rate as a result of Public Law 105-33. For FY 2000, before application of the GAF, the special rate for Puerto Rico hospitals was $174.81. With the changes we are proposing to the factors used to determine the rate, the proposed FY 2001 special rate for Puerto Rico is $185.38. B. Calculation of Inpatient Capital-Related Prospective Payments for FY 2001 During the capital prospective payment system transition period, a hospital is paid for the inpatient capital-related costs under one of two payment methodologies--the fully prospective payment methodology or the hold-harmless methodology. The payment methodology applicable to a particular hospital is determined when a hospital comes under the prospective payment system for capital-related costs by comparing its hospital-specific rate to the Federal rate applicable to the hospital's first cost reporting period under the prospective payment system. The applicable Federal rate was determined by making adjustments as follows: For outliers, by dividing the standard Federal rate by the outlier reduction factor for that fiscal year; and For the payment adjustments applicable to the hospital, by multiplying the hospital's GAF, disproportionate share adjustment factor, and IME adjustment factor, when appropriate. If the hospital-specific rate is above the applicable Federal rate, the hospital is paid under the hold-harmless methodology. If the hospital-specific rate is below the applicable Federal rate, the hospital is paid under the fully prospective methodology. For purposes of calculating payments for each discharge under both the hold-harmless payment methodology and the fully prospective payment methodology, the standard Federal rate is adjusted as follows: (Standard Federal Rate) x (DRG weight) x (GAF) x (Large Urban Add-on, if applicable) x (COLA adjustment for hospitals located in Alaska and Hawaii) x (1 + Disproportionate Share Adjustment Factor + IME Adjustment Factor, if applicable). The result is the adjusted Federal rate. Payments under the hold-harmless methodology are determined under one of two formulas. A hold-harmless hospital is paid the higher of the following: 100 percent of the adjusted Federal rate for each discharge; or An old capital payment equal to 85 percent (100 percent for sole community hospitals) of the hospital's allowable Medicare inpatient old capital costs per discharge for the cost reporting period plus a new capital payment based on a percentage of the adjusted Federal rate for each discharge. The percentage of the adjusted Federal rate equals the ratio of the hospital's allowable Medicare new capital costs to its total Medicare inpatient capital-related costs in the cost reporting period. Once a hospital receives payment based on 100 percent of the adjusted Federal rate in a cost reporting period beginning on or after October 1, 1994 (or the first cost reporting period after obligated capital that is recognized as old capital under Sec. 412.302(c) is put in use for patient care, if later), the hospital continues to receive capital prospective payment system payments on that basis for the remainder of the transition period. Payment for each discharge under the fully prospective methodology is based on the applicable transition blend percentage of the hospital- specific rate and the adjusted Federal rate. Thus, for FY 2001 payments under the fully prospective methodology will be based on 100 percent of the adjusted Federal rate and zero percent of the hospital-specific rate. Hospitals also may receive outlier payments for those cases that qualify under the thresholds established for each fiscal year. Section 412.312(c) provides for a single set of thresholds to identify outlier cases for both inpatient operating and inpatient capital-related payments. Outlier payments are made only on that portion of the Federal rate that is used to calculate the hospital's inpatient capital-related payments. For fully prospective hospitals, that portion is 100 percent of the Federal rate for discharges occurring in cost reporting periods beginning during FY 2001. Thus, a fully prospective hospital will receive 100 percent of the capital-related outlier payment calculated for the case for discharges occurring in cost reporting periods beginning in FY 2001. For hold-harmless hospitals that are paid 85 percent of their reasonable costs for old inpatient capital, the portion of the Federal rate that is included in the hospital's outlier payments is based on the hospital's ratio of Medicare inpatient costs for new capital to total Medicare inpatient capital costs. For hold- harmless hospitals that are paid 100 percent of the Federal rate, 100 percent of the Federal rate is included in the hospital's outlier payments. The proposed outlier thresholds for FY 2001 are in section II.A.4.c. of this Addendum. For FY 2001, a case qualifies as a cost outlier if the cost for the case (after standardization for the indirect teaching adjustment and disproportionate share adjustment) is greater than the prospective payment rate for the DRG plus $17,250. During the capital prospective payment system transition period, a hospital also may receive an additional payment under an exceptions process if its total inpatient capital-related payments are less than a minimum percentage of its allowable Medicare inpatient capital-related costs. The minimum payment level is established by class of hospital under Sec. 412.348. The proposed minimum payment levels for portions of cost reporting periods occurring in FY 2001 are: Sole community hospitals (located in either an urban or rural area), 90 percent; Urban hospitals with at least 100 beds and a disproportionate share patient percentage of at least 20.2 percent or that receive more than 30 percent of their net inpatient care revenues from State or local governments for indigent care, 80 percent; and All other hospitals, 70 percent. Under Sec. 412.348(d), the amount of the exceptions payment is determined by comparing the cumulative payments made to the hospital under the capital prospective payment system to the cumulative minimum payment levels applicable to the hospital for each cost reporting period subject to that system. Any amount by which the hospital's cumulative payments exceed its cumulative minimum payment is deducted from the additional payment that would otherwise be payable for a cost reporting period. New hospitals are exempted from the capital prospective payment system for their first 2 years of operation and are paid 85 percent of their reasonable costs during that period. A new hospital's old capital costs are its allowable costs for capital assets that were put in use for patient care on or before the later of December [[Page 26337]] 31, 1990, or the last day of the hospital's base year cost reporting period, and are subject to the rules pertaining to old capital and obligated capital as of the applicable date. Effective with the third year of operation, we will pay the hospital under either the fully prospective methodology, using the appropriate transition blend in that Federal fiscal year, or the hold-harmless methodology. If the hold- harmless methodology is applicable, the hold-harmless payment for assets in use during the base period would extend for 8 years, even if the hold-harmless payments extend beyond the normal transition period. C. Capital Input Price Index 1. Background Like the operating input price index, the capital input price index (CIPI) is a fixed-weight price index that measures the price changes associated with costs during a given year. The CIPI differs from the operating input price index in one important aspect--the CIPI reflects the vintage nature of capital, which is the acquisition and use of capital over time. Capital expenses in any given year are determined by the stock of capital in that year (that is, capital that remains on hand from all current and prior capital acquisitions). An index measuring capital price changes needs to reflect this vintage nature of capital. Therefore, the CIPI was developed to capture the vintage nature of capital by using a weighted-average of past capital purchase prices up to and including the current year. Using Medicare cost reports, American Hospital Association (AHA) data, and Securities Data Company data, a vintage-weighted price index was developed to measure price increases associated with capital expenses. We periodically update the base year for the operating and capital input prices to reflect the changing composition of inputs for operating and capital expenses. Currently, the CIPI is based to FY 1992 and was last rebased in 1997. The most recent explanation of the CIPI was discussed in the final rule with comment period for FY 1998 published on August 29, 1997 (62 FR 46050). 