[Federal Register: June 2, 2004 (Volume 69, Number 106)]
[Proposed Rules]
[Page 31247-31275]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr02jn04-31]
[[Page 31247]]
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Part IV
Department of Health and Human Services
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Centers for Medicare & Medicaid Services
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42 CFR Part 484
Medicare Program; Home Health Prospective Payment System Rate Update
for Calendar Year 2005; Proposed Rule
[[Page 31248]]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
42 CFR Part 484
[CMS-1265-P]
RIN 0938-AM93
Medicare Program; Home Health Prospective Payment System Rate
Update for Calendar Year 2005
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Proposed rule.
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SUMMARY: This proposed rule would set forth an update to the 60-day
national episode rates and the national per-visit amounts under the
Medicare prospective payment system for home health agencies. As part
of this proposed rule, we also are proposing to rebase and revise the
home health market basket to ensure it continues to adequately reflect
the price changes of efficiently providing home health services. In
addition, we are proposing to revise the fixed dollar loss ratio, which
is used in the calculation of outlier payments. This proposed rule
would be the first update of the home health prospective payment system
(HH PPS) rates on a calendar year update cycle. HH PPS was moved to a
calendar year update cycle as a result the provisions of the Medicare
Prescription Drug, Improvement, and Modernization Act of 2003.
DATE: To be assured of consideration, comments must be received at one
of the addresses provided below, no later than 5 p.m. on August 2,
2004.
ADDRESSES: In commenting, please refer to file code CMS-1265-P. Because
of staff and resource limitations, we cannot accept comments by
facsimile (FAX) transmission.
Submit electronic comments to http://www.cms.hhs.gov/regulations/ecomments or to http://www.regulations.gov. Mail written comments (one
comments (one
original and two copies) to the following address ONLY:
Centers for Medicare & Medicaid Services, Department of Health and
Human Services, Attention: CMS-1265-P, P.O. Box 8016, Baltimore, MD
21244-8016.
Please allow sufficient time for mailed comments to be timely
received in the event of delivery delays.
If you prefer, you may deliver (by hand or courier) your written
comments (one original and three copies) to one of the following
addresses:
Room 443-G, Hubert H. Humphrey Building, 200 Independence Avenue,
SW., Washington, DC 20201, or Room C5-14-03, 7500 Security Boulevard,
Baltimore, MD 21244-1850.
Comments mailed to the addresses indicated as appropriate for hand
or courier delivery may be delayed and could be considered late.
All comments received before the close of the comment period are
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For information on viewing public comments, see the beginning of
the SUPPLEMENTARY INFORMATION section.
FOR FURTHER INFORMATION CONTACT:
Randy Throndset, (410) 786-0131.
Debra Gillespie, (410) 786-4631.
Mary Lee Seifert (Market Basket), (410) 786-0030.
Mollie Knight (Market Basket), (410) 786-7948.
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.
I. Background
(If you choose to comment on issues in this section, please include
the caption Background at the beginning of your comments.)
A. Statutory Background
The Balanced Budget Act of 1997 (BBA), Pub. L. 105-33, enacted on
August 5, 1997, significantly changed the way Medicare pays for
Medicare home health services. Until the implementation of a home
health prospective payment system (HH PPS) on October 1, 2000, home
health agencies (HHAs) received payment under a cost-based
reimbursement system. Section 4603 of the BBA governed the development
of the HH PPS.
Section 4603(a) of the BBA provides the authority for the
development of a PPS for all Medicare-covered home health services
provided under a plan of care that were paid on a reasonable cost basis
by adding section 1895, entitled ``Prospective Payment For Home Health
Services,'' to the Social Security Act (the Act).
Section 1895(b)(1) of the Act requires the Secretary to establish a
PPS for all costs of home health services paid under Medicare.
Section 1895(b)(3)(A) of the Act requires that (1) the computation
of a standard prospective payment amount include all costs of home
health services covered and paid for on a reasonable cost basis and be
initially based on the most recent audited cost report data available
to the Secretary, and (2) the prospective payment amounts be
standardized to eliminate the effects of case-mix and wage levels among
HHAs.
Section 1895(b)(3)(B) of the Act addresses the annual update to the
standard prospective payment amounts by the home health applicable
increase percentage as specified in the statute.
Section 1895(b)(4) of the Act governs the payment computation.
Sections 1895(b)(4)(A)(i) and (b)(4)(A)(ii) of the Act require the
standard prospective payment amount to be adjusted for case-mix and
geographic differences in wage levels. Section 1895(b)(4)(B) of the Act
requires the establishment of an appropriate case-mix adjustment factor
that explains a significant amount of the variation in cost among
different units of services. Similarly, section 1895(b)(4)(C) of the
Act requires the establishment of wage adjustment factors that reflect
the relative level of wages and wage-related costs applicable
[[Page 31249]]
to the furnishing of home health services in a geographic area compared
to the national average applicable level. These wage-adjustment factors
may be the factors used by the Secretary for the different area wage
levels for purposes of section 1886(d)(3)(E) of the Act.
Section 1895(b)(5) of the Act gives the Secretary the option to
grant additions or adjustments to the payment amount otherwise made in
the case of outliers because of unusual variations in the type or
amount of medically necessary care. Total outlier payments in a given
fiscal year cannot exceed 5 percent of total payments projected or
estimated.
B. Updates
On July 3, 2000, we published a final rule (65 FR 41128) in the
Federal Register to implement the HH PPS legislation. That final rule
established requirements for the new PPS for HHAs as required by
section 4603 of the BBA, and as subsequently amended by section 5101 of
the Omnibus Consolidated and Emergency Supplemental Appropriations Act
(OCESAA) for Fiscal Year 1999, Public Law 105-277, enacted on October
21, 1998; and by sections 302, 305, and 306 of the Medicare, Medicaid,
and SCHIP Balanced Budget Refinement Act (BBRA) of 1999, Public Law
106-113, enacted on November 29, 1999. The requirements include the
implementation of a PPS for HHAs, consolidated billing requirements,
and a number of other related changes. The PPS described in that rule
replaced the retrospective reasonable-cost-based system that was used
by Medicare for the payment of home health services under Part A and
Part B.
As required by section 1895(b)(3)(B) of the Act, we have updated
the HH PPS rates annually in a separate Federal Register document. We
will respond to public comments received on the FY 2004 update notice
(68 FR 39764) published on July 2, 2003 in the CY 2005 final rule.
C. System for Payment of Home Health Services
Generally, Medicare makes payment under the HH PPS on the basis of
a national standardized 60-day episode payment, adjusted for case mix
and wage index. For episodes with four or fewer visits, Medicare pays
on the basis of a national per-visit amount by discipline, referred to
as a low utilization payment adjustment (LUPA). Medicare also adjusts
the 60-day episode payment for certain intervening events that give
rise to a partial episode payment adjustment (PEP adjustment) or a
significant change in condition adjustment (SCIC). For certain cases
that exceed a specific cost threshold, an outlier adjustment may also
be available. For a complete and full description of the HH PPS as
required by the BBA and as amended by OCESAA and BBRA, see the July 3,
2000 HH PPS final rule (65 FR 41128).
D. Medicare Prescription Drug, Improvement, and Modernization Act of
2003
On December 8, 2003, the Congress enacted the Medicare Prescription
Drug, Improvement, and Modernization Act (MMA) of 2003 (Pub. L. 108-
173). This new legislation affects our proposed update to HH payment
rates. Specifically, section 421 of MMA requires, for home health
services furnished in a rural area (as defined in section 1886(d)(2)(D)
of the Act), with respect to episodes or visits ending on or after
April 1, 2004 and before April 1, 2005, that the Secretary increase the
payment amount that otherwise would have been made under section 1895
of the Act for the services by 5 percent.
The statute waives budget neutrality for the purposes of this
increase as it specifically states that the Secretary will not reduce
the standard prospective payment amount (or amounts) under section 1895
of the Act applicable to home health services furnished during a period
to offset the increase in payments resulting in the application of this
section of the statute.
Section 701 of the MMA changes the yearly update cycle of the HH
PPS rates from that of a fiscal year to a calendar year update cycle
for 2004 and any subsequent year. Generally, section 701(a) of the MMA
changes the references in the statute to refer to the calendar year for
2004 and any subsequent year. The changes result in updates to the HH
PPS rates described as ``fiscal year'' updates for 2002 and 2003 and as
calendar ``year'' updates for 2004 and any subsequent year (section
1895(b)(3)(B)(i) of the Act). In light of these provisions, we will not
be updating the HH PPS rates on October 1, 2004 as HH PPS will now be
updated on a calendar year update cycle.
In addition to changing the update cycle for HH PPS rates, section
701 of the MMA makes adjustments to the home health applicable increase
percentage for 2004, 2005, and 2006. Specifically, section 701(a)(2)(D)
of the MMA leaves unchanged the home health market basket increase for
the last calendar year quarter of 2003 and the first calendar year
quarter of 2004 (section 1895(b)(3)(B)(ii)(II) of the Act).
Furthermore, section 701(b)(4) of the MMA sets the home health
applicable percentage increase for the last 3 quarters of 2004 as the
home health market basket (3.3 percent) minus 0.8 percentage point
(section 1895(b)(3)(B)(ii)(III) of the Act). We implemented this
provision through Pub. 100-20, One Time Notification, Transmittal 59,
issued February 20, 2004. Section 701(b)(4) of the MMA also provides
that updates for CY 2005 and CY 2006 will equal the applicable home
health market basket percentage increase minus 0.8 percentage point.
Lastly, section 701(b)(3) of the MMA revises the statute to provide
that HH PPS rates for CY 2007 and any subsequent year will be updated
by that year's home health market basket percentage increase (section
1895(b)(3)(B)(ii)(IV) of the Act).
II. Provisions of the Proposed Regulations
(If you choose to comment on issues in this section, please include the
caption ``PROVISIONS OF THE PROPOSED REGULATIONS'' at the beginning of
your comments.)
A. National Standardized 60-Day Episode Rate
Medicare HH PPS has been effective since October 1, 2000. As set
forth in the final rule published July 3, 2000 in the Federal Register
(65 FR 41128), the unit of payment under Medicare HH PPS is a national
standardized 60-day episode rate. As set forth in 42 CFR 484.220, we
adjust the national standardized 60-day episode rate by a case mix
grouping and a wage index value based on the site of service for the
beneficiary. The proposed CY 2005 HH PPS rates use the same case-mix
methodology and application of the wage index adjustment to the labor
portion of the HH PPS rates as set forth in the July 3, 2000 final
rule. We multiply the national 60-day episode rate by the patient's
applicable case-mix weight. We divide the case-mix adjusted amount into
a labor and non-labor portion. We multiply the labor portion by the
applicable wage index based on the site of service of the beneficiary.
As required by section 1895(b)(3)(B) of the Act, we have updated
the HH PPS rates annually in a separate Federal Register document.
Section 484.225 sets forth the specific percentage update for fiscal
years 2001, 2002, and 2003. To reflect the new statutory provisions
enacted by section 701 of the MMA, in Sec. 484.225, we are proposing
to redesignate paragraph (d) as paragraph (g) and revising it to read
as follows:
(g) For 2007 and subsequent calendar years, the unadjusted national
rate is equal to the rate for the previous
[[Page 31250]]
calendar year increased by the applicable home health market basket
index amount.
We are proposing to add new paragraphs (d), (e), and (f) to read as
follows:
(d) For the last calendar quarter of 2003 and the first calendar
quarter of 2004, the unadjusted national prospective 60-day episode
payment rate is equal to the rate from the previous fiscal year (FY
2003) increased by the applicable home health market basket index
amount.
(e) For the last 3 calendar quarters of 2004, the unadjusted
national prospective 60-day episode payment rate is equal to the rate
from the previous fiscal year (FY 2003) increased by the applicable
home health market basket minus 0.8 percentage point.
(f) For each of calendar years 2005 and 2006, the unadjusted
national prospective 60-day episode payment rate is equal to the rate
from the previous calendar year, increased by the applicable home
health market basket minus 0.8 percentage point.
As described in section II.B.2 of this proposed rule, we are
proposing to rebase and revise the home health market basket. As
proposed, the labor related portion of the rebased and revised home
health market basket would be 76.775 percent, and the non-labor portion
would be 23.225 percent. We add the wage-adjusted portion to the non-
labor portion yielding the case-mix and wage-adjusted 60-day episode
rate subject to applicable adjustments.
For CY 2005, we are proposing to use again the design and case-mix
methodology described in section III.G of the HH PPS July 3, 2000 final
rule (65 FR 41192 through 41203). For CY 2005, we are proposing to base
the wage index adjustment to the labor portion of the PPS rates on the
most recent pre-floor and pre-reclassified hospital wage index as
discussed in section III.C of this proposed rule.
As discussed in the July 3, 2000 HH PPS final rule, for episodes
with four or fewer visits, Medicare pays the national per-visit amount
by discipline, referred to as a LUPA. We update the national per-visit
amounts by discipline annually by the applicable home health market
basket percentage. We adjust the national per-visit amount by the
appropriate wage index based on the site of service for the beneficiary
as set forth in Sec. 484.230. We propose to adjust the labor portion
of the updated national per-visit amounts by discipline used to
calculate the LUPA by the most recent pre-floor and pre-reclassified
hospital wage index, as discussed in section III.C of this proposed
rule.
Medicare pays the 60-day case-mix and wage-adjusted episode payment
on a split percentage payment approach. The split percentage payment
approach includes an initial percentage payment and a final percentage
payment as set forth in Sec. 484.205(b)(1) and (b)(2). We may base the
initial percentage payment on the submission of a request for
anticipated payment and the final percentage payment on the submission
of the claim for the episode, as discussed in Sec. 409.43. The claim
for the episode that the HHA submits for the final percentage payment
determines the total payment amount for the episode and whether we make
an applicable adjustment to the 60-day case-mix and wage-adjusted
episode payment. The end date of the 60-day episode as reported on the
claim determines the rate level at which Medicare will pay the claim
for the fiscal period.
We may also adjust the 60-day case-mix and wage-adjusted episode
payment based on the information submitted on the claim to reflect the
following:
A low utilization payment provided on a per-visit basis as
set forth in Sec. 484.205(c) and Sec. 484.230.
A partial episode payment adjustment as set forth in Sec.
484.205(d) and Sec. 484.235.
A significant change in condition adjustment as set forth
in Sec. 484.205(e) and Sec. 484.237.
An outlier payment as set forth in Sec. 484.205(f) and
Sec. 484.240.
This proposed rule would reflect the updated CY 2005 rates that
would be effective January 1, 2005.
B. Rebasing and Revising of the Home Health Market Basket
1. Background
For CY 2005, section 1895(b)(3)(B) of the Act, as amended by MMA,
requires the standard prospective payment amounts to be adjusted by a
factor equal to the applicable home health market basket increase minus
0.8 percentage point.
Effective for cost reporting periods beginning on or after July 1,
1980, we developed and adopted an HHA input price index (that is, the
home health ``market basket''). Although ``market basket'' technically
describes the mix of goods and services used to produce home health
care, this term is also commonly used to denote the input price index
derived from that market basket. Accordingly, the term ``home health
market basket'' used in this document refers to the HHA input price
index.
The percentage change in the home health market basket reflects the
average change in the price of goods and services purchased by HHAs in
providing an efficient level of home health care services. We first
used the home health market basket to adjust HHA cost limits by an
amount that reflected the average increase in the prices of the goods
and services used to furnish reasonable cost home health care. This
approach linked the increase in the cost limits to the efficient
utilization of resources. For a greater discussion on the home health
market basket, see the notice with comment period published in the
Federal Register on February 15, 1980 (45 FR 10450, 10451), notice with
comment period published in the Federal Register on February 14, 1995
(60 FR 8389, 8392), and notice with comment period published in Federal
Register on July 1, 1996 (61 FR 34344, 34347). Beginning with FY 2002,
we used the home health market basket to update payments under the home
health PPS.
The home health market basket is a fixed-weight Laspeyres-type
price index; its weights reflect the cost distribution for the base
year while current period price changes are measured. The home health
market basket is constructed in three steps. First, a base period is
selected and total base period expenditures are estimated for mutually
exclusive and exhaustive spending categories based upon type of
expenditure. Then the proportion of total costs that each spending
category represents is determined. These proportions are called cost or
expenditure weights.
