Monday, 

January 23, 2006 

Part II 

Department of 

Health and Human 

Services 

Centers for Medicare & Medicaid Services 

42 CFR Parts 412 and 424 

Medicare Program; Inpatient Psychiatric 

Facilities Prospective Payment System 

Payment Update for Rate Year Beginning 

July 1, 2006 (RY 2007); Proposed Rule 


cchase on PROD1PC60 with PROPOSALS2
3616 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 412 and 424 

[CMS–1306–P] 

Medicare Program; Inpatient 

Psychiatric Facilities Prospective 

Payment System Payment Update for 

Rate Year Beginning July 1, 2006 (RY 

2007) 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Proposed rule. 

SUMMARY: This proposed rule would 

update the prospective payment rates 

for Medicare inpatient hospital services 

provided by inpatient psychiatric 

facilities (IPFs). These changes are 

applicable to IPF discharges occurring 

during the rate year beginning July 1, 

2006 through June 30, 2007. We are 

proposing to adopt the new Office of 

Management and Budget (OMB) labor 

market area definitions for the purpose 

of geographic classification and the 

wage index. In addition, we are 

proposing other new polices and 

making changes to existing policies. 

DATES: We will consider comments if 

we receive them at the appropriate 

address provided below, no later than 5 

p.m. on March 14, 2006. 

ADDRESSES: In commenting, please refer 

to file code CMS–1306–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http:// 

www.cms.hhs.gov/eRulemaking. 

(Attachments should be in Microsoft 

Word, WordPerfect, or Excel; however, 

we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address ONLY: Centers 

for Medicare & Medicaid Services, 

Department of Health and Human 

Services, Attention: CMS–1306–P, P.O. 

Box 8010, Baltimore, MD 21244. 

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786– 

9994 in advance to schedule your 

arrival with one of our staff members. 

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850. 

(Because access to the interior of the 

Humphrey Building is not readily 

available to persons without Federal 

Government identification, commenters 

are encouraged to leave their comments 

in the CMS drop slots located in the 

main lobby of the building. A stamp-in 

clock is available for persons wishing to 

retain a proof of filing by stamping in 

and retaining an extra copy of the 

comments being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

Submission of comments on 

paperwork requirements. You may 

submit comments on this document’s 

paperwork requirements by mailing 

your comments to the addresses 

provided at the end of the ‘‘Collection 

of Information Requirements’’ section in 

this document. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section. 

FOR FURTHER INFORMATION CONTACT: 

Janet Samen, (410) 786–4533 for general 

information. Mary Lee Seifert, (410) 

786–0030 for information regarding the 

market basket and labor-related share. 

Theresa Bean, (410) 786–2287 for 

impact. Matthew Quarrick, (410) 786– 

9867 for wage index. 

SUPPLEMENTARY INFORMATION: 

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this rule to assist us in fully 

considering issues and developing 

policies. You can assist us by 

referencing the file code CMS–1306–P 

and the specific ‘‘issue identifier’’ that 

precedes the section on which you 

choose to comment. 

Inspection of Public Comments: All 

comments received before the close of 

the comment period are available for 

viewing by the public, including any 

personally identifiable or confidential 

business information that is included in 

a comment. CMS posts all electronic 

comments received before the close of 

the comment period on its public Web 

site as soon as possible after they have 

been received. Hard copy comments 

received timely will be available for 

public inspection as they are received, 

generally beginning approximately 3 

weeks after publication of a document, 

at the headquarters of the Centers for 

Medicare & Medicaid Services, 7500 

Security Boulevard, Baltimore, 

Maryland 21244, Monday through 

Friday of each week from 8:30 a.m. to 

4 p.m. To schedule an appointment to 

view public comments, phone 1–800– 

743–3951. 

Table of Contents 

I. Background 

A. General and Legislative History 

B. Overview of the Establishment of the 

IPF PPS 

C. Applicability of the IPF PPS 

II. Overview for Updating the IPF PPS 

A. Requirements for Updating the IPF PPS 

B. Proposed Updates to the IPF PPS 

C. Transition Period for Implementation of 

the IPF PPS 

III. Proposed Updates to the IPF PPS for Rate 

Year beginning July 1, 2006 

A. Calculation of the Average Per Diem 

Cost 

B. Determining the Standardized BudgetNeutral Federal Per Diem Rate 

1. Standardization of the Federal Per Diem 

Base Rate 

2. Calculation of the Budget Neutrality 

Adjustment 

a. Outlier Adjustment 

b. Stop-Loss Provision Adjustment 

c. Behavioral Offset 

3. Revision of Standardization Factor 

C. Update of the Federal Per Diem Base 

Rate 

1. Market Basket for IPFs Reimbursed 

under the IPF PPS 

a. Proposed IPF Market Basket Index 

b. Overview of the Proposed RPL Market 

Basket 

2. Proposed Methodology for Operating 

Portion of the RPL Market Basket 

3. Proposed Methodology for Capital 

Portion of the RPL Market Basket 

4. Proposed Labor-Related Share 

IV. Update of the IPF PPS Adjustment 

Factors 

A. Overview of the IPF PPS Adjustment 

Factors 

B. Proposed Patient-Level Adjustments 

1. Proposed Adjustment for DRG 

Assignment 

2. Proposed Payment for Comorbid 

Conditions 

3. Proposed Patient Age Adjustment 

4. Proposed Variable Per Diem Adjustment 

C. Facility-Level Adjustments 

1. Wage Index Adjustment 

a. Proposed Revisions of the IPF PPS 

Geographic Classifications 

b. Current IPF PPS Labor Market Areas 

Based on MSAs 

c. Core-Based Statistical Areas 

d. Proposed Revision of the IPF PPS Labor 

Market Areas 

i. New England MSAs 

ii. Metropolitan Divisions 

iii. Micropolitan Areas 

e. Implementation of the Proposed Revised 

Labor Market Area under the IPF PPS 

f. Wage Index Budget Neutrality 

1. Proposed Adjustment for Rural Location 

2. Proposed Teaching Adjustment 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3617 

3. Proposed Cost of Living Adjustment for 

IPFs Located in Alaska and Hawaii 

4. Proposed Adjustment for IPFs with a 

Qualifying Emergency Department 

a. Proposed New Source of Admission 

Code to Implement the ED Adjustment 

b. Applicability of the ED Adjustment to 

IPFs in Critical Access Hospitals 

D. Other Payment Adjustments and 

Policies 

1. Outlier Payments 

a. Proposed Update to the Outlier Fixed 

Dollar Loss Amount 

b. Proposed Statistical Accuracy of Cost-toCharge Ratio 

2. Proposed Stop-loss Provision 

3. Patients who Receive Electroconvulsive 

Therapy 

4. Physician Certification and 

Recertification Requirements 

5. Provisions of Therapeutic Recreation in 

IPFs 

6. Same Day Transfers 

V. Provisions of the Proposed Rule 

VI. Collection of Information Requirements 

VII. Regulatory Impact Analysis 

Acronyms 

Because of the many terms to which 

we refer by acronym in this proposed 

rule, we are listing the acronyms used 

and their corresponding terms in 

alphabetical order below: 

BBA Balanced Budget Act of 1997, (Pub. 

L. 105–33) 

BBRA Medicare, Medicaid and SCHIP 

[State Children’s Health Insurance 

Program] Balanced Budget 

Refinement Act of 1999, (Pub. L. 106–

113) 

BIPA Medicare, Medicaid, and SCHIP 

[State Children’s Health Insurance 

Program] Benefits Improvement and 

Protection Act of 2000, (Pub. L. 106–

554) 

CBSA Core-Based Statistical Areas 

CCR Cost-to-charge ratio 

CMS Centers for Medicare & Medicaid 

Services 

CMSA Consolidated Metropolitan 

Statistical Area 

DSM–IV–TR Diagnostic and Statistical 

Manual of Mental Disorders Fourth 

Edition—Text Revision 

DRGs Diagnosis-related groups 

FY Federal fiscal year 

HCRIS Hospital Cost Report Information 

System 

ICD–9–CM International Classification 

of Diseases, 9th Revision, Clinical 

Modification 

IPFs Inpatient psychiatric facilities 

IRFs Inpatient rehabilitation facilities 

LTCHs Long-term care hospitals 

MedPAR Medicare provider analysis 

and review file 

MMA Medicare Prescription Drug, 

Improvement and Modernization Act 

of 2003, (Pub. L. 108–173) 

MSA Metropolitan Statistical Area 

NECMA New England County 

Metropolitan Area 

OMB Office of Management and Budget 

PIP Periodic interim payments 

RY Rate Year (July 1 through June 30) 

TEFRA Tax Equity and Fiscal 

Responsibility Act of 1982, (Pub. L. 

97–248) 

I. Background 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘BACKGROUND’’ at the beginning of 

your comments.] 

A. General and Legislative History 

The Congress directed 

implementation of a prospective 

payment system (PPS) for acute care 

hospitals with the enactment of Public 

Law 98–21. Section 601 of the Social 

Security Amendments of 1983 (Pub. L. 

98–21) added a new section 1886(d) to 

the Social Security Act (the Act) that 

replaced the reasonable cost-based 

payment system for most hospital 

inpatient services with a PPS. 

Although most hospital inpatient 

services became subject to the PPS, 

certain hospitals, including IPFs, 

inpatient rehabilitation facilities (IRFs), 

long term care hospitals (LTCHs), and 

children’s hospitals were excluded from 

the PPS for acute care hospitals. These 

hospitals and units were paid their 

reasonable costs for inpatient services, 

subject to a per discharge limitation or 

target amount under the authority of the 

Tax Equity and Fiscal Responsibility 

Act of 1982 (TEFRA), Public Law 97–

248. The regulations implementing the 

TEFRA (reasonable cost-based) payment 

provisions are located at 42 CFR part 

413. Cancer hospitals were added to the 

list of excluded hospitals by section 

6004(a) of the Omnibus Budget 

Reconciliation Act of 1989, (Pub. L. 

101–239). 

The Congress enacted various 

provisions in the Balanced Budget Act 

of 1997 (BBA) (Pub. L. 105–33), the 

Medicare, Medicaid, and SCHIP (State 

Children’s Health Insurance Program) 

Balanced Budget Refinement Act of 

1999 (BBRA) (Pub. L. 106–113), and the 

Medicare, Medicaid, and SCHIP 

Benefits Improvement and Protection 

Act of 2000 (BIPA) (Pub. L. 106–554) to 

replace the reasonable cost-based 

method of reimbursement with a PPS 

for IRFs, LTCHs, and IPFs. Section 124 

of the BBRA required implementation of 

the IPF PPS. 

Section 124 of the BBRA mandated 

that the Secretary—(1) develop a per 

diem PPS for inpatient hospital services 

furnished in psychiatric hospitals and 

psychiatric units; (2) include in the PPS 

an adequate patient classification 

system that reflects the differences in 

patient resource use and costs among 

psychiatric hospitals and psychiatric 

units; (3) maintain budget neutrality; (4) 

permit the Secretary to require 

psychiatric hospitals and psychiatric 

units to submit information necessary 

for the development of the PPS; and (5) 

submit a report to the Congress 

describing the development of the PPS. 

Section 124 of the BBRA also required 

that the IPF PPS be implemented for 

cost reporting periods beginning on or 

after October 1, 2002. 

Section 405(g)(2) of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA) (Pub. 

L. 108–173) extended the IPF PPS to 

distinct part psychiatric units of critical 

access hospitals (CAHs). 

B. Overview of the Establishment of the 

IPF PPS 

On November 28, 2003, we published 

a proposed rule in the Federal Register 

(68 FR 66920) that proposed to 

implement section 124 of the BBRA. In 

the November 15, 2004 Federal Register 

(69 FR 66922) our final rule 

implemented the IPF PPS for cost 

reporting periods beginning on or after 

January 1, 2005. Although section 124 of 

the BBRA directed that the IPF PPS be 

implemented for cost reporting periods 

beginning on or after October 1, 2002, 

we explained in the proposed and final 

rules that the creation of a PPS requires 

an extraordinary amount of lead-time to 

create a completely new payment 

system and that we were unable to 

perform the analysis required in time for 

an October 1, 2002 implementation, to 

ensure that a system based on CMS 

administrative data would fulfill the 

statutory mandate of section 124 of the 

BBRA. We explained that despite our 

best efforts, we could not engage in 

notice and comment rulemaking and 

achieve implementation of the IPF PPS 

by October 1, 2002. 

The November 2004 final rule 

(hereinafter referred to as the IPF PPS 

final rule) established regulations for the 

IPF PPS under 42 CFR 412, subpart N. 

The IPF PPS established the Federal 

per diem base rate for each patient day 

in an IPF derived from the national 

average daily routine operating, 

ancillary, and capital costs in IPFs in FY 

2002. The average per diem cost was 

updated to the midpoint of the first year 

under the IPF PPS, standardized to 

account for the overall positive effects of 

the IPF PPS payment adjustments, and 

adjusted for budget neutrality. The 

Federal per diem payment under the IPF 

PPS is comprised of the Federal per 

diem base rate described above and 

certain patient and facility payment 

adjustments that were found in the 

regression analysis to be associated with 


cchase on PROD1PC60 with PROPOSALS2
3618 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

statistically significant per diem cost 

differences (see 69 FR 66933 through 

66936 for a description of the regression 

analysis). The patient-level adjustments 

include age, DRG assignment, 

comorbidities, and variable per diem 

adjustments to reflect the higher cost 

incurred in the early days of a 

psychiatric stay. Facility-level 

adjustments include adjustments for the 

IPF’s wage index, rural location, 

teaching status, a cost of living 

adjustment for IPFs located in Alaska 

and Hawaii, and presence of a 

qualifying emergency department (ED). 

The IPF PPS provides additional 

payments for outlier cases, stop-loss 

protection which is applicable only 

during the IPF PPS transition period, 

includes special payment provisions for 

interrupted stays, and a per treatment 

adjustment for patients who undergo 

electroconvulsive therapy (ECT). We 

refer readers to the IPF PPS final rule for 

a comprehensive discussion of the 

research and data that supported the 

establishment of the IPF PPS. 

On April 1, 2005, we published a 

correction to the IPF PPS final rule in 

the Federal Register (70 FR 16724). Any 

reference to the IPF PPS final rule in 

this proposed rule includes the 

provisions in the correction notice. We 

established a CMS website that contains 

useful information regarding the IPF 

PPS including the proposed rule, final 

rule, and the correction notice. The 

website URL is http://www.cms.hhs.gov/ 

InpatientPsychFacilPPS/ and may be 

accessed to download or view 

publications and other information 

pertinent to the IPF PPS. 

C. Applicability of the IPF PPS 

The IPF PPS is applicable to 

freestanding psychiatric hospitals, 

including government-operated 

psychiatric hospitals, and distinct part 

psychiatric units of acute care hospitals 

and CAHs. 

The regulations at § 412.402 define an 

IPF as a hospital that meets the 

requirements specified in § 412.22, 

§ 412.23(a), § 482.60, § 482.61, and 

§ 482.62, and units that meet the 

requirements specified in § 412.22, 

§ 412.25, and § 412.27. 

However, the following hospitals are 

paid under a special payment provision, 

as described in § 412.22(c) and, 

therefore, are not subject to the IPF PPS 

rules: 

• Veterans Administration hospitals. 

• Hospitals that are reimbursed under 

State cost control systems approved 

under 42 CFR part 403. 

• Hospitals that are reimbursed in 

accordance with demonstration projects 

specified in section 402(a) of Public Law 

90–248 (42 U.S.C. 1395b–1) or section 

222(a) of Public Law 92–603 (42 U.S.C. 

1395b–1(note)). 

• Non-participating hospitals 

furnishing emergency services to 

Medicare beneficiaries. 

II. Overview for Updating the IPF PPS 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘OVERVIEW FOR UPDATING THE IPF 

PPS’’ at the beginning of your 

comments.] 

A. Requirements for Updating the IPF 

PPS 

Section 124 of the BBRA does not 

specify an update strategy for the IPF 

PPS and is broadly written to give the 

Secretary discretion in establishing an 

update methodology. Therefore, we 

reviewed the update approach used in 

other hospital PPSs (specifically, the 

IRF and LTCH PPS update 

methodologies). As a result of this 

analysis, we stated in the IPF PPS final 

rule (69 FR 66966) that we would 

implement the IPF PPS using the 

following update strategy—(1) calculate 

the final Federal per diem base rate to 

be budget neutral for the 18-month 

period (that is, January 1, 2005 through 

June 30, 2006); (2) use a July 1 through 

June 30 annual update cycle; and (3) 

allow the IPF PPS first update to be 

effective for discharges July 1, 2006 

through June 30, 2007. In this proposed 

rule, we are proposing updates to the 

IPF PPS for the period of July 1, 2006 

through June 30, 2007. 

As explained in the IPF PPS final 

rule, we believe it is important to delay 

updating the adjustment factors derived 

from the regression analysis until we 

have IPF PPS data that include as much 

information as possible regarding the 

patient-level characteristics of the 

population that each IPF serves. For this 

reason, we do not intend to update the 

regression analysis and recalculate the 

Federal per diem base rate until we have 

analyzed 1 year of IPF PPS claims and 

cost report data (that is, no earlier than 

FY 2008). Until that analysis is 

complete, we stated our intention to 

publish a notice in the Federal Register 

each spring to update the IPF PPS as 

specified in § 412.428 to include: 

• A description of the methodology 

and data used to calculate the updated 

Federal per diem base payment amount. 

• The rate of increase factor as 

described in § 412.424(a)(2)(iii), which 

is based on the excluded hospital with 

capital market basket under the update 

methodology of 1886(b)(3)(B)(ii) of the 

Act for each year. 

• The best available hospital wage 

index and information regarding 

whether an adjustment to the Federal 

per diem base rate is needed to maintain 

budget neutrality. 

• Updates to the fixed dollar loss 

amount in order to maintain the 

appropriate outlier percentage. 

• Describe the ICD–9–CM coding and 

DRG classification changes discussed in 

the annual update to the hospital 

inpatient prospective payment system 

regulations. 

• Update the ECT adjustment by a 

factor specified by CMS. 

B. Proposed Updates to the IPF PPS 

As discussed above, we intended to 

publish a notice in the Federal Register 

in the spring of 2006 that would 

announce the updates to the IPF PPS in 

accordance with § 412.428 rather than 

update through rulemaking (69 FR 

66966). However, since the 

implementation of the IPF PPS, a new 

market basket index was announced in 

the August 2005 IPPS final rule. We 

believe that this new market basket 

should be implemented in the IPF PPS 

as well in order to update the system 

using the best data available. Therefore, 

rather than publish a notice to update 

the IPF PPS in 2006, we are proposing 

changes in this proposed rule to give 

interested parties the opportunity to 

comment. 

Furthermore, we indicated in the IPF 

PPS final rule (69 FR 66952) that we 

were not adopting the new labor market 

definitions developed by the OMB and 

adopted under the IPPS. Rather, we 

explained that we intended to use the 

metropolitan statistical areas (MSAs) 

developed by OMB in 1993 for the wage 

index under the IPF PPS. At the time we 

published the proposed IPF PPS rule, 

the 2003 MSA definitions had not been 

implemented for any Medicare 

programs. In addition, we indicated that 

we believe that the adoption of the new 

labor market area definitions may have 

a significant impact on the wage index 

applied to IPFs and associated payments 

and that we would assess the 

implications of the new MSA 

definitions on IPFs before proposing to 

adopt them. 

We believe that IPFs should be 

afforded an opportunity to comment on 

the use of the new labor market 

definitions before we adopt them under 

the IPF PPS. For this reason also, we are 

publishing this proposed rule, rather 

than a notice, in order to give interested 

parties an opportunity to comment on 

the new labor market definitions (see 

section III.C.1. of this proposed rule). 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3619 

C. Transition Period for Implementation 

of the IPF PPS 

In the IPF PPS final rule, we 

established § 412.426 to provide for a 3- 

year transition period from reasonable 

cost-based reimbursement to full 

prospective payment for IPFs. New IPFs 

are paid 100 percent of the Federal per 

diem rate. However, for those IPFs that 

are transitioning to a new system, 

during the 3-year period as specified in 

the IPF PPS final rule, payment is based 

on an increasing percentage of the PPS 

payment and a decreasing percentage of 

each IPF’s facility-specific TEFRA 

reimbursement rate. The blend 

percentages are as follows: 

TABLE 1.—IPF PPS FINAL RULE TRANSITION BLEND FACTORS

Transition year Cost reporting periods beginning on or after TEFRA rate 

percentage 

IPF PPS 

Federal rate 

percentage 

1 .................................................................. January 1, 2005 ............................................................................. 75 25 

2 .................................................................. January 1, 2006 ............................................................................. 50 50 

3 .................................................................. January 1, 2007 ............................................................................. 25 75 

January 1, 2008 ............................................................................. 0 100 

Changes to the blend percentages 

occur at the beginning of an IPF’s cost 

reporting period. As a result, for 

discharges occurring during IPF cost 

reporting periods beginning in CY 2006, 

IPFs would receive a blended payment 

consisting of 50 percent of the facilityspecific TEFRA payment and 50 percent 

of the IPF PPS payment amount. 

However, regardless of when an IPF’s 

cost reporting year begins, the payment 

update we are proposing would be 

effective for discharges occurring on or 

after July 1, 2006 through June 30, 2007. 

We are not proposing any changes to the 

transition approach established in the 

IPF PPS final rule. 

III. Proposed Updates to the IPF PPS for 

Rate Year beginning July 1, 2006 

The IPF PPS is based on a 

standardized Federal per diem base rate 

calculated from IPF average per diem 

costs and adjusted for budget-neutrality 

in the implementation year. The Federal 

per diem base rate is used as the 

standard payment per day under the IPF 

PPS and is adjusted by the applicable 

wage index factor and the patient-level 

and facility-level adjustments that are 

applicable to the IPF stay. 

The following is an explanation of 

how we calculated the Federal per diem 

base rate and the standardization and 

budget neutrality factors as described in 

the IPF PPS final rule. 

A. Calculation of the Average Per Diem 

Cost 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘PER DIEM COST’’ at the beginning of 

your comments.] 

As indicated in the IPF PPS final rule, 

to calculate the Federal per diem base 

rate, we estimated the average cost per 

day for—(1) routine services from FY 

2002 cost reports (supplemented with 

FY 2001 cost reports if the FY 2002 cost 

report was missing); and (2) ancillary 

services using data from the FY 2002 

Medicare claims and corresponding data 

from facility cost reports. 

For routine services, the per diem 

operating and capital costs were used to 

develop the average per diem cost 

amount. The per diem routine costs 

were obtained from each facility’s 

Medicare cost report. To estimate the 

costs for routine services included in 

the Federal per diem base rate 

calculation, we added the total routine 

costs (including costs for capital) 

submitted on the cost report for each 

provider and divided it by the total 

Medicare days. 

Some average routine costs per day 

were determined to be aberrant, that is, 

the costs were extraordinarily high or 

low and most likely contained data 

errors. We provided a detailed 

discussion in the IPF PPS final rule (69 

FR 66926 through 66927) of the method 

used to trim extraordinarily high or low 

cost values from the per diem rate 

development file in order to improve 

the accuracy of our results. For ancillary 

services, we calculated the costs by 

converting charges from the FY 2002 

Medicare claims into costs using 

facility-specific, cost-center specific 

cost-to-charge ratios obtained from each 

provider’s applicable cost reports. We 

matched each provider’s departmental 

cost-to-charge ratios from their Medicare 

cost report to each charge on their 

claims reported in the MedPAR file. 

Multiplying the total charges for each 

type of ancillary service by the 

corresponding cost-to-charge ratio 

provided an estimate of the costs for all 

ancillary services received by the 

patient during the stay. We determined 

the average ancillary amount per day by 

dividing the total ancillary costs for all 

stays by the total number of covered 

Medicare days. 

Adding the average ancillary costs per 

day and the average routine costs per 

day including capital costs provided the 

estimated average per diem cost for each 

patient day of inpatient psychiatric care 

in FY 2002. 

B. Determining the Standardized 

Budget-Neutral Federal Per Diem Base 

Rate 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘BUDGET NEUTRAL BASE RATE’’ at 

the beginning of your comments.] 

Section 124(a)(1) of the BBRA 

requires that the implementing IPF PPS 

be budget neutral. In other words, the 

amount of total payments under the IPF 

PPS, including any payment 

adjustments, must be projected to be 

equal to the amount of total payments 

that would have been made if the IPF 

PPS were not implemented. Therefore, 

in the IPF PPS final rule, we calculated 

the budget-neutrality factor by setting 

the total estimated IPF PPS payments to 

be equal to the total estimated payments 

that would have been made under the 

TEFRA methodology had the IPF PPS 

not been implemented. The IPF PPS 

final rule includes a step-by-step 

description of the methodology we used 

to estimate payments under the TEFRA 

payment system (69 FR 66930). For the 

IPF PPS methodology, we calculated the 

final Federal per diem base rate to be 

budget neutral during the 

implementation period under the IPF 

PPS using a July 1 update cycle. Thus, 

the implementation period for the IPF 

PPS is the 18-month period January 1, 

2005 through June 30, 2006. 

We updated the average cost per day 

to the midpoint of the IPF PPS 

implementation period (that is, October 

1, 2005). We used the most recent 

projection of the full percentage 

increase in the 1997-based excluded 

hospital with capital market basket 

index for FY 2003 and later in 

accordance with § 413.40(c)(3)(viii). The 

updated average cost per day of $724.43 

was used in the payment model to 


cchase on PROD1PC60 with PROPOSALS2
3620 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

establish the budget neutrality 

adjustment. 

1. Standardization of the Federal Per 

Diem Base Rate 

In the IPF PPS final rule, we 

standardized the IPF PPS Federal per 

diem base rate in order to account for 

the overall positive effects of the IPF 

PPS payment adjustment factors. To 

standardize the IPF PPS payments, we 

compared the IPF PPS payment 

amounts calculated from the psychiatric 

stays in the FY 2002 MedPAR file to the 

projected TEFRA payments from the FY 

2002 cost report file updated to the 

midpoint of the IPF PPS 

implementation period (that is October 

2005). The standardization factor was 

calculated by dividing total estimated 

payments under the TEFRA payment 

system by estimated payments under 

the IPF PPS. The standardization factor 

was calculated to be 0.8367. As a result, 

in the IPF PPS final rule, the $724.43 

average cost per day was reduced by 

16.33 percent (100 percent minus 83.67 

percent). 

2. Calculation of the Budget Neutrality 

Adjustment 

To compute the budget neutrality 

adjustment for the IPF PPS, we 

separately identified each component of 

the adjustment, that is, the outlier 

adjustment, stop-loss adjustment, and 

behavioral offset. 

a. Outlier Adjustment 

Since the IPF PPS payment amount 

for each IPF includes applicable outlier 

amounts, we reduced the standardized 

Federal per diem base rate to account 

for aggregate IPF PPS payments 

estimated to be made as outlier 

payments. The appropriate outlier 

amount was determined by comparing 

the adjusted prospective payment for 

the entire stay to the computed cost per 

case. If costs were above the prospective 

payment plus the adjusted fixed dollar 

loss threshold amount, an outlier 

payment was computed using the 

applicable risk-sharing percentages, as 

explained in greater detail in section 

IV.D.1 of this proposed rule. The outlier 

amount was computed for all stays, and 

the total outlier amount was added to 

the final IPF PPS payment. The outlier 

adjustment was calculated to be 2 

percent. As a result, the standardized 

Federal per diem base rate was reduced 

by 2 percent to account for projected 

outlier payments. 

b. Stop-Loss Provision Adjustment 

As explained in the IPF PPS final 

rule, we provide a stop-loss payment to 

ensure that an IPF’s total PPS payments 

are no less than a minimum percentage 

of their TEFRA payment, had the IPF 

PPS not been implemented. We reduced 

the standardized Federal per diem base 

rate by the percentage of aggregate IPF 

PPS payments estimated to be made for 

stop-loss payments. 

The stop-loss payment amount was 

determined by comparing aggregate 

prospective payments that the provider 

would receive under the IPF PPS to 

aggregate TEFRA payments that the 

provider would have otherwise received 

without implementation of the IPF PPS. 

If an IPF’s aggregate IPF PPS payments 

are less than 70 percent of its aggregate 

payments under TEFRA, a stop-loss 

payment was computed for that IPF. 

The stop-loss payment amounts were 

computed for those IPFs that were 

projected to receive the payments, and 

the total amount was added to the final 

IPF PPS payment amount. As a result, 

the standardized Federal per diem base 

rate was reduced by 0.39 percent in 

order to maintain budget neutrality in 

the IPF PPS. 

c. Behavioral Offset 

As explained in the IPF PPS final 

rule, implementation of the IPF PPS 

may result in certain changes in IPF 

practices especially with respect to 

coding for comorbid medical 

conditions. As a result, Medicare may 

incur higher payments than assumed in 

our calculations. Accounting for these 

effects through an adjustment is 

commonly known as a behavioral offset. 

Based on accepted actuarial practices 

and consistent with the assumptions 

made in other prospective payment 

systems, we assumed in determining the 

behavioral offset that IPFs would regain 

15 percent of potential ‘‘losses’’ and 

augment payment increases by 5 

percent. We applied this actuarial 

assumption, which is based on our 

historical experience with new payment 

systems, to the estimated ‘‘losses’’ and 

‘‘gains’’ among the IPFs. The behavioral 

offset for the IPF PPS was calculated to 

be 2.66 percent. As a result, we reduced 

the standardized Federal per diem base 

rate by 2.66 percent to maintain budget 

neutrality. 

To summarize, the $724.43 updated 

average per diem cost was reduced by 

16.33 percent to account for 

standardization to projected TEFRA per 

diem payments for the implementation 

period, by 2 percent to account for 

outlier payments, by 0.39 percent to 

account for stop-loss payments, and by 

2.66 percent reduction to account for 

the behavioral offset. The final 

standardized budget-neutral Federal per 

diem base rate for the IPF PPS 

implementation year was calculated to 

be $575.95. We discuss the Federal per 

diem base rate for RY 2007 in section III 

B.3. of this proposed rule. 