2. Forecast of the CIPI for Federal Fiscal Year 2001 We are forecasting the CIPI to increase 0.9 percent for FY 2001. This reflects a projected 1.5 percent increase in vintage-weighted depreciation prices (building and fixed equipment, and movable equipment) and a 3.5 percent increase in other capital expense prices in FY 2001, partially offset by a 1.3 percent decline in vintage- weighted interest rates in FY 2001. The weighted average of these three factors produces the 0.9 percent increase for the CIPI as a whole. V. Proposed Changes to Payment Rates for Excluded Hospitals and Hospital Units: Rate-of-Increase Percentages The inpatient operating costs of hospitals and hospital units excluded from the prospective payment system are subject to rate-of- increase limits established under the authority of section 1886(b) of the Act, which is implemented in regulations at Sec. 413.40. Under these limits, a hospital-specific target amount (expressed in terms of the inpatient operating cost per discharge) is set for each hospital, based on the hospital's own historical cost experience trended forward by the applicable rate-of-increase percentages (update factors). In the case of a psychiatric hospital or hospital unit, a rehabilitation hospital or hospital unit, or a long-term care hospital, the target amount may not exceed the updated figure for the 75th percentile of target amounts adjusted to take into account differences between average wage-related costs in the area of the hospital and the national average of such costs within the same class of hospital for hospitals and units in the same class (psychiatric, rehabilitation, and long-term care) for cost reporting periods ending during FY 1996. The target amount is multiplied by the number of Medicare discharges in a hospital's cost reporting period, yielding the ceiling on aggregate Medicare inpatient operating costs for the cost reporting period. Each hospital-specific target amount is adjusted annually, at the beginning of each hospital's cost reporting period, by an applicable update factor. Section 1886(b)(3)(B) of the Act, which is implemented in regulations at Sec. 413.40(c)(3)(vii), provides that for cost reporting periods beginning on or after October 1, 1998 and before October 1, 2002, the update factor for a hospital or unit depends on the hospital's or hospital unit's costs in relation to the ceiling for the most recent cost reporting period for which information is available. For hospitals with costs exceeding the ceiling by 10 percent or more, the update factor is the market basket increase. For hospitals with costs exceeding the ceiling by less than 10 percent, the update factor is the market basket minus .25 percent for each percentage point by which costs are less than 10 percent over the ceiling. For hospitals with costs equal to or less than the ceiling but greater than 66.7 percent of the ceiling, the update factor is the greater of 0 percent or the market basket minus 2.5 percent. For hospitals with costs that do not exceed 66.7 percent of the ceiling, the update factor is 0. The most recent forecast of the market basket increase for FY 2001 for hospitals and hospital units excluded from the prospective payment system is 3.1 percent. Therefore, the update to a hospital's target amount for its cost reporting period beginning in FY 2001 would be between 0.6 and 3.1 percent, or 0 percent, depending on the hospital's or unit's costs in relation to its rate-of-increase limit. In addition, Sec. 413.40(c)(4)(iii) requires that for cost reporting periods beginning on or after October 1, 1998 and before October 1, 2002, the target amount for each psychiatric hospital or hospital unit, rehabilitation hospital or hospital unit, and long-term care hospital cannot exceed a cap on the target amounts for hospitals in the same class. Section 121 of Public Law 106-113 amended section 1886(b)(3)(H) of the Act to provide for an appropriate wage adjustment to the caps on the target amounts for psychiatric hospitals and units, rehabilitation hospitals and units, and long-term care hospitals, effective for cost reporting periods beginning on or after October 1, 1999, through September 30, 2002. We intend to publish an interim final rule with comment period implementing this provision for cost reporting periods beginning on or after October 1, 1999 and before October 1, 2000. This proposed rule addresses the wage adjustment to the caps for cost reporting periods beginning on or after October 1, 2000. As discussed in section VI. of the preamble of this proposed rule, under section 121 of Public Law 106-113, the cap on the target amount per discharge is determined by adding the hospital's nonlabor-related portion of the national 75th percentile cap to its wage-adjusted, labor-related portion of the national 75th percentile cap (the labor- related portion of costs equals 0.71553 and the nonlabor-related portion of costs equals 0.28447). A hospital's wage-adjusted, labor- related portion of the target amount is calculated by multiplying the labor-related portion of the national 75th percentile cap for the hospital's class by the wage index under the hospital inpatient prospective payment system (see Sec. 412.63), without taking into account reclassifications under sections 1886(a)(10) and (d)(8)(B) of the Act. For cost reporting periods beginning in FY 2001, the proposed caps are as follows: [[Page 26338]] ------------------------------------------------------------------------ Labor- Nonlabor- Class of excluded hospital or unit related related share share ------------------------------------------------------------------------ Psychiatric................................... $8,106 $3,223 Rehabilitation................................ 15,108 6,007 Long-Term Care................................ 29,312 11,654 ------------------------------------------------------------------------ Regulations at Sec. 413.40(d) specify the formulas for determining bonus and relief payments for excluded hospitals and specify established criteria for an additional bonus payment for continuous improvement. Regulations at Sec. 413.40(f)(2)(ii) specify the payment methodology for new hospitals and hospital units (psychiatric, rehabilitation, and long-term care) effective October 1, 1997. VI. Tables This section contains the tables referred to throughout the preamble to this proposed rule and in this Addendum. For purposes of this proposed rule, and to avoid confusion, we have retained the designations of Tables 1 through 5 that were first used in the September 1, 1983 initial prospective payment final rule (48 FR 39844). Tables 1A, 1C, 1D, 1E (a new table, as described in section II of this Addendum), 3C, 4A, 4B, 4C, 4D, 4E, 4F, 5, 6A, 6B, 6C, 6D, 6E, 6F, 6G, 7A, 7B, 8A, and 8B are presented below. The tables presented below are as follows: Table 1A--National Adjusted Operating Standardized Amounts, Labor/ Nonlabor Table 1C--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor Table 1D--Capital Standard Federal Payment Rate Table 1E--National Adjusted Operating Standardized Amounts for Sole Community Hospitals, Labor/Nonlabor Table 3C--Hospital Case Mix Indexes for Discharges Occurring in Federal Fiscal Year 1999 and Hospital Average Hourly Wage for Federal Fiscal Year 2001 Wage Index Table 4A--Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas Table 4B--Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas Table 4C--Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified Table 4D--Average Hourly Wage for Urban Areas Table 4E--Average Hourly Wage for Rural Areas Table 4F--Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF) Table 5--List of Diagnosis Related Groups (DRGs), Relative Weighting Factors, Geometric Mean Length of Stay, and Arithmetic Mean Length of Stay Points Used in the Prospective Payment System Table 6A--New Diagnosis Codes Table 6B--New Procedure Codes Table 6C--Invalid Diagnosis Codes Table 6D--Revised Diagnosis Code Titles Table 6E--Revised Procedure Codes Table 6F--Additions to the CC Exclusions List Table 6G--Deletions to the CC Exclusions List Table 7A--Medicare Prospective Payment System Selected Percentile Lengths of Stay FY 99 MEDPAR Update 12/99 GROUPER V17.0 Table 7B--Medicare Prospective Payment System Selected Percentile Lengths of Stay FY 99 MEDPAR Update 12/99 GROUPER V18.0 Table 8A--Statewide Average Operating Cost-to-Charge Ratios for Urban and Rural Hospitals (Case Weighted) March 2000 Table 8B--Statewide Average Capital Cost-to-Charge Ratios (Case Weighted) March 2000 Table 1A.--National Adjusted Operating Standardized Amounts, Labor/Nonlabor ---------------------------------------------------------------------------------------------------------------- Large urban areas Other areas ---------------------------------------------------------------------------------------------------------------- Labor-related Nonlabor-related Labor-related Nonlabor related ---------------------------------------------------------------------------------------------------------------- $2,856.71 $1,161.17 $2,811.49 $1,142.79 ---------------------------------------------------------------------------------------------------------------- Table 1C.--Adjusted Operating Standardized Amounts for Puerto Rico, Labor/Nonlabor ---------------------------------------------------------------------------------------------------------------- Large urban areas Other areas --------------------------------------------------------------- Labor Nonlabor Labor Nonlabor ---------------------------------------------------------------------------------------------------------------- National........................................ $2,832.11 $1,151.16 $2,832.11 $1,151.16 Puerto Rico..................................... 1,373.19 552.74 1,351.45 543.99 ---------------------------------------------------------------------------------------------------------------- Table 1D.--Capital Standard Federal Payment Rate ------------------------------------------------------------------------ Rate ------------------------------------------------------------------------ National................................................... $383.06 Puerto Rico................................................ 185.38 ------------------------------------------------------------------------ Table 1E.