The second step essential for developing an input price index is to
match each expenditure category to an appropriate price/wage variable,
called a price proxy. These proxy variables are drawn from publicly
available statistical series published on a consistent schedule,
preferably at least quarterly.
In the third and final step, the price level for each spending
category is multiplied by the expenditure weight for that category. The
sum of these products for all cost categories yields the composite
index level in the market basket in a given year. Repeating the third
step for other years will produce a time series of market basket index
levels. Dividing one index level by an earlier index level will produce
rates of growth in the input price index.
We described the market basket as a fixed-weight index because it
answers the question of how much more or less it would cost, at a later
time, to purchase the same mix of goods and services that was purchased
in the base
[[Page 31251]]
period. As such, it measures ``pure'' price changes only. The effects
on total expenditures resulting from changes in the quantity or mix of
goods and services purchased subsequent to the base period are, by
design, not considered.
2. Rebasing and Revising the Home Health Market Basket
We believe that it is desirable to rebase the home health market
basket periodically so the cost category weights reflect changes in the
mix of goods and services that HHAs purchase in furnishing home health
care. We based the cost category weights in the current home health
market basket on FY 1993 data. We are proposing to rebase and revise
the home health market basket to reflect FY 2000 Medicare cost report
data, the latest available, thorough data on the structure of HHA
costs.
The terms ``rebasing'' and ``revising,'' while often used
interchangeably, actually denote different activities. Rebasing is the
term used to define moving the base year for the structure of costs of
an input price index (that is, in this rule, we are proposing to move
the base year cost structure from FY 1993 to FY 2000). Revising is the
term used to define changing data sources, cost categories, and/or
price proxies used in the input price index.
For this proposed revising and rebasing, we modified several
categories in the market basket cost structure. The major revision to
the proposed revised and rebased market basket was the combining of the
Administrative and General and Other Expenses cost categories. The
proposed revised Administrative and General and Other Expenses cost
category was disaggregated further into five separate cost categories
(Telephone, Postage, Professional Fees, Other Products, and Other
Services). The Paper and Printing cost category, which was broken out
in the 1993-based market basket, is included in the proposed Other
Products cost category.
With the exception of the price proxies for the proposed modified
cost categories in the Administrative and General and Other cost
category, we propose no further changes to any of the price proxies.
For this proposed rebased and revised market basket, we reviewed
HHA expenditure data for the market basket cost categories. For each
freestanding HHA, we reviewed Medicare cost reports whose cost
reporting period began on or after October 1, 1999 and before October
1, 2000. We maintained our policy of using data from freestanding HHAs
because they reflect the actual cost structure faced by HHAs. Expense
data for a hospital-based HHA are affected by the allocation of
overhead costs over the entire institution (including but not limited
to hospital, hospital-based skilled nursing facility, hospital-based
HHA). Due to the method of allocation, total expenses will be correct,
but the individual components' expenses may be skewed. Therefore, if
data from hospital-based HHAs were included, the resultant cost
structure could be unrepresentative of the costs facing an average HHA.
Data on HHA expenditures for nine major expense categories (wages
and salaries, employee benefits, transportation, operation and
maintenance, administrative and general, insurance, fixed capital,
movable capital, and a residual ``all other'') were tabulated from the
FY 2000 Medicare HHA cost reports. Since prescription drugs and durable
medical equipment are not payable under the HH PPS, we excluded those
items from the home health market basket. Expenditures for contract
services were also tabulated from these FY 2000 Medicare HHA cost
reports. After totals for these major cost categories were edited to
remove reports where the data were deemed unreasonable (for example,
when total costs were not greater than zero), we then determined the
proportion of total costs that each category represents. The
proportions represent the major rebased home health market basket
weights.
We determined the weights for subcategories (Telephone, Postage,
Professional Fees, Other Products, and Other Services) within the
combined Administrative and General and Other Expenses using the latest
available (1997 benchmark) U.S. Department of Commerce, Bureau of
Economic Analysis (BEA) Input-Output Table, from which we extracted
data for HHAs. The BEA Input-Output table, which is updated at 5-year
intervals, was most recently described in the Survey of Current
Business article, ``Benchmark Input-Output Accounts of the U.S., 1997''
(December 2002). These data were aged from 1997 to 2000 using relevant
price changes.
This work resulted in the identification of 12 separate cost
categories, the same number found in the 1993-based home health market
basket. The differences between the major categories for the proposed
2000-based index and those used for the current 1993-based index are
summarized in Table 1. We have allocated the Contracted Services weight
to the Wages and Salaries, Employee Benefits, and Administrative and
General and Other Expenses cost categories in the proposed 2000-based
index as we did in the 1993-based index.
Table 1.--Comparison of 1993 and Proposed 2000-Based Home Health Market
Basket Major Cost Categories and Weights
------------------------------------------------------------------------
1993-Based home Proposed 2000-
Cost categories health market based home health
basket market basket
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Wages and Salaries, including 64.226 65.766
allocated contract services'
labor............................
Employee Benefits, including 13.442 11.009
allocated contract services'
labor............................
All Other Expenses including 22.332 23.225
allocated contract services'
labor............................
--------------------
Total......................... 100.000 100.000
------------------------------------------------------------------------
The complete proposed 2000-based cost categories and weights are
listed in Table 2.
[[Page 31252]]
Table 2.--Cost Categories, Weights, and Price Proxies in Proposed 2000-Based Home Health Market Basket
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Cost categories Weight Price proxy
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Compensation, including allocated contract 76.775
services' labor.
Wages and Salaries, including allocated 65.766 Proposed Home Health Occupational Wage Index.
contract services' labor.
Employee Benefits, including allocated 11.009 Proposed Home Health Occupational Benefits
contract services' labor. Index.
Operations & Maintenance......................... 0.825 CPI Fuel & Other Utilities.
Administrative & General & Other Expenses 16.633
including allocated contract services' labor*.
Telephone.................................... 0.850 CPI Telephone Services.
Postage...................................... 0.563 CPI Postage.
Professional Fees*........................... 1.405 ECI for Compensation for Professional and
Technical Workers.
Other Products*.............................. 6.419 CPI All Items Less Food and Energy.
Other Services*.............................. 7.396 ECI for Compensation for Service Workers.
Transportation................................... 2.744 CPI Private Transportation.
Capital-Related.................................. 3.023
Insurance.................................... 0.275 CPI Household Insurance.
Fixed Capital................................ 1.777 CPI Owner's Equivalent Rent.
Movable Capital.............................. 0.971 PPI Machinery & Equipment.
Total.................................... 100.000 **
----------------------------------------------------------------------------------------------------------------
* New break-out in cost structure when compared with the 1993-Based home health market basket.
** Figures may not sum to total due to rounding.
Note: Price Proxy explanations are described below.
After we computed the 2000 cost category weights for the proposed
rebased home health market basket, we selected the most appropriate
wage and price indexes to proxy the rate of change for each expenditure
category. These price proxies are based on Bureau of Labor Statistics
(BLS) data and are grouped into one of the following BLS categories:
Employment Cost Indexes--Employment Cost Indexes (ECIs)
measure the rate of change in employee wage rates and employer costs
for employee benefits per hour worked. These indexes are fixed-weight
indexes and strictly measure the change in wage rates and employee
benefits per hour. They are not affected by shifts in skill mix. ECIs
are superior to average hourly earnings as price proxies for input
price indexes for two reasons: (a) They measure pure price change; and
(b) they are available by occupational groups, not just by industry.
Consumer Price Indexes--Consumer Price Indexes (CPIs)
measure change in the prices of final goods and services bought by the
typical consumer. Consumer price indexes are used when the expenditure
is more similar to that of a purchase at the retail level rather than
at the wholesale level, or if no appropriate Producer Price Indexes
(PPIs) were available.
Producer Price Indexes--PPIs are used to measure price
changes for goods sold in other than retail markets. For example, a PPI
for movable equipment is used rather than a CPI for equipment. PPIs in
some cases are preferable price proxies for goods that HHAs purchase at
wholesale levels. These fixed-weight indexes are a measure of price
change at the producer or at the intermediate stage of production.
As part of the revising and rebasing of the home health market
basket, we are proposing to rebase the home health blended wage and
salary index and the home health blended benefits index. We would use
these blended indexes as price proxies for the wages and salary and the
employee benefits portions of the proposed 2000-based home health
market basket, as we did in the 1993-based home health market basket.
The price proxies for these two cost categories are the same as those
used in the 1993-based home health market basket with occupational
weights reflecting the FY 2000 occupational mix in HHAs. These proxies
are a combination of internal (health-industry specific) and external
(economy-wide) proxies. The supply and demand relationships for certain
professional-technical occupations, such as registered nurses, may be
more appropriately reflected in the blended indicators of compensation
changes for professional and technical employees.
3. Price Proxies Used To Measure Cost Category Growth
a. Wages and Salaries, including an allocation for contract
services' labor: For measuring price growth in the 2000-based home
health market basket, as we did in the 1993-based index, five price
proxies would be applied to the four occupational subcategories within
the wages and salaries component, and would be weighted to reflect the
HHA occupational mix. This approach was used because there is not a
wage proxy for home health care workers that reflects only wage changes
and not both wage and skill mix changes. The Professional and Technical
occupational subcategory is represented by a 50-50 blend of hospital
industry and economy-wide price proxies. Therefore, there are five
price proxies used for the four occupational subcategories. The
percentage change in the blended wages and salaries price is applied to
the wages and salaries component of the home health market basket,
which is described in Table 3.
[[Page 31253]]
Table 3.--Proposed Home Health Occupational Wages and Salaries Index
[Wages and salaries component of the proposed 2000-based home health
market basket]
------------------------------------------------------------------------
Cost category Weight Price proxy
------------------------------------------------------------------------
Skilled Nursing & Therapists & 53.816 50 percent
Other Professional/Technical, ECI for Wages &
including an allocation for Salaries in Private
contract services' labor. Industry for
Professional,
Specialty &
Technical Workers.
50 percent
ECI for Wages &
Salaries for
Civilian Hospital
Workers.
Managerial/Supervisory, including 7.431 ECI for Wages &
an allocation for contract Salaries in Private
services' labor. Industry for
Executive,
Administrative &
Managerial Workers.
Clerical, including an allocation 6.822 ECI for Wages &
for contract services' labor. Salaries in Private
Industry for
Administrative
Support, Including
Clerical Workers.
Service, including an allocation 31.931 ECI for Wages &
for contract services' labor. Salaries in Private
Industry Service
Occupations.
----------------
Total......................... 100.000
------------------------------------------------------------------------
We experimented with using a different blend of ECIs for wages and
salaries. In addition to using 50 percent professional and technical
workers and 50 percent hospital workers for the professional/technical
workers category, we also tried using--
100 percent of the professional and technical ECI;
50 percent professional/technical and 50 percent health
services workers; and
100 percent health services workers.
There was very little difference between the three wage and salary
blends and the proposed price proxy. The average difference from 1998
to 2002 between the price proxy chosen and the experimental blends was
at most 0.2 percentage point in any given year. We did not propose a
change from our current blended measure because we believe it reflects
the competition between HHAs and hospitals for registered nurses, while
still capturing the overall wage trends for professional and technical
workers.
b. Employee Benefits, including an allocation for contract
services' labor: For measuring employee benefits price growth in the
2000-based home health market basket, price proxies are applied to the
four occupational subcategories within the employee benefits component,
weighted to reflect the home health occupational mix. The professional
and technical occupational subcategory is represented by a blend of
hospital industry and economy-wide price proxies. Therefore, there are
five price proxies for four occupational subcategories. The percentage
change in the blended price of home health employee benefits is applied
to this component, which is described in Table 4.
Table 4.--Proposed Home Health Occupational Benefits Index
[Employee benefits component of the proposed 2000-based home health
market basket]
------------------------------------------------------------------------
Cost category Weight Price proxy
------------------------------------------------------------------------
Skilled Nursing & Therapists & 53.492 50 percent
Other Professional/Technical, ECI for Benefits in
including an allocation for Private Industry
contract services' labor. for Professional,
Specialty &
Technical Workers.
50 percent
ECI for Benefits
for Civilian
Hospital Workers.
Managerial/Supervisory, including 7.232 ECI for Benefits in
an allocation for contract Private Industry
services' labor. for Executive,
Administrative &
Managerial Workers.
Clerical, including an allocation 6.914 ECI for Benefits in
for contract services' labor. Private Industry
for Administrative
Support, Including
Clerical Workers.
Service, including an allocation 32.362 ECI for Benefits in
for contract services' labor. Private Industry
Service
Occupations.
----------------
Total......................... 100.000
------------------------------------------------------------------------
As we did for wages and salaries, we analyzed three different
alternatives to use as a proxy for professional/technical benefits. The
result of this analysis was similar to that found for wages and
salaries. Therefore, we are proposing to continue to use the same 50-50
split for benefits for professional and technical workers (50 percent
hospital workers and 50 percent professional and technical workers) as
we did in the 1993-based market basket.
c. Operations and Maintenance: The percentage change in the price
of Fuel and Other Utilities as measured by the Consumer Price Index is
applied to this component. The same proxy was used for the 1993-based
market basket.
d. Telephone: The percentage change in the price of Telephone
Service as measured by the Consumer Price Index is applied to this
component. The same proxy was used for the 1993-based market basket.
e. Postage: The percentage change in the price of Postage as
measured by the Consumer Price Index is applied to this component. The
same proxy was used for the 1993-based market basket.
f. Professional Fees: The percentage change in the price of
Professional Fees as measured by the ECI for Compensation for
Professional and Technical Workers is applied to this component. This
category was not broken out separately in the 1993-based home health
market basket.
g. Other Products: The percentage change in the price for all items
less food and energy as measured by the Consumer Price Index is applied
to this component. This category was not broken out separately in the
1993-based home health market basket. It includes paper and printing
that was a separate cost category in the 1993-based home health market
basket.
h. Other Services: The percentage change in the Employment Cost
Index for Compensation for Service Workers is applied to this
component. This category was not broken out separately
[[Page 31254]]
in the 1993-based home health market basket.
i. Transportation: The percentage change in the price of
Transportation as measured by the Consumer Price Index is applied to
this component. The same proxy was used for the 1993-based market
basket.
j. Insurance: The percentage change in the price of Household
Insurance as measured by the Consumer Price Index is applied to this
component. The same proxy was used for the 1993-based market basket.
k. Fixed Capital: The percentage change in the price of Owner's
Equivalent Rent as measured by the Consumer Price Index is applied to
this component. The same proxy was used for the 1993-based market
basket.
l. Movable Capital: The percentage change in the price of Machinery
and Equipment as measured by the Producer Price Index is applied to
this component. The same proxy was used for the 1993-based market
basket.
As we did in the 1993-based home health market basket, we allocated
the Contract Services' share of home health agency expenditures among
Wages and Salaries, Employee Benefits, Administrative and General and
Other Expenses. This method reflects the distribution of expenditures
for contract services as indicated in the Medicare Cost Report.
Table 5 summarizes the proposed 2000-based proxies and compares
them to the 1993-based proxies.
Table 5.--Comparison of Price Proxies Used in the 1993-Based and the Proposed 2000-Based Home Health Market
Baskets
----------------------------------------------------------------------------------------------------------------
Cost category 1993-based price proxy 2000-based proposed price proxy
----------------------------------------------------------------------------------------------------------------
Compensation, including allocated contract ................................
services' labor:
Wages and Salaries, including Home Health Agency Occupational Same.
allocated contract services' labor. Wage Index.
Employee Benefits, including allocated Home Health Agency Occupational Same.
contract services' labor. Benefits Index.
Operations and Maintenance................. CPI-Fuel and Other Utilities..... Same.
Adminstrative & General & Other Expenses, ................................
including allocated contract services'
labor:
Telephone.............................. CPI-U Telephone.................. Same.
Postage................................ CPI-U Postage.................... Same.
Professional Fees...................... N/A.............................. ECI for Compensation for
Professional and Technical
Workers.
Other Products......................... N/A.............................. CPI-U for All Items Less Food
and Energy.
Other Services......................... DN/A............................. ECI for Compensation for Service
Workers.
Other Administrative and General....... CPI Services..................... N/A.
Paper & Printing....................... CPI for Household Paper Products N/A.
& Stationary Supplies.
Transportation............................. CPI Transportation............... Same.