3. Revision of Standardization Factor 

In reviewing the methodology used to 

simulate the IPF PPS payments used for 

the IPF PPS final rule, we discovered 

that the computer code incorrectly 

assigned non-teaching status to most 

teaching facilities. As a result, total IPF 

PPS payments were underestimated by 

about 1.36 percent. The IPF PPS 

estimated payment total was used in 

calculating the IPF PPS standardization 

factor. The standardization factor 

indicates the proportion by which the 

IPF PPS per diem payment rate and the 

ECT rate must be reduced in order to 

make total IPF PPS payments equal to 

estimated total TEFRA payments 

assuming IPFs continued to be paid 

solely under TEFRA for the first PPS 

payment year. The standardization 

factor is calculated as the ratio of 

estimated total TEFRA payments to 

estimated total IPF PPS payments 

assuming no reduction to the per diem 

and ECT payment rates. Since the IPF 

PPS payment total should have been 

larger than the estimated figure, the 

standardization factor should have been 

smaller (0.8254 vs. 0.8367). In turn, the 

per diem rate and the ECT rate should 

have been reduced by 0.8254 instead of 

0.8367. 

To resolve this issue, we are 

proposing to amend the Federal per 

diem base rate prospectively. Using the 

standardization factor of 0.8254, the 

base rate should have been $568.17 for 

the implementation year of the IPF PPS. 

It is this base rate that we propose to 

update using the market basket rate of 

increase of 4.5 percent and the budgetneutral wage index factor of 1.00156 (as 

discussed in section IV.C.1.f. of this 

proposed rule). Applying these factors 

yields a proposed Federal per diem base 

rate of $594.66 for the rate year (RY) 

beginning July 1, 2006 through June 30, 

2007. 

C. Update of the Federal Per Diem Base 

Rate 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘UPDATE ON PER DIEM BASE RATE’’

at the beginning of your comments.] 

1. Market Basket for IPFs Reimbursed 

under the IPF PPS 

a. Proposed IPF Market Basket Index 

The market basket index used to 

develop the IPF PPS is the excluded 

hospital with capital market basket. 

This market basket was based on 1997 

Medicare cost report data and includes 

data for Medicare participating IPFs, 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3621 

IRFs, LTCHs, cancer, and children’s 

hospitals. 

We are presently unable to create a 

separate market basket specifically for 

psychiatric hospitals due to the small 

number of facilities and the limited data 

that are provided (for instance, 

approximately 4 percent of psychiatric 

facilities reported contract labor cost 

data for 2002). However, since all IRFs, 

LTCHs, and IPFs are now paid under a 

PPS, we are proposing to update PPS 

payments made under the IRF PPS, the 

LTCH PPS, and the IPF PPS, in their 

respective Federal Register updates, 

using a market basket reflecting the 

operating and capital cost structures for 

IRFs, IPFs, and LTCHs, hereafter 

referred to as the RPL (rehabilitation, 

psychiatric, long-term care) market 

basket. We are excluding children’s and 

cancer hospitals from the RPL market 

basket because their payments are based 

entirely on reasonable costs subject to 

rate-of-increase limits established under 

the authority of section 1886(b) of the 

Act, which is implemented in § 413.40 

of the regulations. They are not 

reimbursed under a PPS. Also, the FY 

2002 cost structures for children’s and 

cancer hospitals are noticeably different 

than the cost structures of the IRFs, 

IPFs, and LTCHs. 

The services offered in IRFs, IPFs, and 

LTCHs are typically more laborintensive than those offered in cancer 

and children’s hospitals. Therefore, the 

compensation cost weights for IRFs, 

IPFs, and LTCHs are larger than those in 

cancer and children’s hospitals. In 

addition, the depreciation cost weights 

for IRFs, IPFs, and LTCHs are noticeably 

smaller than those for children’s and 

cancer hospitals. 

In the following discussion, we 

provide an overview on the market 

basket and describe the methodologies 

we propose to use for purposes of 

determining the operating and capital 

portions of the proposed FY 2002-based 

RPL market basket. 

b. Overview of the Proposed RPL Market 

Basket 

The proposed RPL market basket is a 

fixed weight, Laspeyres-type price index 

that is constructed in three steps. First, 

a base period is selected (in this case, 

FY 2002) and total base period 

expenditures are estimated for a set of 

mutually exclusive and exhaustive 

spending categories based upon type of 

expenditure. Then the proportion of 

total costs that each category represents 

is determined. These proportions are 

called cost or expenditure weights. 

Second, each expenditure category is 

matched to an appropriate price or wage 

variable, referred to as a price proxy. In 

nearly every instance, these price 

proxies are price levels derived from 

publicly available statistical series that 

are published on a consistent schedule, 

preferably at least on a quarterly basis. 

Finally, the expenditure weight for 

each cost category is multiplied by the 

level of its respective price proxy for a 

given period. The sum of these products 

(that is, the expenditure weights 

multiplied by their price levels) for all 

cost categories yields the composite 

index level of the market basket in a 

given period. Repeating this step for 

other periods produces a series of 

market basket levels over time. Dividing 

an index level for a given period by an 

index level for an earlier period 

produces a rate of growth in the input 

price index over that time period. 

A market basket is described as a 

fixed-weight index because it answers 

the question of how much it would cost, 

at another time, to purchase the same 

mix of goods and services purchased to 

provide hospital services in a base 

period. The effects on total expenditures 

resulting from changes in the quantity 

or mix of goods and services (intensity) 

purchased subsequent to the base period 

are not measured. In this manner, the 

market basket measures only pure price 

change. Only when the index is rebased 

would the quantity and intensity effects 

be captured in the cost weights. 

Therefore, we rebase the market basket 

periodically so that cost weights reflect 

changes in the mix of goods and 

services that hospitals purchase 

(hospital inputs) to furnish patient care 

between base periods. 

The terms rebasing and revising, 

while often used interchangeably, 

actually denote different activities. 

Rebasing means moving the base year 

for the structure of costs of an input 

price index (for example, shifting the 

base year cost structure from FY 1997 to 

FY 2002). Revising means changing data 

sources, methodology, or price proxies 

used in the input price index. We 

propose to rebase and revise the market 

basket used to update the IPF PPS. 

2. Proposed Methodology for Operating 

Portion of the RPL Market Basket 

The operating portion of the proposed 

FY 2002-based RPL market basket 

consists of several major cost categories 

derived from the FY 2002 Medicare cost 

reports for IRFs, IPFs, and LTCHs: 

wages, drugs, professional liability 

insurance, and a residual. We choose to 

use FY 2002 as the base year because we 

believe this is the most recent, complete 

year of Medicare cost report data and is 

consistent with the data year on which 

the IPF PPS is based. Due to insufficient 

Medicare cost report data for IRFs, IPFs, 

and LTCHs, we propose to develop cost 

weights for benefits, contract labor, and 

blood and blood products using the FY 

2002-based IPPS market basket (70 FR 

23384), which we explain in more detail 

later in this section. For example, less 

than 30 percent of IRFs, IPFs, and 

LTCHs reported benefit cost data in FY 

2002. We have noticed an increase in 

cost data for these expense categories 

over the last 4 years. The next time we 

rebase the RPL market basket there may 

be sufficient IRFs, IPFs, and LTCHs cost 

report data to develop the weights for 

these expenditure categories. 

Since the cost weights for the RPL 

market basket are based on facility costs, 

we are proposing to limit our sample to 

hospitals with a Medicare average 

length of stay (LOS) within a 

comparable range of the total facility 

average LOS. We believe this provides 

a more accurate reflection of the 

structure of costs for Medicare covered 

days. Our goal is to measure cost shares 

that are reflective of case mix and 

practice patterns associated with 

providing services to Medicare 

beneficiaries. 

We propose to use those cost reports 

for IRFs and LTCHs whose Medicare 

average LOS is within 15 percent (that 

is, 15 percent higher or lower) of the 

total facility average LOS for the 

hospital. This is the same edit applied 

to the FY 1992-based and FY 1997- 

based excluded hospital with capital 

market basket. We are proposing 15 

percent because it includes those LTCHs 

and IRFs whose Medicare LOS is within 

approximately 5 days of the facility 

LOS. 

However, we are proposing to use a 

less stringent measure of Medicare LOS 

for IPFs whose average LOS is within 30 

or 50 percent (depending on the total 

facility average LOS) of the total facility 

average LOS. Using this less stringent 

edit allows us to increase our sample 

size by over 150 cost reports and 

produce a cost weight more consistent 

with the overall facility. The edit we 

applied to IPFs when developing the FY 

1997-based excluded hospital with 

capital market basket was based on the 

best available data at the time. 

The detailed cost categories under the 

residual (that is, the remaining portion 

of the market basket after excluding 

wages and salaries, drugs, and 

professional liability cost weights) are 

derived from the FY 2002-based IPPS 

market basket and the 1997 Benchmark 

Input-Output (I–O) Tables published by 

the Bureau of Economic Analysis, U.S. 

Department of Commerce. The FY 2002- 

based IPPS market basket was 

developed using FY 2002 Medicare 

hospital cost reports with the most 


cchase on PROD1PC60 with PROPOSALS2
3622 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

recent and detailed cost data (see the 

IPPS final rule in the August 12, 2005 

Federal Register (70 FR 47388)). The 

1997 Benchmark I–O is the most recent, 

comprehensive source of cost data for 

all hospitals. The proposed RPL cost 

weights for benefits, contract labor, and 

blood and blood products were derived 

using the FY 2002-based IPPS market 

basket. For example, the ratio of the 

benefit cost weight to the wages and 

salaries cost weight in the FY 2002- 

based IPPS market basket was applied to 

the RPL wages and salaries cost weight 

to derive a benefit cost weight for the 

RPL market basket. The remaining 

proposed RPL operating cost categories 

were derived using the 1997 Benchmark 

I–O Tables, aged to 2002 using relative 

price changes. (The methodology we 

used to age the data involves applying 

the annual price changes from the price 

proxies to the appropriate cost 

categories. We repeat this practice for 

each year.) Therefore, using this 

methodology, roughly 59 percent of the 

proposed RPL market basket is 

accounted for by wages, drugs, and 

professional liability insurance data 

from FY 2002 Medicare cost report data 

for IRFs, LTCHs, and IPFs. 

Table 2 below sets forth the complete 

proposed 2002-based RPL market basket 

including cost categories, weights, and 

price proxies. For comparison purposes, 

the corresponding FY 1997-based 

excluded hospital with capital market 

basket is listed as well. 

Wages and salaries are 52.895 percent 

of total costs in the proposed FY 2002- 

based RPL market basket compared to 

47.335 percent for the FY 1997-based 

excluded hospital with capital market 

basket. Employee benefits are 12.982 

percent in the proposed FY 2002-based 

RPL market basket compared to 10.244 

percent for the FY 1997-based excluded 

hospital with capital market basket. As 

a result, compensation costs (wages and 

salaries plus employee benefits) for the 

proposed FY 2002-based RPL market 

basket are 65.877 percent of costs 

compared to 57.579 percent for the FY 

1997-based excluded hospital with 

capital market basket. Of the 8 

percentage-point difference between the 

compensation shares, approximately 3 

percentage points are due to the 

proposed new base year (FY 2002 

instead of FY 1997), 3 percentage points 

are due to revised length of stay edit, 

and the remaining 2 percentage points 

are due to the proposed exclusion of 

other hospitals (that is, only including 

IPFs, IRFs, and LTCHs in the market 

basket). 

Following the table is a summary 

outlining the choice of the proxies we 

propose to use for the operating portion 

of the market basket. The price proxies 

for the capital portion are described in 

more detail in the capital methodology 

section (see section III.C.3 of this 

proposed rule). 

TABLE 2.—PROPOSED FY 2002-BASED RPL MARKET BASKET COST CATEGORIES, WEIGHTS, AND PROXIES WITH FY 

1997-BASED EXCLUDED HOSPITAL WITH CAPITAL MARKET BASKET USED FOR COMPARISON

Expense categories 

FY 1997- 

based 

excluded 

hospital with 

capital market 

basket 

Proposed FY 

2002-based 

RPL market 

basket 

Proposed FY 2002 RPL market basket price proxies 

Total .............................................................................. 100.000 100.000 

Compensation ............................................................... 57.579 65.877 

Wages and Salaries* ............................................. 47.335 52.895 ECI-Wages and Salaries, Civilian Hospital Workers. 

Employee Benefits* ............................................... 10.244 12.982 ECI-Benefits, Civilian Hospital Workers. 

Professional Fees, Non-Medical ........................... 4.423 2.892 ECI-Compensation for Professional, Specialty & 

Technical Workers. 

Utilities .......................................................................... 1.180 0.656 

Electricity ............................................................... 0.726 0.351 PPI-Commercial Electric Power. 

Fuel Oil, Coal, etc. ................................................ 0.248 0.108 PPI-Refined Petroleum Products. 

Water and Sewage ................................................ 0.206 0.197 CPI–U—Water & Sewage Maintenance. 

Professional Liability Insurance .................................... 0.733 1.161 CMS Professional Liability Premium Index. 

All Other Products and Services .................................. 27.117 19.265 

All Other Products ........................................................ 17.914 13.323 

Pharmaceuticals ........................................................... 6.318 5.103 PPI Prescription Drugs. 

Food: Direct Purchase .......................................... 1.122 0.873 PPI Processed Foods & Feeds. 

Food: Contract Service ......................................... 1.043 0.620 CPI–U Food Away From Home. 

Chemicals .............................................................. 2.133 1.100 PPI Industrial Chemicals. 

Blood and Blood Products** .................................. 0.748 ........................

Medical Instruments .............................................. 1.795 1.014 PPI Medical Instruments & Equipment. 

Photographic Supplies .......................................... 0.167 0.096 PPI Photographic Supplies. 

Rubber and Plastics .............................................. 1.366 1.052 PPI Rubber & Plastic Products. 

Paper Products ...................................................... 1.110 1.000 PPI Converted Paper & Paperboard Products. 

Apparel .................................................................. 0.478 0.207 PPI Apparel. 

Machinery and Equipment .................................... 0.852 0.297 PPI Machinery & Equipment. 

Miscellaneous ........................................................ 0.783 1.963 PPI Finished Goods less Food & Energy. 

All Other Services ......................................................... 9.203 5.942 

Telephone .............................................................. 0.348 0.240 CPI–U Telephone Services. 

Postage ................................................................. 0.702 0.682 CPI–U Postage. 

All Other: Labor Intensive ............................................. 4.453 2.219 ECI-Compensation for Intensive Private Service Occupations. 

All Other: Non-labor Intensive ...................................... 3.700 2.800 CPI–U All Items. 

Capital-Related Costs ................................................... 8.968 10.149 

Depreciation .......................................................... 5.586 6.186 

Fixed Assets .......................................................... 3.503 4.250 Boeckh Institutional Construction 23-year useful life. 

Movable Equipment ............................................... 2.083 1.937 WPI Machinery & Equipment 11-year useful life. 

Interest Costs ............................................................... 2.682 2.775 

Nonprofit ................................................................ 2.280 2.081 Average yield on domestic municipal bonds (Bond 

Buyer 20 bonds) vintage- weighted (23 years). 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3623 

TABLE 2.—PROPOSED FY 2002-BASED RPL MARKET BASKET COST CATEGORIES, WEIGHTS, AND PROXIES WITH FY 

1997-BASED EXCLUDED HOSPITAL WITH CAPITAL MARKET BASKET USED FOR COMPARISON—Continued 

Expense categories 

FY 1997- 

based 

excluded 

hospital with 

capital market 

basket 

Proposed FY 

2002-based 

RPL market 

basket 

Proposed FY 2002 RPL market basket price proxies 

For Profit ................................................................ 0.402 0.694 Average yield on Moody’s Aaa bonds vintage weighted (23 years). 

Other Capital-Related Costs ........................................ 0.699 1.187 CPI–U Residential Rent. 

* Labor-related. 

** Blood and blood-related products is included in miscellaneous products. 

Note: Due to rounding, weights may not sum to total. 

Below we provide the proxies that we 

are proposing to use for the FY 2002- 

based RPL market basket. With the 

exception of the Professional Liability 

proxy, all the proposed price proxies for 

the operating portion of the proposed 

RPL market basket are based on Bureau 

of Labor Statistics (BLS) data and are 

grouped into one of the following BLS 

categories: 

• Producer Price Indexes—Producer 

Price Indexes (PPIs) measure price 

changes for goods sold in other than 

retail markets. PPIs are preferable price 

proxies for goods that hospitals 

purchase as inputs in producing their 

outputs because the PPIs better reflect 

the prices faced by hospitals. For 

example, we use a special PPI for 

prescription drugs, rather than the 

Consumer Price Index (CPI) for 

prescription drugs because hospitals 

generally purchase drugs directly from 

the wholesaler. The PPIs that we use 

measure price change at the final stage 

of production. 

• Consumer Price Indexes—

Consumer Price Indexes (CPIs) measure 

change in the prices of final goods and 

services bought by the typical 

consumer. Because they may not 

represent the price faced by a producer, 

we use CPIs only if an appropriate PPI 

is not available, or if the expenditures 

are more similar to those of retail 

consumers in general rather than 

purchases at the wholesale level. For 

example, the CPI for food purchases 

away from home is used as a proxy for 

contracted food services. 

• 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. 

Appropriately, they are not affected by 

shifts in employment mix. 

We evaluated the price proxies using 

the criteria of reliability, timeliness, 

availability, and relevance. Reliability 

indicates that the index is based on 

valid statistical methods and has low 

sampling variability. Timeliness implies 

that the proxy is published regularly, 

preferably at least once a quarter. 

Availability means that the proxy is 

publicly available. Finally, relevance 

means that the proxy is applicable and 

representative of the cost category 

weight to which it is applied. The CPIs, 

PPIs, and ECIs selected by us to be 

proposed in this regulation meet these 

criteria. 

We note that the proxies are the same 

as those used for the FY 1997-based 

excluded hospital with capital market 

basket. Because these proxies meet our 

criteria of reliability, timeliness, 

availability, and relevance, we believe 

they continue to be the best measure of 

price changes for the cost categories. For 

further discussion on the FY 1997-based 

excluded hospital with capital market 

basket, see the IPPS final rule published 

in the Federal Register on August 1, 

2002 (67 FR at 50042). 

Wages and Salaries 

For measuring the price growth of 

wages in the proposed FY 2002-based 

RPL market basket, we propose to use 

the ECI for wages and salaries for 

civilian hospital workers as the proxy 

for wages in the RPL market basket. 

Employee Benefits 

The proposed FY 2002-based RPL 

market basket uses the ECI for employee 

benefits for civilian hospital workers. 

Nonmedical Professional Fees 

The ECI for compensation for 

professional and technical workers in 

private industry would be applied to 

this category since it includes 

occupations such as management and 

consulting, legal, accounting, and 

engineering services. 

Fuel, Oil, and Gasoline 

The percentage change in the price of 

gas fuels as measured by the PPI 

(Commodity Code #0552) would be 

applied to this component. 

Electricity 

The percentage change in the price of 

commercial electric power as measured 

by the PPI (Commodity Code #0542) 

would be applied to this component. 

Water and Sewage 

The percentage change in the price of 

water and sewage maintenance as 

measured by the Consumer Price Index 

(CPI) for all urban consumers (CPI Code 

#CUUR0000SEHG01) would be applied 

to this component. 

Professional Liability Insurance 

The proposed FY 2002-based RPL 

market basket would use the percentage 

change in hospital professional liability 

insurance (PLI) premiums as estimated 

by the CMS Hospital Professional 

Liability Index for the proxy of this 

category. In the FY 1997-based excluded 

hospital with capital market basket, the 

same proxy was used. 

We continue to research options for 

improving our proxy for professional 

liability insurance. This research 

includes exploring various options for 

expanding our current survey, including 

the identification of another entity that 

would be willing to work with us to 

collect more complete and 

comprehensive data. We are also 

exploring other options such as third 

party or industry data that might assist 

us in creating a more precise measure of 

PLI premiums. At this time we have not 

identified a preferred option, therefore 

no change is proposed for the proxy in 

this proposed rule. 

Pharmaceuticals 

The percentage change in the price of 

prescription drugs as measured by the 

PPI (PPI Code #PPI32541DRX) would be 

used as a proxy for this cost category. 

This is a special index produced by BLS 

as a proxy in the 1997-based excluded 

hospital with capital market basket. 


cchase on PROD1PC60 with PROPOSALS2
3624 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

Food, Direct Purchases 

The percentage change in the price of 

processed foods and feeds as measured 

by the PPI (Commodity Code #02) 

would be applied to this component. 

Food, Contract Service 

The percentage change in the price of 

food purchased away from home as 

measured by the CPI for all urban 

consumers (CPI Code #CUUR0000SEFV) 

would be applied to this component. 

Chemicals 

The percentage change in the price of 

industrial chemical products as 

measured by the PPI (Commodity Code 

#061) would be applied to this 

component. While the chemicals 

hospitals purchase include industrial as 

well as other types of chemicals, the 

industrial chemicals component 

constitutes the largest proportion by far. 

Thus we believe that Commodity Code 

#061 is the appropriate proxy. 

Medical Instruments 

The percentage change in the price of 

medical and surgical instruments as 

measured by the PPI (Commodity Code 

#1562) would be applied to this 

component. 

Photographic Supplies 

The percentage change in the price of 

photographic supplies as measured by 

the PPI Commodity Code #1542) would 

be applied to this component. 

Rubber and Plastics 

The percentage change in the price of 

rubber and plastic products as measured 

by the PPI (Commodity Code #07) 

would be applied to this component. 

Paper Products 

The percentage change in the price of 

converted paper and paperboard 

products as measured by the PPI 

(Commodity Code #0915) would be 

applied to this component. 

Apparel 

The percentage change in the price of 

apparel as measured by the PPI 

(Commodity Code #381) would be 

applied to this component. 

Machinery and Equipment 

The percentage change in the price of 

machinery and equipment as measured 

by the PPI (Commodity Code #11) 

would be applied to this component. 

Miscellaneous Products 

The percentage change in the price of 

all finished goods less food and energy 

as measured by the PPI (Commodity 

Code #SOP3500) would be applied to 

this component. Using this index would 

remove the double-counting of food and 

energy prices, which are captured 

elsewhere in the market basket. The 

weight for this cost category is higher, 

in part, than in the 1997-based index 

because the weight for blood and blood 

products (1.188) is added to it. In the 

1997-based excluded hospital with 

capital market basket, we included a 

separate cost category for blood and 

blood products, using the BLS PPI for 

blood and derivatives as a price proxy. 

A review of recent trends in the PPI for 

blood and derivatives suggests that its 

movements may not be consistent with 

the trends in blood costs faced by 

hospitals. While this proxy did not 

match exactly with the product 

hospitals are buying, its trend over time 

appears to be reflective of the historical 

price changes of blood purchased by 

hospitals. However, an apparent 

divergence over recent years led us to 

reevaluate whether the PPI for blood 

and derivatives was an appropriate 

measure of the changing price of blood. 

We ran test market baskets classifying 

blood in three separate cost categories: 

blood and blood products, contained 

within chemicals as was done for the 

1992-based excluded hospital with 

capital market basket, and within 

miscellaneous products. These 

categories use as proxies the following 

PPIs: The PPI for blood and blood 

products, the PPI for chemicals, and the 

PPI for finished goods less food and 

energy, respectively. Of these three 

proxies, the PPI for finished goods less 

food and energy moved most like the 

recent blood cost and price trends. In 

addition, the impact on the overall 

market basket by using different proxies 

for blood was negligible, mostly due to 

the relatively small weight for blood in 

the market basket. 

Therefore, we are proposing to use the 

PPI for finished goods less food and 

energy for the blood proxy because we 

believe it more appropriately proxies 

the price changes (not quantities or 

required tests) associated with blood 

purchased by hospitals. We will 

continue to evaluate this proxy for its 

appropriateness and will explore the 

development of alternative price 

indexes to proxy the price changes 

associated with this cost. 

Telephone 

The percentage change in the price of 

telephone services as measured by the 

CPI for all urban consumers (CPI Code 

#CUUR0000SEED) would be applied to 

this component. 

Postage 

The percentage change in the price of 

postage as measured by the CPI for all 

urban consumers (CPI Code 

#CUUR0000SEEC01) would be applied 

to this component. 

All Other Services, Labor Intensive 

The percentage change in the ECI for 

compensation paid to service workers 

employed in private industry would be 

applied to this component. 

All Other Services, Nonlabor Intensive 

The percentage change in the all items 

component of the CPI for all urban 

consumers (CPI Code # CUUR0000SA0) 

would be applied to this component. 

3. Proposed Methodology for Capital 

Portion of the RPL Market Basket 

Unlike for the operating costs of the 

proposed FY 2002-based RPL market 

basket, we did not have IRF, IPF, and 

LTCH FY 2002 Medicare cost report 

data for the capital cost weights, due to 

a change in the FY 2002 reporting 

requirements. Rather, we used these 

hospitals’ expenditure data for the 

capital cost categories of depreciation, 

interest, and other capital expenses for 

FY 2001, and aged the data to a FY 2002 

base year using relevant price proxies. 

We calculated weights for the 

proposed RPL market basket capital 

costs using the same set of Medicare 

cost reports used to develop the 

operating share for IRFs, IPFs, and 

LTCHs. The resulting proposed capital 

weight for the FY 2002 base year is 

10.149 percent. This is based on FY 

2001 Medicare cost report data for IRFs, 

IPFs, and LTCHs, aged to FY 2002 using 

relevant price proxies. 

Lease expenses are not a separate cost 

category in the market basket, but are 

distributed among the cost categories of 

depreciation, interest, and other, 

reflecting the assumption that the 

underlying cost structure of leases is 

similar to capital costs in general. We 

assumed 10 percent of lease expenses 

are overhead and assigned them to the 

other capital expenses cost category as 

overhead. We base this assignment of 10 

percent of lease expenses to overhead 

on the common assumption that 

overhead is 10 percent of costs. The 

remaining lease expenses were 

distributed to the three cost categories 

based on the weights of depreciation, 

interest, and other capital expenses not 

including lease expenses. 

Depreciation contains two 

subcategories: building and fixed 

equipment and movable equipment. The 

split between building and fixed 

equipment and movable equipment was 

determined using the FY 2001 Medicare 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3625 

cost reports for IRFs, IPFs, and LTCHs. 

This methodology was also used to 

compute the 1997-based index (67 FR at 

50044). 

The total interest expense cost 

category is split between the 

government/nonprofit and for-profit 

hospitals. The 1997-based excluded 

hospital with capital market basket 

allocated 85 percent of the total interest 

cost weight to the government nonprofit 

interest, proxies by average yield on 

domestic municipal bonds, and 15 

percent to for-profit interest, proxies by 

average yield on Moody’s Aaa bonds. 

We propose to derive the split using 

the relative FY 2001 Medicare cost 

report data for PPS hospitals on interest 

expenses for the government/nonprofit 

and for-profit hospitals. Due to 

insufficient Medicare cost report data 

for IPFs, IRFs, and LTCHs, we propose 

to use the same split used in the IPPS 

capital input price index. We believe it 

is important that this split reflect the 

latest relative cost structure of interest 

expenses for hospitals and, therefore, 

we propose to use a 75–25 split to 

allocate interest expenses to 

government/nonprofit and for-profit (70 

FR at 47408). 

Since capital is acquired and paid for 

over time, capital expenses in any given 

year are determined by both past and 

present purchases of physical and 

financial capital. The vintage-weighted 

capital index is intended to capture the 

long-term consumption of capital, using 

vintage weights for depreciation 

(physical capital) and interest (financial 

capital). These vintage weights reflect 

the purchase patterns of building and 

fixed equipment and movable 

equipment over time. Depreciation and 

interest expenses are determined by the 

amount of past and current capital 

purchases. Therefore we are proposing 

to use the vintage weights to compute 

vintage-weighted price changes 

associated with depreciation and 

interest expense. 

Vintage weights are an integral part of 

the proposed FY 2002-based RPL market 

basket. Capital costs are inherently 

complicated and are determined by 

complex capital purchasing decisions, 

over time, based on such factors as 

interest rates and debt financing. In 

addition, capital is depreciated over 

time instead of being consumed in the 

same period it is purchased. The capital 

portion of the proposed FY 2002-based 

RPL market basket would reflect the 

annual price changes associated with 

capital costs, and would be a useful 

simplification of the actual capital 

investment process. By accounting for 

the vintage nature of capital, we are able 

to provide an accurate, stable annual 

measure of price changes. Annual nonvintage price changes for capital are 

unstable due to the volatility of interest 

rate changes and, therefore, do not 

reflect the actual annual price changes 

for Medicare capital-related costs. The 

capital component of the proposed FY 

2002-based RPL market basket would 

reflect the underlying stability of the 

capital acquisition process and provide 

hospitals with the ability to plan for 

changes in capital payments. 

To calculate the vintage weights for 

depreciation and interest expenses, we 

needed a time series of capital 

purchases for building and fixed 

equipment and movable equipment. We 

found no single source that provides the 

best time series of capital purchases by 

hospitals for all of the above 

components of capital purchases. The 

early Medicare Cost Reports did not 

have sufficient capital data to meet this 

need. While the American Hospital 

Association (AHA) Panel Survey 

provided a consistent database back to 

1963, it did not provide annual capital 

purchases. However, the AHA Panel 

Survey provided a time series of 

depreciation expenses through 1997 

which could be used to infer capital 

purchases over time. From 1998 to 2001, 

hospital depreciation expenses were 

calculated by multiplying the AHA 

Annual Survey total hospital expenses 

by the ratio of depreciation to total 

hospital expenses from the Medicare 

cost reports. Beginning in 2001, the 

AHA Annual Survey began collecting 

depreciation expenses. We hope to be 

able to use these data in future 

rebasings. 

In order to estimate capital purchases 

from AHA data on depreciation and 

interest expenses, the expected life for 

each cost category (building and fixed 

equipment, movable equipment, and 

debt instruments) is needed. Due to 

insufficient Medicare cost report data 

for IPFs, IRFs, and LTCHs, we propose 

to use FY 2001 Medicare Cost Reports 

for IPPS hospitals to determine the 

expected life of building and fixed 

equipment and movable equipment. We 

believe this data source reflects the 

latest relative cost structure of 

depreciation expenses for hospitals and 

is analogous to IPFs, IRFs, and LTCHs. 