--National Adjusted Operating Standardized Amounts for Sole Community Hospitals, Labor/Nonlabor ---------------------------------------------------------------------------------------------------------------- Large urban areas Other areas ---------------------------------------------------------------------------------------------------------------- Labor-related Nonlabor-related Labor-related Nonlabor-related ---------------------------------------------------------------------------------------------------------------- $2,887.52 $1,173.69 $2,841.81 $1,155.11 ---------------------------------------------------------------------------------------------------------------- [[Page 26339]] [GRAPHIC] [TIFF OMITTED] TP05MY00.018 [[Page 26340]] [GRAPHIC] [TIFF OMITTED] TP05MY00.019 [[Page 26341]] [GRAPHIC] [TIFF OMITTED] TP05MY00.020 [[Page 26342]] [GRAPHIC] [TIFF OMITTED] TP05MY00.021 [[Page 26343]] [GRAPHIC] [TIFF OMITTED] TP05MY00.022 [[Page 26344]] [GRAPHIC] [TIFF OMITTED] TP05MY00.023 [[Page 26345]] [GRAPHIC] [TIFF OMITTED] TP05MY00.024 [[Page 26346]] [GRAPHIC] [TIFF OMITTED] TP05MY00.025 [[Page 26347]] [GRAPHIC] [TIFF OMITTED] TP05MY00.026 [[Page 26348]] [GRAPHIC] [TIFF OMITTED] TP05MY00.027 [[Page 26349]] [GRAPHIC] [TIFF OMITTED] TP05MY00.028 [[Page 26350]] [GRAPHIC] [TIFF OMITTED] TP05MY00.029 [[Page 26351]] [GRAPHIC] [TIFF OMITTED] TP05MY00.030 [[Page 26352]] [GRAPHIC] [TIFF OMITTED] TP05MY00.031 [[Page 26353]] [GRAPHIC] [TIFF OMITTED] TP05MY00.032 [[Page 26354]] [GRAPHIC] [TIFF OMITTED] TP05MY00.033 [[Page 26355]] [GRAPHIC] [TIFF OMITTED] TP05MY00.034 [[Page 26356]] [GRAPHIC] [TIFF OMITTED] TP05MY00.035 [[Page 26357]] [GRAPHIC] [TIFF OMITTED] TP05MY00.036 [[Page 26358]] [GRAPHIC] [TIFF OMITTED] TP05MY00.037 [[Page 26359]] [GRAPHIC] [TIFF OMITTED] TP05MY00.038 [[Page 26360]] [GRAPHIC] [TIFF OMITTED] TP05MY00.039 [[Page 26361]] [GRAPHIC] [TIFF OMITTED] TP05MY00.040 [[Page 26362]] Table 4A.--Wage Index and Capital Geographic Adjustment Factor (GAF) for Urban Areas ------------------------------------------------------------------------ Wage Urban area (constituent counties) index GAF ------------------------------------------------------------------------ 0040 Abilene, TX................................... 0.8318 0.8815 Taylor, TX 0060 Aguadilla, PR................................. 0.4826 0.6072 Aguada, PR Aguadilla, PR Moca, PR 0080 Akron, OH..................................... 1.0557 1.0378 Portage, OH Summit, OH 0120 Albany, GA.................................... 1.1854 1.1235 Dougherty, GA Lee, GA 0160 Albany-Schenectady-Troy, NY................... 0.8563 0.8992 Albany, NY Montgomery, NY Rensselaer, NY Saratoga, NY Schenectady, NY Schoharie, NY 0200 Albuquerque, NM............................... 0.9365 0.9561 Bernalillo, NM Sandoval, NM Valencia, NM 0220 Alexandria, LA................................ 0.8262 0.8774 Rapides, LA 0240 Allentown-Bethlehem-Easton, PA................ 0.9849 0.9896 Carbon, PA Lehigh, PA Northampton, PA 0280 Altoona, PA................................... 0.9262 0.9489 Blair, PA 0320 Amarillo, TX Potter, TX....................... 0.8663 0.9064 Randall, TX 0380 Anchorage, AK................................. 1.2967 1.1947 Anchorage, AK 0440 Ann Arbor, MI................................. 1.1283 1.0862 Lenawee, MI Livingston, MI Washtenaw, MI 0450 Anniston, AL.................................. 0.8331 0.8825 Calhoun, AL 0460 Appleton-Oshkosh-Neenah, WI................... 0.9101 0.9375 Calumet, WI Outagamie, WI Winnebago, WI 0470 Arecibo, PR................................... 0.4540 0.5823 Arecibo, PR Camuy, PR Hatillo, PR 0480 Asheville, NC................................. 0.9527 0.9674 Buncombe, NC Madison, NC 0500 Athens, GA.................................... 0.9829 0.9883 Clarke, GA Madison, GA Oconee, GA 0520 \1\ Atlanta, GA............................... 0.9945 0.9962 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......................... 1.1220 1.0820 Atlantic, NJ Cape May, NJ 0580 Auburn-Opelika, AL............................ 0.8170 0.8707 Lee, AL 0600 Augusta-Aiken, GA-SC.......................... 0.9226 0.9463 Columbia, GA McDuffie, GA Richmond, GA Aiken, SC Edgefield, SC 0640 \1\ Austin-San Marcos, TX..................... 0.9436 0.9610 Bastrop, TX Caldwell, TX Hays, TX Travis, TX Williamson, TX 0680 \2\ Bakersfield, CA........................... 0.9966 0.9977 Kern, CA 0720 \1\ Baltimore, MD............................. 0.9485 0.9644 Anne Arundel, MD Baltimore, MD Baltimore City, MD Carroll, MD Harford, MD Howard, MD Queen Anne's, MD 0733 Bangor, ME.................................... 0.9613 0.9733 Penobscot, ME 0743 Barnstable-Yarmouth, MA....................... 1.3938 1.2553 Barnstable, MA 0760 Baton Rouge, LA............................... 0.8964 0.9278 Ascension, LA East Baton Rouge, LA Livingston, LA West Baton Rouge, LA 0840 Beaumont-Port Arthur, TX...................... 0.8361 0.8846 Hardin, TX Jefferson, TX Orange, TX 0860 Bellingham, WA................................ 1.1491 1.0998 Whatcom, WA 0870 \2\ Benton Harbor, MI......................... 0.9133 0.9398 Berrien, MI 0875 \1\ Bergen-Passaic, NJ........................ 1.1727 1.1153 Bergen, NJ Passaic, NJ 0880 Billings, MT.................................. 0.9577 0.9708 Yellowstone, MT 0920 Biloxi-Gulfport-Pascagoula, MS................ 0.8282 0.8789 Hancock, MS Harrison, MS Jackson, MS 0960 Binghamton, NY................................ 0.8723 0.9107 Broome, NY Tioga, NY 1000 Birmingham, AL................................ 0.8574 0.9000 Blount, AL Jefferson, AL St. Clair, AL Shelby, AL 1010 Bismarck, ND.................................. 0.8016 0.8595 Burleigh, ND Morton, ND 1020 Bloomington-Normal, IL........................ 0.8854 0.9200 Monroe, IN 1040 Bloomington-Normal, IL........................ 0.9294 0.9511 McLean, IL 1080 Boise City, ID................................ 0.9133 0.9398 Ada, ID Canyon, ID 1123 \1\ \2\ Boston-Worcester-Lawrence-Lowell- 1.1348 1.0905 Brockton, MA-NH (MA Hospitals)..................... Bristol, MA Essex, MA Middlesex, MA Norfolk, MA Plymouth, MA Suffolk, MA Worcester, MA Hillsborough, NH Merrimack, NH Rockingham, NH Strafford, NH 1123 \1\ Boston-Worcester-Lawrence-Lowell-Brockton, 1.1239 1.0833 MA-NH (NH Hospitals)............................... 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.......................... 0.9798 0.9861 Boulder, CO 1145 Brazoria, TX.................................. 0.8751 0.9127 Brazoria, TX 1150 Bremerton, WA................................. 1.1069 1.0720 Kitsap, WA 1240 Brownsville-Harlingen-San Benito, TX.......... 0.8794 0.9158 [[Page 26363]] Cameron, TX 1260 Bryan-College Station, TX..................... 0.8306 0.8806 Brazos, TX 1280 \1\ Buffalo-Niagara Falls, NY................. 0.9566 0.9701 Erie, NY Niagara, NY 1303 Burlington, VT................................ 0.9624 0.9741 Chittenden, VT Franklin, VT Grand Isle, VT 1310 Caguas, PR.................................... 0.4591 0.5868 Caguas, PR Cayey, PR Cidra, PR Gurabo, PR San Lorenzo, PR 1320 \2\ Canton-Massillon, OH...................... 0.8778 0.9146 Carroll, OH Stark, OH 1350 \2\ Casper, WY................................ 0.9046 0.9336 Natrona, WY 1360 Cedar Rapids, IA.............................. 0.8396 0.8872 Linn, IA 1400 Champaign-Urbana, IL.......................... 0.9353 0.9552 Champaign, IL 1440 Charleston-North Charleston, SC............... 0.9094 0.9370 Berkeley, SC Charleston, SC Dorchester, SC 1480 Charleston, WV................................ 0.9324 0.9532 Kanawha, WV Putnam, WV 1520 \1\ Charlotte-Gastonia-Rock Hill, NC-SC....... 0.9307 0.9520 Cabarrus, NC Gaston, NC Lincoln, NC Mecklenburg, NC Rowan, NC Stanly, NC Union, NC York, SC 1540 Charlottesville, VA........................... 1.0744 1.0504 Albemarle, VA Charlottesville City, VA Fluvanna, VA Greene, VA 1560 Chattanooga, TN-GA............................ 1.0083 1.0057 Catoosa, GA Dade, GA Walker, GA Hamilton, TN Marion, TN 1580 \2\ Cheyenne, WY.............................. 0.9046 0.9336 Laramie, WY 1600 \1\ Chicago, IL............................... 1.1027 1.0692 Cook, IL DeKalb, IL DuPage, IL Grundy, IL Kane, IL Kendall, IL Lake, IL McHenry, IL Will, IL 1620 Chico-Paradise, CA............................ 1.0684 1.0464 Butte, CA 1640 1Cincinnati, OH-KY-IN......................... 0.9330 0.9536 Dearborn, IN Ohio, IN Boone, KY Campbell, KY Gallatin, KY Grant, KY Kenton, KY Pendleton, KY Brown, OH Clermont, OH Hamilton, OH Warren, OH 1660 Clarksville-Hopkinsville, TN-KY............... 0.8393 0.8869 Christian, KY Montgomery, TN 1680 \1\ Cleveland-Lorain-Elyria, OH............... 0.9649 0.9758 Ashtabula, OH Cuyahoga, OH Geauga, OH Lake, OH Lorain, OH Medina, OH 1720 Colorado Springs, CO.......................... 0.9770 0.9842 El Paso, CO 1740 Columbia, MO.................................. 0.8600 0.9019 Boone, MO 1760 Columbia, SC.................................. 0.9641 0.9753 Lexington, SC Richland, SC 1800 Columbus, GA-AL............................... 0.8607 0.9024 Russell, AL Chattahoochee, GA Harris, GA Muscogee, GA 1840 \1\ Columbus, OH.............................. 0.9741 0.9822 Delaware, OH Fairfield, OH Franklin, OH Licking, OH Madison, OH Pickaway, OH 1880 Corpus Christi, TX............................ 0.8496 0.8944 Nueces, TX San Patricio, TX 1890 Corvallis, OR................................. 1.1439 1.0964 Benton, OR 1900 \2\ Cumberland, MD-WV (MD Hospitals).......... 0.8717 0.9103 Allegany, MD Mineral, WV 1900 Cumberland, MD-WV (WV Hospital)............... 