Capital-Related: ................................
Insurance.............................. CPI Household Insurance.......... Same.
Fixed Capital.......................... CPI Owner's Equivalent Rent...... Same.
Movable Capital........................ PPI Machinery and Equipment...... Same.
Other Expenses, including allocated CPI All Items Less Food and N/A.
contract services' labor. Energy.
Contract Services.......................... Contained within Wages & Contained within Wages &
Salaries, Employee Benefits, Salaries, Employee Benefits,
Administrative & General, Other Administrative & General &
Expenses; see those price Other Expenses; see those price
proxies. proxies.
----------------------------------------------------------------------------------------------------------------
4. Rebasing Results
A comparison of the yearly changes from FY 1999 to FY 2002 for the
1993-based home health market basket and the proposed 2000-based home
health market basket is shown in Table 6. The average annual increase
in the two market baskets is similar, and in no year is the difference
as much as 0.1 percentage point.
Table 6.--Comparison of the 1993-Based Home Health Market Basket and the Proposed 2000-Based Home Health Market
Basket, Percent Change, 1999-2002
----------------------------------------------------------------------------------------------------------------
Proposed home Difference
Home health health market (proposed 2000-
Fiscal years beginning October 1 market basket, basket, 2000- based less 1993-
1993-based based based)
----------------------------------------------------------------------------------------------------------------
Historical: October 1998, FY 1999...................... 2.8 2.8 0.0
October 1999, FY 2000.................................. 3.6 3.5 -0.1
Ocobter 2000, FY 2001.................................. 4.2 4.1 -0.1
October 2001, FY 2002.................................. 3.6 3.6 0.0
Average Change: 1999-2002.............................. 3.6 3.5 -0.1
----------------------------------------------------------------------------------------------------------------
[[Page 31255]]
Section 1895(b)(3)(B) of the Act, as amended by MMA, requires the
standard prospective payment amounts to be paid on a calendar year
basis for 2004 and any subsequent year. Previous market basket updates
were calculated on a fiscal year basis. Table 7 shows that the
forecasted rate of growth for CY 2005, beginning January 1, 2005, for
the proposed rebased and revised home health market basket is 3.3
percent, while the forecasted rate of growth for the current 1993-based
home health market basket is also 3.3 percent. As previously mentioned,
we rebase the home health market basket periodically so the cost
category weights continue to reflect changes in the mix of goods and
services that HHAs purchase in furnishing home health care.
Table 7.--Forecasted Annual Percent Change in the Current and Proposed Revised and Rebased Home Health Market
----------------------------------------------------------------------------------------------------------------
Proposed home Difference
Home health health market (proposed 2000-
Calendar year beginning January 1 market basket, basket, 2000- based less 1993-
1993-based based based)
----------------------------------------------------------------------------------------------------------------
January 2005, CY 2005.................................. 3.3 3.3 0.0
----------------------------------------------------------------------------------------------------------------
Table 8 shows the percent changes for CY 2005 for each cost
category in the home health market basket.
Table 8.--CY 2005 Forecasted Annual Percent Change for All Cost Categories in the Proposed 2000-Based Home
Health Market Basket
----------------------------------------------------------------------------------------------------------------
Forecasted
annual percent
Cost categories Weight Price proxy change for CY
2005
----------------------------------------------------------------------------------------------------------------
Total......................................... 100.000 ................................ 3.3
Compensation.................................. 76.775 ................................ 3.6
Wages and Salaries........................ 65.766 Proposed Home Health 3.5
Occupational Wage Index.
Employee Benefits......................... 11.009 Proposed Home Health 4.3
Occupational Benefits Index.
Operations & Maintenance...................... 0.825 CPI Fuel & Other Utilities...... 0.0
Adminsitrative & General & Other Expenses..... 16.633 ................................ 2.5
Telephone................................. 0.850 CPI Telephone Services.......... 0.8
Postage................................... 0.563 CPI Postage..................... 3.7
Professional Fees*........................ 1.405 ECI for Compensation for 3.7
Professional and Technical
Workers.
Other Products*........................... 6.419 CPI All Items Less Food and 1.3
Energy.
Other Services*........................... 7.396 ECI for Compensation for Service 3.6
Workers.
Transportation................................ 2.744 CPI Private Transportation...... 2.2
Capital-Related............................... 3.023 ................................ 1.8
Insurance................................. 0.275 CPI Household Insurance......... 3.2
Fixed Capital............................. 1.777 CPI Owner's Equivalent Rent..... 2.4
Movable Capital........................... 0.971 PPI Machinery & Equipment....... 0.3
----------------------------------------------------------------------------------------------------------------
* New break-out in cost structure when compared with the 1993-based home health market basket.
5. Labor-Related Share
In the 1993-based home health market basket the labor-related share
was 77.668 percent while the remaining nonlabor-related share was
22.332 percent. In the proposed revised and rebased home health market
basket, the labor-related share would be 76.775 percent. The labor-
related share includes wages and salaries and employee benefits. The
proposed nonlabor-related share would be 23.225 percent. The lower
share of labor-related costs in 2000 may reflect in part the changing
cost structure associated with the implementation of the prospective
payment system for HHAs.
Table 9 details the components of the labor-related share for the
1993-based and proposed 2000-based home health market baskets.
Table 9.--Labor-Related Share of Current and Proposed Home Health Market
Baskets
------------------------------------------------------------------------
1993-based Proposed 2000-
Cost category market basket based market
weight basket weight
------------------------------------------------------------------------
Wages and Salaries.................. 64.226 65.766
Employee Benefits................... 13.442 11.009
Total Labor Related................. 77.668 76.775
[[Page 31256]]
Total Non-Labor Related............. 22.332 23.225
------------------------------------------------------------------------
C. Proposed CY 2005 Update to the Home Health Market Basket Index
Section 1895(b)(3)(B) of the Act, as amended by section 701 of the
MMA, requires for CY 2005 that the standard prospective payment amounts
be increased by a factor equal to the applicable home health market
basket increase minus 0.8 percentage point. As previously noted, we are
proposing to amend the regulations in Sec. 484.225 to reflect this
requirement.
Proposed CY 2005 Adjustments
In calculating the annual update for the CY 2005 60-day episode
rates, we are proposing to first look at the CY 2004 rates as a
starting point. The CY 2004 national 60-day episode rate, as modified
by section 701 of the MMA and implemented through Pub. 100-20 One Time
Notification, Transmittal 59 issued February 20, 2004 is $2,213.37.
In order to calculate the CY 2005 national 60-day episode rate, we
are proposing to multiply the CY 2004 national 60-day episode rate
($2,213.37) by the applicable home health market basket update of 3.3
percent for CY 2005 minus 0.8 percentage point.
We would increase the CY 2004 60-day episode payment rate by the
proposed home health market basket increase (3.3 percent) minus 0.8
percentage point ($2,213.37 x 2.5 percent) to yield the proposed
updated CY 2005 national 60-day episode rate ($2,268.70) (see Table 10
below).
Table 10.--Proposed National 60-Day Episode Amounts Updated by the Applicable Home Health Market Basket CY 2005,
Minus 0.8 Percentage Point, Before Case-Mix Adjustment, Wage Index Adjustment Based on the Site of Service for
the Beneficiary or Applicable Payment Adjustment
----------------------------------------------------------------------------------------------------------------
Multiply by the
applicable home health Proposed CY 2005 updated
Total prospective payment amount per 60-day episode for CY market basket increase national 60-day episode
2004 (as of 04/04/04) (3.3 percent) minus 0.8 rate
percentage point
----------------------------------------------------------------------------------------------------------------
$2,213.37................................................... x 1.025 $2,268.70
----------------------------------------------------------------------------------------------------------------
National Per-visit Amounts Used to Pay LUPAs and Compute
Imputed Costs Used in Outlier Calculations
As discussed previously in this proposed rule, the policies
governing the LUPAs and outlier calculations set forth in the July 3,
2000 HH PPS final rule will continue during CY 2005. In calculating the
annual update for the CY 2005 national per-visit amounts we use to pay
LUPAs and to compute the imputed costs in outlier calculations, we are
proposing to look again at the CY 2004 rates as a starting point. We
then are proposing to multiply those amounts by the proposed home
health market basket increase minus 0.8 percentage point for CY 2005 to
yield the updated per-visit amounts for each home health discipline for
CY 2005. (See Table 11 below.)
Table 11.--Proposed National Per-Visit Amounts for LUPAs and Outlier Calculations Updated by the Applicable Home
Health Market Basket Increase for CY 2005, Minus 0.8 Percentage Point, Before Wage Index Adjustment Based on the
Site of Service for the Beneficiary
----------------------------------------------------------------------------------------------------------------
Multiply by the
Final per-visit amounts applicable home health Proposed per-visit
Home health discipline type per 60-day episode for market basket (3.3 payment amount per
CY 2004 for LUPAs (as percent) minus 0.8 discipline for CY 2005
of 04/01/04) percentage point for LUPAs
----------------------------------------------------------------------------------------------------------------
Home Health Aide..................... $43.75 x 1.025 $44.84
Medical Social Services.............. 154.89 x 1.025 158.76
Occupational Therapy................. 106.36 x 1.025 109.02
Physical Therapy..................... 105.65 x 1.025 108.29
Skilled Nursing...................... 96.63 x 1.025 99.05
Speech-Language Pathology............ 114.80 x 1.025 117.67
----------------------------------------------------------------------------------------------------------------
D. Proposed Update to the Outlier Fixed Dollar Loss Ratio
Outlier payments are payments made in addition to regular 60-day
case-mix and wage-adjusted episode payments for episodes that incur
unusually large costs due to patient home health care needs. Outlier
payments are made for episodes whose estimated cost exceeds a threshold
amount. The episode's estimated cost is the sum of the national wage-
adjusted per-visit payment amounts for all visits delivered during the
episode. The outlier threshold for each case-mix group, PEP adjustment,
or total SCIC adjustment is defined as the 60-day episode payment
amount, PEP adjustment, or total SCIC adjustment for that group plus a
fixed dollar loss amount. Both components of the outlier threshold are
wage-adjusted.
The wage-adjusted fixed dollar loss amount (FDL) represents the
amount of loss that an agency must bear before an episode becomes
eligible for outlier payments. The FDL is computed by
[[Page 31257]]
multiplying the wage-adjusted 60-day episode payment amount by the
fixed dollar loss ratio, which is a proportion expressed in terms of
the national standardized episode payment amount. The outlier payment
is defined to be a proportion of the wage-adjusted estimated costs
beyond the wage-adjusted threshold. The proportion of additional costs
paid as outlier payments is referred to as the loss-sharing ratio.
Section 1895(b)(5) of the Act requires that estimated total outlier
payments are no more than 5 percent of total estimated HH PPS payments.
In response to the concerns about potential financial losses that might
result from unusually expensive cases expressed in comments to the
October 28, 1999 proposed rule (64 FR 58133), the July 2000 final rule
set the target for estimated outlier payments at the 5 percent level.
The fixed dollar loss ratio and the loss-sharing ratio were then
selected so that estimated total outlier payments would meet the 5
percent target.
For a given level of outlier payments, there is a trade-off between
the values selected for the fixed dollar loss ratio and the loss-
sharing ratio. A high fixed dollar loss ratio reduces the number of
episodes that can receive outlier payments, but makes it possible to
select a higher loss-sharing ratio and, therefore, increase outlier
payments for outlier episodes. Alternatively, a lower fixed dollar loss
ratio means that more episodes can qualify for outlier payments, but
outlier payments per episode must be lower. As a result of public
comments on the October 28, 1999 proposed rule, in our July 2000 final
rule, we made the decision to attempt to cover a relatively high
proportion of the costs of outlier cases for the most expensive
episodes that would qualify for outlier payments within the 5 percent
constraint.
We chose a value of 0.80 for the loss-sharing ratio, which is
relatively high, but which preserves incentives for agencies to attempt
to provide care efficiently for outlier cases. It is also consistent
with the loss-sharing ratios used in other Medicare PPS outlier
policies. Having made this decision, we estimated the value of the
fixed dollar loss ratio that would yield estimated total outlier
payments that were 5 percent of total home health PPS payments. The
resulting value for the fixed dollar loss ratio was 1.13.
Analysis of 100 percent of CY 2001 home health claims data reflects
that outlier episodes represent approximately 3 percent of total
episodes and 3 percent of total HH PPS payments. Preliminary analysis
of CY 2002 home health claims data indicates no change in that
parameter. Therefore, it is appropriate to update the outlier policy
based on more recent data than were available when the July 2000 final
rule for HH PPS was developed. We are proposing to make no change in
the 5 percent target for outlier expenditures as a percent of total HH
PPS payments. In addition, we are not proposing to change the loss-
sharing ratio of 0.80. Further, section 1895(b)(3)(C) of the Act
requires that the episode payment amounts be adjusted to effectively
pay for outlier payments within the same level of estimated total
spending. We are not proposing to change the adjustment to the episode
payment amounts for outlier payments. Therefore, the proposed update
would only change the fixed dollar loss ratio, and in turn, the fixed
dollar loss amount.
We performed data analysis on CY 2001 HH PPS analytic data to
update the fixed dollar loss ratio to enable the total estimated
outlier payments to be 5 percent of total HH PPS payments. The results
of this analysis indicate that a fixed dollar loss ratio of 0.72 is
consistent with the existing loss-sharing ratio of 0.80 and a target
percentage of estimated outlier payments of 5 percent. Consequently, we
are proposing to update the fixed dollar loss ratio from the current
ratio of 1.13 to the fixed dollar loss ratio of 0.72. Reducing the
fixed dollar loss ratio from 1.13 to 0.72 would allow approximately 6.5
percent of episodes to qualify for outlier payments. The estimated 6.5
percent outlier episodes is greater than the 3.0 percent of episodes
that currently qualify for outlier payments, and is about the same as
the 6.8 percent for outlier episodes that we estimated in our July 2000
final rule.
Expressed in terms of a fixed dollar loss amount, the proposed
fixed dollar loss ratio of 0.72 implies that providers would absorb
approximately $1,633 of their costs (before wage adjustment), in
addition to their loss-sharing portion of the estimated cost in excess
of the outlier threshold. This fixed dollar loss amount of
approximately $1,633 is computed by multiplying the proposed standard
60-day episode payment amount ($2,268.70) by the proposed fixed dollar
loss ratio (0.72). Using the current fixed dollar loss ratio (1.13),
the fixed dollar loss amount would be approximately $2,564 ($2,268.70 *
1.13). We believe that our proposed fixed dollar loss ratio of 0.72
preserves a reasonable degree of cost sharing, while allowing a greater
number of episodes to qualify for outlier payments. In the final rule,
following publication of this proposed rule, we plan to update our
estimate of the fixed dollar loss ratio using the most current,
complete year of HH PPS data available.
The following analytical tables 12(a) through 12(f), derived from
analysis of CY 2001 home health claims data, characterize outlier
episodes, and depict the differences between outlier and non-outlier
episodes with regards to home health resource groups (HHRGs) and visit
disciplines. Tables 12(a) through 12(f) illustrate various
characteristics of outlier episodes. Outlier episodes are more likely
to be of a higher clinical severity than are non-outlier episodes.
Functional status levels are, however, very similar across all types of
episodes. Our analysis further shows that outlier episodes are less
likely to be high in therapy use than non-outlier episodes. In
addition, the top high volume HHRGs seen in outlier episodes are also
seen as high volume HHRGs in non-outlier episodes. Finally, our
analysis also shows that skilled nursing visits are highly prevalent in
outlier episodes. This analysis excludes LUPAs, as those episodes
inherently do not involve the use of HHRGs and hence are not paid based
on HHRGs. In the final rule, we will confirm all data analysis based on
100 percent home health claims for CY 2002 and available preliminary CY
2003 home health claims data.
Table 12-a.--Severity Level Comparison of HHRG's Clinical Domain in
Outlier & Non-Outlier Episodes
------------------------------------------------------------------------
Clinical domain Percentage of outlier Percentage of non-
severity level episodes outlier episodes
------------------------------------------------------------------------
C1 9 20
C2 19 33
C3[hairsp]* 52 36
C4[hairsp]* 20 11
------------------------------------------------------------------------
* Outlier episodes are more likely to be of a higher clinical severity
level than are non-outlier episodes.