The expected life of any piece of 

equipment can be determined by 

dividing the value of the asset 

(excluding fully depreciated assets) by 

its current year depreciation amount. 

This calculation yields the estimated 

useful life of an asset if depreciation 

were to continue at current year levels, 

assuming straight-line depreciation. 

From the FY 2001 Medicare cost reports 

for IPPS hospitals the expected life of 

building and fixed equipment was 

determined to be 23 years, and the 

expected life of movable equipment was 

determined to be 11 years. 

We also propose to use the fixed and 

movable weights derived from FY 2001 

Medicare cost reports for IPFs, IRFs, and 

LTCHs to separate the depreciation 

expenses into annual amounts of 

building and fixed equipment 

depreciation and movable equipment 

depreciation. By multiplying the annual 

depreciation amounts by the expected 

life calculations from the FY 2001 

Medicare cost reports, year-end asset 

costs for building and fixed equipment 

and movable equipment were 

determined. We then calculated a time 

series back to 1963 of annual capital 

purchases by subtracting the previous 

year asset costs from the current year 

asset costs. From this capital purchase 

time series we were able to calculate the 

vintage weights for building and fixed 

equipment, movable equipment, and 

debt instruments. An explanation of 

each of these sets of vintage weights 

follows. 

For proposed building and fixed 

equipment vintage weights, the real 

annual capital purchase amounts for 

building and fixed equipment derived 

from the AHA Panel Survey were used. 

The real annual purchase amount was 

used to capture the actual amount of the 

physical acquisition, net of the effect of 

price inflation. This real annual 

purchase amount for building and fixed 

equipment was produced by deflating 

the nominal annual purchase amount by 

the building and fixed equipment price 

proxy, the Boeckh Institutional 

Construction Index. This is the same 

proxy used for the FY 1997-based 

excluded hospital with capital market 

basket. We believe this proxy continues 

to meet our criteria of reliability, 

timeliness, availability, and relevance. 

Since building and fixed equipment has 

an expected life of 23 years, the vintage 

weights for building and fixed 

equipment are deemed to represent the 

average purchase pattern of building 

and fixed equipment over 23-year 

periods. With real building and fixed 

equipment purchase estimates back to 

1963, sixteen 23-year periods could be 

averaged to determine the average 

vintage weights for building and fixed 

equipment that are representative of 

average building and fixed equipment 

purchase patterns over time. Vintage 

weights for each 23-year period are 

calculated by dividing the real building 

and fixed capital purchase amount in 

any given year by the total amount of 

purchases in the 23-year period. This 

calculation is done for each year in the 

23-year period, and for each of the 


cchase on PROD1PC60 with PROPOSALS2
3626 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

sixteen 23-year periods. The average of 

each year across the sixteen 23-year 

periods is used to determine the 2002 

average building and fixed equipment 

vintage weights. 

For proposed movable equipment 

vintage weights, the real annual capital 

purchase amounts for movable 

equipment derived from the AHA Panel 

Survey were used to capture the actual 

amount of the physical acquisition, net 

of price inflation. This real annual 

purchase amount for movable 

equipment was calculated by deflating 

the nominal annual purchase amount by 

the movable equipment price proxy, the 

PPI for Machinery and Equipment. This 

is the same proxy used for the FY 1997- 

based excluded hospital with capital 

market basket. We believe this proxy, 

which meets our criteria, is the best 

measure of price changes for this cost 

category. Since movable equipment has 

an expected life of 11 years, the vintage 

weights for movable equipment are 

deemed to represent the average 

purchase pattern of movable equipment 

over an 11-year period. With real 

movable equipment purchase estimates 

available back to 1963, twenty-eight 11- 

year periods could be averaged to 

determine the average vintage weights 

for movable equipment that are 

representative of average movable 

equipment purchase patterns over time. 

Vintage weights for each 11-year period 

would be calculated by dividing the real 

movable capital purchase amount for 

any given year by the total amount of 

purchases in the 11-year period. This 

calculation is done for each year in the 

11-year period, and for each of the 

twenty-eight 11-year periods. The 

average of the twenty-eight 11-year 

periods would be used to determine the 

FY 2002 average movable equipment 

vintage weights. 

For proposed interest vintage weights, 

the nominal annual capital purchase 

amounts for total equipment (building 

and fixed and movable) derived from 

the AHA Panel and Annual Surveys 

were used. Nominal annual purchase 

amounts were used to capture the value 

of the debt instrument. Since hospital 

debt instruments have an expected life 

of 23 years, the vintage weights for 

interest are deemed to represent the 

average purchase pattern of total 

equipment over 23-year periods. With 

nominal total equipment purchase 

estimates available back to 1963, sixteen 

23-year periods could be averaged to 

determine the average vintage weights 

for interest that are representative of 

average capital purchase patterns over 

time. Vintage weights for each 23-year 

period would be calculated by dividing 

the nominal total capital purchase 

amount for any given year by the total 

amount of purchases in the 23-year 

period. This calculation would be done 

for each year in the 23-year period and 

for each of the sixteen 23-year periods. 

The average of the sixteen 23-year 

periods would be used to determine the 

FY 2002 average interest vintage 

weights. The vintage weights for the 

index are presented in Table 3 below. 

In addition to the price proxies for 

depreciation and interest costs 

described above in the vintage weighted 

capital section, we propose to use the 

CPI–U for Residential Rent as a price 

proxy for other capital-related costs. The 

price proxies for each of the capital cost 

categories are the same as those used for 

the IPPS final rule (67 FR at 50044) 

capital input price index. 

TABLE 3.—PROPOSED CMS FY 2002-BASED RPL MARKET BASKET CAPITAL VINTAGE WEIGHTS

Year 

Fixed assets 

(23 year 

weights) 

Movable 

assets 

(11 year 

weights) 

Interest: Capital-related 

(23 year 

weights) 

1 ................................................................................................................................................... 0.021 0.065 0.010 

2 ................................................................................................................................................... 0.022 0.071 0.012 

3 ................................................................................................................................................... 0.025 0.077 0.014 

4 ................................................................................................................................................... 0.027 0.082 0.016 

5 ................................................................................................................................................... 0.029 0.086 0.019 

6 ................................................................................................................................................... 0.031 0.091 0.023 

7 ................................................................................................................................................... 0.033 0.095 0.026 

8 ................................................................................................................................................... 0.035 0.100 0.029 

9 ................................................................................................................................................... 0.038 0.106 0.033 

10 ................................................................................................................................................. 0.040 0.112 0.036 

11 ................................................................................................................................................. 0.042 0.117 0.039 

12 ................................................................................................................................................. 0.045 ........................ 0.043 

13 ................................................................................................................................................. 0.047 ........................ 0.048 

14 ................................................................................................................................................. 0.049 ........................ 0.053 

15 ................................................................................................................................................. 0.051 ........................ 0.056 

16 ................................................................................................................................................. 0.053 ........................ 0.059 

17 ................................................................................................................................................. 0.056 ........................ 0.062 

18 ................................................................................................................................................. 0.057 ........................ 0.064 

19 ................................................................................................................................................. 0.058 ........................ 0.066 

20 ................................................................................................................................................. 0.060 ........................ 0.070 

21 ................................................................................................................................................. 0.060 ........................ 0.071 

22 ................................................................................................................................................. 0.061 ........................ 0.074 

23 ................................................................................................................................................. 0.061 ........................ 0.076 

Total ...................................................................................................................................... 1.000 1.000 1.000 

The proposed rate year (that is, 

beginning July 1, 2006) update for the 

IPF PPS using the proposed FY 2002- 

based RPL market basket and Global 

Insight’s 3rd quarter 2005 forecast 

would be 4.5 percent. This reflects 

increases in both the operating and 

capital portions of the market basket 

from the 18-month period (that is, 

January 1, 2005 through June 30, 2006). 

Global Insight, Inc. is a nationally 

recognized economic and financial 

forecasting firm that contracts with CMS 

to forecast the components of the market 

baskets. Using the current FY 1997- 

based excluded hospital with capital 

market basket (66 FR 41427), Global 

Insight’s 3rd quarter 2005 forecast for 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3627 

the proposed rate year beginning July 1, 

2006 would be 4.5 percent. Table 4 

below compares the proposed FY 2002- 

based RPL market basket and the FY 

1997-based excluded hospital with 

capital market basket percent changes. 

For both the historical and forecasted 

periods between RY 2000 and RY 2008, 

the difference between the two market 

baskets is minor with the exception of 

RY 2002, where the proposed FY 2002- 

based RPL market basket increased three 

tenths of a percentage point higher than 

the FY 1997-based excluded hospital 

with capital market basket. This is 

primarily due to the proposed FY 2002- 

based RPL having a larger compensation 

(that is, the sum of wages and salaries 

and benefits) cost weight than the FY 

1997-based index and the price changes 

associated with compensation costs 

increasing much faster than the prices of 

other market basket components. Also 

contributing is the ‘‘all other nonlabor 

intensive’’ cost weight, which is smaller 

in the proposed FY 2002-based RPL 

market basket than in the FY 1997-based 

index, as well as the slower price 

changes associated with these costs. 

TABLE 4.—PROPOSED FY 2002-BASED RPL MARKET BASKET AND FY 1997-BASED EXCLUDED HOSPITAL WITH CAPITAL

MARKET BASKET, PERCENT CHANGES: 2000–2008 

Rate year 

(RY) 

Proposed 

rebased FY 

2002-based 

RPL market 

basket 

FY 1997- 

based excluded hospital 

market basket 

with capital 

Historical data: 

RY 2000 ............................................................................................................................................................ 2.8 2.7 

RY 2001 ............................................................................................................................................................ 3.8 3.9 

RY 2002 ............................................................................................................................................................ 4.1 3.8 

RY 2003 ............................................................................................................................................................ 3.8 3.7 

RY 2004 ............................................................................................................................................................ 3.6 3.6 

Average RY 2000–2004 ............................................................................................................................ 3.6 3.5 

Forecast: 

RY 2005 ............................................................................................................................................................ 3.8 3.9 

RY 2006 ............................................................................................................................................................ 3.7 3.8 

RY 2007 ............................................................................................................................................................ 3.6 3.6 

RY 2008 ............................................................................................................................................................ 3.5 3.5 

Average RY 2005–2008 ............................................................................................................................ 3.7 3.7 

Source: Global Insight, Inc. 3rd Qtr 2005, @USMACRO/CNTL0905 @CISSIM/TL0805.SIM 

Note: The RY forecasts are based on the standard 12-month period of July 1 to June 30. For this proposed rule, we are moving from an 18- 

month period to a 12-month period. 

4. Proposed Labor-Related Share 

As described in section IV.C.1 of this 

proposed rule, due to the variations in 

costs and geographic wage levels, we are 

proposing that payment rates under the 

IPF PPS continue to be adjusted by a 

geographic wage index. This wage index 

would apply to the labor-related portion 

of the proposed Federal per diem base 

rate, hereafter referred to as the laborrelated share. 

The labor-related share is determined 

by identifying the national average 

proportion of operating costs that are 

related to, influenced by, or vary with 

the local labor market. Using our current 

definition of labor-related, the laborrelated share is the sum of the relative 

importance of wages and salaries, fringe 

benefits, professional fees, laborintensive services, and a portion of the 

capital share from an appropriate 

market basket. 

We are proposing to use the FY 2002- 

based RPL market basket costs to 

determine the proposed labor-related 

share for the IPF PPS. The proposed 

labor-related share for RY 2007 would 

be the sum of the proposed RY 2007 

relative importance of each labor-related 

cost category, and would reflect the 

different rates of price change for these 

cost categories between the base year 

(FY 2002) and RY 2007. The sum of the 

proposed relative importance for RY 

2007 for operating costs (wages and 

salaries, employee benefits, professional 

fees, and labor-intensive services) 

would be 71.845, as shown in Table 5 

below. The portion of capital that is 

influenced by the local labor market 

would be estimated to be 46 percent, 

which is the same percentage used in 

the FY 1997-based IRF and IPF payment 

systems. Since the relative importance 

for capital would be 8.866 (RY 2007) 

percent of the proposed FY 2002-based 

RPL market basket in RY 2007, we are 

proposing to take 46 percent of 8.866 

percent to determine the proposed 

labor-related share of capital for RY 

2007. The result would be 4.078 

percent, which we propose to add to 

71.845 percent for the operating cost 

amount to determine the total proposed 

labor-related share for RY 2007. Thus, 

the labor-related share that we propose 

to use for IPF PPS in RY 2007 would be 

75.923 percent. This proposed laborrelated share is determined using the 

same methodology as employed in 

calculating all previous IPF laborrelated shares (69 FR at 66952). 

Table 5 below shows the proposed RY 

2007 relative importance labor-related 

share using the proposed FY 2002-based 

RPL market basket and the FY 1997- 

based excluded hospital with capital 

market basket. We note that the revised 

and rebased labor-related share would 

benefit those hospitals with a wage 

index greater than or equal to 1.000. 


cchase on PROD1PC60 with PROPOSALS2
3628 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

TABLE 5.—TOTAL LABOR-RELATED SHARE—RELATIVE IMPORTANCE FOR RY 2007 

Cost category 

FY 2002- 

based RPL 

market basket 

relative importance 

(Percent) RY 

2007 

FY 1997 excluded hospital 

with capital 

market basket 

relative importance 

(Percent) RY 

2007 

Wages and salaries ................................................................................................................................................. 52.761 48.301 

Employee benefits ................................................................................................................................................... 14.008 11.517 

Professional fees ..................................................................................................................................................... 2.903 4.527 

All other labor-intensive services ............................................................................................................................. 2.173 4.457 

Subtotal ............................................................................................................................................................. 71.845 68.802 

Labor-related share of capital costs ........................................................................................................................ 4.078 3.225 

Total ........................................................................................................................................................... 75.923 72.027 

IPFs Paid Based on a Blend of the 

Reasonable Cost-based Payments 

Under the broad authority of sections 

1886(b)(3)(A) and (b)(3)(B) of the Act 

and as stated in the FY 2006 IPPS final 

rule (70 FR 47399), for IPFs that are 

transitioning to the fully Federal 

prospective payment rate, we are now 

using the rebased and revised FY 2002- 

based excluded hospital market basket 

to update the reasonable cost-based 

portion of their payments. We rebase the 

market basket periodically so that the 

cost weights reflect changes in the mix 

of goods and services that hospitals 

purchase to furnish inpatient care 

between base periods. We chose FY 

2002 as the base year for the excluded 

hospital market basket because we 

believe this is the most recent, complete 

year of Medicare cost report data. 

The reasonable cost-based payments, 

subject to TEFRA limits, are determined 

on a FY basis. For purposes of the 

update factor for FY 2006, the portion 

of the IPF PPS transitional blend 

payment based on reasonable costs was 

determined by updating the IPF’s 

TEFRA limit by the FY 2002-based 

excluded hospital market basket (or 3.8 

percent) (70 FR 47691). 

As discussed in section III.B.3 of this 

proposed rule, the proposed Federal per 

diem base rate is $594.66 for the RY 

beginning July 1, 2006 and ending June 

30, 2007. 

IV. Update of the IPF PPS Adjustment 

Factors 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘ADJUSTMENT FACTORS’’ at the 

beginning of your comments.] 

A. Overview of the IPF PPS Adjustment 

Factors 

In developing the IPF PPS, in order to 

ensure that the IPF PPS would be able 

to account adequately for each IPF’s 

case-mix, we performed an extensive 

regression analysis of the relationship 

between the per diem costs and certain 

patient and facility characteristics to 

determine those characteristics 

associated with statistically significant 

cost differences on a per diem basis. For 

characteristics with statistically 

significant cost differences, we used the 

regression coefficients of those variables 

to determine the size of the 

corresponding payment adjustments. 

The IPF PPS payment adjustments 

were derived from a regression analysis 

of 100 percent of the FY 2002 MedPAR 

data file which contained 483,038 cases. 

We propose to use the same results of 

this regression analysis for this 

proposed rule. For a more detailed 

description of the data file used for the 

regression analysis, see the IPF PPS 

final rule. 

We computed a per diem cost for each 

Medicare inpatient psychiatric stay, 

including routine operating, ancillary, 

and capital components using 

information from the FY 2002 MedPAR 

file and data from the FY 2002 Medicare 

cost reports. To calculate the cost per 

day for each inpatient psychiatric stay, 

routine costs were estimated by 

multiplying the routine cost per day 

from the IPF’s FY 2002 Medicare cost 

report by the number of Medicare 

covered days on the FY 2002 MedPAR 

stay record. Ancillary costs were 

estimated by multiplying each 

departmental cost-to-charge ratio by the 

corresponding ancillary charges on the 

MedPAR stay record. The total cost per 

day was calculated by summing routine 

and ancillary costs for the stay and 

dividing it by the number of Medicare 

covered days for each day of the stay. 

As discussed in more detail in section 

IV.C.5 of this proposed rule, the IPF PPS 

includes a payment adjustment for IPFs 

with qualifying Emergency Departments 

(EDs), and IPFs that are part of acute 

care hospitals and CAHs with qualifying 

EDs. As a result, ED costs were excluded 

from the dependent variable used in the 

cost regression in order to remove the 

effects of ED costs from other payment 

adjustment factors with which ED costs 

may be correlated and thus avoid 

overpaying ED costs. 

The log of per diem cost, like most 

health care cost measures, appeared to 

be normally distributed. Therefore, the 

natural logarithm of the per diem cost 

was the dependent variable in the 

regression analysis. We included 

variables in the regression to control for 

psychiatric hospitals that do not bill 

ancillary costs and for ECT costs that we 

pay separately. The per diem cost was 

adjusted for differences in labor cost 

across geographic areas using the FY 

2005 hospital wage index unadjusted for 

geographic reclassifications, in order to 

be consistent with our use of the market 

basket labor share in applying the wage 

index adjustment. 

As discussed in the IPF PPS final rule 

(69 FR 66936), we computed a wage 

adjustment factor for each case by 

multiplying the Medicare 2005 hospital 

wage index based on MSA definitions 

defined by OMB in 1993 for each 

facility by the labor-related share and 

adding the non-labor share. We used the 

1997-based excluded hospital with 

capital market basket to determine the 

labor-related share. The per diem cost 

for each case was divided by this factor 

before taking the natural logarithm. The 

payment adjustment for the wage index 

was computed consistently with the 

wage adjustment factor, which is 

equivalent to separating the per diem 

cost into a labor portion and a non-labor 

portion and adjusting the labor portion 

by the wage index. 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3629 

With the exception of the teaching 

adjustment, the independent variables 

were specified as one or more 

categorical variables. Once the 

regression model was finalized based on 

the log normal variables, the regression 

coefficients for these variables were 

converted to payment adjustment 

factors by treating each coefficient as an 

exponent of the base ‘‘e’’ for natural 

logarithms, which is approximately 

equal to 2.718. The payment adjustment 

factors represent the proportional effect 

of each variable relative to a reference 

variable. As a result of the regression 

analysis, we established patient-level 

payment adjustments for age, DRG 

assignment based on patients’ principal 

diagnoses, selected comorbidities, and a 

day of stay adjustment (the variable per 

diem adjustments) to reflect higher 

resource use in the early days of an IPF 

stay. We also established facility-level 

payment adjustments for wage area, 

rural location, teaching status, cost of 

living adjustment for IPFs located in 

Alaska and Hawaii, and an adjustment 

for IPFs with a qualifying ED. We do not 

intend to update the regression analysis 

until we can analyze 1 year of IPF PPS 

claims and cost report data (that is, no 

earlier than RY 2008). CMS plans to 

monitor claims and payment data 

independently from cost report data to 

assess issues, or whether changes in 

case-mix or payment shifts have 

occurred between free-standing 

governmental, non-profit, and private 

psychiatric hospitals, and/or psychiatric 

units of general hospital, and other 

impact issues of importance to 

psychiatric facilities. 

B. Proposed Patient-Level Adjustments 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘PATIENT-LEVEL ADJUSTMENTS’’ at 

the beginning of your comments.] 

We provided payment adjustments for 

the following payment-level 

characteristics in the IPF PPS final rule: 

DRG assignment of the patient’s 

principal diagnosis, selected 

comorbidities, patient age, and the 

variable per diem adjustments. 

1. Proposed Adjustment for DRG 

Assignment 

The IPF PPS includes payment 

adjustments for the psychiatric DRG 

assigned to the claim based on each 

patient’s principal diagnosis. In the IPF 

PPS final rule, we explained that the IPF 

PPS includes 15 diagnosis-related group 

(DRG) adjustment factors (69 FR 66936). 

The adjustment factors were expressed 

relative to the most frequently reported 

DRG in FY 2002, that is, DRG 430. The 

coefficient values and adjustment 

factors were derived from the regression 

analysis. 

In accordance with § 412.27, payment 

under the IPF PPS is made for claims 

with a principal diagnosis included in 

the Diagnostic and Statistical Manual of 

Mental Disorder—Fourth Edition—Text 

Revision (DSM–IV–TR) or Chapter Five 

of the International Classification of 

Diseases—9th Revision—Clinical 

Modifications (ICD–9–CM). The 

Standards for Electronic Transaction 

final rule published in the Federal 

Register on August 17, 2000 (65 FR 

50312), adopted the ICD–9–CM as the 

designated code set for reporting 

diseases, injuries, impairments, other 

health related problems, their 

manifestations, and causes of injury, 

disease, impairment, or other healthrelated problems. As a result, the DSM–

IV–TR, while essential for the diagnosis 

and treatment of mentally ill patients, 

may not be reported on Medicare 

claims. However, in order to recognize 

the importance of the DSM–IV–TR in 

mental health treatment, we updated the 

reference to the DSM in § 412.27 from 

DSM–III–TR to DSM–IV–TR in the IPF 

PPS final rule. As a result, under the 

revised § 412.27, IPFs that are distinct 

part psychiatric units of acute care 

hospitals and CAHs may only admit 

patients who have a principal diagnosis 

in the DSM–IV–TR or Chapter Five of 

the ICD–9–CM although DSM codes 

may not be reported on medical claims. 

IPF claims with a principal diagnosis 

included in Chapter Five of the ICD–9–

CM or the DSM–IV–TR will be paid the 

Federal per diem base rate payment 

under the IPF PPS. Psychiatric principal 

diagnoses that do not group to one of 

the 15 designated DRGs receive the 

Federal per diem base rate and all other 

applicable adjustments, but the payment 

does not include a DRG adjustment. 

Only those claims with diagnoses that 

group to one of these psychiatric DRGs 

would receive a DRG adjustment. 

We believe it is vital to maintain the 

same diagnostic coding and DRG 

classification for IPFs that is used under 

the IPPS for providing the same 

psychiatric care. As we explained in the 

IPF PPS proposed rule (68 FR 66924), 

all changes to the ICD–9–CM coding 

system that would impact the IPF PPS 

are addressed annually in the IPPS 

proposed and final rules published each 

year. The updated codes are effective 

October 1 of each year and must be used 

to report diagnostic or procedure 

information. The official version of the 

ICD–9–CM is available on CD–ROM 

from the U.S. Government Printing 

Office. The FY 2005 version can be 

ordered by contacting the 

Superintendent of Documents, U.S. 

Government Printing Office, Department 

50, Washington, D.C. 20402–9329, 

telephone number (202) 512–1800. The 

stock number is 017–022–01544–7, and 

the price is $25.00. In addition, private 

vendors publish the ICD–9–CM. 

Questions concerning the ICD–9–CM 

should be directed to Patricia E. Brooks, 

Co-Chairperson, ICD–9–CM 

Coordination and Maintenance 

Committee, CMS, Center for Medicare 

Management, Purchasing Policy Group, 

Division of Acute Care, Mailstop C4–

08–06, 7500 Security Boulevard, 

Baltimore, Maryland 21244–1850. 

Questions and comments may be sent 

via e-mail to: 

Patricia.Brooks1@cms.hhs.gov. 

Further information concerning the 

Official Version of the ICD–9–CM can be 

found in the IPPS final regulation, 

‘‘Changes to the Hospital Inpatient 

Prospective Payment Systems and Fiscal 

Year 2006 Rates; Final Rule,’’ in the 

August 12, 2005 Federal Register (70 FR 

47278) and at http://www.cms.hhs.gov/ 

QuarterlyProviderUpdates/downloads/ 

cms1500f.pdf. 

The following two tables below list 

the FY 2006 new ICD diagnosis codes 

and FY 2006 revised diagnosis code 

titles, respectively. These tables are only 

a listing of FY 2006 changes and do not 

reflect all of the currently valid and 

applicable ICD codes classified in the 

DRGs. Table 6 below lists the new FY 

2006 ICD diagnosis codes that are 

classified to one of the 15 DRGs that are 

provided a DRG adjustment in the IPF 

PPS. When coded as a principal code or 

diagnosis, these codes would receive the 

correlating DRG adjustment. 

TABLE 6.—FY 2006 NEW DIAGNOSIS CODES DIAGNOSIS

Diagnosis code Description DRG 

291.82 ................. Alcohol-induced sleep disorders ........................................................................................................................ 521, 522, 523 

292.85 ................. Drug-induced sleep disorders ............................................................................................................................ 521, 522, 523 

327.00 ................. Organic insomnia, unspecified ........................................................................................................................... 432 


cchase on PROD1PC60 with PROPOSALS2
3630 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

TABLE 6.—FY 2006 NEW DIAGNOSIS CODES DIAGNOSIS—Continued 

Diagnosis code Description DRG 

327.01 ................. Insomnia due to medical condition classified elsewhere .................................................................................. 432 

327.02 ................. Insomnia due to mental disorder ....................................................................................................................... 432 

327.09 ................. Other organic insomnia ...................................................................................................................................... 432 

327.10 ................. Organic hypersomnia, unspecified .................................................................................................................... 432 

327.11 ................. Idiopathic hypersomnia with long sleep time ..................................................................................................... 432 

327.12 ................. Idiopathic hypersomnia without long sleep time ................................................................................................ 432 

327.13 ................. Recurrent hypersomnia ...................................................................................................................................... 432 

327.14 ................. Hypersomnia due to medical condition classified elsewhere ............................................................................ 432 

327.15 ................. Hypersomnia due to mental disorder ................................................................................................................ 432 

327.19 ................. Other organic hypersomnia ............................................................................................................................... 432 

Table 7 below lists ICD diagnosis 

codes whose titles have been modified 

in FY 2006. Title changes do not impact 

the DRG adjustment. When used as a 

principal diagnosis, these codes would 

still receive the correlating DRG 

adjustment. 

TABLE 7.—REVISED DIAGNOSIS CODE TITLES

Diagnosis code Description DRG 

307.45 ........................ Circadian rhythm sleep disorder of nonorganic origin ................................................................................ 432 

780.52 ........................ Insomnia, unspecified .................................................................................................................................. 432 

780.54 ........................ Hypersomnia, unspecified ........................................................................................................................... 432 

780.55 ........................ Disruption of 24 hour sleep wake cycle, unspecified .................................................................................. 432 

780.58 ........................ Sleep related movement disorder, unspecified ........................................................................................... 432 

In addition to the aforementioned, in 

the August 2005 IPPS final rule, we 

finalized ICD code 305.1, Tobacco Use 

Disorder, in order to designate this code 

as a noncovered Medicare service when 

reported as the principal diagnosis. 

Below we have republished the 

explanation that was included in the 

IPPS final rule (70 FR 47312) and 

published on the CMS website at http:// 

www.cms.hhs.gov/ 

QuarterlyProviderUpdates/downloads/ 

cms1500f.pdf. 

We have become aware of the possible 

need to add code 305.1 (Tobacco use 

disorder) to the MCE in order to make 

admissions for tobacco use disorder a 

noncovered Medicare service when code 

305.1 is reported as the principal diagnosis. 

On March 22, 2005, CMS published a final 

decision memorandum and related national 

coverage determination (NCD) on smoking 

cessation counseling services on its Web site: 

(http://www.cms.hhs.gov/coverage/). Among 

other things, this NCD provides that: 

‘Inpatient hospital stays with the principal 

diagnosis of 305.1, Tobacco Use Disorder, are 

not reasonable and necessary for the effective 

delivery of tobacco cessation counseling 

services. Therefore, we will not cover tobacco 

cessation services if tobacco cessation is the 

primary reason for the patient’s hospital 

stay.’ Therefore, in order to maintain internal 

consistency with CMS programs and 

decisions, we proposed to add code 305.1 to 

the MCE edit ‘‘Questionable Admission—

Principal Diagnosis Only’’ in order to make 

tobacco use disorder a noncovered 

admission. (70 FR 47312). 

In order to maintain consistency with 

the IPPS, for discharges on or after 

October 1, 2005, ICD code 305.1, 

Tobacco Use Disorder, would not be a 

covered principal diagnosis under the 

IPF PPS. 

Although we are updating the IPF PPS 

to reflect ICD–9–CM coding changes and 

DRG classification changes discussed in 

the annual update to the IPPS, we are 

proposing that the DRG adjustment 

factors currently being paid to IPFs 

would remain the same for discharges 

occurring during the rate year July 1, 

2006 through June 30, 2007. As 

indicated in the IPF PPS final rule, we 

do not intend to update the regression 

analysis until we have analyzed 1 year 

of IPF PPS claims and cost report data. 

As a result, we are proposing to adopt 

the DRG adjustments that are currently 

being paid as indicated in Table 8 

below. 