0.8437 0.8901 Allegany, MD Mineral, WV 1920 \1\ Dallas, TX................................ 0.9220 0.9459 Collin, TX Dallas, TX Denton, TX Ellis, TX Henderson, TX Hunt, TX Kaufman, TX Rockwall, TX 1950 Danville, VA.................................. 0.8527 0.8966 Danville City, VA Pittsylvania, VA 1960 Davenport-Moline-Rock Island, IA-IL........... 0.9021 0.9319 Scott, IA Henry, IL Rock Island, IL 2000 Dayton-Springfield, OH........................ 0.9519 0.9668 Clark, OH Greene, OH Miami, OH Montgomery, OH 2020 Daytona Beach, FL............................. 0.9179 0.9430 Flagler, FL Volusia, FL 2030 Decatur, AL................................... 0.8627 0.9038 Lawrence, AL Morgan, AL 2040 Decatur, IL................................... 0.8601 0.9019 Macon, IL 2080 \1\ Denver, CO................................ 1.0032 1.0022 Adams, CO Arapahoe, CO Denver, CO Douglas, CO Jefferson, CO 2120 Des Moines, IA................................ 0.9211 0.9453 Dallas, IA Polk, IA Warren, IA 2160 \1\ Detroit, MI............................... 1.0057 1.0039 Lapeer, MI Macomb, MI Monroe, MI Oakland, MI St. Clair, MI Wayne, MI 2180 Dothan, AL.................................... 0.8105 0.8660 Dale, AL Houston, AL 2190 Dover, DE..................................... 1.1032 1.0696 Kent, DE 2200 Dubuque, IA................................... 0.8928 0.9253 Dubuque, IA 2240 Duluth-Superior, MN-WI........................ 1.0201 1.0137 St. Louis, MN Douglas, WI [[Page 26364]] 2281 Dutchess County, NY........................... 0.9599 0.9724 Dutchess, NY 2290 \2\ Eau Claire, WI............................ 0.9073 0.9356 Chippewa, WI Eau Claire, WI 2320 El Paso, TX................................... 0.9215 0.9456 El Paso, TX 2330 Elkhart-Goshen, IN............................ 0.9549 0.9689 Elkhart, IN 2335 Elmira, NY.................................... 0.8645 0.9051 Chemung, NY 2340 Enid, OK...................................... 0.8781 0.9148 Garfield, OK 2360 Erie, PA...................................... 0.9021 0.9319 Erie, PA 2400 Eugene-Springfield, OR........................ 1.1026 1.0692 Lane, OR 2440 \2\ Evansville-Henderson, IN-KY (IN Hospitals) 0.8807 0.9167 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2440 Evansville-Henderson, IN-KY (KY Hospitals).... 0.8018 0.8596 Posey, IN Vanderburgh, IN Warrick, IN Henderson, KY 2520 Fargo-Moorhead, ND-MN......................... 0.8830 0.9183 Clay, MN Cass, ND 2560 Fayetteville, NC.............................. 0.8638 0.9046 Cumberland, NC 2580 Fayetteville-Springdale-Rogers, AR............ 0.7999 0.8582 Benton, AR Washington, AR 2620 Flagstaff, AZ-UT.............................. 1.0844 1.0571 Coconino, AZ Kane, UT 2640 Flint, MI..................................... 1.1189 1.0800 Genesee, MI 2650 Florence, AL.................................. 0.7621 0.8302 Colbert, AL Lauderdale, AL 2655 Florence, SC.................................. 0.8838 0.9189 Florence, SC 2670 Fort Collins-Loveland, CO..................... 1.1005 1.0678 Larimer, CO 2680 \1\ Ft. Lauderdale, FL........................ 1.0228 1.0156 Broward, FL 2700 Fort Myers-Cape Coral, FL..................... 0.9112 0.9383 Lee, FL 2710 Fort Pierce-Port St. Lucie, FL................ 0.9672 0.9774 Martin, FL St. Lucie, FL 2720 Fort Smith, AR-OK............................. 0.8858 0.9203 Crawford, AR Sebastian, AR Sequoyah, OK 2750 Fort Walton Beach, FL......................... 0.9351 0.9551 Okaloosa, FL 2760 \2\ Fort Wayne, IN............................ 0.8807 0.9167 Adams, IN Allen, IN De Kalb, IN Huntington, IN Wells, IN Whitley, IN 2800 \1\ Forth Worth-Arlington, TX................. 0.9442 0.9614 Hood, TX Johnson, TX Parker, TX Tarrant, TX 2840 Fresno, CA.................................... 1.0184 1.0126 Fresno, CA Madera, CA 2880 Gadsden, AL................................... 0.8491 0.8940 Etowah, AL 2900 Gainesville, FL............................... 1.0286 1.0195 Alachua, FL 2920 Galveston-Texas City, TX...................... 1.0284 1.0194 Galveston, TX 2960 Gary, IN...................................... 0.9454 0.9623 Lake, IN Porter, IN 2975 \2\ Glens Falls, NY........................... 0.8558 0.8989 Warren, NY Washington, NY 2980 \2\ Goldsboro, NC............................. 0.8553 0.8985 Wayne, NC 2985 Grand Forks, ND-MN............................ 1.0207 1.0141 Polk, MN Grand Forks, ND 2995 Grand Junction, CO............................ 0.9601 0.9725 Mesa, CO 3000 \1\ Grand Rapids-Muskegon-Holland, MI......... 1.0256 1.0175 Allegan, MI Kent, MI Muskegon, MI Ottawa, MI 3040 Great Falls, MT............................... 0.9447 0.9618 Cascade, MT 3060 Greeley, CO................................... 0.9908 0.9937 Weld, CO 3080 Green Bay, WI................................. 0.9359 0.9556 Brown, WI 3120 \1\ Greensboro-Winston-Salem-High Point, NC... 0.9187 0.9436 Alamance, NC Davidson, NC Davie, NC Forsyth, NC Guilford, NC Randolph, NC Stokes, NC Yadkin, NC 3150 Greenville, NC................................ 0.9454 0.9623 Pitt, NC 3160 Greenville-Spartanburg-Anderson, SC........... 0.9160 0.9417 Anderson, SC Cherokee, SC Greenville, SC Pickens, SC Spartanburg, SC 3180 Hagerstown, MD................................ 0.9647 0.9757 Washington, MD 3200 Hamilton-Middletown, OH....................... 0.8892 0.9227 Butler, OH 3240 Harrisburg-Lebanon-Carlisle, PA............... 0.9467 0.9632 Cumberland, PA Dauphin, PA Lebanon, PA Perry, PA 3283 \1\ \2\ Hartford, CT.......................... 1.1798 1.1199 Hartford, CT Litchfield, CT Middlesex, CT Tolland, CT 3285 \2\ Hattiesburg, MS........................... 0.7608 0.8293 Forrest, MS Lamar, MS 3290 Hickory-Morganton-Lenoir, NC.................. 0.8989 0.9296 Alexander, NC Burke, NC Caldwell, NC Catawba, NC 3320 Honolulu, HI.................................. 1.1905 1.1268 Honolulu, HI 3350 Houma, LA..................................... 0.8218 0.8742 Lafourche, LA Terrebonne, LA 3360 \1\ Houston, TX............................... 0.9661 0.9767 Chambers, TX Fort Bend, TX Harris, TX Liberty, TX Montgomery, TX Waller, TX 3400 Huntington-Ashland, WV-KY-OH.................. 0.9961 0.9973 Boyd, KY Carter, KY Greenup, KY Lawrence, OH Cabell, WV Wayne, WV 3440 Huntsville, AL................................ 0.9089 0.9367 Limestone, AL Madison, AL 3480 \1\ Indianapolis, IN.......................... 0.9314 0.9525 Boone, IN Hamilton, IN Hancock, IN [[Page 26365]] Hendricks, IN Johnson, IN Madison, IN Marion, IN Morgan, IN Shelby, IN 3500 Iowa City, IA................................. 0.9749 0.9827 Johnson, IA 3520 \2\ Jackson, MI............................... 0.9133 0.9398 Jackson, MI 3560 Jackson, MS................................... 0.8890 0.9226 Hinds, MS Madison, MS Rankin, MS 3580 Jackson, TN................................... 0.8939 0.9261 Madison, TN Chester, TN 3600 \1\ Jacksonville, FL.......................... 0.8995 0.9300 Clay, FL Duval, FL Nassau, FL St. Johns, FL 3605 \2\ Jacksonville, NC.......................... 0.8553 0.8985 Onslow, NC 3610 \2\ Jamestown, NY............................. 0.8558 0.8989 Chautauqua, NY 3620 Janesville-Beloit, WI......................... 0.9856 0.9901 Rock, WI 3640 Jersey City, NJ............................... 1.0985 1.0664 Hudson, NJ 3660 Johnson City-Kingsport-Bristol, TN-VA......... 0.8412 0.8883 Carter, TN Hawkins, TN Sullivan, TN Unicoi, TN Washington, TN Bristol City, VA Scott, VA Washington, VA 3680 Johnstown, PA................................. 0.8686 0.9080 Cambria, PA Somerset, PA 3700 Jonesboro, AR................................. 0.8587 0.9009 Craighead, AR 3710 Joplin, MO.................................... 0.7924 0.8527 Jasper, MO Newton, MO 3720 Kalamazoo-Battlecreek, MI..................... 1.0247 1.0168 Calhoun, MI Kalamazoo, MI Van Buren, MI 3740 Kankakee, IL.................................. 0.8954 0.9271 Kankakee, IL 3760 \1\ Kansas City, KS-MO........................ 0.9629 0.9744 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................................... 0.9703 0.9796 Kenosha, WI 3810 Killeen-Temple, TX............................ 1.0321 1.0219 Bell, TX Coryell, TX 3840 Knoxville, TN................................. 0.8422 0.8890 Anderson, TN Blount, TN Knox, TN Loudon, TN Sevier, TN Union, TN 3850 Kokomo, IN.................................... 0.9190 0.9438 Howard, IN Tipton, IN 3870 La Crosse, WI-MN.............................. 0.9442 0.9614 Houston, MN La Crosse, WI 3880 Lafayette, LA................................. 0.8852 0.9199 Acadia, LA Lafayette, LA St. Landry, LA St. Martin, LA 3920 Lafayette, IN................................. 0.9091 0.9368 Clinton, IN Tippecanoe, IN 3960 \2\ Lake Charles, LA.......................... 0.7921 0.8525 Calcasieu, LA 3980 Lakeland-Winter Haven, FL..................... 0.8904 0.9236 Polk, FL 4000 Lancaster, PA................................. 0.9274 0.9497 Lancaster, PA 4040 Lansing-East Lansing, MI...................... 0.9873 0.9913 Clinton, MI Eaton, MI Ingham, MI 4080 Laredo, TX.................................... 0.7637 0.8314 Webb, TX 4100 Las Cruces, NM................................ 0.8744 0.9122 Dona Ana, NM 4120 \1\ Las Vegas, NV-AZ.......................... 1.0876 1.0592 Mohave, AZ Clark, NV Nye, NV 4150 Lawrence, KS.................................. 0.8272 0.8782 Douglas, KS 4200 Lawton, OK.................................... 0.9156 0.9414 Comanche, OK 4243 Lewiston-Auburn, ME........................... 0.9064 0.9349 Androscoggin, ME 4280 Lexington, KY................................. 0.8921 0.9248 Bourbon, KY Clark, KY Fayette, KY Jessamine, KY Madison, KY Scott, KY Woodford, KY 4320 Lima, OH...................................... 0.9634 0.9748 Allen, OH Auglaize, OH 4360 Lincoln, NE................................... 0.9808 0.9868 Lancaster, NE 4400 Little Rock-North Little Rock, AR............. 0.8959 0.9275 Faulkner, AR Lonoke, AR Pulaski, AR Saline, AR 4420 Longview-Marshall, TX......................... 0.8816 0.9173 Gregg, TX Harrison, TX Upshur, TX 4480 \1\ Los Angeles-Long Beach, CA................ 1.1955 1.1301 Los Angeles, CA 4520 Louisville, KY-IN............................. 0.9395 0.9582 Clark, IN Floyd, IN Harrison, IN Scott, IN Bullitt, KY Jefferson, KY Oldham, KY 4600 Lubbock, TX................................... 0.8828 0.9182 Lubbock, TX 4640 Lynchburg, VA................................. 0.9218 0.9458 Amherst, VA Bedford, VA Bedford City, VA Campbell, VA Lynchburg City, VA 4680 Macon, GA..................................... 0.9046 0.9336 Bibb, GA Houston, GA Jones, GA Peach, GA Twiggs, GA 4720 Madison, WI................................... 1.0354 1.0241 Dane, WI 4800 \2\ Mansfield, OH............................. 0.8778 0.9146 Crawford, OH Richland, OH 4840 Mayaguez, PR.................................. 0.4617 0.5891 Anasco, PR Cabo Rojo, PR Hormigueros, PR Mayaguez, PR Sabana Grande, PR San German, PR 4880 McAllen-Edinburg-Mission, TX.................. 0.8403 0.8877 Hidalgo, TX 4890 Medford-Ashland, OR........................... 1.0438 1.0298 Jackson, OR 4900 Melbourne-Titusville-Palm Bay, FL............. 0.9713 0.9803 Brevard, Fl [[Page 26366]] 4920 \1\ \2\ Memphis, TN-AR-MS (TN Hospitals)...... 