Table 12-b.--Severity Level Comparison of HHRG's Functional Domain in
Outlier and Non-Outlier Episodes
------------------------------------------------------------------------
Functional domain Percentage of outlier Percentage of non-
severity level episodes outlier episodes
------------------------------------------------------------------------
F0 6 7
F1 22 25
F2 47 43
F3 13 13
F4 12 12
------------------------------------------------------------------------
Note: Functional status levels are similar for both outlier and
non-outlier episodes.
[[Page 31258]]
Table 12-c.--High-Therapy Episode Comparison in Outlier and Non-Outlier
Episodes
------------------------------------------------------------------------
Percentage
Percentage of non-
Type of episode of outlier outlier
episodes episodes
------------------------------------------------------------------------
Episodes with 10 or more therapy visits......... 11* 24
All Other Episodes.............................. 89 76
------------------------------------------------------------------------
* Outlier episodes are less likely to be episodes with high therapy use
(at least 10 therapy visits) than are non-outlier episodes.
Table 12-d.--Top 10 HHRG Comparison in Outlier and Non-Outlier Episodes
----------------------------------------------------------------------------------------------------------------
Percentage of Percentage of
HHRG (weight) Outlier rank outlier Non-outlier non-outlier
episodes rank episodes
----------------------------------------------------------------------------------------------------------------
C2F2S0.......................................... 1 20.3 2 10.7
C2F1S0.......................................... 2 12.4 6 5.1
C1F2S0.......................................... 3 6.1 1 11.3
C3F2S0.......................................... 4 5.8 13 2.4
C1F1S0.......................................... 5 5.3 3 6.4
C3F4S0.......................................... 6 5.0 8 3.9
C2F3S0.......................................... 7 4.8 11 3.2
C2F4S0.......................................... 8 3.8 10 3.5
C3F0S0.......................................... 9 3.6 23 1.3
C3F3S0.......................................... 10 3.3 20 1.4
C0F2S0.......................................... 11 3.1 4 6.0
C0F1S0.......................................... 12 2.6 5 5.7
C2F2S1.......................................... 15 1.7 7 4.1
C1F2S2.......................................... 18 1.0 9 3.7
Top 10 HHRGs, Outlier Episodes.................. .............. 70.4 .............. ..............
Top 10 HHRGs, Non-Outlier Episodes.............. .............. .............. .............. 60.4
----------------------------------------------------------------------------------------------------------------
Note: Except for two HHRGs (C3F0S0 & C3F3S0), the top 10 HHRGs that occur in outlier episodes are also within
the top 13 HHRGs in non-outlier episodes.
Table 12-e.--Percentages of Visit Types in Outlier and Non-Outlier
Episodes
------------------------------------------------------------------------
Outlier Non-outlier
Home health visits episodes episodes
------------------------------------------------------------------------
Average Total Visits.................... 84.5 19.7
Percentage of Total Visits:
Skilled Nursing Visits \1\.......... 75.3 45.1
Home Health Aide Visits............. 18.6 26.3
Physical Therapy Visits \2\......... 3.8 22.8
Occupational Therapy Visits \2\..... 1.4 4.0
Speech Therapy Visits \2\........... 0.5 0.8
Medical Social Visits............... 0.4 1.0
------------------------------------------------------------------------
\1\ Skilled nursing visits make up a significantly greater percentage of
total visits in outlier episodes than in non-outlier episodes.
\2\ Therapy visits are a substantially smaller percentage of total
visits in outlier episodes than in non-outlier episodes.
Table 12-f.--Probability of at Least 1 Occurrence of a Particular Type
of Visit in an Episode for Outlier and Non-Outlier Episodes
------------------------------------------------------------------------
Outlier Non-outlier
Home health visits episodes episodes
(percent) (percent)
------------------------------------------------------------------------
Probability of at least 1 service
occurring:
Skilled Nursing Visits \1\.......... 99.8 89.3
Home Health Aide Visits \2\......... 44.6 35.6
Physical Therapy (PT) Visits \3\.... 27.9 48.6
Occupational Therapy (OT) Visits.... 11.6 14.4
Speech Therapy Visits............... 3.4 2.7
Medical Social Visits............... 16.4 12.5
[[Page 31259]]
Any Therapy (PT, OT, Speech)........ 29.4 50.4
------------------------------------------------------------------------
\1\ Skilled nursing visits are almost always present in outlier
episodes.
\2\ Home health aide visits occur in slightly less than 50 percent of
outlier episodes.
\3\ Physical Therapy is less likely to occur in an outlier episode than
in a non-outlier episode.
E. Rural Add-On as Required by the MMA
As discussed in section I.D. of this preamble, section 421 of the
MMA requires, for home health services furnished in a rural area with
respect to episodes and visits ending on or after April 1, 2004 and
before April 1, 2005, that we increase by 5 percent the payment amount
that otherwise would be made for these services. The statute waives
budget neutrality related to this provision. By statute, the 5 percent
rural add-on applies to home health services furnished in a rural area
(as defined in section 1886(d)(2)(D) of the Act) for episodes and
visits ending on or after April 1, 2004 and before April 1, 2005.
Therefore, the 5 percent rural add-on ends after the first quarter of
CY 2005 for episodes and visits ending before April 1, 2005. After the
rural add-on is determined, the applicable case-mix and wage index
adjustment is then subsequently applied for the provision of home
health services where the site of service is the non-Metropolitan
Statistical Area (MSA) of the beneficiary. Similarly, the applicable
wage index adjustment is subsequently applied to the LUPA per visit
amounts adjusted for the provision of home health services where the
site of service for the beneficiary is a non-MSA area. We implemented
this provision for CY 2004 on April 1, 2004 through Pub. 100-20 One
Time Notification, Transmittal 59 issued February 20, 2004. The CY 2005
5 percent rural add-on is noted in tables below.
Table 13.--Proposed CY 2005 Rural Add-On to 60-Day Episode Payment Amounts Ending On or After April 1, 2004 and
Before April 1, 2005 for Beneficiaries Who Reside in a Non-MSA Area Before Case-Mix Adjustment, Wage Index
Adjustment Based on the Site of Service for the Beneficiary or Applicable Payment Adjustment
----------------------------------------------------------------------------------------------------------------
Proposed CY 2005 final
payment amount per 60-
day episode ending
Proposed total prospective payment amount per 60-day episode 5 percent rural add-on before April 1, 2005 for
for CY 2005 a beneficiary who
resides in a non-MSA
area
----------------------------------------------------------------------------------------------------------------
$2,268.70................................................... x 1.05 $2,382.14
----------------------------------------------------------------------------------------------------------------
Table 14.--Proposed CY 2005 Add-On to LUPA Per-Visit Amounts for Visits Ending On or After April 1, 2004 and
Before April 1, 2005, Before Wage Index Adjustment Based on the Site of Service of the Beneficiary Who Resides
in a Non-MSA Area or Payment Applicable Adjustment
----------------------------------------------------------------------------------------------------------------
Proposed CY 2005 per-
visit payment amounts
Proposed per-visit per 60-day episode
Home health discipline type payment amounts per 60- 5 percent rural add-on ending before April 1,
day episode for CY 2005 2005 for LUPAs for a
for LUPAs beneficiary who resides
in a non-MSA area
----------------------------------------------------------------------------------------------------------------
Home Health Aide..................... $44.84 x 1.05 $47.08
Medical Social Services.............. 158.76 x 1.05 166.70
Occupational Therapy................. 109.02 x 1.05 114.47
Physical Therapy..................... 108.29 x 1.05 113.70
Skilled Nursing...................... 99.05 x 1.05 104.00
Speech-Language Pathology............ 117.67 x 1.05 123.55
----------------------------------------------------------------------------------------------------------------
F. Hospital Wage Index
Sections 1895(b)(4)(A)(ii) and (b)(4)(C) of the Act require the
Secretary to establish area wage adjustment factors that reflect the
relative level of wages and wage-related costs applicable to the
furnishing of home health services and to provide appropriate
adjustments to the episode payment amounts under HH PPS to account for
area wage differences. We apply the appropriate wage index value to the
labor portion of the HH PPS rates based on the geographic area in which
the beneficiary received home health services. We determine each HHA's
labor market area based on definitions of Metropolitan Statistical
Areas (MSAs) issued by the Office of Management and Budget (OMB). We
recognize that on June 6, 2003, the Office of Management and Budget
(OMB) issued OMB Bulletin No. 03-04, announcing revised definitions of
Metropolitan Statistical Areas, and new definitions of Micropolitan
Statistical Areas, and Combined Statistical Areas. A copy of the
Bulletin
[[Page 31260]]
may be obtained at the following Internet address: http://www.whitehouse.gov/omb/bulletins/b03-04.html.
These new definitions
will not be applied to the CY 2005 wage index used in this proposed
update to the HH payment rates.
On May 18, 2004, we published a proposed rule entitled ``Medicare
Program; Changes to the Hospital Inpatient Prospective Payment Systems
and FY 2005 Rates'' (69 FR 28195), which discusses some of the issues
associated with using these new definitions and proposes to use these
new definitions for the Inpatient Hospital PPS for FY 2005. We believe
it is appropriate to wait until the public comments on that proposed
rule have been submitted and analyzed before we consider proposing any
new labor market definitions in the home health context.
As discussed previously and set forth in the July 3, 2000 final
rule, the statute provides that the wage adjustment factors may be the
factors used by the Secretary for purposes of section 1886(d)(3)(E) of
the Act for hospital wage adjustment factors. Again, as discussed in
the July 3, 2000 final rule, we are proposing to use the pre-floor and
pre-reclassified hospital wage index to adjust the labor portion of the
HH PPS rates based on the geographic area in which the beneficiary
receives the home health services. We believe the use of the pre-floor
and pre-reclassified hospital wage index results in the appropriate
adjustment to the labor portion of the costs as required by statute.
For this update to the CY 2005 home health payment rates, we propose to
continue to use the most recent pre-floor and pre-reclassified hospital
wage index available at the time of the final rule. Due to the mandated
change from a fiscal year update cycle to that of a calendar year
update cycle, the most recent pre-floor and pre-reclassified hospital
wage index available for this update of the CY 2005 home health payment
rates will be that of the 2005 pre-floor/pre-reclassified hospital wage
index.
Under previous fiscal year updates, the most recent pre-floor and
pre-reclassified hospital wage index available at the time of
publication of the HH PPS fiscal year update was that of the previous
year. Beginning with the CY 2005 update to home health payment rates,
the most recent pre-floor and pre-reclassified hospital wage index
available at the time of publication will be that of the current year.
Consequently, for our proposed CY 2005 update to the home health
payment rates, we propose to continue to use the most recent pre-floor
and pre-reclassified hospital wage index available at the time of
publication. We recognize that this change to a calendar year update
cycle results in using the current year's wage index values. See
addenda A and B of this proposed rule, respectively, for the proposed
rural and urban hospital wage indexes. Furthermore, we have added an
addendum C that shows a side-by-side comparison of the FY 2003 pre-
floor and pre-reclassified hospital wage index and proposed CY 2005
pre-floor and pre-reclassified hospital wage index for the CY 2005 HH
PPS update proposed rule. For HH PPS rates addressed in this proposed
rule, we are using a preliminary 2005 pre-floor and pre-reclassified
hospital wage index. We will incorporate updated wage data for the 2005
pre-floor and pre-reclassified hospital wage index in the final rule
for the CY 2005 HH PPS update.
III. Collection of Information Requirements
(If you choose to comment on issues in this section, please include
the caption ``COLLECTION OF INFORMATION REQUIREMENTS'' at the beginning
of your comments.)
This document does not impose information collection and
recordkeeping requirements. Consequently, it need not be reviewed by
the Office of Management and Budget under the authority of the
Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.).
IV. Response to Comments
Because of the large number of items of correspondence we normally
receive on Federal Register documents published for comment, we are not
able to acknowledge or respond to them individually. We will consider
all comments we receive by the date and time specified in the DATES
section of the preamble, and, when we proceed with a subsequent
document, we will respond to the comments in the preamble to that
document.
V. Regulatory Impact Analysis
(If you choose to comment on issues in this section, please include
the caption ``REGULATORY IMPACT ANALYSIS'' at the beginning of your
comments.)
A. Overall Impact
We have examined the impacts of this rule as required by Executive
Order 12866 (September 1993, Regulatory Planning and Review), the
Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-354),
section 1102(b) of the Social Security Act, the Unfunded Mandates
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
Executive Order 12866 (as amended by Executive Order 13258, which
merely reassigns responsibility of duties) directs agencies to assess
all costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). A
regulatory impact analysis (RIA) must be prepared for major rules with
economically significant effects ($100 million or more in any 1 year).
The update set forth in this proposed rule would apply to Medicare
payments under HH PPS in CY 2005. Accordingly, the following analysis
describes the impact in CY 2005 only. We estimate that there would be
an additional $270 million in CY 2005 expenditures attributable to the
CY 2005 proposed market basket (3.3 percent), minus 0.8 percentage
point, an estimated increase of 2.5 percent.
Section 421 of the MMA provides for a 5 percent increase in home
health payments to rural providers for episodes and visits ending after
April 1, 2004 and before April 1, 2005. This increase is not subject to
budget neutrality. Consequently, this increase in payments to rural
providers will result in an estimated increase in expenditures of $20
million in FY 2004 and $100 million in FY 2005.
Section 701 of the MMA includes a provision that changes the update
cycle for HH PPS, and thus the home health market basket update, from a
fiscal year basis to that of a calendar year basis in 2004. This
results in a projected reduction in expenditures of approximately $90
million in FY 2005.
The RFA requires agencies to analyze options for regulatory relief
of small businesses. For purposes of the RFA, small entities include
small businesses, nonprofit organizations, and government agencies.
Most hospitals and most other providers and suppliers are small
entities, either by nonprofit status or by having revenues of $6
million to $29 million or less annually (for details, see the Small
Business Administration's regulation that set forth size standards for
health care industries at 65 FR 69432). For purposes of the RFA,
approximately 75 percent of HHAs are considered small businesses
according to the Small Business Administration's size standards with
total revenues of $11.5 million or less in 1 year. Individuals and
States are not included in the definition of a small
[[Page 31261]]
entity. As stated above, this proposed rule would provide an update to
all HHAs for CY 2005 as required by statute. This proposed rule would
have a significant positive effect upon small entities.
In addition, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis if a rule may have a significant impact on
the operations of a substantial number of small rural hospitals. This
analysis must conform to the provisions of section 603 of the RFA. For
purposes of section 1102(b) of the Act, we define a small rural
hospital as a hospital that is located outside of a metropolitan
statistical area (MSA) and has fewer than 100 beds. We have determined
that this proposed rule would not have a significant economic impact on
the operations of a substantial number of small rural hospitals.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in expenditure in any 1 year by State,
local, or tribal governments, in the aggregate, or by the private
sector, of $110 million. We believe this proposed rule would not
mandate expenditures in that amount.
Executive Order 13132 establishes certain requirements that an
agency must meet when it promulgates a proposed rule (and subsequent
final rule) that imposes substantial direct requirement costs on State
and local governments, preempts State law, or otherwise has Federalism
implications. We have reviewed this rule under the threshold criteria
of Executive Order 13132, Federalism. We have determined that this
proposed rule would not have substantial direct effects on the rights,
roles, and responsibilities of States.
B. Anticipated Effects
In accordance with the requirements of section 1895(b)(3) of the
Act, we publish an update for each subsequent fiscal year that will
provide an update to the payment rates. Section 1895(b)(3)(B) of the
Act, as amended by section 701 of the MMA, requires us, for CY 2005, to
increase the prospective payment amounts by the applicable home health
market basket increase minus 0.8 percentage point. We estimate that
with a proposed home health market basket of 3.3 percent minus 0.8
percentage point, the estimated proposed increase for CY 2005 is 2.5
percent.
1. Effects on the Medicare Program
This proposed rule would merely provide a percentage update to all
Medicare HHAs. Therefore, we have not furnished any impact tables. We
would increase the payment to each Medicare HHA equally by the home
health market basket update for CY 2005, minus 0.8 percentage point, as
required by statute. There is no differential impact among provider
types. The impact is in the aggregate. We can show the impact that the
proposed CY 2005 wage index would have on providers. Addendum C shows a
side-by-side comparison of the FY 2003 pre-floor and pre-reclassified
hospital wage index and the proposed CY 2005 pre-floor and pre-
reclassified hospital wage index for the CY 2005 HH PPS update proposed
rule. We estimate that there would be an additional $270 million in CY
2005 expenditures attributable to the CY 2005 proposed market basket
(3.3 percent), minus 0.8 percentage point, estimated increase resulting
in 2.5 percent. Thus, the anticipated expenditures outlined in this
proposed rule would exceed the $100 million annual threshold for a
major rule as defined in Title 5, USC, section 804(2).