TABLE 8.—FY 2006 PROPOSED DRGS AND ADJUSTMENT FACTOR

DRG DRG definition Adjustment 

factor 

DRG 424 ................... O.R. Procedure with Principal Diagnosis of Mental Illness ......................................................................... 1.22 

DRG 425 ................... Acute Adjustment Reaction & Psychosocial Dysfunction ........................................................................... 1.05 

DRG 426 ................... Depressive Neurosis .................................................................................................................................... 0.99 

DRG 427 ................... Neurosis, Except Depressive ...................................................................................................................... 1.02 

DRG 428 ................... Disorders of Personality & Impulse Control ................................................................................................ 1.02 

DRG 429 ................... Organic Disturbances & Mental Retardation ............................................................................................... 1.03 

DRG 430 ................... Psychoses ................................................................................................................................................... 1.00 

DRG 431 ................... Childhood Mental Disorders ........................................................................................................................ 0.99 

DRG 432 ................... Other Mental Disorder Diagnoses ............................................................................................................... 0.92 

DRG 433 ................... Alcohol/Drug Abuse or Dependence, Leave Against Medical Advice (LAMA) ........................................... 0.97 

DRG 521 ................... Alcohol/Drug Abuse or Dependence with CC ............................................................................................. 1.02 

DRG 522 ................... Alcohol/Drug Abuse or Dependence with Rehabilitation Therapy without CC ........................................... 0.98 

DRG 523 ................... Alcohol/Drug Abuse or Dependence without Rehabilitation Therapy without CC ...................................... 0.88 

DRG 12 ..................... Degenerative Nervous System Disorders ................................................................................................... 1.05 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3631 

TABLE 8.—FY 2006 PROPOSED DRGS AND ADJUSTMENT FACTOR—Continued 

DRG DRG definition Adjustment 

factor 

DRG 23 ..................... Non-traumatic Stupor & Coma .................................................................................................................... 1.07 

Section § 412.424(d) separately 

identifies both ‘‘Diagnosis-related group 

assignment’’ and ‘‘Principal diagnosis’’

as patient level adjustments. Since 

publication of the IPF PPS final rule, we 

have received inquiries related to 

whether the IPF PPS includes two 

patient-level payment adjustments for 

principal diagnosis, an adjustment for 

the diagnosis-related group assignment 

and a separate adjustment for providing 

a principal diagnosis in general. We 

intended that the IPF PPS provide one 

patient-level adjustment for principal 

diagnosis, that is ‘‘Diagnosis-related 

group assignment.’’

In order to clarify our policy, we are 

proposing to modify the language in 

section § 412.424(d). We are proposing 

to delete sub-paragraph 

§ 412.424(d)(2)(iii). 

2. Proposed Payment for Comorbid 

Conditions 

In the IPF PPS final rule, we 

established 17 comorbidity categories 

and identified the ICD–9–CM diagnosis 

codes that generate a payment 

adjustment under the IPF PPS. 

Comorbidities are specific patient 

conditions that are secondary to the 

patient’s primary diagnosis, and that 

require treatment during the stay. 

Diagnoses that relate to an earlier 

episode of care and have no bearing on 

the current hospital stay are excluded 

and not reported on IPF claims. 

Comorbid conditions must co-exist at 

the time of admission, develop 

subsequently, affect the treatment 

received, affect the length of stay or 

affect both treatment and length of stay. 

The intent of the comorbidity 

adjustments was to recognize the 

increased cost associated with comorbid 

conditions by providing additional 

payments for certain concurrent medical 

or psychiatric conditions that are 

expensive to treat. An IPF may receive 

only one comorbidity adjustment per 

comorbidity category, but it may receive 

an adjustment for more than one 

comorbidity category. Billing 

instructions require that IPFs must enter 

the full ICD–9–CM codes for up to 8 

additional diagnoses if they co-exist at 

the time of admission or developed 

subsequently. 

The comorbidity adjustments were 

determined based on regression analysis 

using the diagnoses reported by 

hospitals as other diagnoses in FY 2002. 

The principal diagnoses were used to 

establish the DRG adjustment and were 

not accounted for in establishing the 

comorbidity category adjustments, 

except where ICD–9–CM ‘‘code first’’

instructions apply. As we explained in 

the IPF PPS final rule, the code first rule 

applies when a condition has both an 

underlying etiology and a manifestation 

due to the underlying etiology. For these 

conditions, the ICD–9–CM has a coding 

convention that requires the underlying 

conditions to be sequenced first 

followed by the manifestation. 

Whenever a combination exists, there is 

a ‘‘use additional code’’ note at the 

etiology code and a ‘‘code first’’ note at 

the manifestation code. 

Although we are updating the IPF PPS 

to reflect updates to the ICD–9–CM 

codes, we are proposing that the 

comorbidity adjustment factors 

currently in effect would remain in 

effect for the rate year beginning July 1, 

2006. As we indicated in the IPF PPS 

final rule, we do not intend to update 

the regression analysis until we have 

analyzed 1 year of IPF PPS claims and 

cost report data. The proposed 

comorbidity adjustments are shown in 

Table 9 below. 

As previously discussed in the DRG 

section, we believe it is essential to 

maintain the same diagnostic coding set 

for IPFs that is used under the IPPS for 

providing the same psychiatric care. 

Therefore, we are proposing to use the 

most current FY 2006 ICD codes. They 

are reflected in the FY 2006 GROUPER, 

version 23.0 and are effective for 

discharges occurring on or after October 

1, 2005. 

Table 9 lists the updated FY 2006 new 

ICD diagnosis codes that impact the 

comorbidity adjustment under the IPF 

PPS and Table 10 lists the invalid ICD 

codes no longer applicable for the 

comorbidity adjustment. Table 9 only 

lists the FY 2006 new codes and does 

not reflect all of the currently valid ICD 

codes applicable for the IPF PPS 

comorbidity adjustment. 

We note that ICD diagnosis code 585 

Chronic Renal Failure was modified in 

two ways—(1) by expanding the level of 

specificity to include seven new codes; 

and (2) by changing the original code of 

585 to invalid, thereby leaving the 

remaining more specific codes 

reportable. Since diagnosis code 585 is 

no longer valid, we are proposing to 

eliminate this code from the 

comorbidity category ‘‘Renal Failure, 

Chronic.’’

ICD diagnosis code 585 chronic Renal 

Failure is defined in the ICD–9–CM as 

‘‘Progressive, persistent inadequate 

kidney function characterized by anuria, 

accumulation of urea and other 

nitrogenous bodies in the blood, nausea, 

vomiting, gastrointestinal bleeding, and 

yellowish-brown discoloration of the 

skin.’’ This code included the various 

stages of chronic kidney disease, but it 

is no longer valid. The new codes listed 

below reflect the various stages of 

chronic kidney failure. Since diagnosis 

code 585 is no longer valid, we are 

proposing to eliminate it from the 

comorbidity category, ‘‘Renal Failure, 

Chronic’’. 

We are proposing to provide 

comorbidity adjustments for 585.3, 

‘‘Chronic kidney disease, Stage III 

(moderate),’’ 585.4, ‘‘Chronic kidney 

disease, Stage IV (severe),’’ 585.5, 

‘‘Chronic kidney disease, Stage V,’’

585.6, ‘‘End Stage renal disease,’’ and 

585.9, ‘‘Chronic kidney disease, 

unspecified.’’ However, since the 

purpose of the comorbidity adjustment 

is to account for the higher resource 

costs associated with comorbid 

conditions that are expensive to treat on 

a per diem basis, we are not proposing 

a comorbidity adjustment for 585.1, 

‘‘Chronic kidney disease, Stage I’’ and 

585.2, ‘‘Chronic kidney disease, Stage II 

(mild).’’

We believe that these conditions 

(585.1 and 585.2) are less costly to treat 

on a per diem basis because patients 

with these conditions are either 

asymptomatic or may have only mild 

symptoms. These conditions represent a 

minimal to mild decrease in kidney 

function that is almost completely 

compensated such that the only finding 

is typically an abnormal laboratory test. 

Unlike patients with more significant 

kidney dysfunction, these patients do 

not usually require more costly patient 

care interventions such as additional lab 

tests to monitor renal function, special 

pharmacy attention to reduced dosages 

or kidney-sparing medications, or fluid 

and electrolyte precautions with special 

diets, frequent weights, Input/Output 

balance, and fluid restriction. As such, 

the resources and costs that these 

patients require for staff time, 


cchase on PROD1PC60 with PROPOSALS2
3632 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

medications and supplies, and 

administrative services are expected to 

be similar to other patients without 

these conditions. 

TABLE 9.—FY 2006 NEW ICD CODES APPLICABLE FOR THE COMORBIDITY ADJUSTMENT

Diagnosis code Description DRG Comorbidity category 

585.3 .......................... Chronic kidney disease, Stage III (moderate) ....... 315–316 Renal Failure, Chronic. 

585.4 .......................... Chronic kidney disease, Stage IV (severe) ........... 315–316 Renal Failure, Chronic. 

585.5 .......................... Chronic kidney disease, Stage V ........................... 315–316 Renal Failure, Chronic. 

585.6 .......................... End stage renal disease ........................................ 315–316 Renal Failure, Chronic. 

585.9 .......................... Chronic kidney disease, unspecified ..................... 315–316 Renal Failure, Chronic. 

V46.13 ........................ Encounter for weaning from respirator [ventilator] 467 Chronic Obstructive Pulmonary Disease. 

V46.14 ........................ Mechanical complication of respirator [ventilator] .. 467 Chronic Obstructive Pulmonary Disease. 

In Table 10 below, we list the FY 2006 

invalid ICD diagnosis code 585 that we 

are proposing to remove from the 

comorbidity adjustment under the IPF 

PPS. This table does not reflect all of the 

currently valid ICD codes applicable for 

the IPF PPS comorbidity adjustment. 

TABLE 10.—FY 2006 INVALID ICD CODES NO LONGER APPLICABLE FOR THE COMORBIDITY ADJUSTMENT

Diagnosis code Description DR Comorbidity category 

585 ............................. Chronic renal failure ............................................... 315–36 Renal Failure, Chronic. 

We are aware that ICD code 404.03, 

Hypertensive Heart and Renal Disease, 

Malignant, with Heart Failure and Renal 

Failure, has caused confusion since this 

ICD code is currently used to code an 

adjustment in two separate IPF 

comorbidity categories, (that is, both 

‘‘Renal Failure, Chronic’’ and ‘‘Cardiac 

Conditions’’). After a careful review of 

this code, we believe that it more 

appropriately corresponds to the 

‘‘Cardiac Conditions’’ comorbidity than 

to the ‘‘Renal Failure, Chronic’’

comorbidity. Therefore, to be more 

clinically cohesive and to eliminate 

confusion, we are proposing to remove 

ICD code 404.03 from the comorbidity 

adjustment category ‘‘Renal Failure, 

Chronic,’’ but retaining it in the 

‘‘Cardiac Conditions’’ comorbidity 

category. Since both comorbidity 

categories have the same adjustment 

factor of 1.11, no negative payment 

consequence would result from this 

change. 

The seventeen comorbidity categories 

for which we are proposing to provide 

an adjustment, their respective codes 

including the new FY 2006 ICD codes, 

and their respective adjustment factors 

are listed below in Table 11. 

TABLE 11.—FY 2006 DIAGNOSIS CODES AND ADJUSTMENT FACTORS FOR COMORBIDITY CATEGORIES

Description of comorbidity ICD–9CM Code Adjustment 

factor 

Development Disabilities .......... 317, 3180, 3181, 3182, and 319 .................................................................................................. 1.04 

Coagulation Factor deficits ....... 2860 through 2864 ....................................................................................................................... 1.13 

Tracheotomy ............................. 51900—through 51909 and V440 ................................................................................................ 1.06 

Renal Failure, Acute ................. 5845 through 5849, 63630, 63631, 63632, 63730, 63731, 63732, 6383, 6393, 66932, 66934, 

9585.

1.11 

Renal Failure, Chronic .............. 40301, 40311, 40391, 40402, 40412, 40413, 40492, 40493, 5853, 5854, 5855, 5856, 5859, 

586, V451, V560, V561, and V562.

1.11 

Oncology Treatment ................. 1400 through 2399 with a radiation therapy code 92.21–92.29 or chemotherapy code 99.25 .. 1.07 

Uncontrolled Diabetes-Mellitus 

with or without complications.

25002, 25003, 25012, 25013, 25022, 25023, 25032, 25033, 25042, 25043, 25052, 25053, 

25062, 25063, 25072, 25073, 25082, 25083, 25092, and 25093.

1.05 

Severe Protein calorie malnutrition.260 through 262 ........................................................................................................................... 1.13 

Eating and Conduct Disorders 3071, 30750, 31203, 31233, and 31234 ...................................................................................... 1.12 

Infectious Disease .................... 01000 through 04110, 042, 04500 through 05319, 05440 through 05449, 0550 through 0770, 

0782 through 07889, and 07950 through 07959.

1.07 

Drug and/or Alcohol Induced 

Mental Disorders.

2910, 2920, 29212, 2922, 30300, and 30400 ............................................................................. 1.03 

Cardiac Conditions ................... 3910, 3911, 3912, 40201, 40403, 4160, 4210, 4211, and 4219 ................................................. 1.11 

Gangrene .................................. 44024 and 7854 ........................................................................................................................... 1.10 

Chronic Obstructive Pulmonary 

Disease.

49121, 4941, 5100, 51883, 51884, V4611 and V4612, V4613 and V4614 ................................ 1.12 

Artificial Openings—Digestive 

and Urinary.

56960 through 56969, 9975, and V441 through V446 ................................................................ 1.08 

Severe Musculoskeletal and 

Connective Tissue Diseases.

6960, 7100, 73000 through 73009, 73010 through 73019, and 73020 through 73029 .............. 1.11 

Poisoning .................................. 96500 through 96509, 9654, 9670 through 9699, 9770, 9800 through 9809, 9830 through 

9839, 986, 9890 through 9897.

1.11 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3633 

3. Proposed Patient Age Adjustments 

As explained in the IPF PPS final 

rule, we analyzed the impact of age on 

per diem cost by examining the age 

variable (that is, the range of ages) for 

payment adjustments. 

In general, we found that the cost per 

day increases with increasing age. The 

older age groups are more costly than 

the under 45 years of age group, the 

differences in per diem cost increase for 

each successive age group, and the 

differences are statistically significant. 

Based on the results of the regression 

analysis, we established 8 adjustment 

factors for age beginning with age 

groupings, 45 and under 50, 50 and 

under 55, 55 and under 60, 60 and 

under 65, 65 and under 70, 70 and 

under 75, 75 and under 80, and 80 years 

of age and over. Patients under 45 years 

of age are assigned an age adjustment 

factor of 1.00. As we indicated in the 

IPF PPS final rule, we do not intend to 

update the regression analysis until we 

can analyze 1 year of IPF PPS claims 

and cost report data. As a result, in this 

proposed rule, we are proposing to 

adopt the patient age adjustments 

currently in effect and shown in Table 

12 below. 

TABLE 12.—AGE GROUPINGS AND

ADJUSTMENT FACTORS

Age Adjustment 

factor 

Under 45 ................................... 1.00 

45 and under 50 ....................... 1.01 

50 and under 55 ....................... 1.02 

55 and under 60 ....................... 1.04 

60 and under 65 ....................... 1.07 

65 and under 70 ....................... 1.10 

70 and under 75 ....................... 1.13 

75 and under 80 ....................... 1.15 

80 and over .............................. 1.17 

4. Proposed Variable Per Diem 

Adjustments 

We explained in the IPF PPS final 

rule that cost regressions indicated that 

per diem cost declines as the length of 

stay increases (69 FR 66947). The 

variable per diem adjustments to the 

Federal per diem base rate account for 

ancillary and administrative costs that 

occur disproportionately in the first 

days after admission to an IPF. 

We used regression analysis to 

estimate the average differences in per 

diem cost among stays of different 

length. Regression analysis 

simultaneously controls for cost 

differences associated with the other 

variables (for example, age, DRG, and 

presence of specific comorbidities). The 

regression coefficients measure the 

relative average cost per day for stays of 

differing lengths compared to a 

reference group’s length of stay. We 

analyzed through cost regression, the 

relative cost per day for day 1 through 

day 30. We determined that the average 

per diem cost declined smoothly until 

the 22nd day. As a result of this 

analysis, we established variable per 

diem adjustments that begin on day 1 

and decline gradually until day 21 of a 

patient’s stay. For day 22 and thereafter, 

the variable per diem adjustment 

remains the same each day for the 

remainder of the stay. However, the 

adjustment applied to day 1 depends 

upon whether the IPF has a qualifying 

Emergency Department (ED). If an IPF 

has a qualifying ED, it receives a 1.31 

adjustment for day 1 of each patient 

stay. If an IPF does not have a qualifying 

ED, it receives a 1.19 adjustment for day 

1 of the stay. The ED adjustment is 

explained in more detail in section 

IV.C.5. of this proposed rule. 

As we indicated in the IPF PPS final 

rule, we do not intend to make changes 

to the regression analysis until we can 

analyze 1 year of IPF PPS claims and 

cost report data. As a result, for the rate 

year beginning July 1, 2006, we are 

proposing to adopt the variable per 

diem adjustment factors currently in 

effect. Table 13 below shows the 

variable per diem adjustments we are 

proposing for updating the IPF PPS. 

Higher payments for the early days of 

stay in IPFs are not fully compensated 

by the lower payments after day 10, but 

are paid for by the standardization 

portion which is applied to the federal 

per diem base rate. 

TABLE 13.—VARIABLE PER DIEM

ADJUSTMENTS

Day-of-stay Adjustment 

factor 

Day 1-IPF Without a Qualified 

ED ......................................... 1.19 

Day 1-IPF With a Qualified ED 1.31 

Day 2 ........................................ 1.12 

Day 3 ........................................ 1.08 

Day 4 ........................................ 1.05 

Day 5 ........................................ 1.04 

Day 6 ........................................ 1.02 

Day 7 ........................................ 1.01 

Day 8 ........................................ 1.01 

Day 9 ........................................ 1.00 

Day 10 ...................................... 1.00 

Day 11 ...................................... 0.99 

Day 12 ...................................... 0.99 

Day 13 ...................................... 0.99 

Day 14 ...................................... 0.99 

Day 15 ...................................... 0.98 

Day 16 ...................................... 0.97 

Day 17 ...................................... 0.97 

Day 18 ...................................... 0.96 

Day 19 ...................................... 0.95 

Day 20 ...................................... 0.95 

Day 21 ...................................... 0.95 

TABLE 13.—VARIABLE PER DIEM

ADJUSTMENTS—Continued 

Day-of-stay Adjustment 

factor 

After Day 21 ............................. 0.92 

C. Facility-Level Adjustments 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘FACILITY-LEVEL ADJUSTMENTS’’ at 

the beginning of your comments.] 

The IPF PPS includes facility-level 

adjustments for the wage index, IPFs 

located in rural areas, teaching IPFs, 

cost of living adjustments for IPFs 

located in Alaska and Hawaii, and IPFs 

with a qualifying ED. 

1. Wage Index Adjustment 

a. Proposed Revisions of IPF PPS 

Geographic Classifications 

In the IPF PPS final rule, we 

explained that in establishing an 

adjustment for area wage levels, the 

labor-related portion of an IPF’s Federal 

prospective payment is adjusted by 

using an appropriate wage index. We 

also explained that an IPF’s wage index 

is determined based on the location of 

the IPF in an urban or rural area as 

defined in § 412.62(f)(1)(ii) and 

(f)(1)(iii), respectively. An urban area 

under the IPF PPS is defined at 

§ 412.62(f)(1)(ii)(A) and (B). In general, 

an urban area is defined as a 

Metropolitan Statistical Area (MSA) or 

New England County Metropolitan Area 

(NECMA) as defined by the Office of 

Management and Budget (OMB). In 

addition, a few counties located outside 

of MSAs are considered urban as 

specified at § 412.62(f)(1)(ii)(B). Under 

§ 412.62(f)(1)(iii), a rural area is defined 

as any area outside of an urban area. 

The geographic classifications defined 

in § 412.62(f)(1)(ii) and (f)(1)(iii), were 

used under the IPPS from FYs 1984 

through 2004 (§ 412.62(f) and 

§ 412.63(b)), and have been used under 

the IPF PPS since it was implemented 

for cost reporting periods beginning on 

or after January 1, 2005. 

Under the IPPS, the wage index is 

calculated and assigned to hospitals on 

the basis of the labor market area in 

which the hospital is located or 

geographically reclassified to in 

accordance with sections 1886(d)(8) and 

(d)(10) of the Act. Under the IPF PPS, 

the wage index is calculated using IPPS 

wage index data (as discussed below in 

section IV C.1.d of this preamble) on the 

basis of the labor market area in which 

the IPF is located, without taking into 

account geographic reclassification 

under sections 1886(d)(8) and (d)(10) of 


cchase on PROD1PC60 with PROPOSALS2
3634 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

the Act and without applying the ‘‘rural 

floor’’ established under section 4410 of 

the BBA. (Section 4410 of the BBA 

provides that for the purposes of section 

1886(d)(3)(E) of the Act, the area wage 

index applicable to hospitals located in 

an urban area of a State may not be less 

than the area wage index applicable to 

hospitals located in rural areas in the 

State. This provision is commonly 

referred to as the ‘‘rural floor’’ under the 

IPPS.) However, when we established 

the IPF PPS, we did not apply the rural 

floor to IPFs. For this reason, the 

hospital wage index used for IPFs is 

commonly referred to as the ‘‘pre-floor’’

hospital wage index indicating that the 

‘‘rural floor’’ provision of the BBA is not 

applied. As a result, the applicable IPF 

wage index value is assigned to the IPF 

on the basis of the labor market area in 

which the IPF is geographically located. 

As noted above, the current IPF PPS 

labor market areas are defined based on 

the definitions of MSAs, Primary MSAs 

(PMSAs), and NECMAs issued by the 

OMB (commonly referred to collectively 

as ‘‘MSAs’’). The MSA definitions, 

which are discussed in greater detail 

below, are currently used under the IPF 

PPS and other PPSs (that is, the IRF 

PPS, the LTCH PPS, and the PPSs for 

home health agencies (HHA PPS) and 

skilled nursing facilities (SNF PPS)). In 

the FY 2005 IPPS final rule (69 FR 

49026 through 49034), revised labor 

market area definitions were adopted 

under the IPPS (§ 412.64(b)), which 

were effective October 1, 2004. These 

new standards, called Core-Based 

Statistical Areas (CBSAs), were 

announced by the OMB late in 2000 and 

are discussed in greater detail below. 

b. Current IPF PPS Labor Market Areas 

Based on MSAs 

When we published the IPF PPS final 

rule, we explained that we were not 

adopting the new statistical area 

definitions defined by OMB for the 

following reasons. First, the change in 

labor market areas under the IPPS had 

not changed at the time we published 

the IPF PPS proposed rule on November 

28, 2003. As a result, IPFs and other 

interested parties were not afforded an 

opportunity to comment on the use of 

the new labor market area definitions 

under the IPF PPS. Second, we wanted 

to conduct a thorough analysis of the 

impact of the new labor market area 

definitions on payments under the IPF 

PPS. Finally, in the IPF PPS final rule, 

we indicated our intent to publish in a 

proposed rule any changes we were 

considering for new labor market 

definitions. 

The analysis of the impact of the new 

labor market definitions has been 

completed and we are proposing to 

adopt new labor market area definitions 

under the IPF PPS. As a result, we 

believe it is helpful to provide a detailed 

description of the current IPF PPS labor 

market areas, in order to better 

understand the proposed changes to the 

IPF PPS labor market areas presented in 

this proposed rule. 

As mentioned earlier, since the 

implementation of the IPF PPS, we have 

used labor market areas to further 

characterize urban and rural areas as 

determined under § 412.62(f)(1)(ii) and 

(iii). To this end, we have defined labor 

market areas under the IPF PPS based 

on the definitions of MSAs, PMSAs, and 

NECMAs issued by the OMB in 1993, 

which is consistent with the IPPS 

approach prior to FY 2005. We note that 

OMB also defines Consolidated MSAs 

(CMSAs). A CMSA is a metropolitan 

area with a population of 1 million or 

more, comprising two or more PMSAs 

(identified by their separate economic 

and social character). However, for 

purposes of the wage index, we use the 

PMSAs rather than CMSAs because they 

allow a more precise breakdown of labor 

costs. If a metropolitan area is not 

designated as part of a PMSA, we use 

the applicable MSA. 

These different designations use 

counties as the building blocks upon 

which they are based. Therefore, under 

the IPF PPS, hospitals are assigned to 

either an MSA, PMSA, or NECMA based 

on whether the county in which the IPF 

is located is part of that area. All of the 

counties in a State outside a designated 

MSA, PMSA, or NECMA are designated 

as rural. 

c. Core-Based Statistical Areas 

The OMB reviews its Metropolitan 

Area definitions preceding each 

decennial census. As discussed in the 

FY 2005 IPPS final rule (69 FR 49026), 

in the fall of 1998, OMB chartered the 

Metropolitan Area Standards Review 

Committee to examine the Metropolitan 

Area standards and develop 

recommendations for possible changes 

to those standards. Three notices related 

to the review of the standards, providing 

an opportunity for public comment on 

the recommendations of the Committee, 

were published in the Federal Register 

on the following dates: December 21, 

1998 (63 FR 70526); October 20, 1999 

(64 FR 56628); and August 22, 2000 (65 

FR 51060). 

In the December 27, 2000 Federal 

Register (65 FR 82228 through 82238), 

OMB announced its new standards. In 

that notice, OMB defines a Core-Based 

Statistical Area (CBSA), beginning in 

2003, as ‘‘a geographic entity associated 

with at least one core of 10,000 or more 

population, plus adjacent territory that 

has a high degree of social and 

economic integration with the core as 

measured by commuting ties. The 

standards designate and define two 

categories of CBSAs: Metropolitan 

Statistical Areas and Micropolitan 

Statistical Areas.’’ (65 FR 82236 through 

82238). 

According to the OMB, MSAs are 

based on urbanized areas of 50,000 or 

more population, and Micropolitan 

Statistical Areas (referred to in this 

discussion as Micropolitan Areas) are 

based on urban clusters of at least 

10,000 population, but less than 50,000 

population. Counties that do not fall 

within CBSAs (either MSAs or 

Micropolitan Areas) are deemed 

‘‘Outside CBSAs.’’ In the past, OMB 

defined MSAs around areas with a 

minimum core population of 50,000, 

and smaller areas were ‘‘Outside 

MSAs.’’ On June 6, 2003, the OMB 

announced the new CBSAs, comprised 

of MSAs and the new Micropolitan 

Areas based on Census 2000 data. (A 

copy of the announcement may be 

obtained at the following Internet 

address: http://www.whitehouse.gov/ 

omb/bulletins/fy04/b04–03.html.) 

The new CBSA designations 

recognize 49 new MSAs and 565 new 

Micropolitan Areas, and extensively 

revise the composition of many of the 

existing MSAs. There are 1,090 counties 

in MSAs under the new CBSA 

designations (previously, there were 848 

counties in MSAs). Of these 1,090 

counties, 737 are in the same MSA as 

they were prior to the change in 

designations, 65 are in a different MSA, 

and 288 were not previously designated 

to any MSA. There are 674 counties in 

Micropolitan Areas. Of these, 41 were 

previously in an MSA, while 633 were 

not previously designated to an MSA. 

There are five counties that previously 

were designated to an MSA but are no 

longer designated to either an MSA or 

a new Micropolitan Area: Carter County, 

KY; St. James Parish, LA; Kane County, 

UT; Culpepper County, VA; and King 

George County, VA. For a more detailed 

discussion of the conceptual basis of the 

new CBSAs, refer to the FY 2005 IPPS 

final rule (67 FR 49026 through 49034). 

d. Proposed Revision of the IPF PPS 

Labor Market Areas 

In its June 6, 2003 announcement, 

OMB cautioned that these new 

definitions ‘‘should not be used to 

develop and implement Federal, State, 

and local nonstatistical programs and 

policies without full consideration of 

the effects of using these definitions for 

such purposes. These areas should not 

serve as a general-purpose geographic 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3635 

framework for nonstatistical activities, 

and they may or may not be suitable for 

use in program funding formulas.’’

We currently use MSAs to define 

labor market areas for purposes of 

Medicare wage indices in the IPF PPS 

since its implementation for cost 

reporting periods beginning on or after 

January 1, 2005. Until recently, MSAs 

were used to define labor market areas 

for purposes of the wage index for many 

of the other Medicare payment systems 

(for example, IRF PPS, SNF PPS, HHA 

PPS, and Outpatient PPS). While we 

recognize MSAs are not designed 

specifically to define labor market areas, 

we believe they represent a useful proxy 

for this purpose, because they are based 

upon characteristics we believe also 

generally reflect the characteristics of 

unified labor market areas. For example, 

CBSAs consist of a core population plus 

an adjacent territory that reflects a high 

degree of social and economic 

integration. This integration is measured 

by commuting ties, thus demonstrating 

that these areas may draw workers from 

the same general areas. In addition, the 

most recent CBSAs reflect the most upto-date information. Our analysis and 

discussion here are focused on issues 

related to adopting the new CBSA 

designations to define labor market 

areas for the purposes of the IPF PPS. 

Historically, Medicare PPSs have 

utilized Metropolitan Area definitions 

developed by the OMB. As noted above, 

the labor market areas currently used 

under the IPF PPS are based on the 

Metropolitan Area definitions issued by 

the OMB and the OMB reviews its 

Metropolitan Area definitions preceding 

each decennial census to reflect more 

recent population changes. The CBSAs 

are OMB’s latest Metropolitan Area 

definitions based on the Census 2000 

data. Because we believe that the OMB’s 

latest Metropolitan Area designations 

more accurately reflect the local 

economies and wage levels of the areas 

in which hospitals are currently located, 

we adopted revised labor market area 

designations based on the OMB’s CBSA 

designations under the IPPS effective 

October 1, 2004. When we implemented 

the wage index adjustment at 

§ 412.424(d)(1)(i) under the IPF PPS 

final rule (69 FR 66952 through 66954), 

we explained that the IPF PPS wage 

index adjustment was intended to 

reflect the relative hospital wage levels 

in the geographic area of the hospital as 

compared to the national average 

hospital wage level. The OMB’s CBSA 

designations based on Census 2000 data 

reflect the most recent available 

geographic classifications (Metropolitan 

Area definitions). Therefore, we are 

proposing to revise the labor market 

area definitions used under the IPF PPS 

based on the OMB’s CBSA designations. 

This change would ensure that the IPF 

PPS wage index adjustment most 

appropriately accounts for and reflects 

the relative hospital wage levels in the 

geographic area of the hospital as 

compared to the national average 

hospital wage level. 