0.7980 0.8568 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4920 \1\ \2\ Memphis, TN-AR-MS (AR Hospitals)...... 0.7538 0.8240 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4920 \1\ \2\ Memphis, TN-AR-MS (MS Hospitals)...... 0.7608 0.8293 Crittenden, AR DeSoto, MS Fayette, TN Shelby, TN Tipton, TN 4940 \2\ Merced, CA................................ 0.9966 0.9977 Merced, CA 5000 \1\ Miami, FL................................. 1.0148 1.0101 Dade, FL 5015 \1\ Middlesex-Somerset-Hunterdon, NJ.......... 1.0342 1.0233 Hunterdon, NJ Middlesex, NJ Somerset, NJ 5080 \1\ Milwaukee-Waukesha, WI.................... 0.9803 0.9865 Milwaukee, WI Ozaukee, WI Washington, WI Waukesha, WI 5120 \1\ Minneapolis-St. Paul, MN-WI............... 1.1118 1.0753 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.................................. 0.9462 0.9628 Missoula, MT 5160 Mobile, AL.................................... 0.8205 0.8733 Baldwin, AL Mobile, AL 5170 Modesto, CA................................... 1.0481 1.0327 Stanislaus, CA 5190 \1\ Monmouth-Ocean, NJ........................ 1.1552 1.1038 Monmouth, NJ Ocean, NJ 5200 Monroe, LA.................................... 0.8467 0.8923 Ouachita, LA 5240 \2\ Montgomery, AL............................ 0.7610 0.8294 Autauga, AL Elmore, AL Montgomery, AL 5280 Muncie, IN.................................... 1.0734 1.0497 Delaware, IN 5330 Myrtle Beach, SC.............................. 0.8658 0.9060 Horry, SC 5345 Naples, FL.................................... 0.9396 0.9582 Collier, FL 5360 \1\ Nashville, TN............................. 0.9201 0.9446 Cheatham, TN Davidson, TN Dickson, TN Robertson, TN Rutherford TN Sumner, TN Williamson, TN Wilson, TN 5380 \1\ Nassau-Suffolk, NY........................ 1.3089 1.2024 Nassau, NY Suffolk, NY 5483 \1\ New Haven-Bridgeport-Stamford-Waterbury- 1.2135 1.1417 Danbury, CT........................................ Fairfield, CT New Haven, CT 5523 New London-Norwich, CT........................ 1.1984 1.1319 New London, CT 5560 \1\ New Orleans, LA........................... 0.9283 0.9503 Jefferson, LA Orleans, LA Plaquemines, LA St. Bernard, LA St. Charles, LA St. James, LA St. John The Baptist, LA St. Tammany, LA 5600 \1\ New York, NY.............................. 1.4445 1.2864 Bronx, NY Kings, NY New York, NY Putnam, NY Queens, NY Richmond, NY Rockland, NY Westchester, NY 5640 \1\ Newark, NJ................................ 1.0717 1.0486 Essex, NJ Morris, NJ Sussex, NJ Union, NJ Warren, NJ 5660 Newburgh, NY-PA............................... 1.0946 1.0639 Orange, NY Pike, PA 5720 \1\ Norfolk-Virginia Beach-Newport News, VA-NC 0.8429 0.8896 Currituck, NC Chesapeake City, VA Gloucester, VA Hampton City, VA Isle of Wight, VA James City, VA Mathews, VA Newport News City, VA Norfolk City, VA Poquoson City, VA Portsmouth City, VA Suffolk City, VA Virginia Beach City, VA Williamsburg City, VA York, VA 5775 \1\ Oakland, CA............................... 1.5051 1.3231 Alameda, CA Contra Costa, CA 5790 Ocala, FL..................................... 0.8904 0.9236 Marion, FL 5800 Odessa-Midland, TX............................ 0.9168 0.9422 Ector, TX Midland, TX 5880 \1\ Oklahoma City, OK......................... 0.8910 0.9240 Canadian, OK Cleveland, OK Logan, OK McClain, OK Oklahoma, OK Pottawatomie, OK 5910 Olympia, WA................................... 1.0787 1.0532 Thurston, WA 5920 Omaha, NE-IA.................................. 0.9707 0.9798 Pottawattamie, IA Cass, NE Douglas, NE Sarpy, NE Washington, NE 5945 \1\ Orange County, CA......................... 1.1560 1.1044 Orange, CA 5960 \1\ Orlando, FL............................... 0.9959 0.9972 Lake, FL Orange, FL Osceola, FL Seminole, FL 5990 \2\ Owensboro, KY............................. 0.8017 0.8595 Daviess, KY 6015 Panama City, FL............................... 0.9129 0.9395 Bay, FL 6020 \2\ Parkersburg-Marietta, WV-OH (WV Hospitals) 0.8321 0.8817 Washington, OH Wood, WV 6020 \2\ Parkersburg-Marietta, WV-OH (OH Hospitals) 0.8778 0.9146 Washington, OH Wood, WV 6080 \2\ Pensacola, FL............................. 0.8904 0.9236 Escambia, FL Santa Rosa, FL [[Page 26367]] 6120 Peoria-Pekin, IL.............................. 0.8687 0.9081 Peoria, IL Tazewell, IL Woodford, IL 6160 \1\ Philadelphia, PA-NJ....................... 1.0660 1.0447 Burlington, NJ Camden, NJ Gloucester, NJ Salem, NJ Bucks, PA Chester, PA Delaware, PA Montgomery, PA Philadelphia, PA 6200 \1\ Phoenix-Mesa, AZ.......................... 0.9532 0.9677 Maricopa, AZ Pinal, AZ 6240 Pine Bluff, AR................................ 0.7866 0.8484 Jefferson, AR 6280 \1\ Pittsburgh, PA............................ 0.9818 0.9875 Allegheny, PA Beaver, PA Butler, PA Fayette, PA Washington, PA Westmoreland, PA 6323 \2\ Pittsfield, MA............................ 1.1348 1.0905 Berkshire, MA 6340 Pocatello, ID................................. 1.0819 1.0554 Bannock, ID 6360 Ponce, PR..................................... 0.4347 0.5652 Guayanilla, PR Juana Diaz, PR Penuelas, PR Ponce, PR Villalba, PR Yauco, PR 6403 Portland, ME.................................. 0.9779 0.9848 Cumberland, ME Sagadahoc, ME York, ME 6440 \1\ Portland-Vancouver, OR-WA................. 1.0928 1.0627 Clackamas, OR Columbia, OR Multnomah, OR Washington, OR Yamhill, OR Clark, WA 6483 \1\ Providence-Warwick-Pawtucket, RI.......... 1.0955 1.0645 Bristol, RI Kent, RI Newport, RI Providence, RI Washington, RI 6520 Provo-Orem, UT................................ 0.9972 0.9981 Utah, UT 6560 \2\ Pueblo, CO................................ 0.9179 0.9430 Pueblo, CO 6580 Punta Gorda, FL............................... 0.9565 0.9700 Charlotte, FL 6600 Racine, WI.................................... 0.9298 0.9514 Racine, WI 6640 \1\ Raleigh-Durham-Chapel Hill, NC............ 0.9749 0.9827 Chatham, NC Durham, NC Franklin, NC Johnston, NC Orange, NC Wake, NC 6660 Rapid City, SD................................ 0.8463 0.8920 Pennington, SD 6680 Reading, PA................................... 0.9203 0.9447 Berks, PA 6690 Redding, CA................................... 1.1795 1.1197 Shasta, CA 6720 Reno, NV...................................... 1.0508 1.0345 Washoe, NV 6740 Richland-Kennewick-Pasco, WA.................. 1.1564 1.1046 Benton, WA Franklin, WA 6760 Richmond-Petersburg, VA....................... 0.9679 0.9779 Charles City County, VA Chesterfield, VA Colonial Heights City, VA Dinwiddie, VA Goochland, VA Hanover, VA Henrico, VA Hopewell City, VA New Kent, VA Petersburg City, VA Powhatan, VA Prince George, VA Richmond City, VA 6780 \1\ Riverside-San Bernardino, CA.............. 1.1159 1.0780 Riverside, CA San Bernardino, CA 6800 Roanoke, VA................................... 0.9543 0.9685 Botetourt, VA Roanoke, VA Roanoke City, VA Salem City, VA 6820 Rochester, MN................................. 1.1361 1.0913 Olmsted, MN 6840 \1\ Rochester, NY............................. 0.8846 0.9195 Genesee, NY Livingston, NY Monroe, NY Ontario, NY Orleans, NY Wayne, NY 6880 Rockford, IL.................................. 0.8904 0.9236 Boone, IL Ogle, IL Winnebago, IL 6895 Rocky Mount, NC............................... 0.8875 0.9215 Edgecombe, NC Nash, NC 6920 \1\ Sacramento, CA............................ 1.2003 1.1332 El Dorado, CA Placer, CA Sacramento, CA 6960 Saginaw-Bay City-Midland, MI.................. 0.9475 0.9637 Bay, MI Midland, MI Saginaw, MI 6980 St. Cloud, MN................................. 1.0164 1.0112 Benton, MN Stearns, MN 7000 St. Joseph, MO................................ 0.9245 0.9477 Andrew, MO Buchanan, MO 7040 \1\ St. Louis, MO-IL.......................... 0.9114 0.9384 Clinton, IL Jersey, IL Madison, IL Monroe, IL St. Clair, IL Franklin, MO Jefferson, MO Lincoln, MO St. Charles, MO St. Louis, MO St. Louis City, MO Warren, MO 7080 \2\ Salem, OR................................. 1.0300 1.0204 Marion, OR Polk, OR 7120 Salinas, CA................................... 1.4649 1.2988 Monterey, CA 7160 \1\ Salt Lake City-Ogden, UT.................. 0.9661 0.9767 Davis, UT Salt Lake, UT Weber, UT 7200 San Angelo, TX................................ 0.7747 0.8396 Tom Green, TX 7240 \1\ San Antonio, TX........................... 0.8087 0.8647 Bexar, TX Comal, TX Guadalupe, TX Wilson, TX 7320 \1\ San Diego, CA............................. 1.1901 1.1266 San Diego, CA 7360 \1\ San Francisco, CA......................... 1.4433 1.2857 Marin, CA San Francisco, CA San Mateo, CA 7400 \1\ San Jose, CA.............................. 1.4376 1.2822 Santa Clara, CA 7440 \1\ San Juan-Bayamon, PR...................... 0.4691 0.5955 Aguas Buenas, PR Barceloneta, PR Bayamon, PR Canovanas, PR Carolina, PR Catano, PR Ceiba, PR Comerio, PR Corozal, PR Dorado, PR Fajardo, PR [[Page 26368]] 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.... 