We estimate that the applicable home health market basket (minus
0.8 percentage point) increase of 2.5 percent for CY 2005 applies to
all Medicare-participating HHAs. We do not believe there is a
differential impact due to the aggregate nature of the update.
Table 15
------------------------------------------------------------------------
Additional CY 2005
Medicare home
CY 2005 update to home health PPS rates required by health estimated
the act expenditures due
to annual update
required by law
------------------------------------------------------------------------
Section 1895(b)(3)(B) of the Act requires HH PPS \1\ $270
rates increased by applicable home health market
basket increase (3.3 percent) minus 0.8 percentage
point, yielding 2.5 percent........................
------------------------------------------------------------------------
Source: President's FY 2004 Budget.
\1\ In millions.
2. Effects on Providers
This proposed rule would have a positive effect on providers of
Medicare home health services by increasing their rate of Medicare
payment. We do not anticipate specific effects on other providers. This
proposed rule would reflect the statutorily required annual update to
the HH PPS rates. We do not believe there is a differential impact due
to the consistent and aggregate nature of the update.
C. Alternatives Considered
As discussed in section II, this proposed rule reflects an annual
update to the HH PPS rates as required by statute. We believe that the
statute provides no latitude for alternatives other than the approach
set forth in this proposed rule reflecting the CY 2005 proposed annual
update to the HH PPS rates. Other than the positive effect of the
market basket increase, this proposed rule would not have a significant
economic impact nor would it impose an additional burden on small
entities. When a regulation or notice imposes additional burden on
small entities, we are required under the RFA to examine alternatives
for reducing burden.
As discussed in the ``Rebasing and Revising the Home Health Market
Basket'' section of this proposed rule, we believe that it is desirable
to rebase the home health market basket periodically. Consequently, as
part of this proposed rule, we are proposing to rebase and revise the
home health market basket by moving the base year from FY 1993 to FY
2000 to reflect the latest available, thorough data on the structure of
HHA costs. CMS periodically rebases and revises market baskets for
multiple types of health care providers, generally on a 5-year cycle.
We continue to believe that by rebasing and revising the home health
market basket periodically, cost category weights will better reflect
changes in the mix of goods and services that HHAs purchase in
furnishing home health
[[Page 31262]]
care. The alternative to not rebase and revise the market basket would
be to delay the inevitable task of rebasing and revising the home
health market basket to some later date. For this proposed rule, the
forecasted rate of growth for CY 2005 for both the proposed rebased and
revised home health market basket and the current 1993-based home
health market basket is 3.3 percent (see Table 7 of this proposed
rule). However, it should be noted that while for this proposed rule
the home health market basket percentage is the same for both the 1993-
based and the proposed 2000-based rate of growth, that future updates
will be better served by using a more up-to-date cost structure, as
proposed in the revised and rebased home health market basket.
Section 1895(b)(5) of the Act states that the total amount of
payments for outliers, under HH PPS, may not exceed 5 percent of the
total payments projected or estimated to be made for a given fiscal
year or years. As discussed in the ``Proposed Update to the Outlier
Fixed Dollar Loss Ratio'' section of this proposed rule, we are
proposing to reduce the fixed dollar loss ratio used in the formula to
determine outlier cases in HH PPS, from that of 1.13 to 0.72. Analysis
indicates that a fixed dollar loss ratio of 0.72 is consistent with the
existing loss-sharing ratio of 0.80 and our target percentage of
estimated outlier payments of 5 percent of total home health payments.
Other alternatives considered in the updating of the formula for
determining outlier cases included updating/changing the loss-sharing
ratio from that of 0.80 as well as changing the outlier payment target
of to less than 5 percent of total home health payments. We believe
that a value of 0.80 for the loss-sharing ratio is appropriate in that
it preserves incentives for agencies to provide care efficiently for
outlier cases. Similarly, we continue to believe that the total outlier
payment target of 5 percent of total home health payments appropriately
targets the most costly cases under HH PPS.
D. Conclusion
We have examined the economic impact of this proposed rule on small
entities and have determined that the economic impact is positive,
significant, and that all HHAs would be affected. To the extent that
small rural hospitals are affiliated with HHAs, the impact on these
facilities would also be positive. Finally, we have determined that the
economic effects described above are largely the result of the specific
statutory provisions, which this proposed rule serves to announce.
In accordance with the provisions of Executive Order 12866, this
regulation was reviewed by the Office of Management and Budget.
List of Subjects in 42 CFR Part 484
Health facilities, Health professions, Medicare, Reporting and
recordkeeping requirements.
For the reasons set forth in the preamble, 42 CFR chapter IV is
proposed to be amended as set forth below:
PART 484--HOME HEALTH SERVICES
1. The authority citation for part 484 continues to read as
follows:
Authority: Secs. 1102 and 1871 of the Social Security Act (42
U.S.C. 1302 and 1395(hh)) unless otherwise indicated.
2. Section 484.225 is amended as follows:
A. Paragraph (d) is redesignated as paragraph (g) and is revised.
B. New paragraph (d) is added.
C. New paragraph (e) is added.
D. New paragraph (f) is added.
The revisions and additions read as follows: Sec. 484.225 Annual
update of the unadjusted national prospective 60-day episode payment
rate.
* * * * *
(d) For the last calendar quarter of 2003 and the first calendar
quarter of 2004, the unadjusted national prospective 60-day episode
payment rate is equal to the rate from the previous fiscal year (FY
2003) increased by the applicable home health market basket index
amount.
(e) For the last 3 calendar quarters of 2004, the unadjusted
national prospective 60-day episode payment rate is equal to the rate
from the previous fiscal year (FY 2003) increased by the applicable
home health market basket minus 0.8 percentage point.
(f) For each calendar year of 2005 and 2006, the unadjusted
national prospective 60-day episode payment rate is equal to the rate
from the previous calendar year, increased by the applicable home
health market basket minus 0.8 percentage point.
(g) For 2007 and subsequent calendar years, the unadjusted national
rate is equal to the rate for the previous calendar year increased by
the applicable home health market basket index amount.
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Dated: November 5, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
Dated: April 23, 2004.
Tommy G. Thompson,
Secretary.
Note: The following addenda will not be published in the Code of
Federal Regulations.
Addendum A.--Proposed Wage Index for Rural Areas--Applicable Pre-Floor
and Pre-Reclassified Hospital Wage Index
[CY 2005]
------------------------------------------------------------------------
Wage
MSA name index
------------------------------------------------------------------------
ALABAMA...................................................... 0.7492
ALASKA....................................................... 1.1886
ARIZONA...................................................... 0.9270
ARKANSAS..................................................... 0.7734
CALIFORNIA................................................... 0.9967
COLORADO..................................................... 0.9328
CONNECTICUT.................................................. 1.2183
DELAWARE..................................................... 0.9557
FLORIDA...................................................... 0.8855
GEORGIA...................................................... 0.8369
GUAM......................................................... 0.9611
HAWAII....................................................... 0.9958
IDAHO........................................................ 0.8974
ILLINOIS..................................................... 0.8254
INDIANA...................................................... 0.8824
IOWA......................................................... 0.8416
KANSAS....................................................... 0.8074
KENTUCKY..................................................... 0.7973
LOUISIANA.................................................... 0.7451
MAINE........................................................ 0.8812
MARYLAND..................................................... 0.9125
MASSACHUSETTS................................................ 1.0432
MICHIGAN..................................................... 0.8877
MINNESOTA.................................................... 0.9330
MISSISSIPPI.................................................. 0.7778
MISSOURI..................................................... 0.8056
MONTANA...................................................... 0.8800
NEBRASKA..................................................... 0.8822
NEVADA....................................................... 0.9806
NEW HAMPSHIRE................................................ 1.0030
NEW JERSEY \1\
NEW MEXICO................................................... 0.8270
NEW YORK..................................................... 0.8526
NORTH CAROLINA............................................... 0.8456
NORTH DAKOTA................................................. 0.7778
OHIO......................................................... 0.8820
OKLAHOMA..................................................... 0.7537
OREGON....................................................... 0.9994
PENNSYLVANIA................................................. 0.8378
PUERTO RICO.................................................. 0.4018
RHODE ISLAND \1\
SOUTH CAROLINA............................................... 0.8498
SOUTH DAKOTA................................................. 0.8195
TENNESSEE.................................................... 0.7886
TEXAS........................................................ 0.7780
UTAH......................................................... 0.8974
VERMONT...................................................... 0.9307
VIRGINIA..................................................... 0.8498
VIRGIN ISLANDS............................................... 0.7195
WASHINGTON................................................... 1.0388
WEST VIRGINIA................................................ 0.8018
WISCONSIN.................................................... 0.9304
[[Page 31263]]
WYOMING...................................................... 0.9110
------------------------------------------------------------------------
\1\ All counties within State are classified as Urban.
Addendum B.--Proposed CY 2005 Wage Index for Urban Areas--Pre-Floor and
Pre-Reclassified Hospital Wage Index
------------------------------------------------------------------------
Wage
MSA Urban area (constituent counties) index
------------------------------------------------------------------------
0040....................... Abilene, TX...................... 0.7627
Taylor, TX
0060....................... Aguadilla, PR.................... 0.4306
Aguada, PR
Aguadilla, PR
Moca, PR
0080....................... Akron, OH........................ 0.9246
Portage, OH
Summit, OH
0120....................... Albany, GA....................... 1.0863
Dougherty, GA
Lee, GA
0160....................... Albany-Schenectady-Troy, NY...... 0.8489
Albany, NY
Montgomery, NY
Rensselaer, NY
Saratoga, NY
Schenectady, NY
Schoharie, NY
0200....................... Albuquerque, NM.................. 0.9300
Bernalillo, NM
Sandoval, NM
Valencia, NM
0220....................... Alexandria, LA................... 0.8019
Rapides, LA
0240....................... Allentown-Bethlehem-Easton, PA... 0.9721
Carbon, PA
Lehigh, PA
Northampton, PA
0280....................... Altoona, PA...................... 0.8806
Blair, PA
0320....................... Amarillo, TX, Potter, TX......... 0.8986
Randall, TX
0380....................... Anchorage, AK.................... 1.2216
Anchorage, AK
0440....................... Ann Arbor, MI.................... 1.1074
Lenawee, MI
Livingston, MI
Washtenaw, MI
0450....................... Anniston, AL..................... 0.8090
Calhoun, AL
0460....................... Appleton-Oshkosh-Neenah, WI...... 0.9035
Calumet, WI
Outagamie, WI
Winnebago, WI
0470....................... Arecibo, PR...................... 0.4155
Arecibo, PR
Camuy, PR
Hatillo, PR
0480....................... Asheville, NC.................... 0.9720
Buncombe, NC
Madison, NC
0500....................... Athens, GA....................... 0.9818
Clarke, GA
Madison, GA
Oconee, GA
0520....................... Atlanta, GA...................... 1.0130
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............ 1.0795
Atlantic, NJ
Cape May, NJ
0580....................... Auburn-Opelka, AL................ 0.8494
Lee, AL
0600....................... Augusta-Aiken, GA-SC............. 0.9625
Columbia, GA
McDuffie, GA
Richmond, GA
Aiken, SC
Edgefield, SC
0640....................... Austin-San Marcos, TX............ 0.9609
Bastrop, TX
Caldwell, TX
Hays, TX
Travis, TX
Williamson, TX
0680....................... Bakersfield, CA.................. 0.9810
Kern, CA
0720....................... Baltimore, MD.................... 0.9919
Anne Arundel, MD
Baltimore City, MD
Carroll, MD
Harford, MD
Howard, MD
Queen Annes, MD
0733....................... Bangor, ME....................... 0.9904
Penobscot, ME
0743....................... Barnstable-Yarmouth, MA.......... 1.2956
Barnstable, MA
0760....................... Baton Rouge, LA.................. 0.8406
Ascension, LA
East Baton Rouge, LA
Livingston, LA
West Baton Rouge, LA
0840....................... Beaumont-Port Arthur, TX......... 0.8424
Hardin, TX
Jefferson, TX
Orange, TX
0860....................... Bellingham, WA................... 1.1757
Whatcom, WA
0870....................... Benton Harbor, MI................ 0.8935
Berrien, MI
0875....................... Bergen-Passaic, NJ............... 1.1692
Bergen, NJ
Passaic, NJ
0880....................... Billings, MT..................... 0.8961
Yellowstone, MT
0920....................... Biloxi-Gulfport-Pascagoula, MS... 0.9029
Hancock, MS
Harrison, MS
Jackson, MS
0960....................... Binghamton, NY................... 0.8428
Broome, NY
Tioga, NY
1000....................... Birmingham, AL................... 0.9212
Blount, AL
Jefferson, AL
St. Clair, AL
Shelby, AL
1010....................... Bismarck, ND..................... 0.7965
Burleigh, ND
Morton, ND
1020....................... Bloomington, IN.................. 0.8662
Monroe, IN
1040....................... Bloomington-Normal, IL........... 0.8832
McLean, IL
1080....................... Boise City, ID................... 0.9209
Ada, ID
Canyon, ID
1123....................... Boston-Worcester-Lawrence-Lowell- 1.1233
Brockton, MA-NH.
Bristol, MA
Essex, MA
Middlesex, MA
Norfolk, MA
Plymouth, MA
Suffolk, MA
Worcester, MA
Hillsborough, NH
Merrimack, NH
Rockingham, NH
Strafford, NH
1125....................... Boulder-Longmont, CO............. 1.0049
Boulder, CO
1145....................... Brazoria, TX..................... 0.8137
Brazoria, TX
1150....................... Bremerton, WA.................... 1.0580
Kitsap, WA
1240....................... Brownsville-Harlingen-San Benito, 1.0303
TX.
Cameron, TX......................
1260....................... Bryan-College Station, TX........ 0.9019
Brazos, TX
1280....................... Buffalo-Niagara Falls, NY........ 0.9604
Erie, NY
Niagara, NY
1303....................... Burlington, VT................... 0.9704
Chittenden, VT
Franklin, VT
Grand Isle, VT
1310....................... Caguas, PR....................... 0.4158
Caguas, PR
[[Page 31264]]
Cayey, PR
Cidra, PR
Gurabo, PR
San Lorenzo, PR
1320....................... Canton-Massillon, OH............. 0.9071
Carroll, OH
Stark, OH
1350....................... Casper, WY....................... 0.9095
Natrona, WY
1360....................... Cedar Rapids, IA................. 0.8874
Linn, IA
1400....................... Champaign-Urbana, IL............. 0.9907
Champaign, IL
1440....................... Charleston-North Charleston, SC.. 0.9332
Berkeley, SC
Charleston, SC
Dorchester, SC
1480....................... Charleston, WV................... 0.8880
Kanawha, WV
Putnam, WV
1520....................... Charlotte-Gastonia-Rock Hill, NC- 0.9730
SC.