Specifically, we are proposing to 

revise the IPF PPS labor market 

definitions based on the OMB’s new 

CBSA designations (as discussed in 

greater detail below) effective for IPF 

PPS discharges occurring on or after 

July 1, 2006. Accordingly, we are 

proposing to revise § 412.402, 

definitions for rural and urban areas, 

effective for discharges occurring on or 

after July 1, 2006 would be defined in 

§ 412.64(b)(1)(ii)(A) through (C). These 

definitions are the labor market 

definitions based on OMB’s CBSA 

designations. For clarity, we are 

proposing to revise the regulation text to 

explicitly reference urban and rural 

definitions for a cost reporting period 

beginning on or after January 1, 2005, 

with respect to discharges occurring 

during the period covered by such cost 

reports but before July 1, 2006 under 

§ 412.62(f)(1)(ii) and § 412.62(f)(1)(iii). 

We note that these are the same labor 

market area definitions (based on the 

OMB’s new CBSA designations) 

implemented for acute care hospitals 

under the IPPS at § 412.64(b), which 

were effective for those hospitals 

beginning October 1, 2004 as discussed 

in the FY 2005 IPPS final rule (69 FR 

49026–49034). The IPF PPS uses the 

acute care inpatient hospitals’ wage data 

in calculating the IPF PPS wage index. 

However, unlike the IPPS, and similar 

to other Medicare payment systems (for 

example, SNF PPS and IRF PPS), the 

IPF PPS uses the pre-floor, prereclassified hospital wage index. 

Below, we discuss the composition of 

the proposed IPF PPS labor market areas 

based on OMB’s new CBSA 

designations. It should be noted that 

OMB’s new CBSA designations are 

comprised of several county-based area 

definitions as explained above, which 

include Metropolitan Areas, 

Micropolitan Areas, and areas ‘‘outside 

CBSAs.’’ We implemented the IPF PPS 

using two types of labor market areas, 

that is, urban and rural. In this proposed 

rule, we are proposing to adopt the 

revised labor market areas based on 

OMB’s new CBSA-based designations. 

We are also proposing to continue to 

have 2 types of labor market areas 

(urban and rural). In the discussion that 

follows, we explain our proposal to 

recognize Metropolitan Areas, which 

include New England MSAs and 

Metropolitan Divisions, as urban. We 

also explain our proposal to recognize 

Micropolitan Areas and areas ‘‘outside 

CBSAs’’ as rural. The following 

discussion describes the proposed 

methodology for mapping OMB’s CBSAbased designations into the IPF PPS 

(urban area or rural area) format. 

i. New England MSAs 

As stated above, we currently use 

NECMAs to define labor market areas in 

New England, because these are countybased designations, rather than the 1990 

MSA definitions for New England, 

which used minor civil divisions such 

as cities and towns. Under the current 

MSA definitions, NECMAs provided 

more consistency in labor market 

definitions for New England compared 

with the rest of the country, where 

MSAs are county-based. Under the new 

CBSAs, the OMB has now defined the 

MSAs and Micropolitan Areas in New 

England on the basis of counties. The 

OMB also established New England City 

and Town Areas, which are similar to 

the previous New England MSAs. 

In order to create consistency across 

all IPF labor market areas, we are 

proposing to use the county-based areas 

for all MSAs in the nation, including 

those in New England. The OMB has 

now defined the New England area 

based on counties, creating a city- and 

town-based system as an alternative. We 

believe that adopting county-based labor 

market areas for the entire country 

except those in New England would 

lead to inconsistencies in our 

designations. Adopting county-based 

labor market areas for the entire country 

provides consistency and stability in 

Medicare program payment because all 

of the labor market areas throughout the 

country, including New England, would 

be defined using the same system (that 

is, counties) rather than different 

systems in different areas of the county, 

and minimizes programmatic 

complexity. 

In addition, we have consistently 

employed a county-based system for 

New England for precisely that reason: 

to maintain consistency with the labor 

market definitions used throughout the 

country. Since we have never used 

cities and towns for defining IPF labor 

market areas, employing a county-based 

system in New England maintains that 

consistent practice. We note that this is 

consistent with the implementation of 

the CBSA-based designations under the 

IPPS for New England (69 FR 49028). 

Accordingly, for the IPF PPS, we are 

proposing to use the New England 

MSAs as determined under the 

proposed new CBSA-based labor market 

area definitions in defining the 


cchase on PROD1PC60 with PROPOSALS2
3636 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

proposed revised IPF PPS labor market 

areas. 

ii. Metropolitan Divisions 

Under OMB’s new CBSA 

designations, a Metropolitan Division is 

a county or group of counties within a 

CBSA that contains a core population of 

at least 2.5 million, representing an 

employment center, plus adjacent 

counties associated with the main 

county or counties through commuting 

ties. A county qualifies as a main county 

if 65 percent or more of its employed 

residents work within the county and 

the ratio of the number of jobs located 

in the county to the number of 

employed residents is at least 0.75. A 

county qualifies as a secondary county 

if 50 percent or more, but less than 65 

percent, of its employed residents work 

within the county and the ratio of the 

number of jobs located in the county to 

the number of employed residents is at 

least 0.75. After all the main and 

secondary counties are identified and 

grouped, each additional county that 

already has qualified for inclusion in 

the MSA falls within the Metropolitan 

Division associated with the main/ 

secondary county or counties with 

which the county at issue has the 

highest employment interchange 

measure. Counties in a Metropolitan 

Division must be contiguous (65 FR 

82236). 

The construct of relatively large MSAs 

being comprised of Metropolitan 

Divisions is similar to the current 

construct of CMSAs comprised of 

PMSAs. As noted above, in the past, the 

OMB designated CMSAs as 

Metropolitan Areas with a population of 

1 million or more and comprised of two 

or more PMSAs. Under the IPF PPS, we 

currently use the PMSAs rather than 

CMSAs to define labor market areas 

because they comprise a smaller 

geographic area with potentially varying 

labor costs due to different local 

economies. We believe that CMSAs may 

be too large of an area with a relatively 

large number of hospitals, to accurately 

reflect the local labor costs of all of the 

individual hospitals included in that 

relatively ‘‘large’’ area. A large market 

area designation increases the 

likelihood of including many hospitals 

located in areas with very different labor 

market conditions within the same 

market area designation. This variation 

could increase the difficulty in 

calculating a single wage index that 

would be relevant for all hospitals 

within the market area designation. 

Similarly, we believe that MSAs with a 

population of 2.5 million or greater may 

be too large of an area to accurately 

reflect the local labor costs of all of the 

individual hospitals included in that 

relatively ‘‘large’’ area. Furthermore, as 

indicated above, Metropolitan Divisions 

represent the closest approximation to 

PMSAs, the building block of the 

current IPF PPS labor market area 

definitions, and therefore, would most 

accurately maintain our current 

structuring of the IPF PPS labor market 

areas. Therefore, as implemented under 

the IPPS (69 FR 49029), we are 

proposing to use the Metropolitan 

Divisions where applicable (as 

described below) under the proposed 

new CBSA-based labor market area 

definitions. 

In addition to being comparable to the 

organization of the labor market areas 

under current MSA designations (that 

is, the use of PMSAs rather than 

CMSAs), we believe that using 

Metropolitan Divisions where 

applicable (as described below) under 

the IPF PPS would result in a more 

accurate adjustment for the variation in 

local labor market areas for IPFs. 

Specifically, if we would recognize the 

relatively ‘‘larger’’ CBSA that comprises 

two or more Metropolitan Divisions as 

an independent labor market area for 

purposes of the wage index, it would be 

too large and would include the data 

from too many hospitals to compute a 

wage index that would accurately reflect 

the various local labor costs of all of the 

individual hospitals included in that 

relatively ‘‘large’’ CBSA. As mentioned 

earlier, a large market area designation 

increases the likelihood of including 

many hospitals located in areas with 

very different labor market conditions 

within the same market area 

designation. This variation could 

increase the difficulty in calculating a 

single wage index that would be 

relevant for all hospitals within the 

market area designation. Rather, by 

proposing to recognize Metropolitan 

Divisions where applicable (as 

described below) under the proposed 

new CBSA-based labor market area 

definitions under the IPF PPS, we 

believe that in addition to more 

accurately maintaining the current 

structuring of the IPF PPS labor market 

areas, the local labor costs would be 

more accurately reflected, thereby 

resulting in a wage index adjustment 

that better reflects the variation in the 

local labor costs of the local economies 

of the IPFs located in these relatively 

‘‘smaller’’ areas. 

Below we describe where 

Metropolitan Divisions would be 

applicable under the proposed new 

CBSA-based labor market area 

definitions under the IPF PPS. 

Under OMB’s new CBSA-based 

designations, there are 11 MSAs 

containing Metropolitan Divisions: 

Boston; Chicago; Dallas; Detroit; Los 

Angeles; Miami; New York; 

Philadelphia; San Francisco; Seattle; 

and Washington, DC. Although these 

MSAs were also CMSAs under the prior 

definitions, in some cases these areas 

have been significantly altered. Under 

the current IPF PPS MSA designations, 

Boston is a single NECMA. Under the 

proposed CBSA-based labor market area 

designations, it would be comprised of 

four Metropolitan Divisions. Los 

Angeles would go from four PMSAs 

under the current IPF PPS MSA 

designations to two Metropolitan 

Divisions under the proposed CBSAbased labor market area designations 

because two MSAs became separate 

MSAs. The New York CMSA would go 

from 15 PMSAs under the current IPF 

PPS MSA designations down to only 

four Metropolitan Divisions under the 

proposed CBSA-based labor market area 

designations. The five PMSAs in 

Connecticut under the current IPF PPS 

MSA designations would become 

separate MSAs under the proposed 

CBSA-based labor market area 

designations, and the number of PMSAs 

in New Jersey under the current IPF PPS 

MSA designations would go from five to 

two, with the consolidation of two New 

Jersey PMSAs (Bergen-Passaic and 

Jersey City) into the New York-WayneWhite Plains, NY–NJ Division, under 

the proposed CBSA-based labor market 

area designations. In San Francisco, 

under the proposed CBSA-based labor 

market area designations, there are only 

two Metropolitan Divisions. Currently, 

there are six PMSAs, some of which are 

now separate MSAs under the current 

IPF PPS labor market area designations. 

Under the current IPF PPS labor 

market area designations, Cincinnati, 

Cleveland, Denver, Houston, 

Milwaukee, Portland, Sacramento, and 

San Juan are all designated as CMSAs, 

but would no longer be designated as 

CMSAs under the proposed CBSA-based 

labor market area designations. As noted 

previously, the population threshold to 

be designated as a CMSA under the 

current IPF PPS labor market area 

designations is 1 million. In most of 

these cases, counties currently in a 

PMSA under the current IPF PPS labor 

market area designations would become 

separate, independent MSAs under the 

proposed CBSA-based labor market area 

designations. 

iii. Micropolitan Areas 

Under OMB’s new CBSA-based 

designations, Micropolitan Areas are 

essentially a third area definition 

consisting primarily of currently rural 

areas, but also include some or all of 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3637 

areas that are currently designated as an 

urban MSA. As discussed in greater 

detail in the FY 2005 IPPS final rule (69 

FR 49029 through 49032), how these 

areas are treated would have significant 

impacts on the calculation and 

application of the wage index. 

Specifically, whether or not 

Micropolitan Areas are included as part 

of the respective statewide rural wage 

indices would impact the value of 

statewide rural wage index of any State 

that contains a Micropolitan Area 

because a hospital’s classification as 

urban or rural affects which hospitals’

wage data are included in the statewide 

rural wage index. As discussed above in 

section IV.C.1.b. we combine all of the 

counties in a State outside a designated 

urban area together to calculate the 

statewide rural wage index for each 

State. 

Including Micropolitan Areas as part 

of the statewide rural labor market area 

would result in an increase to the 

statewide rural wage index because 

hospitals located in those Micropolitan 

Areas typically have higher labor costs 

than other rural hospitals in the State. 

Alternatively, if Micropolitan Areas 

would be recognized as independent 

labor market areas, because there would 

be so few hospitals in each labor market 

area, the wage indices for IPFs in those 

areas could become relatively unstable 

as they would change considerably from 

year to year. 

We currently use MSAs to define 

urban labor market areas and group all 

the hospitals in counties within each 

State that are not assigned to an MSA 

together into a statewide rural labor 

market area. We have used the terms 

‘‘urban’’ and ‘‘rural’’ wage indexes in 

the past for ease of reference. However, 

the introduction of Micropolitan Areas 

by the OMB potentially complicates this 

terminology because these areas include 

many hospitals that are currently 

included in the statewide rural labor 

market areas. 

We are proposing to treat 

Micropolitan Areas as rural labor market 

areas under the IPF PPS for the reasons 

outlined below. That is, counties that 

are assigned to a Micropolitan Area 

under the CBSA-based designations 

would be treated the same as other 

‘‘rural’’ counties that are not assigned to 

either an MSA (Metropolitan Statistical 

Area) or a Micropolitan Area. Therefore, 

in determining an IPF’s applicable wage 

index (based on IPPS hospital wage 

index data), we are proposing that an 

IPF in a Micropolitan Area under OMB’s 

CBSA-based designations would be 

classified as ‘‘rural’’ and would be 

assigned the statewide rural wage index 

for the State in which it resides. 

In the FY 2005 IPPS final rule (69 FR 

49029 through 49032), we discuss our 

evaluation of the impact of treating 

Micropolitan Areas as part of the 

statewide rural labor market area 

instead of treating Micropolitan Areas as 

independent labor market areas for 

hospitals paid under the IPPS. As 

discussed in that same final rule, one of 

the reasons Micropolitan Areas have 

such a dramatic impact on the wage 

index is because Micropolitan Areas 

encompass smaller populations than 

MSAs. In addition, they tend to include 

fewer hospitals per Micropolitan Area. 

Currently, there are only 25 MSAs with 

one hospital in the MSA. However, 

under the new proposed CBSA-based 

definitions, there are 373 Micropolitan 

Areas with one hospital, and 49 MSAs 

with only one hospital. 

Since Micropolitan Areas encompass 

smaller populations than MSAs, they 

tend to include fewer hospitals per 

Micropolitan Area, recognizing 

Micropolitan Areas as independent 

labor market areas would generally 

increase the potential for dramatic shifts 

in those areas’ wage indices from one 

year to the next because a single 

hospital (or group of hospitals) could 

have a disproportionate effect on the 

wage index of the area. The large 

number of labor market areas with only 

one hospital and the increased potential 

for dramatic shifts in the wage indexes 

from 1 year to the next is a problem for 

several reasons. First, it creates 

instability in the wage index from year 

to year for a large number of hospitals. 

Second, it reduces the averaging effect 

(averaging effect allows for more data 

points to be used to calculate a 

representative standard of measured 

labor costs within a market area.) 

lessening some of the incentive for 

hospitals to operate efficiently. This 

incentive is inherent in a system based 

on the average hourly wages for a large 

number of hospitals, as hospitals could 

profit more by operating below that 

average. In labor market areas with a 

single hospital, high wage costs are 

passed directly into the wage index with 

no counterbalancing averaging with 

lower wages paid at nearby competing 

hospitals. Third, it creates an arguably 

inequitable system when so many 

hospitals have wage indexes based 

solely on their own wages, while other 

hospitals’ wage indexes are based on an 

average hourly wage across many 

hospitals. 

For the reasons noted above, and 

consistent with the treatment of these 

areas under the IPPS, we are proposing 

not to adopt Micropolitan Areas as 

independent labor market areas under 

the IPF PPS. However, we are proposing 

that Micropolitan Areas, under the 

CBSA-based labor market area 

definitions, would be considered part of 

the statewide rural labor market area. 

Accordingly, we are proposing that the 

IPF PPS statewide rural wage index 

would be determined using acute-care 

IPPS hospital wage data (the rationale 

for using IPPS hospital wage data is 

discussed in greater detail above in 

section IV.C.1.d.iii of this proposed 

rule) from hospitals located in non-MSA 

areas (for example, rural areas, 

including Micropolitan Areas) and that 

statewide rural wage index would be 

assigned to IPFs located in those nonMSA areas. 

e. Implementation of the Proposed 

Revised Labor Market Areas Under the 

IPF PPS 

Section 124 of the BBRA, is broadly 

written and gives the Secretary 

discretion in developing and making 

adjustments to the IPF PPS. 

When the revised labor market areas 

based on the OMB’s new CBSA-based 

designations were adopted under the 

acute care hospital IPPS beginning on 

October 1, 2004, a transition to the new 

labor market area designations was 

established due to the scope and 

substantial implications of these new 

boundaries and to buffer the subsequent 

significant impacts it may have on 

payments to numerous hospitals. As 

discussed in the FY 2005 IPPS final rule 

(69 FR 49032), during FY 2005, a blend 

of wage indexes is calculated for those 

acute care IPPS hospitals experiencing a 

drop in their wage indexes because of 

the adoption of the new labor market 

areas. 

While we recognize that, just like 

IPPS hospitals, some IPFs may 

experience decreases in their wage 

index as a result of the proposed labor 

market area changes, our analysis shows 

that a majority of IPFs either expect no 

change in wage index or an increase in 

wage index based on CBSA definitions. 

In addition, a very small number of IPFs 

(fewer than 3 percent) would experience 

a decline of 5 percent or more in the 

wage index based on CBSA 

designations. We also found that a very 

small number of IPFs (approximately 5 

percent) would experience a change in 

either rural or urban designation under 

the CBSA-based definitions. Since a 

majority of IPFs would not be 

significantly impacted by the proposed 

labor market areas, we believe it is not 

necessary to propose a transition to the 

proposed new CBSA-based labor market 

area for the purposes of the IPF PPS 

wage index. 

In addition, because we are in the 

midst of a transition to a full wage-index 


cchase on PROD1PC60 with PROPOSALS2
3638 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

adjustment under the IPF PPS, we 

believe that the effects on the IPF PPS 

wage index from the proposed changes 

to the IPF PPS labor market areas 

definitions would be mitigated. 

Specifically, most IPFs would be in 

their FY 2006 cost reporting period and 

therefore would be in the second year of 

the 3-year phase-in of the IPF PPS wage 

index adjustment when the revised 

labor market area designations would be 

applied. During the second year of the 

transition to the IPF PPS, the applicable 

wage index value is one-half (50 

percent) of the applicable full IPF PPS 

wage index adjustment. Since most IPFs 

would be in the second year of the 3- 

year phase-in of the wage index 

adjustment, for most IPFs, the laborrelated portion of the standard Federal 

rate is only adjusted by 50 percent of the 

applicable full wage index (that is, onehalf wage index value). As noted above, 

the IPF PPS wage index adjustment is 

made by multiplying the labor-related 

share of the IPF PPS standard Federal 

per diem base rate by the applicable 

wage index value, and the proposed IPF 

PPS labor related-share is 75.923 

percent. Consequently, for most IPFs, 

only 38 percent of the standard Federal 

per diem base rate is affected by the 

wage index adjustment (75.923 percent 

× 0.50 = 37.9615 percent), and the 

proposed revision to the labor market 

area definitions based on OMB’s new 

CBSA-based designations would only 

have a minimal impact on IPF PPS 

payments. Therefore, because the 

impact of the proposed revision to the 

labor market area definitions would 

only have a minimal impact on IPF PPS 

payments, we do not believe it is 

necessary to propose a transition policy 

for the proposed revision to the IPF PPS 

labor market area definitions. 

For the reasons discussed above, we 

are not proposing a transition under the 

IPF PPS from the current MSA-based 

labor market areas designations to the 

new CBSA-based labor market area 

designations. Rather, we are proposing 

under the IPF PPS to adopt the new 

CBSA-based labor market area 

definitions beginning with the July 1, 

2006 IPF PPS rate year without a 

transition period. 

As discussed below, the IPPS adopted 

a hold-harmless policy and an ‘‘outcommuting’’ adjustment. We are also 

not proposing a hold harmless policy or 

an ‘‘out-commuting’’ adjustment under 

the IPF PPS from the current MSAbased labor market areas designations to 

the new CBSA-based labor market area 

designations as discussed below. We are 

proposing to adopt the new CBSA-based 

labor market area definitions beginning 

with the July 1, 2006 IPF PPS rate year 

without a hold harmless policy and 

without an ‘‘out-commuting’’

adjustment. 

We believe that our proposed policies 

are appropriate for IPFs because, despite 

some similarities between the IPF PPS 

and the IPPS, there are clear distinctions 

between the payment systems, 

particularly regarding wage index 

issues. Where a wage index adjustment 

has been a stable feature of the acute 

care hospital IPPS since its 1983 

implementation and had utilized the 

prior MSA-based labor market area 

designation for over 10 years, this is not 

the case for the IPF PPS, which has only 

been implemented since January 1, 

2005. 

The most significant distinction 

between acute care hospitals under the 

IPPS and IPFs under the IPF PPS, is that 

acute care hospitals have been paid 

using full wage index adjusted 

payments since 1983 and had used the 

previous IPPS MSA-based labor market 

area designations for over 10 years, 

whereas under the IPF PPS, a wage 

index adjustment is being phased-in 

over a 3-year period. As previously 

explained, the impact that the wage 

index can have on IPF PPS payments is 

limited at this point, since only a small 

percentage of the IPF PPS Federal per 

diem base rate is affected by the wage 

index (approximately 38 percent in 

most cases) because of the 3-year phasein of the wage index adjustment. In 

contrast, a transition policy to the 

revised IPPS labor market area 

definitions under the IPPS was 

appropriate because there is no phasein of a wage index adjustment under the 

IPPS and the full labor-related share of 

the IPPS standardized amount (that is, 

Federal rate) is affected by the IPPS 

wage index adjustment, which resulted 

in a more significant projected impact 

for acute care hospitals under the IPPS. 

As discussed in the August 11, 2004 

IPPS final rule (69 FR 49032), during FY 

2005, a hold harmless policy was 

implemented to minimize the overall 

impact of hospitals that were in FY 2004 

designated as urban under the MSA 

designations, but would become rural 

under the CBSA designations. In the 

same final rule, hospitals were afforded 

a 3-year hold harmless policy because 

the IPPS determined that acute-care 

hospitals that changed designations 

from urban to rural would be 

substantially impacted by the significant 

change in wage index. Currently, under 

the IPF PPS urban facilities that become 

rural would receive the rural facility 

adjustment (that is, 17 percent). As 

discussed in section IV.C.2 of this 

proposed rule, we are proposing to keep 

the rural adjustment at 17 percent. The 

rural facility adjustment would be 

applied in the same way to urban 

facilities that would become rural under 

the CBSA-based definitions, if we were 

to adopt them. Thus, we believe that the 

impact on any urban facilities that 

become rural under the new definitions 

would be mitigated by the rural 

adjustment. Therefore, we do not 

believe it is appropriate or necessary to 

adopt a hold harmless policy for 

facilities that would experience a 

change in designation under the CBSAbased definitions. 

In addition, we note that section 505 

of the MMA established new section 

1886(d)(13) of the Act. The new section 

1886(d)(13) of the Act requires that the 

Secretary establish a process to make 

adjustments to the hospital wage index 

based on commuting patterns of 

hospital employees. We believe that this 

requirement for an ‘‘out-commuting’’ or 

‘‘out-migration’’ adjustment applies 

specifically to the IPPS. Therefore, we 

are not proposing an adjustment for the 

IPF PPS. 

We note that for the CBSA 

designations, we identified some 

geographic areas where there were no 

hospitals, and thus no hospital wage 

index data on which to base the 

calculation of the July 1, 2006 rate year 

IPF PPS proposed wage index. In 

addressing this situation, we are 

proposing approaches that we believe 

serve as proxies for hospital wage data 

and would provide an appropriate 

standard that accounts for geographic 

variation in labor costs. 

The first situation involves rural 

locations in Massachusetts and Puerto 

Rico. We have determined that there are 

no rural hospitals in those locations. 

Since there is no reasonable proxy for 

more recent rural data within those 

areas, we are proposing to use last year’s 

wage index value for rural 

Massachusetts and rural Puerto Rico. 

This approach is consistent with other 

Medicare PPSs (for example, SNF PPS 

and IRF PPS). 

The second situation has to do with 

the urban area of Hinesville, GA (CBSA 

25980). Under the proposed new labor 

market areas there are no urban 

hospitals within this area. We propose 

to use all of the urban areas within the 

State to serve as a reasonable proxy for 

the urban areas without specific 

hospital wage index data in determining 

the IPF PPS wage index. Therefore, in 

this proposed rule, we are calculating 

the urban wage index value for purposes 

of the wage index for these areas 

without urban hospital data as the 

average wage index for all urban areas 

within the State. This approach is 

consistent with other Medicare PPSs 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3639 

(for example, SNF PPS and IRF PPS). 

We could not apply a similar averaging 

in rural areas because in the rural areas 

there are no State rural hospital wage 

data available for averaging on a Statewide basis. We solicit comments on 

these approaches to calculating the 

wage index values for areas without 

hospitals for RY 2007 and subsequent 

years. 

To facilitate an understanding of the 

proposed policies related to the 

proposed change to the IPF PPS labor 

market areas discussed above, in the 

MSA/CBSA Crosswalk included as 

Addendum B of this proposed rule, we 

are providing a listing of each Social 

Security Administration (SSA) State and 

county location code; State and county 

name; existing MSA-based labor market 

area designation; MSA-based wage 

index value; CBSA-based labor market 

area; and the new CBSA-based wage 

index value. We are also providing in 

Addenda C1 and C2 the proposed wage 

index for urban and rural areas based on 

CBSA labor market areas. 

f. Wage Index Budget Neutrality 

Any proposed adjustment or update 

to the IPF wage index would be made 

in a budget neutral manner that assures 

that the estimated aggregated payments 

under this subsection in the RY 

beginning July 1, 2006 are not greater or 

less than those that would have been 

made in the year without such an 

adjustment. Therefore, we would 

calculate a budget-neutral wage index 

adjustment factor. We propose to 

calculate this factor using the following 

steps: 

Steps 1: Determine the total amount of 

the estimated IPF PPS payments for the 

implementation year using the laborrelated share and wage indices from FY 

2005 (based on MSAs). 

Step 2: Calculate the total amount of 

estimated IPF PPS payments for RY 

2007 using the proposed labor-related 

share and wage indices from FY 2006 

(based on CBSAs). 

Step 3: Divide the amount calculated 

in Step 1 by the amount calculated in 

Step 2 which yields a RY 2007 budgetneutral wage adjustment of 1.00156. 

This factor would be applied in the 

update of the Federal per diem base rate 

for RY 2007. 

1. Proposed Adjustment for Rural 

Location 

In the IPF PPS Final Rule (69 FR 

66954), we provided a 17 percent 

payment adjustment for IPFs located in 

a rural area. This adjustment was based 

on the regression analysis which 

indicated that the per diem cost of rural 

facilities was 17 percent higher than 

that of urban facilities after accounting 

for the influence of the other variables 

included in the regression. Many rural 

IPFs are small psychiatric units within 

small general acute care hospitals. We 

also stated in the IPF PPS final rule that 

small-scale facilities are more costly on 

a per diem basis because there are 

minimum levels of fixed costs that 

cannot be avoided, and they do not have 

the economies of size advantage. 

Based on the results of our regression 

analysis for the final rule using the most 

recent complete data available (that is, 

FY 2002 data), we provided a payment 

adjustment for IPFs located in rural 

areas of 17 percent. In this proposed 

rule, we are not proposing to change 

this adjustment factor. In addition, we 

stated that we do not intend to conduct 

another regression analysis until we are 

able to analyze 1 year of IPF PPS claims 

and cost report data. At that time, we 

can compare rural and urban IPFs to 

determine how much more costly rural 

facilities are on a per diem basis under 

the IPF PPS. In the meantime, we are 

proposing to apply a 17 percent 

payment adjustment for IPFs located in 

a rural area as defined at 

§ 412.64(b)(1)(ii)(C). 

2. Proposed Teaching Adjustment 

In the IPF PPS final rule, we 

established a facility-level adjustment 

for IPFs that are, or are part of, teaching 

institutions. The teaching status 

adjustment accounts for the higher 

indirect operating costs experienced by 

facilities that participate in graduate 

medical education (GME) programs. We 

have received numerous requests for 

clarification of the IPF PPS teaching 

adjustment, especially with regard to 

comparisons with the IPPS IME 

adjustment that were included in the 

IPF PPS final rule. As a result, we are 

including an expanded explanation of 

the IPF PPS teaching status adjustment 

and are proposing clarifying changes to 

§ 412.424(d)(1)(iii) regarding the 

teaching adjustment. 

Medicare makes direct GME payments 

(for direct costs such as resident and 

teaching physician salaries, and other 

direct teaching costs) to all teaching 

hospitals including those paid under the 

IPPS, and those that were once paid 

under the TEFRA rate-of-increase limits 

but are now paid under other PPSs. 

These direct GME payments are made 

separately from payments for hospital 

operating costs and are not part of the 

PPSs. However, the direct GME 

payments do not address the higher 

indirect operating costs experienced by 

teaching hospitals. For teaching 

hospitals paid under the TEFRA rate-ofincrease limits, Medicare did not make 

separate medical education payments 

because payments to these hospitals 

were based on the hospitals’ reasonable 

costs. Since payments under TEFRA 

were based on hospitals’ reasonable 

costs, the higher indirect costs that 

might be associated with teaching 

programs would automatically have 

been factored into the TEFRA payments. 

As previously mentioned, we 

conducted regression analysis of FY 

2002 IPF data as the basis for the 

payment adjustments included in the 

IPF PPS final rule. In conducting the 

analysis, we used the resident counts 

reported on hospital cost reports 

(worksheet S–3, Part 1, line 12, column 

7 for freestanding psychiatric hospitals 

and worksheet S–3, Part 1, line 14 (or 

line 14.01 for subprovider 2), column 7 

for psychiatric units of acute care 

hospitals). That is, for the freestanding 

psychiatric hospitals, we used the 

number of residents and interns 

reported for the entire hospital. For the 

psychiatric units of acute care hospitals, 

we used the number of residents and 

interns reported for the psychiatric unit, 

which are reported separately on the 

cost report from the number reported for 

the rest of the hospital. 