1.0755 1.0511 San Luis Obispo, CA 7480 Santa Barbara-Santa Maria-Lompoc, CA.......... 1.0728 1.0493 Santa Barbara, CA 7485 Santa Cruz-Watsonville, CA.................... 1.4736 1.3041 Santa Cruz, CA 7490 Santa Fe, NM.................................. 0.9383 0.9573 Los Alamos, NM Santa Fe, NM 7500 Santa Rosa, CA................................ 1.3182 1.2083 Sonoma, CA 7510 Sarasota-Bradenton, FL........................ 0.9670 0.9773 Manatee, FL Sarasota, FL 7520 Savannah, GA.................................. 0.8689 0.9083 Bryan, GA Chatham, GA Effingham, GA 7560 \2\ Scranton-Wilkes-Barre-Hazleton, PA........ 0.8686 0.9080 Columbia, PA Lackawanna, PA Luzerne, PA Wyoming, PA 7600 \1\ Seattle-Bellevue-Everett, WA.............. 1.1134 1.0763 Island, WA King, WA Snohomish, WA 7610 \2\ Sharon, PA................................ 0.8686 0.9080 Mercer, PA 7620 \2\ Sheboygan, WI............................. 0.9073 0.9356 Sheboygan, WI 7640 Sherman-Denison, TX........................... 0.8619 0.9032 Grayson, TX 7680 Shreveport-Bossier City, LA................... 0.8853 0.9200 Bossier, LA Caddo, LA Webster, LA 7720 Sioux City, IA-NE............................. 0.8571 0.8998 Woodbury, IA Dakota, NE 7760 Sioux Falls, SD............................... 0.8890 0.9226 Lincoln, SD Minnehaha, SD 7800 South Bend, IN................................ 1.0233 1.0159 St. Joseph, IN 7840 Spokane, WA................................... 1.1979 1.1316 Spokane, WA 7880 Springfield, IL............................... 0.8744 0.9122 Menard, IL Sangamon, IL 7920 Springfield, MO............................... 0.8357 0.8843 Christian, MO Greene, MO Webster, MO 8003 \2\ Springfield, MA........................... 1.1348 1.0905 Hampden, MA Hampshire, MA 8050 State College, PA............................. 0.9114 0.9384 Centre, PA 8080 \2\ Steubenville-Weirton, OH-WV (OH Hospitals) 0.8778 0.9146 Jefferson, OH Brooke, WV Hancock, WV 8080 Steubenville-Weirton, OH-WV (WV Hospitals).... 0.8658 0.9060 Jefferson, OH Brooke, WV Hancock, WV 8120 Stockton-Lodi, CA............................. 1.0711 1.0482 San Joaquin, CA 8140 \2\ Sumter, SC................................ 0.8445 0.8907 Sumter, SC 8160 Syracuse, NY.................................. 0.9662 0.9767 Cayuga, NY Madison, NY Onondaga, NY Oswego, NY 8200 Tacoma, WA.................................... 1.1658 1.1108 Pierce, WA 8240 \2\ Tallahassee, FL........................... 0.8904 0.9236 Gadsden, FL Leon, FL 8280 \1\ Tampa-St. Petersburg-Clearwater, FL....... 0.9111 0.9382 Hernando, FL Hillsborough, FL Pasco, FL Pinellas, FL 8320 \2\ Terre Haute, IN........................... 0.8807 0.9167 Clay, IN Vermillion, IN Vigo, IN 8360 Texarkana, AR-Texarkana, TX................... 0.7962 0.8555 Miller, AR Bowie, TX 8400 Toledo, OH.................................... 0.9705 0.9797 Fulton, OH Lucas, OH Wood, OH 8440 Topeka, KS.................................... 0.9134 0.9399 Shawnee, KS 8480 Trenton, NJ................................... 0.9919 0.9944 Mercer, NJ 8520 Tucson, AZ.................................... 0.8826 0.9180 Pima, AZ 8560 Tulsa, OK..................................... 0.8698 0.9089 Creek, OK Osage, OK Rogers, OK Tulsa, OK Wagoner, OK 8600 Tuscaloosa, AL................................ 0.8081 0.8642 Tuscaloosa, AL 8640 Tyler, TX..................................... 0.9270 0.9494 Smith, TX 8680 \2\ Utica-Rome, NY............................ 0.8558 0.8989 Herkimer, NY Oneida, NY 8720 Vallejo-Fairfield-Napa, CA.................... 1.2672 1.1761 Napa, CA Solano, CA 8735 Ventura, CA................................... 1.0586 1.0398 Ventura, CA 8750 Victoria, TX.................................. 0.8133 0.8680 Victoria, TX 8760 Vineland-Millville-Bridgeton, NJ.............. 1.0462 1.0314 Cumberland, NJ 8780 \2\ Visalia-Tulare-Porterville, CA............ 0.9966 0.9977 Tulare, CA 8800 Waco, TX...................................... 0.8402 0.8876 McLennan, TX 8840 \1\ Washington, DC-MD-VA-WV................... 1.0832 1.0563 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 [[Page 26369]] Warren, VA Berkeley, WV Jefferson, WV 8920 Waterloo-Cedar Falls, IA...................... 0.8932 0.9256 Black Hawk, IA 8940 Wausau, WI.................................... 0.9511 0.9663 Marathon, WI 8960 \1\ West Palm Beach-Boca Raton, FL............ 0.9658 0.9765 Palm Beach, FL 9000 \2\ Wheeling, WV-OH (WV Hospitals)............ 0.8321 0.8817 Belmont, OH Marshall, WV Ohio, WV 9000 \2\ Wheeling, WV-OH (OH Hospitals)............ 0.8778 0.9146 Belmont, OH Marshall, WV Ohio, WV 9040 Wichita, KS................................... 0.9574 0.9706 Butler, KS Harvey, KS Sedgwick, KS 9080 Wichita Falls, TX............................. 0.7668 0.8337 Archer, TX Wichita, TX 9140 \2\ Williamsport, PA.......................... 0.8686 0.9080 Lycoming, PA 9160 Wilmington-Newark, DE-MD...................... 1.1281 1.0860 New Castle, DE Cecil, MD 9200 Wilmington, NC................................ 0.9474 0.9637 New Hanover, NC Brunswick, NC 9260 \2\ Yakima, WA................................ 1.0763 1.0516 Yakima, WA 9270 Yolo, CA...................................... 1.0261 1.0178 Yolo, CA 9280 York, PA...................................... 0.9427 0.9604 York, PA 9320 Youngstown-Warren, OH......................... 0.9604 0.9727 Columbiana, OH Mahoning, OH Trumbull, OH 9340 Yuba City, CA................................. 1.0820 1.0555 Sutter, CA Yuba, CA 9360 Yuma, AZ...................................... 0.9605 0.9728 Yuma, AZ ------------------------------------------------------------------------ \1\ Large Urban Area \2\ Hospitals geographically located in the area are assigned the statewide rural wage index for FY 2000. Table 4B.--Wage Index and Capital Geographic Adjustment Factor (GAF) for Rural Areas ------------------------------------------------------------------------ Wage Nonurban Area Index GAF ------------------------------------------------------------------------ Alabama............................................. 0.7610 0.8294 Alaska.............................................. 1.2681 1.1766 Arizona............................................. 0.8400 0.8875 Arkansas............................................ 0.7538 0.8240 California.......................................... 0.9966 0.9977 Colorado............................................ 0.9179 0.9430 Connecticut......................................... 1.1798 1.1199 Delaware............................................ 0.9349 0.9549 Florida............................................. 0.8904 0.9236 Georgia............................................. 0.8510 0.8954 Hawaii.............................................. 1.1438 1.0964 Idaho............................................... 0.8831 0.9184 Illinois............................................ 0.8320 0.8817 Indiana............................................. 0.8807 0.9167 Iowa................................................ 0.8196 0.8726 Kansas.............................................. 0.7710 0.8369 Kentucky............................................ 0.8017 0.8595 Louisiana........................................... 0.7921 0.8525 Maine............................................... 0.8813 0.9171 Maryland............................................ 0.8717 0.9103 Massachusetts....................................... 1.1348 1.0905 Michigan............................................ 0.9133 0.9398 Minnesota........................................... 0.9116 0.9386 Mississippi......................................... 0.7608 0.8293 Missouri............................................ 0.7766 0.8410 Montana............................................. 0.9017 0.9316 Nebraska............................................ 0.8265 0.8777 Nevada.............................................. 0.9354 0.9553 New Hampshire....................................... 0.9995 0.9997 New Jersey \1\...................................... 0.0000 ........ New Mexico.......................................... 0.8425 0.8893 New York............................................ 0.8558 0.8989 North Carolina...................................... 0.8553 0.8985 North Dakota........................................ 0.7698 0.8360 Ohio................................................ 0.8778 0.9146 Oklahoma............................................ 0.7622 0.8303 Oregon.............................................. 1.0300 1.0204 Pennsylvania........................................ 0.8686 0.9080 Puerto Rico......................................... 0.4232 0.5550 Rhode Island \1\.................................... 0.0000 ........ South Carolina...................................... 0.8445 0.8907 South Dakota........................................ 0.7786 0.8425 Tennessee........................................... 0.7980 0.8568 Texas............................................... 0.7523 0.8229 Utah................................................ 0.9182 0.9432 Vermont............................................. 0.9538 0.9681 Virginia............................................ 0.8361 0.8846 Washington.......................................... 1.0763 1.0516 West Virginia....................................... 0.8321 0.8817 Wisconsin........................................... 0.9073 0.9356 Wyoming............................................. 0.9046 0.9336 ------------------------------------------------------------------------ \1\ All counties within the State are classified as urban. Table 4C.