Cabarrus, NC
Gaston, NC
Lincoln, NC
Mecklenburg, NC
Rowan, NC
Stanley, NC
Union, NC
York, SC
1540....................... Charlottesville, VA.............. 1.0025
Albemarle, VA
Charlottesville City, VA
Fluvanna, VA
Greene, VA
1560....................... Chattanooga, TN-GA............... 0.9086
Catoosa, GA
Dade, GA
Walker, GA
Hamilton, TN
Marion, TN
1580....................... Cheyenne, WY..................... 0.8796
Laramie, WY
1600....................... Chicago, IL...................... 1.0892
Cook, IL
DeKalb, IL
DuPage, IL
Grundy, IL
Kane, IL
Kendall, IL
Lake, IL
McHenry, IL
Will, IL
1620....................... Chico-Paradise, CA............... 1.0193
Butte, CA
1640....................... Cincinnati, OH-KY-IN 0.9413
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.. 0.8244
Christian, KY
Montgomery, TN
1680....................... Cleveland-Lorain-Elyria, OH...... 0.9671
Ashtabula, OH
Cuyahoga, OH
Geauga, OH
Lake, OH
Lorain, OH
Medina, OH
1720....................... Colorado Springs, CO............. 0.9833
El Paso, CO
1740....................... Columbia, MO..................... 0.8695
Boone, MO
1760....................... Columbia, SC..................... 0.8902
Lexington, SC
Richland, SC
1800....................... Columbus, GA-AL.................. 0.8694
Russell, AL
Chattahoochee, GA
Harris, GA
Muscogee, GA
1840....................... Columbus, OH..................... 0.9648
Delaware, OH
Fairfield, OH
Franklin, OH
Licking, OH
Madison, OH
Pickaway, OH
1880....................... Corpus Christi, TX............... 0.8521
Nueces, TX
San Patricio, TX
1890....................... Corvallis, OR.................... 1.1516
Benton, OR
1900....................... Cumberland, MD-WV................ 0.8200
Allegany, MD
Mineral, WV
1920....................... Dallas, TX....................... 0.9974
Collin, TX
Dallas, TX
Denton, TX
Ellis, TX
Henderson, TX
Hunt, TX
Kaufman, TX
Rockwall, TX
1950....................... Danville, VA..................... 0.9035
Danville City, VA
Pittsylvania, VA
1960....................... Davenport-Moline-Rock Island, IA- 0.8985
IL
Scott, IA
Henry, IL
Rock Island, IL
2000....................... Dayton-Springfield, OH........... 0.9518
Clark, OH
Greene, OH
Miami, OH
Montgomery, OH
2020....................... Daytona Beach, FL................ 0.9060
Flagler, FL
Volusia, FL
2030....................... Dacatur, AL...................... 0.8828
Lawrence, AL
Morgan, AL
2040....................... Dacatur, IL...................... 0.8161
Macon, IL
2080....................... Denver, CO....................... 1.0837
Adams, CO
Arapahoe, CO
Denver, CO
Douglas, CO
Jefferson, CO
2120....................... Des Moines, IA................... 0.9106
Dallas, IA ........
Polk, IA
Warren, IA
2160....................... Detroit, MI...................... 1.0101
Lapeer, MI
Macomb, MI
Monroe, MI
Oakland, MI
St. Clair, MI
Wayne, MI
2180....................... Dothan, AL....................... 0.7741
Dale, AL
Houston, AL
2190....................... Dover, DE........................ 0.9805
Kent, DE
2200....................... Dubuque, IA...................... 0.8886
Dubuque, IA
2240....................... Duluth-Superior, MN-WI........... 1.0171
St. Louis, MN
Douglas, WI
2281....................... Dutchess County, NY.............. 1.0934
Dutchess, NY
2290....................... Eau Claire, WI................... 0.9064
Chippewa, WI
Eau Claire, WI
2320....................... El Paso, TX...................... 0.9196
El Paso, TX
2330....................... Elkhart-Goshen, IN............... 0.9783
Elkhart, IN
2335....................... Elmira, NY....................... 0.8377
Chemung, NY
2340....................... Enid, OK......................... 0.8559
Garfield, OK
2360....................... Erie, PA......................... 0.8601
Erie, PA
2400....................... Eugene-Springfield, OR........... 1.1456
Lane, OR
2440....................... Evansville-Henderson, IN-KY...... 0.8429
Posey, IN
Vanderburgh, IN
Warrick, IN
Henderson, KY
2520....................... Fargo-Moorhead, ND-MN............ 0.9797
Clay, MN
Cass, ND
2560....................... Fayetteville, NC................. 0.8986
Cumberland, NC
2580....................... Fayetteville-Springdale-Rogers, 0.8396
AR.
Benton, AR
Washington, AR
2620....................... Flagstaff, AZ-UT................. 1.1333
Coconino, AZ
Kane, UT
2640....................... Flint, MI........................ 1.0858
[[Page 31265]]
Genesee, MI
2650....................... Florence, AL..................... 0.7747
Colbert, AL
Lauderdale, AL
2655....................... Florence, SC..................... 0.8709
Florence, SC
2670....................... Fort Collins-Loveland, CO........ 1.0108
Larimer, CO
2680....................... Ft. Lauderdale, FL............... 1.0163
Broward, FL
2700....................... Fort Myers-Cape Coral, FL........ 0.9816
Lee, FL
2710....................... Fort Pierce-Port St. Lucie, FL... 1.0008
Martin, FL
St. Lucie, FL
2720....................... Fort Smith, AR-OK................ 0.8424
Crawford, AR
Sebastian, AR
Sequoyah, OK
2750....................... Fort Walton Beach, FL............ 0.8966
Okaloosa, FL
2760....................... Fort Wayne, IN................... 0.9585
Adams, IN
Allen, IN
De Kalb, IN
Huntington, IN
Wells, IN
Whitley, IN
2800....................... Forth Worth-Arlington, TX........ 0.9359
Hood, TX
Johnson, TX
Parker, TX
Tarrant, TX
2840....................... Fresno, CA....................... 1.0142
Fresno, CA
Madera, CA
2880....................... Gadsden, AL...................... 0.8206
Etowah, AL
2900....................... Gainesville, FL.................. 0.9693
Alachua, FL
2920....................... Galveston-Texas City, TX......... 0.9279
Galveston, TX
2960....................... Gary, IN......................... 0.9410
Lake, IN
Porter, IN
2975....................... Glens Falls, NY.................. 0.8475
Warren, NY
Washington, NY
2980....................... Goldsboro, NC.................... 0.8622
Wayne, NC
2985....................... Grand Forks, ND-MN............... 0.8636
Polk, MN
Grand Forks, ND
2995....................... Grand Junction, CO............... 0.9633
Mesa, CO
3000....................... Grand Rapids-Muskegon-Holland, MI 0.9469
Allegan, MI
Kent, MI
Muskegon, MI
Ottawa, MI
3040....................... Great Falls, MT.................. 0.8809
Cascade, MT
3060....................... Greeley, CO...................... 0.9372
Weld, CO
3080....................... Green Bay, WI.................... 0.9461
Brown, WI
3120....................... Greensboro-Winston-Salem-High 0.9166
Point, NC.
Alamance, NC
Davidson, NC
Davie, NC
Forsyth, NC
Guilford, NC
Randolph, NC
Stokes, NC
Yadin, NC
3150....................... Greenville, NC................... 0.9098
Pitt, NC
3160....................... Greenville, Spartanburg-Anderson, 0.9335
SC.
Anderson, SC
Cherokee, SC
Greenville, SC
Pickens, SC
Spartanburg, SC
3180....................... Hagerstown, MD................... 0.9172
Washington, MD
3200....................... Hamilton-Middletown, OH.......... 0.9214
Butler, OH
3240....................... Harrisburg-Lebanon-Carlisle, PA.. 0.9164
Cumberland, PA
Dauphin, PA
Lebanon, PA
Perry, PA
3283....................... Hartford, CT..................... 1.1555
Hartford, CT
Litchfield, CT
Middlesex, CT
Tolland, CT
3285....................... Hattiesburg, MS.................. 0.7307
Forrest, MS
Lamar, MS
3290....................... Hickory-Morganton-Lenoir, NC..... 0.9242
Alexander, NC
Burke, NC
Caldwell, NC
Catawaba, NC
3320....................... Honolulu, HI..................... 1.1098
Honolulu, HI
3350....................... Houma, LA........................ 0.7771
Lafourche, LA
Terrebonne, LA
3360....................... Houston, TX...................... 0.9834
Chambers, TX
Fort Bend, TX
Harris, TX
Liberty, TX
Montgomery, TX
Waller, TX
3400....................... Huntington-Ashland, WV-KY-OH..... 0.9595
Boyd, KY
Carter, KY
Grenup, KY
Lawrence, OH
Cabell, WV
Wayne, WV
3440....................... Huntsville, AL................... 0.9245
Limestone, AL
Madison, AL
3480....................... Indianapolis, IN................. 0.9916
Boone, IN
Hamilton, IN
Hancoock, IN
Hendricks, IN
Johnson, IN
Madison, IN
Marion, IN
Morgan, IN
Shelby, IN
3500....................... Iowa City, IA.................... 0.9548
Johnson, IA
3520....................... Jackson, MI...................... 0.8986
Jackson, MI
3560....................... Jackson, MS...................... 0.8357
Hinds, MS
Madison, MS
Rankin MS
3580....................... Jackson, TN...................... 0.8984
Madison, TN
Chester, TN
3600....................... Jacksonville, FL................. 10.9529
Clay, FL
Duval, FL
Nassau, FL
St. Johns, FL
3605....................... Jacksonville, NC................. 0.8544
Onslow, NC
3610....................... Jamestown, NY.................... 0.7762
Chautauqua, NY
3620....................... Janesville-Beloit, WI............ 0.9282
Rock, WI
3640....................... Jersey City, NJ.................. 1.1115
Hudson, NJ
3660....................... Johnson City-Kingsport-Bristol, 0.8253
TN-VA.
Carter, TN.......................
Hawkins, TN
Sullivan, TN
Unicoi, TN
Washington, TN
Bristol City, VA
Scott, VA
Washington, VA
3680....................... Johnstown, PA.................... 0.8158
Cambria, PA
Somerset, PA
3700....................... Jonesboro, AR.................... 0.7794
Craighead, AR
3710....................... Joplin, MO....................... 0.8681
Jasper, MO
Newton, MO
3720....................... Kalamazoo-Battlecreek, MI 1.0500
Calhoun, MI
Kalamazoo, MI
Van Buren, MI
3740....................... Kankakee, IL..................... 1.0419
Kankakee, IL
3760....................... Kansas City, KS-MO............... 0.9715
Johnson, KS
Leavenworth, KS
Miami, KS
Wyandotte, KS
Cass, MO
Clay, MO
[[Page 31266]]
Clinton, MO
Jackson, MO
Lafayette, MO
Platte, MO
Ray, MO
3800....................... Kenosha, WI...................... 0.9761
Kenosha, WI
3810....................... Killeen-Temple, TX............... 0.9159
Bell, TX
Coryell, TX
3840....................... Knoxville, TN.................... 0.8820
Anderson, TN
Blount, TN
Knox, TN
Loudon, TN
Sevier, TN
Union, TN
3850...................... Kokomo, IN....................... 0.9045
Howard, IN
Tipton, IN
3870....................... La Crosse, WI-MN................. 0.9247
Houston, MN
La Crosse, WI
3880....................... Lafayette, LA.................... 0.8207
Acadia, LA
Lafayette, LA
St. Landry, LA
St. Martin, LA
3920....................... Lafayette, IN.................... 0.9036
Clinton, IN
Tippecanoe, IN
3960....................... Lake Charles, LA................. 0.7841
Calcasieu, LA
3980....................... Lakeland-Winter Haven, FL........ 0.8811
Polk, FL
4000....................... Lancaster, PA.................... 0.9282
Lancaster, PA
4040....................... Lansing-East Lansing, MI......... 0.9714
Clinton, MI
Eaton, MI
Ingham, MI
4080....................... Laredo, TX....................... 0.8091
Webb, TX
4100....................... Las Cruces, NM................... 0.8688
Dona Ana, NM
4120....................... Las Vegas, NV-AZ................. 1.1528
Mohave, AZ
Clark, NV
Nye, NV
4150....................... Lawrence, KS..................... 0.8074
Douglas, KS
4200....................... Lawton, OK....................... 0.8267
Comanche, OK
4243....................... Lewiston-Auburn, ME.............. 0.9383
Androscoggin, ME
4280....................... Lexington, KY.................... 0.8685
Bourbon, KY
Clark, KY
Fayette, KY
Jessamine, KY
Madison, KY
Scott, KY
Woodford, KY
4320....................... Lima, OH......................... 0.9522
Allen, OH
Auglaize, OH
4360....................... Lincoln, NE...................... 1.0033
Lancaster, NE
4400....................... Little Rock-North Little Rock, AR 0.8923
Faulkner, AR
Lonoke, AR
Pulaski, AR
Saline, AR
4420....................... Longview-Marshall, TX............ 0.9113
Gregg, TX
Harrison, TX
Upshur, TX
4480....................... Los Angeles-Long Beach, CA....... 1.1795
Los Angeles, CA
4520....................... Louisville, KY-IN................ 0.9242
Clark, IN
Floyd, IN
Harrison, IN
Scott, IN
Bullitt, KY
Jefferson, KY
Oldham, KY
4600....................... Lubbock, TX...................... 0.8272
Lubbock, TX
4640....................... Lynchburg, VA.................... 0.9134
Amherst, VA
Bedford, VA
Bedford City, VA
Campbell, VA
Lynchburg City, VA
4680....................... Macon, GA........................ 0.8953
Bibb, GA
Houston, GA
Jones, GA
Peach, GA
Twiggs, GA
4720....................... Madison, WI...................... 1.0264
Dane, WI
4800....................... Mansfield, OH.................... 0.9180
Crawford, OH
Richland, OH
4840....................... Mayaguez, PR..................... 0.4795
Anasco, PR
Cabo Rojo, PR
Hormigueros, PR
Mayaguez, PR
Sabana Grande, PR
San German, PR
4880....................... McAllen-Edinburg-Mission, TX..... 0.8381
Hidalgo, TX
4890....................... Medford-Ashland, OR.............. 1.0772
Jackson, OR
4900....................... Melbourne-Titusville-Palm Bay, FL 0.9776
Brevard, FL
4920....................... Memphis, TN-AR-MS................ 0.9009
Crittenden, AR
DeSoto, MS
Fayette, TN
Shelby, TN
Tipton, TN
4940....................... Merced, CA....................... 0.9692
Merced, CA
5000....................... Miami, FL........................ 0.9894
Dade, FL
5015....................... Middlesex-Somerset-Hunterdon, NJ. 1.1366
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
5080....................... Milwaukee-Waukesha, WI........... 0.9988
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120....................... Minneapolis-St. Paul, MN-WI...... 1.1001
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..................... 0.8718
Missoula, MT
5160....................... Mobile, AL....................... 0.7994
Baldwin, AL
Mobile, AL
5170....................... Modesto, CA...................... 1.1275
Stanislaus, CA
5190....................... Monmouth-Ocean, NJ............... 1.0956
Monmouth, NJ
Ocean, NJ
5200....................... Monroe, LA....................... 0.7922
Ouachita, LA
5240....................... Montgomery, AL................... 0.7907
Autauga, AL
Elmore, AL
Montgomery, AL
5280....................... Muncie, IN....................... 0.8775
Delaware, IN
5330....................... Myrtle Beach, SC................. 0.9112
Horry, SC
5345....................... Naples, FL....................... 0.9790
Collier, FL
5360....................... Nashville, TN.................... 0.9855
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
Rutherford, TN
Sumner, TN
Williamson, TN
Wilson, TN
5380....................... Nassau-Suffolk, NY............... 1.3140
Nassau, NY
Suffolk, NY
5483....................... New Haven-Bridgeport-Stamford- 1.2385
Waterbury-Danbury, CT.
Fairfield, CT
New Haven, CT
5523....................... New London-Norwich, CT........... 1.1631
New London, CT
[[Page 31267]]
5560....................... New Orleans, LA.................. 0.9174
Jefferson, LA
Orleans, LA
Plaquemines, LA
St. Bernard, LA
St. Charles, LA
St. James, LA
St. John The Baptist, LA
St. Tammany, LA
5600....................... New York, NY..................... 1.4018
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
Richmond, NY
Rockland, NY
Westchester, NY
5640....................... Newark, NJ....................... 1.1518
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
Warren, NJ
5660....................... Newburgh, NY--PA................. 1.1509
Orange, NY
Pike, PA
5720....................... Norfolk-Virginia Beach-Newport 0.8619
News, VA-NC.