The regression analysis (with the 

logarithm of costs as the dependent 

variable) showed that the indirect 

teaching cost variable is significant in 

explaining the higher costs of IPFs that 

have teaching programs. We calculated 

the teaching adjustment based on the 

IPF’s ‘‘teaching variable,’’ which is one 

plus the ratio of the number of full-time 

equivalent (FTE) residents training in 

the IPF (subject to limitations described 

below) to the IPF’s average daily census 

(ADC). 

In the cost regressions conducted for 

the IPF PPS final rule, the logarithm of 

the teaching variable had a coefficient 

value of 0.5150. We converted this cost 

effect to a teaching payment adjustment 

by treating the regression coefficient as 

an exponent and raising the teaching 

variable to a power equal to the 

coefficient value. In other words, the 

teaching adjustment is calculated by 

raising the teaching variable (1 + FTE 

residents/ADC) to the 0.5150 power. To 

compute the percentage increase in the 

IPF PPS payment attributable to the 

teaching adjustment (that is, the amount 

to be reconciled at cost report 

settlement), raise the teaching variable 

(1 + FTE residents/ADC) to the 0.5150 

power. For example, for an IPF with a 

teaching variable of 0.10 and using a 

coefficient value of 0.5150, the per diem 

payment would increase by 5.03 

percent; for an IPF with a teaching 

variable of 0.05, the per diem payment 

would increase by 2.54 percent. We note 


cchase on PROD1PC60 with PROPOSALS2
3640 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

that the coefficient value of 0.5150 was 

based on regression analysis holding all 

other components of the payment 

system constant. 

In addition, we established the 

teaching adjustment in a manner that 

limited the incentives for IPFs to add 

FTE residents for the purpose of 

increasing their teaching adjustment. 

We imposed a cap on the number of 

FTE residents that may be counted for 

purposes of calculating the teaching 

adjustment, similar to that established 

by sections 4621 (IME FTE cap for IPPS 

hospitals) and 4623 (direct GME FTE 

cap for all hospitals) of the BBA. We 

emphasize that the cap limits the 

number of FTE residents that teaching 

IPFs may count for the purposes of 

calculating the IPF PPS teaching 

adjustment, not the number of residents 

teaching institutions can hire or train. 

The FTE resident cap is applied the 

same way in freestanding teaching 

psychiatric hospitals and in distinct part 

psychiatric units with GME programs. 

Similar to the regulations for counting 

FTE residents under the IPPS as 

described in § 412.105(f), we calculated 

the number of FTE residents that trained 

in the IPF during a ‘‘base year’’ and use 

that FTE resident number as the cap. An 

IPF’s FTE resident cap would ultimately 

be determined based on the final 

settlement of the IPF’s most recent cost 

report filed before November 15, 2004 

(that is, the publication date of the IPF 

PPS final rule). 

Similar to teaching hospitals under 

the IPPS, IPFs that first begin training 

residents after November 15, 2004 

initially receive an FTE cap of ‘‘0’’. The 

FTE caps for teaching IPFs (whether 

they are new or existing IPFs) that start 

training residents in a new GME 

program (may be subsequently adjusted 

in accordance with the IPPS policies 

described in § 412.105(f)(1)(vii) and 

GME policies described in 

§ 413.79(e)(1)(i) and (ii). For purposes of 

this section, a new medical residency 

training program means a medical 

residency that receives initial 

accreditation by the appropriate 

accrediting body or begins training 

residents on or after November 15, 2004. 

However, contrary to the policy for IME 

FTE resident caps under the IPPS, we 

do not allow IPFs to aggregate the FTE 

resident caps used to compute the IPF 

PPS teaching adjustment through 

affiliation agreements. We included 

these policies because we believe it is 

important to limit the total pool of 

resident FTE cap positions within the 

IPF community and avoid incentives for 

IPFs to add FTE residents in order to 

increase their payments. 

Residents with less than full-time 

status and residents rotating through the 

psychiatric hospital or unit for less than 

a full year are counted in proportion to 

the time they spend in their assignment 

with the IPF (for example, a resident on 

a full-time, 3-month rotation to the IPF 

would be counted as 0.25 FTE for 

purposes of counting residents to 

calculate the ratio). No FTE resident 

time counted for purposes of the IPPS 

IME adjustment is counted for purposes 

of the teaching status adjustment for the 

IPF PPS. 

As noted previously, the denominator 

used to calculate the teaching 

adjustment under the IPF PPS is the 

IPF’s average daily census (ADC) from 

the current cost reporting period. We 

chose to use the ADC because it is 

closely related to the IPF’s patient load, 

which affects the number of interns and 

residents the IPF can train. We also 

believe the ADC is a measure that can 

be defined precisely and is difficult to 

manipulate. Although the IPPS IME 

adjustment uses the hospital’s number 

of beds as the denominator, the capital 

PPS (as specified at § 412.322) and the 

IRF PPS (as specified at § 412.624(e)(4) 

both use the ADC as the denominator 

for the indirect medical education and 

teaching adjustments, respectively. 

If a psychiatric hospital’s or unit’s 

FTE count of residents in a given year 

is higher than the FTE count in the base 

year (the base year being used to 

establish the cap), we base payments in 

that year on the lower number (the cap 

amount). This approach is consistent 

with the IME adjustment under the IPPS 

and the teaching adjustment under the 

IRF PPS. The IPF remains free to add 

FTE residents above the cap amount, 

but it cannot count the number of FTE 

residents above the cap for purposes of 

calculating the teaching adjustment. 

This means that the cap serves as an 

upper limit on the number of FTE 

residents that may be counted for 

purposes of calculating the teaching 

status adjustment. IPFs can adjust their 

number of FTE residents counted for 

purposes of calculating the teaching 

adjustment as long as they remain under 

the cap. On the other hand, if a 

psychiatric hospital or unit were to have 

fewer FTE residents in a given year than 

in the base year (that is, fewer residents 

than its FTE resident cap), teaching 

adjustment payments in that year would 

be based on the lower number (that is, 

the current year’s FTE count of 

resident). 

In response to inquiries about how the 

teaching adjustment is applied under 

the IPF PPS, we are proposing to add a 

new paragraph § 412.424(d)(1)(iii)(E) to 

clarify that the teaching adjustment is 

made on a claim basis as an interim 

payment and the final payment for the 

claim would be made in full during the 

final settlement of the cost report. The 

difference between those interim 

payments and the actual teaching 

adjustment amount computed in the 

cost report would be adjusted through 

lump sum payments/recoupments when 

the cost report is filed and later settled. 

As noted in section III.B.3 of this 

proposed rule, in reviewing the 

methodology used to simulate the IPF 

PPS payments used for the IPF PPS final 

rule, we discovered that the computer 

code incorrectly assigned non-teaching 

status to most teaching facilities. As a 

result, total IPF PPS payments were 

underestimated by about 1.36 percent. 

To resolve the issue, as discussed in 

section III.B.3 of this proposed rule, we 

are proposing to amend the Federal per 

diem base rate prospectively for all IPFs. 

As with other adjustment factors 

derived through the regression analysis, 

we do not intend to rerun the regression 

analysis until we can analyze 1 year of 

IPF PPS claims and cost report data. 

Until then, we are proposing to retain 

the 0.5150 teaching adjustment to the 

Federal per diem base rate. 

3. Proposed Cost of Living Adjustment 

for IPFs Located in Alaska and Hawaii 

The IPF PPS includes a payment 

adjustment for IPFs located in Alaska 

and Hawaii based upon the county in 

which the IPF is located. As we 

explained in the IPF PPS final rule, the 

FY 2002 data demonstrated that IPFs in 

Alaska and Hawaii had per diem costs 

that were disproportionately higher than 

other IPFs. Other Medicare prospective 

payment systems (for example, IPPS and 

IRF PPS) have adopted a cost of living 

adjustment (COLA) to account for the 

cost differential of care furnished in 

Alaska and Hawaii. We analyzed the 

effect of applying a COLA to payments 

for IPFs located in Alaska and Hawaii. 

The results of our analysis demonstrated 

that a COLA for IPFs located in Alaska 

and Hawaii would improve payment 

equity for these facilities. As a result of 

this analysis, we provided a COLA 

adjustment in the IPF PPS final rule. 

In general, the COLA would account 

for the higher costs in the IPF and 

eliminate the projected loss that IPFs in 

Alaska and Hawaii would experience 

absent the COLA. A COLA adjustment 

for IPFs located in Alaska and Hawaii is 

made by multiplying the non-labor 

share of the Federal per diem base rate 

by the applicable COLA factor based on 

the county in which the IPF is located. 

Table 14 lists the specific COLA for 

Alaska and Hawaii IPFs. The COLA 

factors were obtained from the U.S. 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3641 

Office of Personnel Management (OPM). 

The COLA factors are published on the 

U.S. Office of Personnel Management 

(OPM) website (http://www.opm.gov/ 

oca/cola/rates.asp). We are proposing to 

adopt the COLA adjustments obtained 

from OPM. We propose to update the 

COLA factors if OPM updates them and 

as updated by OPM. Any change in the 

COLA factors would be made in one of 

our IPF PPS RY update documents. We 

are proposing to amend § 412.428 to 

update the COLA factors if appropriate. 

TABLE 14.—PROPOSED COLA FACTORS FOR ALASKA AND HAWAII IPFS

Location COLA 

Alaska: 

All areas .............................. 1 .25 

Hawaii: 

Honolulu County ................. 1 .25 

Hawaii County ..................... 1 .165 

Kauai County ...................... 1 .2325 

Maui County ........................ 1 .2375 

Kalawao County .................. 1 .2375 

4. Proposed Adjustment for IPFs With a 

Qualifying Emergency Department (ED) 

Currently, the IPF PPS includes a 

facility-level adjustment for IPFs with 

qualifying EDs. As explained in the IPF 

PPS final rule, we provide an 

adjustment to the standardized Federal 

per diem base rate to account for the 

costs associated with maintaining a fullservice ED. The adjustment is intended 

to account for ED costs allocated to the 

hospital’s distinct part psychiatric unit 

for preadmission services otherwise 

payable under Medicare Part B 

furnished to a beneficiary during the 

day immediately preceding the date of 

admission to the IPF (see § 413.40(c)) 

and the overhead cost of maintaining 

the ED. This payment is a facility-level 

adjustment that applies to all IPF 

admissions (with the one exception as 

described below), regardless of whether 

a particular patient receives 

preadmission services in the hospital’s 

ED. 

The ED adjustment is incorporated 

into the variable per diem adjustment 

for the first day of each stay for IPFs 

with a qualifying ED. That is, IPFs with 

a qualifying ED receive a 31 percent 

adjustment as the variable per diem 

adjustment for day 1 of each stay. If an 

IPF does not have a qualifying ED, it 

receives a 19 percent adjustment as the 

variable per diem adjustment for day 1 

of each patient stay. 

While any IPF with a qualifying ED 

receives the adjustment, the adjustment 

is paid most often to IPFs that are 

psychiatric units of acute care hospitals 

or CAHs because these providers are 

more likely to have an ED that meets the 

definition of a qualified ED in 

§ 412.424(d)(1)(v). We defined a 

qualifying ED in order to avoid 

providing the ED adjustment to an 

intake unit that is not comparable to a 

full-service ED with respect to the array 

of emergency services available or cost. 

We defined a qualifying ED as one that 

is staffed and equipped to furnish a 

comprehensive array of emergency 

services and that meets the definition of 

a ‘‘dedicated emergency department’’ as 

specified in § 489.24(b) and the 

definition of ‘‘provider-based status’’ as 

specified in § 413.65. We intended that 

a qualifying ED provide a 

comprehensive array of medical and 

psychiatric services. 

Therefore, in order to clarify that a 

comprehensive array of emergency 

services includes medical as well as 

psychiatric services, we are proposing to 

amend § 412.424(d)(1)(V)(A). 

As specified in § 489.24, a dedicated 

ED means ‘‘any department or facility of 

the hospital, regardless of whether it is 

located on or off the main hospital 

campus, that meets at least one of the 

following requirements: 

• It is licensed by the State in which 

it is located under applicable State law 

as an emergency room or emergency 

department; 

• It is held out to the public (by 

name, posted signs, advertising, or other 

means) as a place that provides care for 

emergency medical conditions on an 

urgent basis without requiring a 

previously scheduled appointment; or 

• During the calendar year 

immediately preceding the calendar 

year in which a determination under 

this section is being made, based on a 

representative sample of patient visits 

that occurred during the calendar year, 

it provides at least one-third of all its 

outpatient visits for the treatment of 

emergency medical conditions on an 

urgent basis without requiring a 

previously scheduled appointment.’’

As specified in § 413.65, providerbased status means ‘‘the relationship 

between a main provider and a 

provider-based entity or a department of 

a provider, remote location of a hospital, 

or satellite facility that complies with 

the provisions.’’ Including providerbased status in the definition of a 

qualifying ED reflects the common 

ownership of the hospital and the 

distinct part psychiatric unit. 

As discussed in the IPF PPS final rule, 

three steps were involved in the 

calculation of the ED adjustment factor. 

Step 1: We estimated the proportion 

by which the ED costs of a case would 

increase the cost of the first day of the 

stay. Using the IPFs with ED admissions 

in FY 2002, we divided their average ED 

cost per stay admitted through the ED 

($198) by their average cost per day 

($715), which equals 0.28. 

Step 2: We adjusted the factor 

estimated in Step 1 to account for the 

fact that we would pay the higher first 

day adjustment for all cases in the 

qualifying IPFs, not just the cases 

admitted through the ED. Since on 

average, 44 percent of the cases in IPFs 

with ED admissions are admitted 

through the ED, we multiplied 0.28 by 

0.44, which equals 0.12. 

Step 3: We added the adjusted factor 

calculated in the previous 2 steps to the 

variable per diem adjustment derived 

from the regression equation that we 

used to derive our other payment 

adjustment factors. The first day 

payment factor from this regression is 

1.19. Adding the 0.12, we obtained a 

first day variable per diem adjustment 

for IPFs with a qualifying ED equal to 

1.31. 

The ED adjustment is made on every 

qualifying claim except as described 

below. As specified in 

§ 412.424(d)(1)(V)(B), the ED adjustment 

is not made where a patient is 

discharged from an acute care hospital 

or CAH and admitted to the same 

hospital’s or CAH’s psychiatric unit. An 

ED adjustment is not made in this case 

because the costs associated with ED 

services are reflected in the DRG 

payment to the acute care hospital or 

through the reasonable cost payment 

made to the CAH. As we explained in 

the IPF PPS final rule, if we provided 

the ED adjustment in these cases, the 

hospital would be paid twice for the 

overhead costs of the ED (69 FR 66960). 

Therefore, when patients are 

discharged from an acute care hospital 

or CAH and admitted to the same 

hospital’s or CAH’s psychiatric unit, the 

IPF receives the 1.19 adjustment factor 

as the variable per diem adjustment for 

the first day of the patient’s stay in the 

IPF. As with other adjustment factors 

under the IPF PPS, we do not intend to 

conduct a new regression analysis for 

this IPF PPS update. Rather, we intend 

to wait until we can analyze 1 year of 

IPF PPS claims and cost report data. 

Therefore, we are proposing to retain 

the 1.31 adjustment factor for IPFs with 

qualifying EDs for the rate year 

beginning July 1, 2006. As we indicated 

in the final rule, in FY 2002, one third 

of the IPFs admissions were through the 

ED. Commenters on the IPF PPS 

proposed rule indicated that the 

percentage of admissions through the 

ED were understated. We plan to 

monitor claims data to determine the 

number of IPF admissions admitted 

through the ED. 


cchase on PROD1PC60 with PROPOSALS2
3642 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

a. Proposed New Source of Admission 

Code To Implement the ED Adjustment 

In order to ensure that the ED 

adjustment is not paid for patients who 

are discharged from an acute care 

hospital or CAH and admitted to the 

same hospital’s or CAH’s psychiatric 

unit, we directed IPFs to enter source of 

admission code 4 (transfers from 

hospital inpatient) on those claims. The 

source of admission code is a required 

field on Medicare claims and indicates 

the source of the patient admissions. 

However, as we have implemented the 

IPF PPS, we have realized that 

admission code 4 is too broad to 

distinguish these claims because it 

reflects transfers from any acute care 

hospital or CAH. Currently, where 

admission code 4 is entered on a claim, 

the ED adjustment is not paid, even if 

the patient is transferred from a 

different acute hospital or CAH. 

In order to pay these IPF claims 

appropriately, CMS requested a new 

source of admission code from the 

National Uniform Billing Committee to 

identify transfers from the same hospital 

or CAH. On June 7, 2005, the National 

Uniform Billing Committee granted our 

request to establish a new source of 

admission code to indicate transfers 

from the same hospital or CAH. The 

new source of admission code ‘‘D’’ is 

effective April 1, 2006. We are 

proposing that the new code would be 

used by IPFs to identify IPF patients 

who have been transferred to the IPF 

from the same hospital or CAH. Claims 

with source of admission code ‘‘D’’

would not receive the ED adjustment. 

b. Applicability of the ED Adjustment to 

IPFs in Critical Access Hospitals 

The BBA created the CAH program, 

designed to represent a separate 

provider type to provide acute care 

services in rural areas. Generally, in 

order to qualify as a CAH, a hospital 

must be located in a rural area, provide 

24-hour emergency care services, have 

an average length of stay of 96 hours or 

less, operate up to 25 beds for inpatient 

critical access care, be located more 

than 35 miles from a hospital or another 

CAH or more than 15 miles in 

mountainous terrain or only secondary 

roads, or be certified by the State as of 

December 31, 2005 as being a 

‘‘necessary provider’’ of health care 

services to residents in the area. 

Section 405(g) of the MMA authorizes 

CAHs to establish distinct part 

psychiatric and rehabilitation units of 

up to 10 beds effective for cost reporting 

periods beginning on or after October 1, 

2004. Services in these units are paid 

under the payment methodology that 

would apply if such services were 

provided in a distinct part psychiatric or 

rehabilitation unit of a hospital. As a 

result, IPFs that are distinct part units 

of CAHs are paid the same as if they 

were a distinct part unit of a hospital. 

Otherwise, the CAH is paid on a 

reasonable cost basis for inpatient 

critical access services. 

In the IPF PPS final rule, we amended 

§413.70(e) to clarify that payments for 

services of distinct part psychiatric 

units in CAHs are made in accordance 

with the IPF PPS. In order to pay CAHs 

the same as other IPFs, CAHs would be 

subject to the 1-day preadmission 

services bundling provision specified in 

§ 413.40(c)(2) for patients who are 

admitted to the CAH’s IPF. As a result, 

the cost of preadmission services, 

including ED services furnished to CAH 

IPF patients would be allocated to the 

IPF. 

D. Other Payment Adjustments and 

Policies 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘OTHER ADJUSTMENTS AND 

POLICIES’’ at the beginning of your 

comments.] 

The IPF PPS includes the following 

payment adjustments: (1) An outlier 

policy to promote access to IPF care for 

those patients who require expensive 

care and to limit the financial risk of 

IPFs treating unusually costly patients; 

(2) a stop-loss provision, applicable 

during the transition period, to reduce 

financial risk to IPFs projected to 

experience substantial reductions in 

Medicare payments under the IPF PPS; 

(3) an interrupted stay policy to avoid 

overpaying stays that include a brief 

absence from the IPF followed by 

readmission to the IPF; and (4) a 

payment for patients who receive ECT. 

We are proposing to update those 

policies in this proposed rule. We are 

also proposing clarifications to the 

physician certification and 

recertification requirements in order to 

ensure consistent practices across IPFs. 

In addition, we are clarifying coverage 

of recreation therapy. 

1. Outlier Payments 

In the IPF PPS final rule, we 

implemented regulations at 

§ 412.424(d)(3)(i) to provide a payment 

adjustment for IPF stays that have 

extraordinarily high costs. Providing 

additional payments for outlier cases to 

IPFs that are beyond the IPF’s control 

strongly improves the accuracy of the 

IPF PPS in determining resource costs at 

the patient and facility level because 

facilities receive additional 

compensation over and above the 

adjusted Federal prospective payment 

amount for uniquely high-cost cases. 

These additional payments reduce the 

financial losses that would otherwise be 

caused by treating patients who require 

more costly care and, therefore, reduce 

the incentives to under-serve these 

patients. 

Under the IPF PPS, outlier payments 

are made on a per case basis rather than 

on a per diem basis because it is the 

overall financial ‘‘gain’’ or ‘‘loss’’ of the 

case, and not of individual days, that 

determines an IPF’s financial risk. In 

addition, because patient-level charges 

(from which costs are estimated) are 

typically aggregated for the entire IPF 

stay, they are not reported in a manner 

that would permit accurate accounting 

on a daily basis. 

Currently, we make outlier payments 

for discharges in which an IPF’s 

estimated total cost for a case exceeds a 

fixed dollar loss threshold amount 

(multiplied by the IPF’s facility-level 

adjustments) plus the Federal per diem 

payment amount for the case. 

In instances when the case qualifies 

for an outlier payment, we pay 80 

percent of the difference between the 

estimated cost for the case and the 

adjusted threshold amount for days 1 

through 9 of the stay (consistent with 

the median length of stay for IPFs in FY 

2002), and 60 percent of the difference 

for day 10 and thereafter. We 

established the 80 percent and 60 

percent loss sharing ratios because we 

were concerned that a single ratio 

established at 80 percent (like other 

Medicare hospital PPSs) might provide 

an incentive under the IPF per diem 

payment system to increase length of 

stay in order to receive additional 

payments. After establishing the loss 

sharing ratios, we determined the 

current fixed dollar loss threshold 

amount of $5,700 through payment 

simulations designed to compute a 

dollar loss beyond which payments are 

estimated to meet the 2 percent outlier 

spending target. 

a. Proposed Update to the Outlier Fixed 

Dollar Loss Threshold Amount 

As indicated in section II.A of this 

proposed rule, in accordance with the 

update methodology described in 

§ 412.428(d), we are proposing to update 

the fixed dollar loss threshold amount 

used under the IPF PPS outlier policy. 

Based on the regression analysis and 

payment simulations used to develop 

the IPF PPS, we established a 2 percent 

outlier policy to make an appropriate 

balance between protecting IPFs from 

extraordinarily costly cases while 

ensuring the adequacy of the Federal 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3643 

per diem base rate for all other cases 

that are not outlier cases. 

We continue to believe a 2 percent 

outlier policy is an appropriate target 

percentage and are proposing to retain 

the 2 percent outlier policy. However, 

we believe it is necessary to update the 

fixed dollar loss threshold amount 

because analysis of the latest available 

data indicates adjusting the fixed dollar 

loss amount is necessary in order to 

maintain an outlier percentage that 

equals 2 percent of total estimated IPF 

PPS payments. We intend to continue to 

analyze estimated outlier payments for 

subsequent years using the best 

available data in order to maintain 

estimated outlier payments at 2 percent 

of total estimated IPF PPS payments. 

We have determined that in certain 

sections of the IPF PPS final rule, we 

used the phrase ‘‘Fixed-dollar loss 

threshold’’ and, in other sections, we 

used the phrase ‘‘Fixed-dollar loss 

amount’’ to describe the dollar amount 

by which the costs of a case exceed 

payment in order to qualify for an 

outlier payment. In order to avoid 

confusion regarding these phrases, we 

are proposing to use the term ‘‘fixeddollar loss threshold amount’’ when we 

are referring to the dollar amount by 

which the costs of a case exceed 

payment in order to qualify for an 

outlier payment. 

As a result of this clarification, in 

§ 412.402, we are proposing to revise the 

term ‘‘Fixed dollar loss threshold’’ to 

‘‘Fixed dollar loss threshold amount.’’

We are also proposing clarifying 

changes to § 412.424(d)(3)(i) and 

§ 412.424(d)(3)(i)(A) to state that we 

would provide an outlier payment if an 

IPF’s estimated total cost for a case 

exceeds a ‘‘fixed dollar loss threshold 

amount’’ plus the total IPF adjusted 

payment amount for the stay, and that 

it is the fixed dollar loss threshold 

amount that is adjusted by the IPF’s 

facility-level adjustments. 

Aside from updating the terminology 

‘‘fixed dollar loss threshold amount’’

and making the conforming changes to 

the regulation text described above, we 

are not proposing any other changes to 

the outlier policy. Therefore, we would 

continue to adjust the fixed dollar loss 

threshold amount by the applicable 

facility-level payment adjustments and 

add this amount to the IPF PPS payment 

amount in order to determine if a case 

qualifies for an outlier payment. For 

cases that meet the threshold amount, 

we would pay 80 percent for days 1 

through 9 and 60 percent for day 10 and 

thereafter. 

In the IPF PPS final rule, we 

described the process by which we 

calculate the outlier fixed dollar loss 

threshold amount. We are proposing to 

continue to use this process in this 

proposed rule. We begin by simulating 

aggregate payments with and without an 

outlier policy, and applying an iterative 

process to a fixed dollar loss amount 

that would result in outlier payments 

being equal to 2 percent of total 

simulated payments under the 

simulation. Based on this process, we 

are proposing $6200 as the fixed dollar 

loss threshold amount in the outlier 

calculation in order to maintain the 

proposed 2 percent outlier policy. 

We note that the simulation analysis 

used to calculate the proposed $6200 

fixed dollar loss threshold amount 

includes all of the proposed changes to 

the IPF PPS discussed in this proposed 

rule. As a result, for the RY beginning 

July 1, 2006, the final fixed dollar loss 

threshold amount is subject to change in 

the final rule depending on the policies 

contained in the final rule. 

b. Proposed Statistical Accuracy of Costto-Charge Ratios 

As stated previously, under the IPF 

PPS, an outlier payment is made if an 

IPF’s cost for a stay exceeds a fixed 

dollar loss threshold amount. In order to 

establish an IPF’s cost for a particular 

case, we multiply the IPF’s reported 

charges on the discharge bill by their 

overall cost to charge ratio (CCR). This 

approach to determining a provider’s 

cost is consistent with the approach 

used under the IPPS and other 

prospective payment systems. In FY 

2004, we implemented changes to the 

IPPS outlier policy used to determine 

CCRs for acute care hospitals because 

we became aware that payment 

vulnerabilities resulted in inappropriate 

outlier payments. Under the IPPS, we 

established a statistical measure of 

accuracy for CCRs in order to ensure 

that aberrant CCR data did not result in 

inappropriate outlier payments. As we 

indicated in the IPF PPS final rule, 

because we believe the IPF outlier 

policy is susceptible to the same 

payment vulnerabilities as the IPPS, we 

adopted an approach to ensure the 

statistical accuracy of CCRs under the 

IPF PPS. Therefore, we adopted the 

following two procedures in the IPF PPS 

final rule: 

• We calculated two national ceilings, 

one for IPFs located in rural areas and 

one for IPFs located in urban areas. We 

computed the ceilings by first 

calculating the national average and the 

standard deviation of the CCR for both 

urban and rural IPFs. 

To determine the rural and urban 

ceilings, we multiplied each of the 

standard deviations by 3 and added the 

result to the appropriate national CCR 

average (either rural or urban). The 

current upper threshold CCR for IPFs is 

1.8853 for rural IPFs, and 1.8040 for 

urban IPFs, based upon MSA-based 

geographic designations. If an IPF’s CCR 

is above the applicable ceiling, the ratio 

is considered statistically inaccurate 

and we assign the appropriate national 

(either rural or urban) median CCR to 

the IPF. 

Additional information regarding the 

national median CCRs is included in the 

IPF PPS final rule (69 FR 66961). 

• We do not apply the applicable 

national median CCR when an IPF’s 

CCR falls below a floor. We made this 

decision because using the national 

median CCR in place of the provider’s 

actual CCR would overstate the IPF’s 

costs. We are proposing to apply the 

national CCRs to the following 

situations: 

++ New IPFs that have not yet 

submitted their first Medicare cost 

report. 

++ IPFs whose operating or capital 

CCR is in excess of 3 standard 

deviations above the corresponding 

national geometric mean (that is, above 

the ceiling). 

++ Other IPFs for whom the fiscal 

intermediary obtains inaccurate or 

incomplete data with which to calculate 

either an operating or capital CCR or 

both. 

The current national CCRs were 

estimated to be 0.7115 for rural IPFs and 

0.5658 for urban IPFs and would be 

used in each of the three situations cited 

above. These estimates were based on 

the IPF’s location (either urban or rural) 

using the MSA-based geographic 

designations. For new facilities, we are 

proposing to use these national ratios 

until the facility’s actual CCR can be 

computed using the first tentatively 

settled or final settled cost report, which 

would then be used for the subsequent 

cost report period. 

We are not proposing any changes to 

the procedures for ensuring the 

statistical accuracy of CCRs in RY 2007. 

However, we are proposing to update 

the national urban and rural CCRs 

(ceilings and medians) for IPFs for RY 

2007 based on the full calendar year 

2005 CCRs entered in the ProviderSpecific File. In addition, we are 

proposing that the updated ceilings and 

national median CCRs would be based 

on CBSA-based geographic designations 

because the CBSAs are the geographic 

designations we are proposing to adopt 

for purposes of computing the proposed 

wage index adjustment to IPF payments 

beginning July 1, 2006. We would 

include the updated ceiling and 

national median CCRs in the final RY 

2007 regulations. 


cchase on PROD1PC60 with PROPOSALS2
3644 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

In subsequent years, we are proposing 

to update the national urban and rural 

CCRs (median and ceilings) based on 

the previous full calendar year’s 

Provider-Specific File. These CCRs 

would be announced in each year’s 

annual notice of prospective payment 

rates published in the Federal Register. 

We are proposing to add a new 

paragraph (g) to § 412.428 to clarify that 

we intend to update the national urban 

and rural ceilings and medians as part 

of the annual update of the IPF PPS and 

to specify when the national median 

urban and rural CCRs would be used. 

1. Proposed Stop-Loss Provision 

In the IPF PPS final rule, we 

implemented a stop-loss policy to 

reduce financial risk for those facilities 

expected to experience substantial 

reductions in Medicare payments 

during the IPF PPS transition period. 