--Wage Index and Capital Geographic Adjustment Factor (GAF) for Hospitals That Are Reclassified ------------------------------------------------------------------------ Wage Area index GAF ------------------------------------------------------------------------ Abilene, TX......................................... 0.8318 0.8815 Akron, OH........................................... 1.0181 1.0124 Albany, GA.......................................... 1.0783 1.0530 Alexandria, LA...................................... 0.8262 0.8774 Amarillo, TX........................................ 0.8663 0.9064 Anchorage, AK....................................... 1.2967 1.1947 Ann Arbor, MI....................................... 1.1177 1.0792 Atlanta, GA......................................... 0.9945 0.9962 Atlantic-Cape May, NJ............................... 1.0998 1.0673 Augusta-Aiken, GA-SC................................ 0.9226 0.9463 Baltimore, MD....................................... 0.9485 0.9644 Barnstable-Yarmouth, MA............................. 1.3694 1.2402 Baton Rouge, LA..................................... 0.8856 0.9202 Benton Harbor, MI................................... 0.9133 0.9398 Bergen-Passaic, NJ.................................. 1.1727 1.1153 Billings, MT........................................ 0.9577 0.9708 Binghamton, NY...................................... 0.8723 0.9107 Birmingham, AL...................................... 0.8574 0.9000 Bismarck, ND........................................ 0.8016 0.8595 Bloomington, IN..................................... 0.9294 0.9511 Boise City, ID...................................... 0.9133 0.9398 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1239 1.0833 (NH, RI, and VT Hospitals)......................... Bryan-College Station, TX........................... 0.8306 0.8806 Burlington, VT (VT Hospitals)....................... 0.9538 0.9681 Burlington, VT (NY Hospital)........................ 0.9238 0.9472 Casper, WY.......................................... 0.9046 0.9336 Champaign-Urbana, IL................................ 0.9353 0.9552 Charleston-North Charleston, SC..................... 0.9094 0.9370 Charleston, WV...................................... 0.9003 0.9306 Charlotte-Gastonia-Rock Hill, NC-SC................. 0.9307 0.9520 Chattanooga, TN-GA.................................. 0.9795 0.9859 Chicago, IL......................................... 1.0902 1.0609 Cincinnati, OH-KY-IN................................ 0.9330 0.9536 Clarksville-Hopkinsville, TN-KY..................... 0.8393 0.8869 Cleveland-Lorain-Elyria, OH......................... 0.9649 0.9758 Columbia, MO........................................ 0.8600 0.9019 Columbia, SC........................................ 0.9517 0.9667 Columbus, OH........................................ 0.9741 0.9822 Dallas, TX.......................................... 0.9220 0.9459 Danville, VA........................................ 0.8361 0.8846 Davenport-Moline--Rock Island, IA-IL................ 0.9021 0.9319 Dayton-Springfield, OH.............................. 0.9519 0.9668 Denver, CO.......................................... 1.0032 1.0022 Des Moines, IA...................................... 0.9087 0.9365 Dothan, AL.......................................... 0.8105 0.8660 Dover, DE........................................... 0.9349 0.9549 Duluth-Superior, MN-WI.............................. 1.0201 1.0137 Eau Claire, WI...................................... 0.9073 0.9356 Erie, PA............................................ 0.9021 0.9319 Eugene-Springfield, OR.............................. 1.1026 1.0692 Fargo-Moorhead, ND-MN (ND and SD Hospitals)......... 0.8597 0.9017 Fayetteville, NC.................................... 0.8553 0.8985 Flagstaff, AZ-UT.................................... 1.0678 1.0459 Flint, MI........................................... 1.1189 1.0800 Florence, AL........................................ 0.7621 0.8302 Florence, SC........................................ 0.8838 0.9189 [[Page 26370]] Fort Collins-Loveland, CO........................... 1.1005 1.0678 Ft. Lauderdale, FL.................................. 1.0228 1.0156 Fort Pierce-Port St. Lucie, FL...................... 0.9672 0.9774 Fort Smith, AR-OK................................... 0.8634 0.9043 Fort Wayne, IN...................................... 0.8807 0.9167 Forth Worth-Arlington, TX........................... 0.9442 0.9614 Gadsden, AL......................................... 0.8491 0.8940 Grand Forks, ND-MN.................................. 1.0042 1.0029 Grand Junction, CO.................................. 0.9601 0.9725 Grand Rapids-Muskegon-Holland, MI................... 1.0150 1.0102 Great Falls, MT..................................... 0.9447 0.9618 Greeley, CO......................................... 0.9642 0.9753 Green Bay, WI....................................... 0.9359 0.9556 Greensboro-Winston-Salem-High Point, NC............. 0.9187 0.9436 Greenville, NC...................................... 0.9244 0.9476 Greenville-Spartanburg-Anderson, SC................. 0.9160 0.9417 Harrisburg-Lebanon-Carlisle, PA..................... 0.9360 0.9557 Hartford, CT (MA Hospital).......................... 1.1530 1.1024 Hattiesburg, MS..................................... 0.7608 0.8293 Hickory-Morganton-Lenoir, NC........................ 0.8766 0.9138 Honolulu, HI........................................ 1.1905 1.1268 Houston, TX......................................... 0.9661 0.9767 Huntington-Ashland, WV-KY-OH........................ 0.9721 0.9808 Huntsville, AL...................................... 0.8882 0.9220 Indianapolis, IN.................................... 0.9314 0.9525 Jackson, MS......................................... 0.8776 0.9145 Jackson, TN......................................... 0.8939 0.9261 Jacksonville, FL.................................... 0.8995 0.9300 Jersey City, NJ..................................... 1.0985 1.0664 Johnson City-Kingsport-Bristol, TN-VA............... 0.8412 0.8883 Joplin, MO.......................................... 0.7924 0.8527 Kalamazoo-Battlecreek, MI........................... 1.0144 1.0098 Kansas City, KS-MO.................................. 0.9629 0.9744 Knoxville, TN....................................... 0.8422 0.8890 Kokomo, IN.......................................... 0.9190 0.9438 Lafayette, LA....................................... 0.8852 0.9199 Lansing-East Lansing, MI............................ 0.9873 0.9913 Las Cruces, NM...................................... 0.8623 0.9035 Las Vegas, NV-AZ.................................... 1.0876 1.0592 Lexington, KY....................................... 0.8769 0.9140 Lima, OH............................................ 0.9497 0.9653 Lincoln, NE......................................... 0.9808 0.9868 Little Rock-North Little Rock, AR................... 0.8841 0.9191 Longview-Marshall, TX............................... 0.8403 0.8877 Los Angeles-Long Beach, CA.......................... 1.1955 1.1301 Louisville, KY-IN................................... 0.9395 0.9582 Lynchburg, VA....................................... 0.9090 0.9368 Macon, GA........................................... 0.9046 0.9336 Madison, WI......................................... 1.0354 1.0241 Mansfield, OH....................................... 0.8778 0.9146 Memphis, TN-AR-MS (AR Hospital)..................... 0.7538 0.8240 Memphis, TN-AR-MS (MS Hospital)..................... 0.7608 0.8293 Milwaukee-Waukesha, WI.............................. 0.9803 0.9865 Minneapolis-St. Paul, MN-WI......................... 1.1118 1.0753 Missoula, MT........................................ 0.9462 0.9628 Mobile, AL.......................................... 0.8205 0.8733 Monmouth-Ocean, NJ.................................. 1.1552 1.1038 Montgomery, AL...................................... 0.7610 0.8294 Myrtle Beach, SC (NC Hospital)...................... 0.8553 0.8985 Nashville, TN....................................... 0.9078 0.9359 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT. 1.2135 1.1417 New London-Norwich, CT.............................. 1.1861 1.1240 New Orleans, LA..................................... 0.9283 0.9503 New York, NY........................................ 1.4445 1.2864 Newburgh, NY-PA..................................... 0.9919 0.9944 Norfolk-Virginia Beach-Newport News, VA-NC (NC 0.8553 0.8985 Hospital).......................................... Oakland, CA......................................... 1.5051 1.3231 Ocala, FL........................................... 0.8904 0.9236 Odessa-Midland, TX.................................. 0.9058 0.9345 Oklahoma City, OK................................... 0.8910 0.9240 Omaha, NE-IA........................................ 0.9707 0.9798 Orange County, CA................................... 1.1560 1.1044 Orlando, FL......................................... 0.9856 0.9901 Peoria-Pekin, IL.................................... 0.8687 0.9081 Pine Bluff, AR...................................... 0.7762 0.8407 Pittsburgh, PA...................................... 0.9713 0.9803 Pittsfield, MA (VT Hospital)........................ 