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....................... Oakland, CA...................... 1.4921
Alameda, CA
Contra Costa, CA
5790....................... Ocala, FL........................ 0.9728
Marion, FL
5800....................... Odessa-Midland, TX............... 0.9327
Ector, TX
Midland, TX
5880....................... Oklahoma City, OK................ 0.8984
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910....................... Olympia, WA...................... 1.0963
Thurston, WA
5920....................... Omaha, NE-IA..................... 0.9745
Pottawattamie, IA
Cass, NE
Douglas, NE
Sarpy, NE
Washington, NE
5945....................... Orange County, CA................ 1.1372
Orange, CA
5960....................... Orlando, FL...................... 0.9654
Lake, FL
Orange, FL
Osceola, FL
Seminole, FL
5990....................... Owensboro, KY.................... 0.8374
Daviess, KY
6015....................... Panama City, FL.................. 0.8202
Bay, FL
6020....................... Parkersburg-Marietta, WV-OH...... 0.8039
Washington, OH
Wood, WV
6080....................... Pensacola, FL.................... 0.8753
Escambia, FL
Santa Rosa, FL
6120....................... Peoria-Pekin, IL................. 0.8734
Peoria, IL
Tazewell, IL
Woodford, IL
6160....................... Philadelphia, PA-NJ.............. 1.0883
Burlington, NJ
Camden, NJ
Gloucester, NJ
Salem, NJ
Bucks, PA
Chester, PA
Delaware, PA
Mongtomery, PA
Philadelphia, PA
6200....................... Phoenix-Mesa, AZ................. 1.0129
Maricopa, AZ
Pinal, AZ
6240....................... Pine Bluff, AR................... 0.7865
Jefferson, AR
6280....................... Pittsburgh, PA................... 0.8901
Allegheny, PA
Beaver, PA
Butler, PA
Fayette, PA
Washington, PA
Westmoreland, PA
6323....................... Pittsfield, MA................... 1.0276
Berkshire, MA
6340....................... Pocatello, ID.................... 0.9042
Bannock, ID
6360....................... Ponce, PR........................ 0.4708
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
6403....................... Portland, ME..................... 0.9949
Cumberland, ME
Sagadahoc, ME
York, ME
6440....................... Portland-Vancouver, OR-WA........ 1.1213
Clackamas, OR
Columbia, OR
Multnomah, OR
Washington, OR
Yamhill, OR
Clark, WA
6483....................... Providence-Warwick-Pawtucket, RI. 1.0977
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520....................... Provo-Orem, UT................... 0.9976
Utah, UT
6560....................... Pueblo, CO....................... 0.8778
Pueblo, CO
6580....................... Punta Gorda, FL.................. 0.9510
Charlotte, FL
6600....................... Racine, WI....................... 0.8814
Racine, WI
6640....................... Raleigh-Durham-Chapel Hill, NC... 0.9959
Chatham, NC
Durham, NC
Franklin, NC
Johnston, NC
Orange, NC
Wake, NC
6660....................... Rapid City, SD................... 0.8806
Pennington, SD
6680....................... Reading, PA...................... 0.9133
Berks, PA
6690....................... Redding, CA...................... 1.1352
Shasta, CA
6720....................... Reno, NV......................... 1.0682
Washoe, NV
6740....................... Richland-Kennewick-Pasco, WA..... 1.0609
Benton, WA
Franklin, WA
6760....................... Richmond-Petersburg, VA.......... 0.9349
Charles City County, VA
Chesterfield, VA
Colonia Heights City, VA
Dinwiddie, VA
Goochland, VA
Hanover, VA
Henrico, VA
Hopewell City, VA
New Kent, VA
Petersburg City, VA
Powhatan, VA
Prince George, VA
Richmond City, VA
6780....................... Riverside-San Bernardino, CA..... 1.1348
Riverside, CA
San Bernardino, CA
6800....................... Roanoke, VA...................... 0.8700
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820....................... Rochester, MN.................... 1.1739
Olmsted, MN
6840....................... Rochester, NY.................... 0.9430
Genesee, NY
Livingston, NY
Monroe, NY
Ontario, NY
Orleans, NY
Wayne, NY
[[Page 31268]]
6880....................... Rockford, IL..................... 0.9666
Boone, IL
Ogle, IL
Winnebago, IL
6895....................... Rocky Mount, NC.................. 0.9076
Edgecombe, NC
Nash, NC
6920....................... Sacramento, CA................... 1.1845
El Dorado, CA
Placer, CA
Sacramento, CA
6960....................... Saginaw-Bay City-Midland, MI..... 1.0032
Bay, MI
Midland, MI
Saginaw, MI
6980....................... St. Cloud, MN.................... 0.9506
Benton, MN
Stearns, MN
7000....................... St. Joseph, MO................... 0.8056
Andrew, MO
Buchanan, MO
7040....................... St. Louis, MO-IL................. 0.9033
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....................... Salem, OR........................ 1.0482
Marion, OR
Polk, OR
7120....................... Salinas, CA...................... 1.4339
Monterey, CA
7160....................... Salt Lake City-Ogden, UT......... 0.9913
Davis, UT
Salt Lake, UT
Weber, UT
7200....................... San Angelo, TX................... 0.8535
Tom Green, TX
7240....................... San Antonio, TX.................. 0.8870
Bexar, TX
Comal, TX
Guadalupe, TX
Wilson, TX
7320....................... San Diego, CA.................... 1.1147
San Diego, CA
7360....................... San Francisco, CA................ 1.4514
Marin, CA
San Francisco, CA
San Mateo, CA
7400....................... San Jose, CA..................... 1.4626
Santa Clara, CA
7440....................... San Juan-Bayamon, PR............. 0.4909
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
Fajardo, PR
Florida, PR
Guaynabo, PR
Humacao, PR
Juncos, PR
Los Piedras, PR
Loiza, PR
Luguillo, PR
Manati, PR
Morovis, PR
Naguabo, PR
Naranjito, PR
Rio Grande, PR
San Juan, PR
Toa Alta, PR
Toa Baja, PR
Trujillo Alto, PR
Vega Alta, PR
Vega Baja, PR
Yabucoa, PR
7460....................... San Luis Obispo-Atascadero-Paso.. 1.1429
Robles, CA
San Luis Obispo, CA
7480....................... Santa Barbara-Santa Maria-Lompoc, 1.0441
CA
Santa Barbara, CA
7485....................... Santa Cruz-Watsonville, CA 1.2942
Santa Cruz, CA
7490....................... Santa Fe, NM..................... 1.0653
Los Alamos, NM
Santa Fe, NM
7500....................... Santa Rosa, CA................... 1.2877
Sonoma, CA
7510....................... Sarasota-Bradenton, FL........... 0.9964
Manatee, FL
Sarasota, FL
7520....................... Savannah, GA..................... 0.9472
Bryan, GA
Chatham, GA
Effingham, GA
7560....................... Scranton-Wilkes-Barre-Hazleton, 0.8412
PA
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600....................... Seattle-Bellevue-Everett, WA 1.1562
Island, WA
King, WA
Snohomish, WA
7610....................... Sharon, PA....................... 0.7751
Mercer, PA
7620....................... Sheboygan, WI.................... 0.8624
Sheboygan, WI
7640....................... Sherman-Denison, TX.............. 0.9700
Grayson, TX
7680....................... Shreveport-Bossier City, LA 0.9083
Bossier, LA
Caddo, LA
Webster, LA
7720....................... Sioux City, IA-NE................ 0.8993
Woodbury, IA
Dakota, NE
7760....................... Sioux Falls, SD.................. 0.9309
Lincoln, SD
Minnehaha, SD
7800....................... South Bend, IN................... 0.9821
St. Joseph, IN
7840....................... Spokane, WA...................... 1.0901
Spokane, WA
7880....................... Springfield, IL.................. 0.8944
Menard, IL
Sangamon, IL
7920....................... Springfield, MO.................. 0.8457
Christian, MO
Greene, MO
Webster, MO
8003....................... Springfield, MA.................. 1.0543
Hampden, MA
Hampshire, MA
8050....................... State College, PA................ 0.8740
Centre, PA
8080....................... Steubenville-Weirton, OH-WV 0.8398
Jefferson, OH
Brooke, WV
Hancock, WV
8120....................... Stockton-Lodi, CA................ 1.0404
San Joaquin, CA
8140....................... Sumter, SC....................... 0.8243
Sumter, SC
8160....................... Syracuse, NY..................... 0.9412
Cayuga, NY
Madison, NY
Onondaga, NY
Oswego, NY
8200....................... Tacoma, WA....................... 1.1116
Pierce, WA
8240....................... Tallahassee, FL.................. 0.8520
Gadsden, FL
Leon, FL
8280....................... Tampa-St. Petersburg-Clearwater, 0.9103
FL.
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320....................... Terre Haute, IN.................. 0.8325
Clay, IN
Vermillion, IN
Vigo, IN
8360....................... Texarkana, AR-Texarkana, TX...... 0.8150
Miller, AR
Bowie, TX
8400....................... Toledo, OH....................... 0.9381
Fulton, OH
Lucas, OH
Wood, OH
8440....................... Topeka, KS....................... 0.9108
Shawnee, KS
8480....................... Trenton, NJ...................... 1.0517
Mercer, NJ
8520....................... Tucson, AZ....................... 0.8981
Pima, AZ
8560....................... Tulsa, OK........................ 0.9185
Creek, OK
[[Page 31269]]
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600....................... Tuscaloosa, AL................... 0.8212
Tuscaloosa, AL
8640....................... Tyler, TX........................ 0.9404
Smith, TX
8680....................... Utica-Rome, NY................... 0.8403
Herkimer, NY
Oneida, NY
8720....................... Vallejo-Fairfield-Napa, CA....... 1.3377
Napa, CA
Solano, CA
8735....................... Ventura, CA...................... 1.1064
Ventura, CA
8750....................... Victoria, TX..................... 0.8184
Victoria, TX
8760....................... Vineland-Millville-Bridgeton, NJ. 1.0405
Cumberland, NJ
8780....................... Visalia-Tulare-Porterville, CA... 0.9856
Tulare, CA
8800....................... Waco, TX......................... 0.8394
McLennan, TX
8840....................... Washington, DC-MD-VA-WV.......... 1.0904
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Clarke, VA
Culpeper, VA
Fairfax, VA
Fairfax City, VA
Falls Church City, VA
Fauquier, VA
Fredericksburg City, VA
King George, VA
Loudoun, VA
Manassas City, VA
Manassas Park City, VA
Prince William, VA
Spotsylvania, VA
Stafford, VA
Warren, VA
Berkeley, WV
Jefferson, WV
8920....................... Waterloo-Cedar Falls, IA......... 0.8366
Black Hawk, IA
8940....................... Wausau, WI....................... 0.9692
Marathon, WI
8960....................... West Palm Beach-Boca Raton, FL... 0.9798
Palm Beach, FL
9000....................... Wheeling, WV-OH.................. 0.7494
Belmont, OH
Marshall, WV
Ohio, WV
9040....................... Wichita, KS...................... 0.9238
Butler, KS
Harvey, KS
Sedgwick, KS
9080....................... Wichita Falls, TX................ 0.8341
Archer, TX
Wichita, TX
9140....................... Williamsport, PA................. 0.8158
Lycoming, PA
9160....................... Wilmington-Newark, DE-MD......... 1.0882
New Castle, DE
Cecil, MD
9200....................... Wilmington, NC................... 0.9563
New Hanover, NC
Brunswick, NC
9260....................... Yakima, WA....................... 1.0372
Yakima, WA
9270....................... Yolo, CA......................... 0.9204
Yolo, CA
9280....................... York, PA......................... 0.9119
York, PA
9320....................... Youngstown-Warren, OH............ 0.9214
Columbiana, OH
Mahoning, OH
Trumbull, OH
9340....................... Yuba City, CA.................... 1.0196
Sutter, CA
Yuba, CA
9360....................... Yuma, AZ......................... 0.8895
Yuma, AZ
------------------------------------------------------------------------
Addendum C.--Comparison of Pre-Floor and Pre-Reclassified Hospital Wage
Index for FY 2003 and Proposed CY 2005
------------------------------------------------------------------------
Proposed Percent
FY 2003 CY 2005 change, FY
Rural area wage wage 2003--proposed
index index CY 2005
------------------------------------------------------------------------
ALABAMA........................... 0.766 0.7492 -2.19
ALASKA............................ 1.2293 1.1886 -3.31
ARIZONA........................... 0.8493 0.9270 9.15
ARKANSAS.......................... 0.7666 0.7734 0.89
CALIFORNIA........................ 0.9840 0.9967 1.29
COLORADO.......................... 0.9015 0.9328 3.47
CONNECTICUT....................... 1.2394 1.2183 -1.70
DELAWARE.......................... 0.9128 0.9557 4.70
FLORIDA........................... 0.8814 0.8855 0.47
GEORGIA........................... 0.8230 0.8369 1.69
GUAM.............................. 0.9611 0.9611
HAWAII............................ 1.0255 0.9958 -2.90
IDAHO............................. 0.8747 0.8974 2.60
ILLINOIS.......................... 0.8204 0.8254 0.61
INDIANA........................... 0.8755 0.8824 0.79
IOWA.............................. 0.8315 0.8416 1.21
KANSAS............................ 0.7923 0.8074 1.91
KENTUCKY.......................... 0.8079 0.7973 -1.31
LOUISIANA......................... 0.7567 0.7451 -1.53
MAINE............................. 0.8874 0.8812 -0.70
MARYLAND.......................... 0.8946 0.9125 2.00
MASSACHUSETTS..................... 1.1288 1.0432 -7.58
MICHIGAN.......................... 0.9000 0.8877 -1.37
MINNESOTA......................... 0.9151 0.9330 1.96
MISSISSIPPI....................... 0.7680 0.7778 1.28
[[Page 31270]]
MISSOURI.......................... 0.8021 0.8056 0.44
MONTANA........................... 0.8481 0.8800 3.76
NEBRASKA.......................... 0.8204 0.8822 7.53
NEVADA............................ 0.9577 0.9806 2.39
NEW HAMPSHIRE..................... 0.9796 1.0030 2.39
NEW JERSEY........................ ......... ......... ..............
NEW MEXICO........................ 0.8872 0.8270 -6.79
NEW YORK.......................... 0.8542 0.8526 -0.19
NORTH CAROLINA.................... 0.8666 0.8456 -2.42
NORTH DAKOTA...................... 0.7788 0.7778 -0.13
OHIO.............................. 0.8613 0.8820 2.40
OKLAHOMA.......................... 0.7590 0.7537 -0.70
OREGON............................ 1.0303 0.9994 -3.00
PENNSYLVANIA...................... 0.8462 0.8378 -0.99
PUERTO RICO....................... 0.4356 0.4018 -7.76
RHODE ISLAND...................... ......... ......... ..............