This stop-loss policy guarantees that 

each facility receives total IPF PPS 

payments that are no less than 70 

percent of its TEFRA payments, had the 

IPF PPS not been implemented. 

This policy is applied to the IPF PPS 

portion of Medicare payments during 

the 3-year transition. Hence, during year 

1, three-quarters of the payment were 

based on TEFRA and one-quarter on the 

IPF PPS. Under the 70 percent policy, 

75 percent of total payment is TEFRA 

payments, and the 25 percent is IPF PPS 

payments, which are at least 70 percent 

of the TEFRA payments. The resulting 

92.5 percent of TEFRA payments in year 

1 is the sum of 75 percent and 25 

percent times 70 percent. 

In year 2, one-half of the payment will 

be based on TEFRA and one-half on the 

IPF PPS. In year 3, one-quarter of the 

payment will be based on TEFRA and 

three-quarters on the IPF PPS. In year 4 

of the IPF PPS, Medicare payments are 

based 100 percent on the IPF PPS. 

The combined effects of the transition 

and the stop-loss policies will be to 

ensure that the total estimated IPF PPS 

payments were no less than 92.5 percent 

in year 1, 85 percent in year 2, and 77.5 

percent in year 3. 

The 70 percent of TEFRA payment 

stop-loss policy will require a reduction 

in the Federal per diem and ECT base 

rates of 0.39 percent in order to make 

the stop-loss payments budget neutral. 

We estimate that about 10 percent of 

IPFs would receive stop-loss payments 

under the 70 percent policy. 

We are not proposing to make any 

changes to the stop-loss policy. 

2. Patients Who Receive 

Electroconvulsive Therapy (ECT) 

In developing the IPF PPS, we 

received numerous public comments 

recommending that we include a 

payment adjustment for patients who 

receive ECT treatments during their IPF 

stay because furnishing ECT treatment, 

either directly or under arrangements, 

adds significantly to the cost of these 

stays. When we analyzed the FY 2002 

MedPAR data, we found that ECT cases 

comprised about 6 percent of all cases 

and that almost 95 percent of ECT cases 

were treated in IPFs that are psychiatric 

units of acute care hospitals. Even 

among psychiatric units, ECT cases are 

concentrated among a relatively small 

number of facilities. Overall, 

approximately 450 facilities had cases 

with ECT. Among these facilities, we 

estimated the mean number of ECT 

cases per facility to be approximately 

25. In addition, approximately one-half 

of the IPFs providing ECT had no more 

than 15 cases in FY 2002. 

Our analysis confirmed that cases 

with ECT are substantially more costly 

than cases without ECT. We found that 

on a per case basis, ECT cases are 

approximately twice as expensive as 

non-ECT cases ($16,287 compared to 

$7,684). Most of this difference is due to 

variation in length of stay (20.5 days for 

ECT cases compared to 11.6 days for 

non-ECT cases). In addition, the 

ancillary costs per case for ECT cases 

are $2,740 higher than those for nonECT cases. 

Although we are able to determine the 

cost of stays with ECT, we are unable to 

develop an ECT cost per treatment using 

the FY 2002 IPF claims data because the 

claims do not include the number of 

treatments. As a result, in the IPF PPS 

final rule, we established the following 

methodology for calculating the IPF PPS 

ECT payment adjustment. 

We established an ECT base rate using 

the pre-scaled and pre-adjusted median 

hospital cost for CPT procedure code 

90870 used for payment under hospital 

outpatient PPS (OPPS), based on 

hospital claims data. The median cost 

for all OPPS services are posted after 

publication of the OPPS proposed rule 

at the following address: http:// 

www.cms.hhs.gov/ 

hospitaloutpatientPPS. We used 

unadjusted hospital claims data under 

the OPPS, that is, the pre-scaled and 

pre-adjusted median hospital cost per 

treatment, to establish the ECT base rate 

because we did not want the ECT 

payment under the IPF PPS to be 

affected by factors that are relevant to 

OPPS but not specifically applicable to 

IPFs. The median cost ($311.88) was 

then standardized and adjusted for 

budget neutrality, resulting in an ECT 

payment adjustment of $247.96 per 

treatment. The ECT base rate is adjusted 

for wage and COLA differences in the 

same manner that we adjust the Federal 

per diem base rate. 

In order to receive the payment 

adjustment, IPFs must indicate on their 

claims the revenue code for ECT (901), 

along with the total number of units 

(ECT treatments) provided to the patient 

during their IPF stay. In addition, IPFs 

must include the ICD–9-CM procedure 

code for ECT (94.27) and the date of the 

last ECT treatment the patient received. 

As we stated in the IPF PPS final rule, 

although we established the ECT 

adjustment as a distinct payment under 

the IPF PPS, our preferred approach 

would be to include a patient level 

adjustment as a component of the model 

(for example, determined through the 

regression analyses) to account for the 

higher costs associated with ECT (69 FR 

66951). Although our analysis will 

continue, we do not intend to redo the 

regression analysis until we are able to 

analyze 1 year of IPF PPS claims and 

cost report data. However, we believe 

the data currently being submitted by 

IPFs may permit development of an IPFspecific ECT base rate, rather than using 

hospital outpatient claims data. 

It is important to note that since ECT 

treatment is a specialized procedure, not 

all providers are equipped to provide 

the treatment. Therefore, many patients 

who need ECT treatment during their 

IPF stay must be referred to other 

providers to receive the ECT treatments, 

and then return to the IPF. In 

accordance with § 412.404(d)(3), in 

these cases where the IPF is not able to 

furnish necessary treatment directly, the 

IPF would furnish ECT under 

arrangements with another provider. 

While a patient is an inpatient of the 

IPF, the IPF is responsible for all 

services furnished, including those 

furnished under arrangements by 

another provider. As a result, the IPF 

claim for these cases should reflect the 

services furnished under arrangements 

by other providers. 

Therefore, in accordance with the 

update methodology specified in 

§ 412.428(f), we are proposing to update 

the ECT base rate using the pre-scaled 

pre-adjusted hospital median cost for 

ECT used for the CY 2006 update of the 

OPPS. The median cost would then be 

standardized, adjusted for budget 

neutrality, and adjusted for wage and 

COLA differences in the same manner 

that we adjust the per diem rate. 

We are proposing to pay the median 

cost for an ECT treatment, posted as part 

of the calendar year (CY) 2006 OPPS 

update, which is based on CY 2004 

outpatient hospital claims. The median 

cost is $324.44. After applying the 

standardization factor and the wage 

index budget neutrality factor (as 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3645 

described in section III.C.1.f. of this 

proposed rule), the adjusted proposed 

ECT payment for RY 2007 is $268.21. 

We would monitor this area to ensure 

that the increased payments for ECT do 

not lead to changes in the frequency of 

utilization by reviewing the CY 2005 

MedPAR claims data. 

3. Physician Certification and 

Recertification Requirements 

Since the publication of the IPF PPS 

final rule, we have received inquiries 

related to physician certification and 

recertification. It appears that some 

psychiatric units in acute care hospitals 

have been following the timeframes that 

are applicable to the acute care hospital 

of which they are a part (as specified in 

§ 424.13) rather than those that apply to 

psychiatric hospitals (as specified in 

§ 424.14). 

To eliminate the confusion that we 

believe may be caused by the titles of 

§ 424.13 and § 424.14, to ensure 

consistency in compliance of the 

requirements among all IPFs, we are 

proposing to revise the title of § 424.14 

from ‘‘Requirements for inpatient 

services of psychiatric hospitals’’ to 

‘‘Requirements for inpatient services of 

inpatient psychiatric facilities.’’ We are 

proposing that for the purposes of 

payment under the IPF PPS, all IPFs 

would follow the physician certification 

and recertification requirements as 

specified in § 424.14. 

In the IPF proposed rule published on 

November 28, 2003 (68 FR 66920), we 

proposed to—(1) amend § 424.14 to state 

that in recertifying a patient’s need for 

continued inpatient care in an IPF, a 

physician must indicate that the patient 

continues to need, on a daily basis, 

inpatient psychiatric care (furnished 

directly by or requiring the supervision 

of IPF personnel) or other professional 

services that, as a practical matter, can 

be provided only on an inpatient basis; 

and (2) revise § 424.14(d) to require that 

a physician recertify a patient’s 

continued need for inpatient psychiatric 

care on the 10th day following 

admission to the IPF rather than the 

18th day following admission to the IPF 

(68 FR 66939). 

However, in the IPF PPS final rule, we 

did not include the proposed physician 

recertification requirement changes 

because most of the public comments 

we received on this issue did not 

support the proposed changes and 

indicated that there are inconsistencies 

in the timeframes currently required for 

IPFs that warranted additional analysis. 

Instead, we stated that we would 

continue to require that a physician 

recertify a patient’s continued need for 

inpatient psychiatric care on the 18th 

day following admission to the IPF. 

Since publication of the final rule, we 

have received additional inquiries 

related to the physician certification and 

recertification timeframes that currently 

apply to IPFs. As noted above, it 

appears that some psychiatric units in 

acute care hospitals have been following 

the timeframes that are applicable to the 

acute care hospital of which they are a 

part (as specified in § 424.13) rather 

than those that apply to psychiatric 

hospitals (as specified in § 424.14). 

Section 424.13(d) requires the initial 

certification no later than as of the 12th 

day of hospitalization and the first 

recertification is required no later than 

as of the 18th day of hospitalization. 

Section § 424.14(d) requires certification 

at the time of admission or as soon 

thereafter as is reasonable and 

practicable and the first recertification is 

required as of the 18th day of 

hospitalization. 

We are proposing that, for purposes of 

payment under the IPF PPS, all IPFs 

(distinct part units of acute care 

hospitals and CAHs and psychiatric 

hospitals) would meet the following 

physician certification and 

recertification timeframes. We would 

revise § 424.14(d) to provide that the 

initial physician certification would be 

required at the time of admission or as 

soon thereafter as is reasonable and 

practicable and the first recertification 

would be required as of the 12th day of 

hospitalization. Subsequent 

recertifications would be required at 

intervals established by the hospital’s 

UR committee (on a case-by-case basis 

if desired), but no less frequently than 

every 30 days. We chose the 12th day 

because it is more in line with the 

average LOS and it is current practice 

for certification in psychiatric units. 

We have also received inquiries from 

Fiscal Intermediaries requesting 

guidance on the content requirement of 

physician certifications at § 424.14(c), 

relating to the medical necessity of 

continued inpatient psychiatric care. As 

a result, we are proposing to add 

language to clarify that for purposes of 

payment under the IPF PPS, the 

physician would also recertify that the 

patient continues to need, on a daily 

basis, active treatment furnished 

directly by or requiring the supervision 

of inpatient psychiatric facility 

personnel. 

4. Provision of Therapeutic Recreation 

in IPFs 

Before the implementation of the IPPS 

payment methodology, Medicare 

coverage guidelines gave specific 

recognition to therapeutic recreation in 

inpatient psychiatric hospitals. The 

guidelines in § 3102.1.A of the Medicare 

Intermediary Manual, Part 3 (MIM–3), 

and in § 212.1 of the Medicare Hospital 

Manual (which now appear in the CMS 

Internet Online Manual at Pub. 100–02, 

Chapter 2, §§ 20.1ff.) specifically 

identify therapeutic recreation as one of 

the services that can constitute ‘‘active 

treatment’’ in this setting when they 

are—

• Provided under an individualized 

treatment or diagnostic plan; 

• Reasonably expected to improve the 

patient’s condition or for the purpose of 

diagnosis; and 

• Supervised and evaluated by a 

physician. 

However, these guidelines refer to 

therapeutic recreation in terms of being 

an ‘‘adjunctive’’ therapy, indicating that 

even in this setting, it would not 

independently serve as a patient’s sole 

or primary form of therapeutic 

treatment, but rather, would be 

furnished in support of (but subordinate 

to) some other, primary form of therapy. 

When the IPPS was developed in 

1983, to the extent that therapeutic 

recreation and other services had been 

furnished during the IPPS base period, 

the bundled IPPS payment for that 

setting would reflect these costs. 

However, during the IPPS rulemaking 

process, we received public comments 

stating ‘‘* * * concern that the costsaving incentives of the prospective 

payment system would lead hospitals 

paid under the system to stop providing 

recreational therapy services.’’ In 

response, in the January 3, 1984 IPPS 

final rule (49 FR 242) we indicated that 

implementation of the IPPS would not, 

in fact, prohibit the provision of 

recreational therapy services, and that 

‘‘* * * these services will continue to 

be covered to the same extent they 

always have been under existing 

Medicare policies’’. 

In implementing the IPPS regulations, 

we included criteria for identifying 

certain types of institutions (for 

example, psychiatric hospitals) that 

would be excluded from the IPPS and, 

thus, would continue to be paid under 

some other methodology. The 

regulations also introduced criteria for 

identifying an IPPS-excluded inpatient 

psychiatric unit housed within a larger 

acute-care hospital that would itself be 

subject to the IPPS. One of these 

identifying criteria at 42 CFR 

405.471(c)(4)(ii)(B) (later recodified at 

42 CFR 412.27(b)) was the provision, 

through the use of qualified personnel, 

of a number of specified types of 

services, including psychological 

services, social work services, 


cchase on PROD1PC60 with PROPOSALS2
3646 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

psychiatric nursing, occupational 

therapy, and recreational therapy. 

As we explained in the IPPS interim 

final rule published on September 1, 

1983 (48 FR 39758), the regulations 

designated these particular services 

because their provision ‘‘* * * is 

typical of units which treat patients 

whose characteristics are like those in 

psychiatric hospitals. Consequently, the 

provision of these services is an 

identifier of such a patient population’’. 

We note that the designation of these 

particular services in this context did 

not serve to define the scope of their 

coverage under Medicare, nor to 

mandate their provision in this setting, 

but merely to identify them as being 

characteristic of the type of psychiatric 

unit that would qualify for exclusion 

from the IPPS. 

At the same time the IPPS was being 

developed, a parallel evolution was 

taking place in the certification 

requirements that facilities must meet in 

order to participate in the Medicare 

program: A shift from primarily 

‘‘process-oriented’’ requirements to 

more ‘‘outcome-oriented’’ requirements, 

which focus more on direct indicators of 

the quality of care actually being 

furnished to the facility’s patients (as 

reflected in the presence of positive 

results and the absence of negative 

ones), and less on the specific ‘‘process’’

through which the facility achieves the 

desired outcome. 

In order to participate in the Medicare 

program, psychiatric hospitals not only 

had to meet the conditions of 

participation (COPs) that apply to 

general, acute-care hospitals, but 

additionally had to meet special 

conditions related to medical records 

and staffing. Consistent with the 

recognition of therapeutic recreation as 

constituting active treatment in this one 

particular setting (as discussed above), 

the original COPs for psychiatric 

hospitals at 42 CFR 405.1038(g) 

mandated the presence of qualified 

therapists, assistants, or aides ‘‘* * * 

sufficient in number to provide 

comprehensive therapeutic activities, 

including at least occupational, 

recreational and physical therapy, as 

needed, to assure that appropriate 

treatment is rendered for each patient, 

and to establish and maintain a 

therapeutic milieu.’’ Furthermore, 42 

CFR 405.1038(g)(3) further specified 

that ‘‘recreational or activity therapy 

services are available under the direct 

supervision of a member of the staff 

who has demonstrated competence in 

therapeutic recreation programs,’’ and 

§§ 405.1038(g)(4) and (5) went on to 

prescribe additional standards regarding 

therapy assistants or aides and overall 

staffing for recreational and activity 

therapy. 

However, when the special medical 

record and staffing COPs for psychiatric 

hospitals were subsequently recodified 

at 42 CFR 482.62(g), the specific 

references to recreation therapy were 

deleted and replaced with a more 

general requirement to provide a 

therapeutic activities program. In 

response to public comments that 

recommended us to restore the deleted 

requirements, we indicated that we 

believe that the deleted requirements 

concerning therapeutic activities were 

overly and unnecessarily prescriptive 

and that the hospital should have the 

flexibility to determine which activities 

are most appropriate to its patient 

population and to determine the criteria 

to be met by employees providing these 

services. (see the IPPS PPS rule 

published on June 17, 1986 (51 FR 

22032)). 

When the 1986 COP changes 

applicable to psychiatric hospitals were 

made, we inadvertently retained 

specific references to recreation therapy 

in § 412.27. Since the intent of 

§ 412.27(b) is to identify services 

provided in psychiatric units that are 

characteristic of services furnished in 

psychiatric hospitals, we believe it is no 

longer appropriate to include references 

to specific therapies in § 412.27. In 

order to have consistent requirements 

among IPFs, we are proposing to remove 

recreational therapy from § 412.27(b). 

Although we are proposing to remove 

the specific reference to recreation 

therapy, we want to emphasize that 

recreation therapy is, and would 

continue to be, an accepted therapeutic 

intervention in psychiatric treatment. In 

addition, we believe the IPF PPS base 

rate which was developed using FY 

2002 data, reflects the provision of 

recreation therapy. 

5. Same Day Transfers 

Currently, when a transfer, discharge, 

or death occurs on the same day as an 

admission to an IPF, the IPF PPS 

PRICER does not recognize any covered 

IPF days and the IPF claims are 

suspended. Based on review of a limited 

sample of the IPF and subsequent IPPS 

claims, it appears that many of these 

patients are first seen in a hospital’s ED, 

are admitted to the hospital’s 

psychiatric unit and, later the same day, 

determined to be too medically 

compromised to be managed in the 

psychiatric unit. This scenario may 

occur because the patient presents at the 

ED and is admitted to the psychiatric 

unit in the middle of the night, and 

when the patient’s admission to the unit 

is reviewed by a psychiatrist the next 

morning, the physician determines that 

the patient should be discharged for 

acute care. In other cases, a patient may 

have been admitted to a freestanding 

psychiatric hospital based on the 

information furnished by an ED of an 

acute care hospital. However, after 

admission, the psychiatric hospital staff 

evaluates the patient and determines 

that the patient has medical needs that 

they are not staffed or equipped to meet. 

The Provider Reimbursement Manual 

addresses the same day transfer issue 

from the perspective of counting 

Medicare days for the purpose of 

Medicare cost reporting. Section 2205 

indicates that only full patient days may 

be used to apportion inpatient routine 

care service costs and that a day begins 

at midnight and ends 24 hours later. 

However, section 2205.1 explains how 

to count a day if the day of admission 

and the day of discharge are the same. 

Section 2205.1 indicates that when a 

patient is admitted and then transferred 

from one participating provider to 

another before midnight of the same 

day, a day (except for utilization 

purposes) is counted at both providers. 

A day of Medicare utilization is charged 

only for the admission to the second 

provider. This distinction is important 

for psychiatric admissions because IPF 

stays are subject to the 190-day lifetime 

limit on inpatient psychiatric care. 

Section 1812(b) of the Act and 42 CFR 

409.62 indicate that payment is not 

available for inpatient psychiatric 

hospital services furnished beyond the 

190-day lifetime limit. Thus, Medicare 

coverage of IPF services, specifically IPF 

services furnished in freestanding 

psychiatric hospitals is limited to 190 

days. In consideration of the limit on 

coverage of IPF services, where there is 

a same day transfer between Medicare 

participating providers, we only count 

the second admission for utilization 

purposes. Therefore, the initial 

admission to the IPF does not count 

against a beneficiary’s lifetime 

psychiatric services limit. 

We have some concerns regarding 

same day transfers from an IPF. Under 

TEFRA, a hospital receives its cost up 

to the hospital’s TEFRA limit. The 

TEFRA limit is based on the hospital’s 

average cost per discharge in a base 

period. When an admission and 

discharge occur on the same day, the 

hospital’s cost is unlikely to exceed the 

TEFRA limit, so the hospital receives its 

cost for the day. These same day 

transfers also improve the hospital’s 

payment under TEFRA by slightly 

reducing its cost per discharge. We are 

also concerned that when the transfer 

occurs in the same hospital, this 

practice circumvents bundling rules 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3647 

under the IPPS, in that it unbundles the 

ED charges from the IPPS claim and 

allocates the ED costs to the psychiatric 

unit even though the patient may have 

been inappropriately admitted to the 

unit. 

Based on the review of IPF PPS claims 

we conducted, it did not appear that the 

admissions to the IPF were medically 

reasonable and necessary. However, we 

believe it is important to base a decision 

regarding coverage of these days on a 

comprehensive review of the claims. 

Therefore, we are not proposing a 

change in payment policy in this 

proposed rule. However, we are 

considering several alternative methods 

for addressing same day transfers under 

the IPF PPS which are described below. 

Any change to treatment of same day 

transfers would be made prospectively. 

We could treat these days as covered 

days under the IPF PPS. However, 

under the IPF PPS, a 19 percent 

adjustment to the base rate is applied to 

day 1 of the stay to reflect the additional 

administrative and clinical costs 

associated with admission and the day 

1 adjustment is increased to 31 percent 

when the IPF has a qualifying ED. The 

IPF may also receive, for example, a 

teaching adjustment or rural adjustment, 

for these partial days of care. Several of 

the claims in our analysis indicate a stay 

of 2 hours. We are concerned that this 

approach would overpay IPFs and 

encourage inappropriate admissions and 

transfers. 

Another option would be to make no 

PPS payment, but continue making 

TEFRA payments during the IPF PPS 

transition period. For example, for cost 

reporting periods beginning in 2006, 

IPFs will receive a blended payment 

consisting of 50 percent PPS and 50 

percent TEFRA. Therefore, under this 

approach we would allow some 

payment for these days for cost 

reporting periods in 2006 and 2007, but 

once the IPF PPS transition period is 

over, the IPFs would receive no 

payment for these days. We think this 

approach would encourage changes in 

admission practices in order to avoid 

the need to transfer patients. However, 

once the IPF PPS transition is over, 

there would be no payment mechanism 

to pay IPFs for stays in which there is 

a circumstance, not reasonably 

foreseeable by the admitting IPF such as 

a serious change in health status on the 

day of admission. 

We could treat these same day 

transfer cases as covered days under the 

IPF PPS but limit payment to the 

Federal per diem base rate or some other 

payment amount, for example, half the 

Federal per diem base rate. This 

approach would limit payment to IPFs 

in order to provide an incentive for IPFs 

to make medical clearance 

determinations as early in the IPF stay 

as possible. However, we are concerned 

that this approach would not lead to 

changes in admission practices to avoid 

inappropriate admissions and the need 

for subsequent transfers. 

It is important to note that the cost for 

these days was included in the cost 

reports used to develop the IPF PPS, 

and, as a result, the average cost per day 

that was used to establish the Federal 

per diem base rate is higher than it 

would otherwise have been had those 

days not been included. 

We specifically request public 

comment from IPFs on this issue to help 

us to develop a payment policy that 

pays IPFs appropriately for these days 

and provides an incentive to avoid same 

day transfers wherever possible. 

V. Provisions of the Proposed Rule 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘PROVISIONS’’ at the beginning of your 

comments.] 

We are proposing to make revisions to 

the regulation in order to implement the 

proposed prospective payment for IPFs 

for discharges occurring during the RY 

beginning July 1, 2006. As part of the 

update, we are proposing to incorporate 

OMB’s revised definitions for MSAs and 

its new definitions of Micropolitan 

Statistical Areas and Core-Based 

Statistical Areas. In addition, we are 

proposing the following—

• Update payments for IPF facilities 

using a market basket reflecting the 

operating and capital cost structures for 

the RPL market basket. 

• Develop cost weights for benefits, 

contract labor, and blood and blood 

products using the FY 2002-based IPPS 

market. 

• Provide weights and proxies for the 

FY 2002-based RPL market basket. 

• Indicate the methodology for the 

capital portion of the FY 2002-based 

RPL market basket. 

• Update the outlier threshold 

amount to maintain total outlier 

payments at 2 percent of total estimated 

payments. 

• Use source code ‘‘D’’ to identify IPF 

patients who have been transferred to 

the IPF from the same hospital or CAH. 

• Retain the 17 percent adjustment 

for IPFs located in rural areas, the 1.31 

adjustment for IPFs with a qualifying 

ED, the 0.5150 teaching adjustment to 

the Federal per diem base rate, and the 

DRG adjustment factor currently being 

paid to IPFs for discharges occurring 

during RY 2007. 

• Update the payment rate for ECT. 

• Update the DRG listing and 

comorbidity categories to reflect the 

ICD–9–CM revisions effective October 1, 

2005. 

In addition to discussing these general 

issues in the IPF PPS 2007 RY, we also 

proposed making the following specific 

revisions to the existing text of the 

regulations. Specifically, we are 

proposing to make conforming changes 

in 42 CFR part 412 and 424 as discussed 

through out this preamble. 

In § 412.27, we are proposing to revise 

paragraph (b) to remove the reference to 

recreational therapy. 

In § 412.402, we are proposing to 

revise the heading of ‘‘Fixed dollar lossthreshold’’ to ‘‘Fixed dollar loss 

threshold amount’’ and revise the 

definitions of ‘‘Fixed dollar loss 

threshold amount’’, ‘‘Qualifying 

emergency department’’, ‘‘Rural area’’

and ‘‘Urban area.’’ For consistency, we 

are proposing to make conforming 

changes to these terminologies wherever 

they appear in the regulations text. 

In § 412.424, we are also proposing to 

add paragraph (d)(1)(iii)(E) to clarify 

that the teaching adjustment is made on 

a claim basis as an interim payment and 

the final payment in full is made during 

the final settlement of the cost report. 

For clarity, we are proposing to revise 

paragraph (d)(2) introductory text. The 

current language in (d)(2)(iii) would 

become the introductory text for 

paragraph (d)(2) and paragraph 

(d)(2)(iii) would be removed. In 

addition, we are proposing to revise 

§ 412.424(d)(3)(i)(A) to clarify that an 

outlier payment is made if an IPF’s 

estimated total cost for a case exceeds a 

fixed dollar loss threshold amount plus 

the Federal payment amount for the 

case. 

In § 412.426(a), we are proposing to 

correct the cross reference to the Federal 

per diem payment amount. We 

incorrectly referenced the Federal per 

diem base rate at § 424.424(c). The 

correct cross reference to the Federal per 

diem payment amount is § 424.424(d). 

In § 412.428, we are proposing to 

revise paragraph (b) to specify that for 

discharges occurring on or after January 

1, 2005 but before July 1, 2006 the rate 

of increase factor for the Federal portion 

of the payment is based on the FY 1997- 

based excluded hospital with capital 

market basket and for discharges 

occurring on or after July 1, 2006, the 

rate of increase factor for the Federal 

portion of the payment is based on the 

FY 2002-based RPL market basket. 

In addition, we are proposing to add 

a new paragraph (g) to state that we 

would update the national urban and 

rural cost to charge ratio median and 

ceiling. Paragraph (1) through (3) would 


cchase on PROD1PC60 with PROPOSALS2
3648 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

specify the types of IPFs in which to 

apply the national cost to charge ratio. 

Furthermore, we are proposing to add a 

new paragraph (h) to update the cost of 

living adjustment factors if appropriate. 

In § 424.14, we are proposing to revise 

the title to read, ‘‘Requirements for 

inpatient services of inpatient 

psychiatric facilities,’’ to ensure 

consistency in compliance with the 

requirements among all IPFs. We are 

proposing to add a new paragraph (c)(3) 

to clarify for purposes of payment under 

the IPF PPS, that the physician would 

also recertify that the patient continues 

to need, on a daily basis, active 

inpatient psychiatric care (furnished 

directly by or requiring the supervision 

of inpatient psychiatric facility 

personnel) or other professional services 

that can only be provided on an 

inpatient basis. 

In addition, we are revising paragraph 

(d)(2) to state that the first recertification 

is required as of the 12th day of 

hospitalization. Subsequent 

recertifications are required at intervals 

established by the UR committee (on a 

case-by-case basis if it so chooses), but 

no less frequently than every 30 days. 

VI. Collection of Information 

Requirement 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘INFORMATION COLLECTION’’ 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. 

VII. Regulatory Impact Analysis 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘IMPACT’’ at the beginning of your 

comments.] 

A. Overall Impact 

We have examined the impact of this 

proposed rule as required by Executive 

Order 12866 (September 1993, 

Regulatory Planning and Review), the 

Regulatory Flexibility Act (RFA) 

(September 19, 1980, Pub. L. 96–354), 

section 1102(b) of the Social Security 

Act, the Unfunded Mandates Reform 

Act of 1995 (UMRA) (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). 

Based on the impact analysis, we 

estimate the expenditures from the IPF 

PPS implementation year to the 2007 

IPF PPS RY will be increased by $180 

million. The updates to the IPF laborrelated share and wage indices are made 

in a budget neutral manner and thus 

have no effect on estimated costs to the 

Medicare program. Therefore, the 

estimated increased cost to the Medicare 

program is the result of a combination 

of the updated IPF market baskets, 

which is offset by the transition blend 

and the revision of the standardization 

factor. 

CMS notes that aspects of the 

transition, including the stop-loss policy 

and the transition to the 50/50 percent 

blend in the 2007 IPF PPS RY and the 

transition to the 75/25 percent blend in 

the 2008 IPF PPS RY, were included in 

the 2004 final rule and are thus not 

incremental to this rulemaking. 

Nevertheless, it is essential to analyze 

the impact of the transition blend in 

order to calculate the increase in cost to 

the Medicare program. 

The impact of the transition blend is 

an approximately .2 percent (about $10 

million) decrease in overall payments 

for the 2007 IPF PPS RY and the 

distribution of that impact is 

summarized in Table 15. Therefore, the 

impact attributable to the policy 

changes proposed in this rulemaking, 

primarily the market basket update and 

the standardization correction, is 

approximately $180 million in the 2007 

IPF PPS RY. 

Since costs to the Medicare program 

are estimated to be greater than $100 

million, this proposed rule is 

considered a major economic rule, as 

defined in 5 U.S.C. 40(2). 

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 

governmental jurisdictions. Most IPFs 

and most other providers and suppliers 

are considered small entities, either by 

nonprofit status or by having revenues 

of $6 million to $29 million in any 1 

year. (For details, see the Small 

Business Administration’s regulation 

that set forth size standards for health 

care industries at 65 FR 69432.) 