1.0032 1.0022 Pocatello, ID....................................... 0.9265 0.9491 Portland, ME........................................ 0.9622 0.9740 Portland-Vancouver, ORWA............................ 1.0928 1.0627 Provo-Orem, UT...................................... 0.9972 0.9981 Raleigh-Durham-Chapel Hill, NC...................... 0.9749 0.9827 Rapid City, SD...................................... 0.8463 0.8920 Redding, CA......................................... 1.1795 1.1197 Reno, NV............................................ 1.0508 1.0345 Richland-Kennewick-Pasco, WA........................ 1.1267 1.0851 Roanoke, VA......................................... 0.9543 0.9685 Rochester, MN....................................... 1.1361 1.0913 Rockford, IL........................................ 0.8904 0.9236 Sacramento, CA...................................... 1.2003 1.1332 Saginaw-Bay City-Midland, MI........................ 0.9475 0.9637 St. Cloud, MN....................................... 1.0164 1.0112 St. Joseph, MO...................................... 0.9036 0.9329 St. Louis, MO-IL.................................... 0.9114 0.9384 Salinas, CA......................................... 1.4649 1.2988 Salt Lake City-Ogden, UT............................ 0.9661 0.9767 San Diego, CA....................................... 1.1901 1.1266 Santa Cruz-Watsonville, CA.......................... 1.2834 1.1863 Santa Fe, NM........................................ 0.9383 0.9573 Santa Rosa, CA...................................... 1.2832 1.1862 Seattle-Bellevue-Everett, WA........................ 1.1134 1.0763 Sherman-Denison, TX................................. 0.8619 0.9032 Sioux City, IA-NE................................... 0.8571 0.8998 South Bend, IN...................................... 1.0233 1.0159 Spokane, WA......................................... 1.1608 1.1075 Springfield, IL..................................... 0.8744 0.9122 Springfield, MO..................................... 0.8089 0.8648 Syracuse, NY........................................ 0.9662 0.9767 Tampa-St. Petersburg-Clearwater, FL................. 0.9111 0.9382 Texarkana, AR-Texarkana, TX......................... 0.7962 0.8555 Toledo, OH.......................................... 0.9705 0.9797 Topeka, KS.......................................... 0.9134 0.9399 Tucson, AZ.......................................... 0.8826 0.9180 Tulsa, OK........................................... 0.8698 0.9089 Tuscaloosa, AL...................................... 0.8081 0.8642 Tyler, TX........................................... 0.9077 0.9358 Victoria, TX........................................ 0.8133 0.8680 Washington, DC-MD-VA-WV............................. 1.0832 1.0563 Waterloo-Cedar Falls, IA............................ 0.8932 0.9256 Wausau, WI.......................................... 0.9511 0.9663 Wichita, KS......................................... 0.9290 0.9508 Rural Alabama....................................... 0.7610 0.8294 Rural Florida....................................... 0.8904 0.9236 Rural Illinois...................................... 0.8320 0.8817 Rural Louisiana..................................... 0.7921 0.8525 Rural Michigan...................................... 0.9133 0.9398 Rural Minnesota..................................... 0.9116 0.9386 Rural Missouri...................................... 0.7766 0.8410 Rural Montana....................................... 0.9017 0.9316 Rural Oregon........................................ 1.0300 1.0204 Rural Texas (OK Hospital)........................... 0.7622 0.8303 Rural Washington.................................... 1.0763 1.0516 Rural West Virginia................................. 0.8321 0.8817 Rural Wisconsin..................................... 0.9073 0.9356 Rural Wyoming....................................... 0.8905 0.9237 ------------------------------------------------------------------------ Table 4D.--Average Hourly Wage for Urban Areas ------------------------------------------------------------------------ Average Urban area hourly wage ------------------------------------------------------------------------ Abilene, TX.................................................. 18.0486 Aguadilla, PR................................................ 10.4725 Akron, OH.................................................... 22.9067 Albany, GA................................................... 25.7222 Albany-Schenectady-Troy, NY.................................. 18.5809 Albuquerque, NM.............................................. 20.3203 Alexandria, LA............................................... 17.8813 Allentown-Bethlehem-Easton, PA............................... 21.3707 Altoona, PA.................................................. 20.0974 Amarillo, TX................................................. 18.7968 Anchorage, AK................................................ 27.9780 Ann Arbor, MI................................................ 24.4830 Anniston, AL................................................. 18.0781 Appleton-Oshkosh-Neenah, WI.................................. 19.7485 Arecibo, PR.................................................. 9.8505 [[Page 26371]] Asheville, NC................................................ 20.6721 Athens, GA................................................... 21.3273 Atlanta, GA.................................................. 21.5792 Atlantic-Cape May, NJ........................................ 24.3464 Auburn-Opelika, AL........................................... 17.7284 Augusta-Aiken, GA-SC......................................... 20.0184 Austin-San Marcos, TX........................................ 20.4753 Bakersfield, CA.............................................. 21.1738 Baltimore, MD................................................ 20.4985 Bangor, ME................................................... 20.8595 Barnstable-Yarmouth, MA...................................... 30.2448 Baton Rouge, LA.............................................. 19.4498 Beaumont-Port Arthur, TX..................................... 18.1415 Bellingham, WA............................................... 24.9338 Benton Harbor, MI............................................ 19.0728 Bergen-Passaic, NJ........................................... 25.6998 Billings, MT................................................. 20.6821 Biloxi-Gulfport-Pascagoula, MS............................... 17.9703 Binghamton, NY............................................... 18.9273 Birmingham, AL............................................... 18.5525 Bismarck, ND................................................. 17.1607 Bloomington,IN............................................... 19.2118 Bloomington-Normal, IL....................................... 20.0254 Boise City, ID............................................... 19.7312 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH............. 24.3877 Boulder-Longmont, CO......................................... 21.2598 Brazoria, TX................................................. 18.9889 Bremerton, WA................................................ 24.0180 Brownsville-Harlingen-San Benito, TX......................... 19.0812 Bryan-College Station, TX.................................... 17.9622 Buffalo-Niagara Falls, NY.................................... 20.7580 Burlington, VT............................................... 23.6135 Caguas, PR................................................... 9.9614 Canton-Massillon, OH......................................... 18.8702 Casper, WY................................................... 19.0746 Cedar Rapids, IA............................................. 18.2191 Champaign-Urbana, IL......................................... 20.1555 Charleston-North Charleston, SC.............................. 19.7335 Charleston, WV............................................... 20.2316 Charlotte-Gastonia-Rock Hill, NC-SC.......................... 20.1566 Charlottesville, VA.......................................... 23.3140 Chattanooga, TN-GA........................................... 21.8793 Cheyenne, WY................................................. 18.3270 Chicago, IL.................................................. 23.9273 Chico-Paradise, CA........................................... 23.1834 Cincinnati, OH-KY-IN......................................... 20.2453 Clarksville-Hopkinsville, TN-KY.............................. 17.9692 Cleveland-Lorain-Elyria, OH.................................. 20.9457 Colorado Springs, CO......................................... 21.1998 Columbia, MO................................................. 18.6606 Columbia, SC................................................. 20.9200 Columbus, GA-AL.............................................. 18.6769 Columbus, OH................................................. 21.1363 Corpus Christi, TX........................................... 18.4356 Corvallis, OR................................................ 24.8210 Cumberland, MD-WV............................................ 18.3080 Dallas, TX................................................... 20.0063 Danville, VA................................................. 18.5023 Davenport-Moline-Rock Island, IA-IL..................................................... 19.5749 Dayton-Springfield, OH....................................... 20.6558 Daytona Beach, FL............................................ 20.0411 Decatur, AL.................................................. 18.7206 Decatur, IL.................................................. 18.6640 Denver, CO................................................... 21.7676 Des Moines, IA............................................... 19.9873 Detroit, MI.................................................. 21.8228 Dothan, AL................................................... 17.4329 Dover, DE.................................................... 23.9388 Dubuque, IA.................................................. 19.3729 Duluth-Superior, MN-WI....................................... 22.0638 Dutchess County, NY.......................................... 22.3565 Eau Claire, WI............................................... 17.5107 El Paso, TX.................................................. 19.9962 Elkhart-Goshen, IN........................................... 20.7202 Elmira, NY................................................... 18.7582 Enid, OK..................................................... 19.0534 Erie, PA..................................................... 19.5749 Eugene-Springfield, OR.....................