SOUTH CAROLINA.................... 0.8607 0.8498 -1.27
SOUTH DAKOTA...................... 0.7815 0.8195 4.86
TENNESSEE......................... 0.7877 0.7886 0.11
TEXAS............................. 0.7821 0.7780 -0.52
UTAH.............................. 0.9312 0.8974 -3.63
VERMONT........................... 0.9345 0.9307 -0.41
VIRGINIA.......................... 0.8504 0.8498 -0.07
VIRGIN ISLANDS.................... 0.7845 0.7195 -8.29
WASHINGTON........................ 1.0179 1.0388 2.05
WEST VIRGINIA..................... 0.7975 0.8018 0.54
WISCONSIN......................... 0.9162 0.9304 1.55
WYOMING........................... 0.9007 0.9110 1.14
------------------------------------------------------------------------
------------------------------------------------------------------------
Percent
FY 2003 Proposed CY change, FY
Urban MSA wage index 2005 wage 2003--proposed
index CY 2005
------------------------------------------------------------------------
0040.......................... 0.7792 0.7627 -2.12
0060.......................... 0.4587 0.4306 -6.13
0080.......................... 0.9600 0.9246 -3.69
0120.......................... 1.0594 1.0863 2.54
0160.......................... 0.8384 0.8489 1.25
0200.......................... 0.9315 0.9300 -0.16
0220.......................... 0.7859 0.8019 2.04
0240.......................... 0.9735 0.9721 -0.14
0280.......................... 0.9225 0.8806 -4.54
0320.......................... 0.9034 0.8986 -0.53
0380.......................... 1.2358 1.2216 -1.15
0440.......................... 1.1103 1.1074 -0.26
0450.......................... 0.8044 0.8090 0.57
0460.......................... 0.8997 0.9035 0.42
0470.......................... 0.4337 0.4155 -4.20
0480.......................... 0.9876 0.9720 -1.58
0500.......................... 1.0211 0.9818 -3.85
0520.......................... 0.9991 1.0130 1.39
0560.......................... 1.1017 1.0795 -2.02
0580.......................... 0.8325 0.8494 2.03
0600.......................... 1.0264 0.9625 -6.23
0640.......................... 0.9637 0.9609 -0.29
0680.......................... 0.9899 0.9810 -0.90
0720.......................... 0.9929 0.9919 -0.10
0733.......................... 0.9664 0.9904 2.48
0743.......................... 1.3202 1.2956 -1.86
0760.......................... 0.8294 0.8406 1.35
0840.......................... 0.8324 0.8424 1.20
0860.......................... 1.2282 1.1757 -4.27
0870.......................... 0.9042 0.8935 -1.18
0875.......................... 1.2150 1.1692 -3.77
[[Page 31271]]
0880.......................... 0.9022 0.8961 -0.68
0920.......................... 0.8757 0.9029 3.11
0960.......................... 0.8341 0.8428 1.04
1000.......................... 0.9222 0.9212 -0.11
1010.......................... 0.7972 0.7965 -0.09
1020.......................... 0.8907 0.8662 -2.75
1040.......................... 0.9109 0.8832 -3.04
1080.......................... 0.9310 0.9209 -1.08
1123.......................... 1.1235 1.1233 -0.02
1125.......................... 0.9689 1.0049 3.72
1145.......................... 0.8535 0.8137 -4.66
1150.......................... 1.0944 1.0580 -3.33
1240.......................... 0.8880 1.0303 16.02
1260.......................... 0.8821 0.9019 2.24
1280.......................... 0.9365 0.9604 2.55
1303.......................... 1.0052 0.9704 -3.46
1310.......................... 0.4371 0.4158 -4.87
1320.......................... 0.8932 0.9071 1.56
1350.......................... 0.9690 0.9095 -6.14
1360.......................... 0.9056 0.8874 -2.01
1400.......................... 1.0635 0.9907 -6.85
1440.......................... 0.9235 0.9332 1.05
1480.......................... 0.8898 0.8880 -0.20
1520.......................... 0.9850 0.9730 -1.22
1540.......................... 1.0438 1.0025 -3.96
1560.......................... 0.8976 0.9086 1.23
1580.......................... 0.8628 0.8796 1.95
1600.......................... 1.1044 1.0892 -1.38
1620.......................... 0.9745 1.0193 4.60
1640.......................... 0.9381 0.9413 0.34
1660.......................... 0.8406 0.8244 -1.93
1680.......................... 0.9670 0.9671 0.01
1720.......................... 0.9916 0.9833 -0.84
1740.......................... 0.8496 0.8695 2.34
1760.......................... 0.9307 0.8902 -4.35
1800.......................... 0.8374 0.8694 3.82
1840.......................... 0.9751 0.9648 -1.06
1880.......................... 0.8729 0.8521 -2.38
1890.......................... 1.1453 1.1516 0.55
1900.......................... 0.7847 0.8200 4.50
1920.......................... 0.9998 0.9974 -0.24
1950.......................... 0.8859 0.9035 1.99
1960.......................... 0.8835 0.8985 1.70
2000.......................... 0.9282 0.9518 2.54
2020.......................... 0.9062 0.9060 -0.02
2030.......................... 0.8973 0.8828 -1.62
2040.......................... 0.8055 0.8161 1.32
2080.......................... 1.0601 1.0837 2.23
2120.......................... 0.8791 0.9106 3.58
2160.......................... 1.0448 1.0101 -3.32
2180.......................... 0.8137 0.7741 -4.87
2190.......................... 0.9356 0.9805 4.80
2200.......................... 0.8795 0.8886 1.03
2240.......................... 1.0368 1.0171 -1.90
2281.......................... 1.0684 1.0934 2.34
2290.......................... 0.8952 0.9064 1.25
2320.......................... 0.9265 0.9196 -0.74
2330.......................... 0.9722 0.9783 0.63
2335.......................... 0.8416 0.8377 -0.46
2340.......................... 0.8376 0.8559 2.18
2360.......................... 0.8925 0.8601 -3.63
2400.......................... 1.0944 1.1456 4.68
2440.......................... 0.8177 0.8429 3.08
2520.......................... 0.9684 0.9797 1.17
2560.......................... 0.8889 0.8986 1.09
2580.......................... 0.8100 0.8396 3.65
2620.......................... 1.0682 1.1333 6.09
2640.......................... 1.1135 1.0858 -2.49
2650.......................... 0.7792 0.7747 -0.58
2655.......................... 0.8780 0.8709 -0.81
[[Page 31272]]
2670.......................... 1.0066 1.0108 0.42
2680.......................... 1.0297 1.0163 -1.30
2700.......................... 0.9680 0.9816 1.40
2710.......................... 0.9823 1.0008 1.88
2720.......................... 0.7895 0.8424 6.70
2750.......................... 0.9693 0.8966 -7.50
2760.......................... 0.9457 0.9585 1.35
2800.......................... 0.9446 0.9359 -0.92
2840.......................... 1.0216 1.0142 -0.72
2880.......................... 0.8505 0.8206 -3.52
2900.......................... 0.9871 0.9693 -1.80
2920.......................... 0.9465 0.9279 -1.97
2960.......................... 0.9584 0.9410 -1.82
2975.......................... 0.8281 0.8475 2.34
2980.......................... 0.8892 0.8622 -3.04
2985.......................... 0.8897 0.8636 -2.93
2995.......................... 0.9456 0.9633 1.87
3000.......................... 0.9525 0.9469 -0.59
3040.......................... 0.8950 0.8809 -1.58
3060.......................... 0.9237 0.9372 1.46
3080.......................... 0.9502 0.9461 -0.43
3120.......................... 0.9282 0.9166 -1.25
3150.......................... 0.9100 0.9098 -0.02
3160.......................... 0.9122 0.9335 2.34
3180.......................... 0.9268 0.9172 -1.04
3200.......................... 0.9418 0.9214 -2.17
3240.......................... 0.9223 0.9164 -0.64
3283.......................... 1.1549 1.1555 0.05
3285.......................... 0.7659 0.7307 -4.60
3290.......................... 0.9028 0.9242 2.37
3320.......................... 1.1457 1.1098 -3.13
3350.......................... 0.8385 0.7771 -7.32
3360.......................... 0.9892 0.9834 -0.59
3400.......................... 0.9636 0.9595 -0.43
3440.......................... 0.8903 0.9245 3.84
3480.......................... 0.9717 0.9916 2.05
3500.......................... 0.9587 0.9548 -0.41
3520.......................... 0.9532 0.8986 -5.73
3560.......................... 0.8607 0.8357 -2.90
3580.......................... 0.9275 0.8984 -3.14
3600.......................... 0.9381 0.9529 1.58
3605.......................... 0.8239 0.8544 3.70
3610.......................... 0.7976 0.7762 -2.68
3620.......................... 0.9849 0.9282 -5.76
3640.......................... 1.1190 1.1115 -0.67
3660.......................... 0.8268 0.8253 -0.18
3680.......................... 0.8329 0.8158 -2.05
3700.......................... 0.7749 0.7794 0.58
3710.......................... 0.8613 0.8681 0.79
3720.......................... 1.0595 1.0500 -0.90
3740.......................... 1.0790 1.0419 -3.44
3760.......................... 0.9736 0.9715 -0.22
3800.......................... 0.9686 0.9761 0.77
3810.......................... 1.0399 0.9159 -11.92
3840.......................... 0.8970 0.8820 -1.67
3850.......................... 0.8971 0.9045 0.82
3870.......................... 0.9400 0.9247 -1.63
3880.......................... 0.8475 0.8207 -3.16
3920.......................... 0.9278 0.9036 -2.61
3960.......................... 0.7965 0.7841 -1.56
3980.......................... 0.9357 0.8811 -5.84
4000.......................... 0.9078 0.9282 2.25
4040.......................... 0.9726 0.9714 -0.12
4080.......................... 0.8472 0.8091 -4.50
4100.......................... 0.8745 0.8688 -0.65
4120.......................... 1.1521 1.1528 0.06
4150.......................... 0.7923 0.8074 1.91
4200.......................... 0.8315 0.8267 -0.58
4243.......................... 0.9179 0.9383 2.22
4280.......................... 0.8581 0.8685 1.21
[[Page 31273]]
4320.......................... 0.9483 0.9522 0.41
4360.......................... 0.9892 1.0033 1.43
4400.......................... 0.9097 0.8923 -1.91
4420.......................... 0.8629 0.9113 5.61
4480.......................... 1.2001 1.1795 -1.72
4520.......................... 0.9276 0.9242 -0.37
4600.......................... 0.9646 0.8272 -14.24
4640.......................... 0.9219 0.9134 -0.92
4680.......................... 0.9204 0.8953 -2.73
4720.......................... 1.0467 1.0264 -1.94
4800.......................... 0.8900 0.9180 3.15
4840.......................... 0.4914 0.4795 -2.42
4880.......................... 0.8428 0.8381 -0.56
4890.......................... 1.0498 1.0772 2.61
4900.......................... 1.0253 0.9776 -4.65
4920.......................... 0.8920 0.9009 1.00
4940.......................... 0.9837 0.9692 -1.47
5000.......................... 0.9802 0.9894 0.94
5015.......................... 1.1213 1.1366 1.36
5080.......................... 0.9893 0.9988 0.96
5120.......................... 1.0903 1.1001 0.90
5140.......................... 0.9157 0.8718 -4.79
5160.......................... 0.8108 0.7994 -1.41
5170.......................... 1.0498 1.1275 7.40
5190.......................... 1.0674 1.0956 2.64
5200.......................... 0.8137 0.7922 -2.64
5240.......................... 0.7734 0.7907 2.24
5280.......................... 0.9284 0.8775 -5.48
5330.......................... 0.8976 0.9112 1.52
5345.......................... 0.9754 0.9790 0.37
5360.......................... 0.9578 0.9855 2.89
5380.......................... 1.3357 1.3140 -1.62
5483.......................... 1.2408 1.2385 -0.19
5523.......................... 1.1767 1.1631 -1.16
5560.......................... 0.9046 0.9174 1.41
5600.......................... 1.4414 1.4018 -2.75
5640.......................... 1.1381 1.1518 1.20
5660.......................... 1.1387 1.1509 1.07
5720.......................... 0.8574 0.8619 0.52
5775.......................... 1.5072 1.4921 -1.00
5790.......................... 0.9402 0.9728 3.47
5800.......................... 0.9397 0.9327 -0.74
5880.......................... 0.8900 0.8984 0.94
5910.......................... 1.0960 1.0963 0.03
5920.......................... 0.9978 0.9745 -2.34
5945.......................... 1.1474 1.1372 -0.89
5960.......................... 0.9640 0.9654 0.15
5990.......................... 0.8344 0.8374 0.36
6015.......................... 0.8865 0.8202 -7.48
6020.......................... 0.8127 0.8039 -1.08
6080.......................... 0.8645 0.8753 1.25
6120.......................... 0.8739 0.8734 -0.06
6160.......................... 1.0713 1.0883 1.59
6200.......................... 0.9820 1.0129 3.15
6240.......................... 0.7962 0.7865 -1.22
6280.......................... 0.9365 0.8901 -4.95
6323.......................... 1.0235 1.0276 0.40
6340.......................... 0.9372 0.9042 -3.52
6360.......................... 0.5169 0.4708 -8.92
6403.......................... 0.9794 0.9949 1.58
6440.......................... 1.0667 1.1213 5.12
6483.......................... 1.0854 1.0977 1.13
6520.......................... 0.9984 0.9976 -0.08
6560.......................... 0.8820 0.8778 -0.48
6580.......................... 0.9218 0.9510 3.17
6600.......................... 0.9334 0.8814 -5.57
6640.......................... 0.9990 0.9959 -0.31
6660.......................... 0.8846 0.8806 -0.45
6680.......................... 0.9295 0.9133 -1.74
6690.......................... 1.1135 1.1352 1.95
[[Page 31274]]
6720.......................... 1.0648 1.0682 0.32
6740.......................... 1.1491 1.0609 -7.68
6760.......................... 0.9477 0.9349 -1.35
6780.......................... 1.1365 1.1348 -0.15
6800.......................... 0.8614 0.8700 1.00
6820.......................... 1.2139 1.1739 -3.30
6840.......................... 0.9194 0.9430 2.57
6880.......................... 0.9625 0.9666 0.43
6895.......................... 0.9228 0.9076 -1.65
6920.......................... 1.1500 1.1845 3.00
6960.......................... 0.9650 1.0032 3.96
6980.......................... 0.9700 0.9506 -2.00
7000.......................... 0.8021 0.8056 0.44
7040.......................... 0.8855 0.9033 2.01
7080.......................... 1.0367 1.0482 1.11
7120.......................... 1.4623 1.4339 -1.94
7160.......................... 0.9945 0.9913 -0.32
7200.......................... 0.8374 0.8535 1.92
7240.......................... 0.8753 0.8870 1.34
7320.......................... 1.1131 1.1147 0.14
7360.......................... 1.4142 1.4514 2.63
7400.......................... 1.4145 1.4626 3.40
7440.......................... 0.4741 0.4909 3.54
7460.......................... 1.1271 1.1429 1.40
7480.......................... 1.0481 1.0441 -0.38
7485.......................... 1.3646 1.2942 -5.16
7490.......................... 1.0712 1.0653 -0.55
7500.......................... 1.3046 1.2877 -1.30
7510.......................... 0.9425 0.9964 5.72
7520.......................... 0.9376 0.9472 1.02
7560.......................... 0.8599 0.8412 -2.17
7600.......................... 1.1474 1.1562 0.77
7610.......................... 0.7869 0.7751 -1.50
7620.......................... 0.8697 0.8624 -0.84
7640.......................... 0.9255 0.9700 4.81
7680.......................... 0.8987 0.9083 1.07
7720.......................... 0.9046 0.8993 -0.59
7760.......................... 0.9257 0.9309 0.56
7800.......................... 0.9802 0.9821 0.19
7840.......................... 1.0852 1.0901 0.45
7880.......................... 0.8659 0.8944 3.29
7920.......................... 0.8424 0.8457 0.39
8003.......................... 1.0927 1.0543 -3.51
8050.......................... 0.8941 0.8740 -2.25
8080.......................... 0.8804 0.8398 -4.61
8120.......................... 1.0506 1.0404 -0.97
8140.......................... 0.8273 0.8243 -0.36
8160.......................... 0.9714 0.9412 -3.11
8200.......................... 1.0940 1.1116 1.61
8240.......................... 0.8504 0.8520 0.19
8280.......................... 0.9065 0.9103 0.42
8320.......................... 0.8599 0.8325 -3.19
8360.......................... 0.8088 0.8150 0.77
8400.......................... 0.9810 0.9381 -4.37
8440.......................... 0.9199 0.9108 -0.99
8480.......................... 1.0432 1.0517 0.81
8520.......................... 0.8911 0.8981 0.79
8560.......................... 0.8332 0.9185 10.24
8600.......................... 0.8130 0.8212 1.01
8640.......................... 0.9521 0.9404 -1.23
8680.......................... 0.8465 0.8403 -0.73
8720.......................... 1.3354 1.3377 0.17
8735.......................... 1.1096 1.1064 -0.29
8750.......................... 0.8756 0.8184 -6.53
8760.......................... 1.0031 1.0405 3.73
8780.......................... 0.9429 0.9856 4.53
8800.......................... 0.8073 0.8394 3.98
8840.......................... 1.0851 1.0904 0.49
8920.......................... 0.8069 0.8366 3.68
8940.......................... 0.9782 0.9692 -0.92
[[Page 31275]]
8960.......................... 0.9939 0.9798 -1.42
9000.......................... 0.7670 0.7494 -2.29
9040.......................... 0.9520 0.9238 -2.96
9080.......................... 0.8498 0.8341 -1.85
9140.......................... 0.8544 0.8158 -4.52
9160.......................... 1.1173 1.0882 -2.60
9200.......................... 0.9640 0.9563 -0.80
9260.......................... 1.0569 1.0372 -1.86
9270.......................... 0.9434 0.9204 -2.44
9280.......................... 0.9026 0.9119 1.03
9320.......................... 0.9358 0.9214 -1.54
9340.......................... 1.0276 1.0196 -0.78
9360.......................... 0.8589 0.8895 3.56
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[FR Doc. 04-12314 Filed 5-28-04; 4:00 pm]
BILLING CODE 4120-01-P