HHS considers that a substantial 

number of entities are affected if the 

rule impacts more than 5 percent of the 

total number of small entities as it does 

in this rule. We included all 

freestanding psychiatric hospitals (79 

are non-profit hospitals) in the analysis 

since their total revenues do not exceed 

the $29 million threshold. We also 

included psychiatric units of small 

hospitals, that is, those hospitals with 

fewer than 100 beds. We did not include 

psychiatric units within larger hospitals 

in the analysis because we believe this 

proposed rule would not significantly 

impact total revenues of the entire 

hospital that supports the unit. We have 

provided the following RFA analysis in 

section B to emphasize that, although 

the proposed rule would impact a 

substantial number of IPFs that were 

identified as small entities, we do not 

believe it would have a significant 

economic impact. Based on the analysis 

of the 1063 psychiatric facilities that 

were classified as small entities as 

described above, we estimate the 

combined impact of the IPF PPS will be 

a 4.6-percent increase in payments in 

RY 2007 relative to their payments in 

the implementation year of the IPF PPS. 

Based on the information available, we 

believe that Medicare payments may 

constitute a small portion of 

governmental IPF’s revenue stream. We 

have prepared the impact analysis in 

section VI.B.2 to describe the impact of 

the proposed rule in order to provide a 

factual basis for our conclusions 

regarding small business impact. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a proposed 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. With the exception of 

hospitals located in certain New 

England counties, for purposes of 

section 1102(b) of the Act, we 

previously defined a small rural 

hospital as a hospital with fewer than 

100 beds that is located outside of a 

Metropolitan Statistical Area (MSA) or 

New England County Metropolitan Area 

(NECMA). However, under the new 

labor market definitions that we are 

proposing to adopt, we would no longer 

employ NECMAs to define urban areas 

in New England. Therefore, for purposes 

of this analysis, we now define a small 

rural hospital as a hospital with fewer 

than 100 beds that is located outside of 

an MSA. We have determined that this 

proposed rule would have a substantial 

impact on hospitals classified as located 

in rural areas. As discussed earlier in 

this preamble, we are proposing to 

continue to provide a payment 

adjustment of 17 percent for IPFs 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3649 

located in rural areas. In addition, we 

have established a 3-year transition to 

the new system to allow IPFs an 

opportunity to adjust to the new system. 

Therefore, the impacts shown in Table 

15 below reflect the adjustments that are 

designed to minimize or eliminate any 

potentially significant negative impact 

that the IPF PPS may otherwise have on 

small rural IPFs. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

proposed rule whose mandates require 

spending in any 1 year of $100 million 

in 1995 dollars, updated annually for 

inflation. That threshold level is 

currently approximately $120 million. 

This proposed rule would not mandate 

any requirements for State, local, or 

tribal governments, nor would it affect 

private sector costs. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule that imposes substantial 

direct requirement costs on State and 

local governments, preempts State law, 

or otherwise has Federalism 

implications. 

We have reviewed this proposed rule 

under the criteria set forth in Executive 

Order 13132 and have determined that 

the proposed rule would not have any 

substantial impact on the rights, roles, 

and responsibilities of State, local, or 

tribal governments. 

B. Anticipated Effects of the Proposed 

Rule 

We discuss below the impact of this 

proposed rule on the Federal Medicare 

budget and on IPFs. 

1. Budgetary Impact 

As discussed in detail in the IPF PPS 

final rule and summarized in section 

III.B. of this proposed rule, we applied 

a budget neutrality factor to the Federal 

per diem and ECT base rates to ensure 

that total payments under the IPF PPS 

in the implementation period would 

equal the amount that would have been 

paid if the IPF PPS had not been 

implemented. In addition, as discussed 

in section IV.C.1 of this proposed rule, 

we are proposing to adopt the new 

CBSAs and labor market share in a 

budget neutral manner by applying a 

wage index budget neutrality factor to 

the Federal per diem and ECT base 

rates. Thus, the budgetary impact to the 

Medicare program by the update of the 

IPF PPS will be the combination of the 

proposed market basket updates (see 

section III.C of this proposed rule), the 

proposed revision of the standardization 

factor (see section III.B.3 of this 

proposed rule), and the planned update 

of the payment blend discussed below. 

2. Impacts on Providers 

To understand the impact of the 

changes to the IPF PPS discussed in this 

proposed rule on providers, it is 

necessary to compare estimated 

payments under the IPF PPS rates and 

factors for the 2007 IPF rate year to 

estimated payments under the IPF PPS 

rates and factors for the IPF PPS 

implementation year. The estimated 

payments for the IPF implementation 

year are a blend of: 75 percent of the 

facility-specific TEFRA payment and 25 

percent of the IPF PPS payment with 

stop loss payment. The estimated 

payments for the 2007 IPF rate year are 

a blend of: 50 percent of the facilityspecific TEFRA payment and 50 percent 

of the IPF PPS payment with stop loss 

payment. We determined the percent 

change of estimated 2007 IPF PPS rate 

year payments to estimated IPF PPS 

implementation year payments for each 

category of IPFs. In addition, for each 

category of IPFs, we have included the 

estimated percent change in payments 

resulting from the revision of the 

standardization factor (as discussed in 

section III.B.3 of this proposed rule, the 

ratio of estimated total TEFRA payments 

to estimated total PPS payments in the 

implementation year was overestimated 

and therefore needed to be reduced. We 

are proposing to apply the revised 

standardization factor prospectively to 

the Federal per diem base rate and ECT 

amount), the wage index changes for the 

2007 IPF PPS rate year, the proposed 

market basket update to IPF PPS 

payments, and the transition blend for 

the 2007 rate year of the IPF PPS 

payment and the facility-specific 

TEFRA payment. 

To illustrate the impacts of the 

proposed RY 2007 changes, our analysis 

begins with an implementation year 

baseline simulation model based on FY 

2002 IPF payments inflated to 2005 with 

market baskets; the estimated outlier 

payments in 2005; the estimated stoploss payments in 2005; the MSA 

designations for IPFs based on OMB’s 

MSA definitions before June 2003; the 

2005 MSA wage index; the 

implementation year labor-market share; 

and the implementation year percentage 

amount of the rural adjustment. During 

the simulation, the outlier payment is 

maintained at the target of 2 percent of 

total PPS payments. 

Each of the following proposed 

changes is added incrementally to this 

baseline model in order for us to isolate 

the effects of each change: 

• IPF PPS payments adjusted by the 

revised standardization factor. 

• The new CBSAs based on new 

geographic area definitions announced 

by OMB in June 2003 and the RY 2007 

proposed budget-neutral labor-related 

share and wage index adjustment. 

• A blended market basket update of 

4.7 percent resulting in an update to the 

hospital-specific TEFRA target amount 

and an update to the IPF PPS base rates 

as discussed below. 

++ As discussed in section III.C.4 of 

this proposed rule and in the IPPS final 

rule published August 12, 2005 (70 FR 

47707), we established an update factor 

of 3.8 percent effective for cost reporting 

periods beginning on or after October 1, 

2005 using the 2002-based excluded 

hospital market basket. The 3.8 percent 

update is applied to the IPF’s target cost 

per discharge established under TEFRA 

for cost reporting periods beginning on 

or after October 1, 2005. However, since 

the midpoints of the 2007 rate year and 

the IPF PPS implementation period are 

15 months apart, the TEFRA payment 

increase is projected to be 4.8 percent. 

++ An update to the Federal per diem 

base rate of 4.5 percent based on the 

2002-based RPL market basket (see 

section III.C.1.b of this proposed rule). 

The market basket update is based on a 

15-month time period (from the 

midpoint of the IPF PPS 

implementation period to the midpoint 

of the 2007 rate year). 

• The transition to 50 percent IPF 

PPS payment and 50 percent facilityspecific TEFRA payment. 

Our final comparison illustrates the 

percent change in payments from the 

IPF PPS implementation year (that is, 

January 1, 2005 to June 30, 2006) to RY 

2007 (that is, July 1, 2006 to June 30, 

2007). 


cchase on PROD1PC60 with PROPOSALS2
3650 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

TABLE 15.—PROJECTED IMPACTS

Facility by type Number of 

facilities 

Standardization factor correction CBSA wage 

index and 

labor share 

Market basket Transition 

blend Total 

(1) (2) (3) (4) (5) (6) (7) 

All Facilities .............................................. 1,806 ¥0.3% 0.0% 4.7% ¥0.2% 4.2% 

By Type of Ownership: 

Psychiatric Hospitals.

Government ............................... 178 ¥0.4% 0.0% 4.7% 11.0% 15.7% 

Non-profit ................................... 79 ¥0.3% 0.1% 4.7% 1.6% 6.1% 

For-profit .................................... 150 ¥0.4% 0.1% 4.7% 4.3% 8.9% 

Psychiatric Units ........................ 1,399 ¥0.3% 0.0% 4.7% ¥1.8% 2.5% 

Rural ......................................................... 384 ¥0.3% ¥0.2% 4.7% ¥1.1% 3.0% 

Urban ....................................................... 1,422 ¥0.3% 0.0% 4.7% ¥0.1% 4.3% 

By Urban or Rural Classification: 

Urban by Facility Type.

Psychiatric Hospitals.

Government ............................... 144 ¥0.4% 0.1% 4.7% 10.8% 15.6% 

Non-profit ................................... 73 ¥0.3% 0.1% 4.7% 1.7% 6.2% 

For-profit .................................... 143 ¥0.4% 0.1% 4.7% 4.4% 9.0% 

Psychiatric Units ........................ 1,062 ¥0.3% 0.0% 4.7% ¥1.7% 2.6% 

Rural by Facility Type.

Psychiatric Hospitals.

Government ............................... 34 ¥0.5% ¥0.3% 4.7% 11.8% 16.1% 

Non-profit ................................... 6 ¥0.3% 0.3% 4.7% ¥0.7% 3.9% 

For-profit .................................... 7 ¥0.2% ¥0.1% 4.7% ¥1.8% 2.4% 

Psychiatric Units ........................ 337 ¥0.3% ¥0.2% 4.7% ¥2.2% 1.8% 

By Teaching Status: 

Non-teaching ..................................... 1,537 ¥0.3% 0.0% 4.7% ¥0.3% 4.0% 

Less than 10% interns and residents to beds ......................... 148 ¥0.3% 0.0% 4.7% 0.4% 4.8% 

10% to 30% interns and residents to beds ......................... 72 ¥0.3% ¥0.1% 4.7% 0.4% 4.6% 

More than 30% interns and residents to beds ......................... 49 ¥0.3% 0.1% 4.7% ¥0.1% 4.4% 

By Region: 

New England .................................... 126 ¥0.3% 0.0% 4.7% ¥0.5% 3.9% 

Mid-Atlantic ....................................... 306 ¥0.4% 0.1% 4.7% 2.8% 7.3% 

South Atlantic .................................... 238 ¥0.3% ¥0.1% 4.7% 0.2% 4.5% 

East North Central ............................ 325 ¥0.3% ¥0.1% 4.7% ¥1.5% 2.8% 

East South Central ........................... 159 ¥0.3% 0.0% 4.7% ¥0.2% 4.2% 

West North Central ........................... 169 ¥0.3% ¥0.2% 4.7% ¥1.1% 3.1% 

West South Central .......................... 237 ¥0.3% ¥0.1% 4.7% ¥2.7% 1.6% 

Mountain ........................................... 83 ¥0.3% 0.0% 4.7% ¥0.4% 4.0% 

Pacific ............................................... 156 ¥0.3% 0.3% 4.7% ¥0.6% 4.1% 

By Bed Size: 

Psychiatric Hospitals.

Under 12 beds ........................... 26 ¥0.1% 0.1% 4.7% ¥3.8% 0.8% 

12 to 25 beds ............................ 46 ¥0.2% ¥0.1% 4.7% 0.3% 4.7% 

25 to 50 beds ............................ 91 ¥0.4% 0.2% 4.7% 4.3% 8.9% 

50 to 75 beds ............................ 82 ¥0.4% 0.1% 4.7% 3.8% 8.4% 

Over 75 beds ............................. 162 ¥0.4% 0.0% 4.7% 8.5% 13.1% 

Psychiatric Units.

Under 12 beds ........................... 600 ¥0.2% 0.0% 4.7% ¥4.5% ¥0.2% 

12 to 25 beds ............................ 474 ¥0.3% 0.0% 4.7% ¥1.9% 2.4% 

25 to 50 beds ............................ 228 ¥0.3% 0.0% 4.7% ¥0.6% 3.7% 

50 to 75 beds ............................ 58 ¥0.3% 0.0% 4.7% 0.1% 4.4% 

Over 75 beds ............................. 39 ¥0.3% ¥0.1% 4.7% 1.2% 5.5% 

3. Results 

Table 15 above displays the results of 

our analysis. The table groups IPFs into 

the categories listed below based on 

characteristics provided in the Online 

Survey and Certification and Reporting 

(OSCAR) file and the 2002 cost report 

data from HCRIS: 

• Facility Type 

• Location 

• Teaching Status Adjustment 

• Census Region 

• Size 

The top row of the table shows the 

overall impact on the 1,806 IPFs 

included in the analysis. 

In column 3, we present the effects of 

the revised standardization factor (refer 

to section III.B.3 of this proposed rule 

for a discussion of this revision). This is 

defined to be the comparison of the 

simulated implementation year payment 

under the revised budget neutral factor 

to the simulated implementation year 

payment under the original budget 

neutral factor. In aggregate, the 

proposed revision would result in a 0.3 

percent decrease in overall payments to 

IPFs. There are small distributional 

effects among different categories of 

IPFs. For example, rural government 

psychiatric hospitals would receive the 

largest decrease of 0.5 percent while 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3651 

rural for-profit psychiatric hospitals 

would receive a 0.2 percent decrease. 

Also psychiatric hospitals with over 75 

beds would receive a decrease of 0.4 

percent while psychiatric hospitals with 

fewer than 12 beds would receive the 

smallest decrease of 0.1 percent. 

In column 4, we present the effects of 

the budget-neutral update to the laborrelated share and the wage index 

adjustment under the new CBSA 

geographic area definitions announced 

by OMB in June 2003. This is a 

comparison of the simulated 

implementation year payment under 

revised budget neutral factor and laborrelated share and wage index under 

CBSA classification to the simulated 

implementation year payment under 

revised budget neutral factor and laborrelated share and wage index under 

current MSA classification. There is no 

change in aggregate payments to IPFs as 

indicated in the first row of column 4. 

There would, however, be small 

distributional effects among different 

categories of IPFs. For example, rural 

IPFs would experience a 0.2 percent 

decrease in payments while urban IPFs 

would experience no change in 

payments. Rural government hospitals 

would receive the largest decrease of 0.3 

percent while rural non-profit hospitals 

would receive the largest increase of 0.3 

percent. 

In column 5, we present the effects of 

the proposed market basket update to 

the IPF PPS payments by applying the 

TEFRA and PPS updates to payments 

under revised budget neutral factor and 

labor-related share and wage index 

under CBSA classification. In the 

aggregate the proposed update would 

result in a 4.7 percent increase in 

overall payments to IPFs. This 4.7 

percent reflects the current blend of the 

4.8 percent update for IPF TEFRA 

payments and the 4.5 percent update for 

the IPF PPS payments. 

In column 6, we present the effects of 

the payment change in transition blend 

percentages to transition year 2 (TEFRA 

Rate Percentage = 50 percent, IPF PPS 

Federal Rate Percentage = 50 percent) 

from transition year 1 (TEFRA Rate 

Percentage = 75 percent, IPF PPS 

Federal Rate Percentage = 25 percent) of 

the IPF PPS under revised budget 

neutral factor, labor-related share and 

wage index under CBSA classification, 

and TEFRA and PPS updates to RY 

2007. The overall aggregate effect, across 

all hospital groups, would be a 0.2 

percent decrease in payments to IPFs. 

There are distributional effects of these 

changes among different categories of 

IPFs. The largest increases would be 

among government psychiatric 

hospitals, with rural government 

hospitals receiving an 11.8 percent 

increase and urban government 

hospitals receiving a 10.8 percent 

increase. Alternatively, psychiatric 

hospitals and units with fewer than 12 

beds would receive the largest decreases 

of 3.8 percent and 4.5 percent 

respectively. 

Column 7 compares our estimates of 

proposed changes reflected in this 

proposed rule for RY 2007, to our 

estimates of payments in the 

implementation year (without these 

proposed changes). This column reflects 

all RY 2007 proposed changes relative 

to the implementation year, shown in 

columns 3 through 6. The average 

increase for all IPFs is approximately 

4.2 percent. This increase includes the 

effects of the market basket updates 

resulting in a 4.7 percent increase in 

total RY 2007 payments. It also includes 

a 0.3 percent decrease in RY 2007 

payments for the standardization factor 

revision and a 0.2 percent decrease in 

RY 2007 payments for the transition 

blend. 

Overall, the largest payment increase 

would be among government IPFs. 

Urban government psychiatric hospitals 

would receive a 15.6 percent increase 

and rural government psychiatric 

hospitals would receive a 16.1 percent 

increase. Psychiatric hospitals with 

fewer than 12 beds would receive a 0.8 

percent increase and psychiatric units 

with fewer than 12 beds would receive 

a 0.2 percent decrease. 

4. Effect on the Medicare Program 

Based on actuarial projections 

resulting from our experience with other 

PPSs, we estimate that Medicare 

spending (total Medicare program 

payments) for IPF services over the next 

5 years would be as follows: 

TABLE 16.—ESTIMATED PAYMENTS

Rate year Dollars in 

millions 

July 1, 2006 to June 30, 

2007 .................................. $4,257 

July 1, 2007 to June 30, 

2008 .................................. 4,382 

July 1, 2008 to June 30, 

2009 .................................. 4,559 

July 1, 2009 to June 30, 

2010 .................................. 4,762 

July 1, 2010 to June 30, 

2011 .................................. 4,979 

These estimates are based on the 

current estimate of increases in the 

excluded hospital with capital market 

basket as follows: 

• 3.6 percent for RY 2007; 

• 3.5 percent for RY 2008; 

• 3.1 percent for RY 2009; 

• 2.6 percent for RY 2010; and 

• 3.0 percent for RY 2011. 

We estimate that there would be a 

change in fee-for-service Medicare 

beneficiary enrollment as follows: 

• ¥2.3 percent in RY 2007; 

• ¥1.0 percent in RY 2008; 

• 0.3 percent in RY 2009; 

• 0.3 percent in RY 2010; and 

• 0.6 percent in RY 2011. 

In the implementation year we 

estimated aggregate payments under the 

IPF PPS to equal the estimated aggregate 

payments that would be made if the IPF 

PPS were not implemented. Our 

methodology for estimating payments 

for purposes of the budget-neutrality 

calculations uses the best available data. 

We will evaluate the accuracy of the 

assumptions used to compute the 

budget-neutrality calculation in the 

implementation year. We intend to 

analyze claims and cost report data from 

the implementation year of the IPF PPS 

to determine whether the factors used to 

develop the Federal per diem base rate 

are not significantly different from the 

actual results experienced in that year. 

We are planning to compare payments 

under the final IPF PPS (which relies on 

an estimate of cost-based TEFRA 

payments using historical data from a 

base year and assumptions that trend 

the data to the initial implementation 

period) to estimated cost-based TEFRA 

payments based on actual data from the 

first year of the IPF PPS. If we find that 

an adjustment is necessary, the percent 

difference (either positive or negative) 

would be applied prospectively to the 

established prospective payment rates to 

ensure the rates accurately reflect the 

payment levels intended by the statute. 

Section 124 of Public Law 106–113 

provides the Secretary broad authority 

to make an adjustment. We intend to 

perform this analysis within the first 5 

years of the implementation of the IPF 

PPS. 

5. Effect on Beneficiaries 

Under the IPF PPS, IPFs would 

receive payment based on the average 

resources consumed by patients for each 

day. We do not expect changes in the 

quality of care or access to services for 

Medicare beneficiaries under the IPF 

PPS. In fact, we believe that access to 

IPF services would be enhanced due to 

the patient and facility level adjustment 

factors, all of which are intended to 

adequately reimburse IPFs for expensive 

cases. Finally, the stop-loss policy is 

intended to assist IPFs during the 

transition. In addition, we expect that 

paying prospectively for IPF services 

would enhance the efficiency of the 

Medicare program. 


cchase on PROD1PC60 with PROPOSALS2
3652 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

6. Computer Hardware and Software 

We do not anticipate that IPFs would 

incur additional systems operating costs 

in order to effectively participate in the 

IPF PPS. We believe that IPFs and CAHs 

possess the computer hardware 

capability to handle the billing 

requirements under the IPF PPS. Our 

belief is based on indications that 

approximately 99 percent of hospital 

inpatient claims are submitted 

electronically. In addition, we are not 

adopting significant changes in claims 

processing (see section IV.C of this 

proposed rule). 

C. Accounting Statement 

As required by OMB Circular A–4 

(available at http:// 

www.whitehouse.gov/omb/circulars/ 

a004/a-4.pdf), in Table 17 below, we 

have prepared an accounting statement 

showing the classification of the 

expenditures associated with the 

provisions of this proposed rule. This 

table provides our best estimate of the 

increase in Medicare payments under 

the IPF PPS as a result of the changes 

presented in this proposed rule based 

on the data for 1,806 IPFs in our 

database. All expenditures are classified 

as transfers to Medicare providers (that 

is, IPFs). 

TABLE 17.—ACCOUNTING STATEMENT: CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM THE 2006 IPF PPS RY TO

THE 2007 IPF PPS RY 

(In millions) 

Category Transfers 

Annualized Monetized Transfers .............................................................. $180. 

From Whom To Whom? ........................................................................... Federal Government To IPFs Medicare Providers. 

D. Alternatives Considered 

We considered the following 

alternatives in developing the update to 

the IPF PPS: 

One option we considered was 

incorporating a transition from MSAbased labor market definitions to CBSAbased labor market definitions for the 

purpose of applying the area wage 

index. As stated in section IV.C.1.e of 

this proposed rule, we are not adopting 

a transition policy here because IPFs are 

already in a transition from reasonable 

cost based reimbursement to IPF PPS 

payments. In addition, as evident in 

Table 15 above, the wage index change 

does not appear to have a large impact 

on IPFs. 

We also considered increasing our 

outlier percentage so that outlier 

payments would be projected to be 3 

percent (or higher) of total PPS 

payments. However, this approach 

would not target the truly costly cases. 

Instead, implementing such a policy 

would have the effect of lowering the 

fixed dollar loss amount, therefore 

spreading outlier payments across more 

IPFs. In addition, the Federal per diem 

base rate would have to be reduced by 

another percentage point. 

It is also worth noting that in this 

proposed rule, we used the best 

available complete data set (that is, FY 

2002 claims and cost report data) to 

assess the impact of the various policy 

changes. As previously stated, we won’t 

know the true impact of the wage index 

changes, the transition blend period, or 

the market basket increases until we are 

able to analyze 1 year of IPF PPS claims 

and cost report data. 

We considered alternative policies in 

order to reduce financial risk to 

facilities in the event that they 

experience substantial reductions in 

Medicare payments during the period of 

transition to the IPF PPS. As discussed 

previously in this proposed rule, we 

have adopted a provision that would 

guarantee each facility an average 

payment per case under the IPF PPS 

that is estimated to be no less than a 

minimum proportion of its average 

payment per case under TEFRA. We 

analyzed the impact on losses if we 

were to make a payment adjustment to 

ensure that the minimum IPF PPS per 

case payment to an IPF is at least 70 

percent of its TEFRA payment. 

The stop-loss adjustment is applied to 

the IPF PPS portion of Medicare 

payments during the transition. For 

example, during year 2 of the 3-year 

transition period, half of the payment is 

based on TEFRA, and half of the 

payment is based on the Federal rate. 

We apply the stop-loss adjustment to 

the portion of the IPF’s payments during 

the transition based on the Federal rate. 

We estimate that the combined effects of 

the transition and the stop-loss policies 

will ensure that per case payments 

relative to pre-IPF PPS TEFRA per case 

payments are no less than 92.5 percent 

in year 1, 85 percent in year 2, and 77.5 

percent in year 3. We estimate that 

about 10 percent of IPFs would receive 

additional payments under the stop-loss 

policy. 

The 70 percent of TEFRA stop-loss 

policy required a reduction in the per 

diem rate to make the stop-loss policy 

budget neutral during the 

implementation year. As a result, in the 

IPF PPS final rule, we made a reduction 

to the Federal per diem base rate of 0.4 

percent in order to maintain budget 

neutrality. 

In the IPF PPS final rule, we 

considered an 80 percent stop-loss 

policy as well as a 70 percent policy. In 

order to target the stop-loss policy to the 

IPFs that experience the greatest impact 

relative to current payments and to limit 

the size of the reduction to the Federal 

per diem base rate, we adopted the 70 

percent policy. In developing this 

proposed rule, we again considered an 

80 percent stop-loss policy for RY 2007. 

Adopting an 80 percent policy would 

require a reduction in the Federal per 

diem base rate of over 2.5 percent, and 

we estimate that about 29 percent of 

IPFs would receive additional 

payments. We chose to stay with the 70 

percent policy for the same reasons 

discussed in the IPF PPS final rule. 

Specifically, the 70 percent stop-loss 

policy targets the IPFs that experience 

the greatest impact relative to current 

payments, and it limits the size of the 

reduction to the Federal per diem base 

rate. 

In accordance with the provisions of 

Executive Order 12866, this rule was 

previously reviewed by OMB. 

List of Subjects 

42 CFR Part 412 

Administrative practice and 

procedure, Health facilities, Medicare, 

Puerto Rico, Reporting and 

recordkeeping requirements. 

42 CFR Part 424 

Emergency medical services, Health 

facilities, Health professions, Medicare, 

Reporting and recordkeeping 

requirements. 

For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services proposes to amend 

42 CFR chapter IV as follows: 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3653 

PART 412—PROSPECTIVE PAYMENT 

SYSTEMS FOR HOSPITAL SERVICES 

1. The authority citation for part 412 

is revised to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh), Sec. 124 of Pub. L. 106–113, 113 

Stat. 1515, and Sec. 405 of Pub. L. of 108–

173, 117 Stat. 2266. 

2. Amend § 412.27 by revising 

paragraph (b) to read as follows: 

§ 412.27 Excluded psychiatric units: 

Additional requirements. 

* * * * * 

(b) Furnish, through the use of 

qualified personnel, psychological 

services, social work services, 

psychiatric nursing, and occupational 

therapy. 

* * * * * 

3. Section 412.402 is amended by—

A. Republishing the introductory text. 

B. Revising the heading of ‘‘Fixed 

dollar loss threshold,’’ to read ‘‘Fixed 

dollar loss threshold amount.’’

C. Revising the definition of ‘‘Fixed 

dollar loss threshold amount,’’

‘‘Qualifying emergency department,’’

‘‘Rural area,’’ and ‘‘Urban area.’’

The revisions read as follows: 

§ 412.402 Definitions. 

As used in this subpart—

* * * * * 

Fixed dollar loss threshold amount 

means a dollar amount which, when 

added to the Federal payment amount 

for case, the estimated costs of a case 

must exceed in order for the case to 

qualify for an outlier payment. 

* * * * * 

Qualifying emergency department 

means an emergency department that is 

staffed and equipped to furnish a 

comprehensive array of emergency 

services and meeting the definitions of 

a dedicated emergency department as 

specified in § 489.24(b) of this chapter 

and the definition of ‘‘provider-based 

status’’ as specified in § 413.65 of this 

chapter. 

Rural area means for cost reporting 

periods beginning January 1, 2005, with 

respect to discharges occurring during 

the period covered by such cost reports 

but before July 1, 2006, an area as 

defined in § 412.62(f)(1)(iii). For 

discharges occurring on or after July 1, 

2006, rural area means an area as 

defined in § 412.64(b)(1)(ii)(C). 

Urban area means for cost reporting 

periods beginning on or after January 1, 

2005, with respect to discharges 

occurring during the period covered by 

such cost reports but before July 1, 2006, 

an area as defined in § 412.62(f)(1)(ii). 

For discharges occurring on or after July 

1, 2006, urban area means an area as 

defined in § 412.64(b)(1)(ii)(A) and 

§ 412.64(b)(1)(ii)(B). 

4. Section 412.424 is amended by—

A. Revising paragraph (d)(1)(iii). 

B. Republishing the heading of 

paragraph (d)(1)(v). 

C. Revising paragraph (d)(1)(v)(A). 

D. Adding paragraph (d)(2) 

introductory text. 

E. Removing and reserving paragraph 

(d)(2)(iii). 

F. Revising paragraphs (d)(3)(i) 

introductory text and (d)(3)(i)(A). 

The revisions and additions read as 

follows: 

§ 412.424 Methodology for calculating the 

Federal per diem payment amount. 

* * * * * 

(d) * * * 

(1) * * * 

(iii) Teaching adjustment. CMS 

adjusts the Federal per diem base rate 

by a factor to account for indirect 

teaching costs. 

(A) An inpatient psychiatric facility’s 

teaching adjustment is based on the 

ratio of the number of full-time 

equivalent residents training in the 

inpatient psychiatric facility divided by 

the facility’s average daily census. 

(B) Residents with less than full-time 

status and residents rotating through the 

inpatient psychiatric facility for less 

than a full year will be counted in 

proportion to the time they spend in the 

inpatient psychiatric facility. 

(C) Except as described in paragraph 

(d)(1)(iii)(D) of this section, the actual 

number of current year full-time 

equivalent residents used in calculating 

the teaching adjustment is limited to the 

number of full-time equivalent residents 

in the inpatient psychiatric facility’s 

most recently filed cost report filed with 

its fiscal intermediary before November 

15, 2004 (base year). 

(D) If the inpatient psychiatric facility 

first begins training residents in a new 

approved graduate medical education 

program after November 15, 2004, the 

number of full-time equivalent residents 

determined under paragraph 

(d)(1)(iii)(C) of this section may be 

adjusted using the method described in 

§ 413.79(e)(1)(i) and (ii) of this chapter. 

(E) The teaching adjustment is made 

on a claim basis as an interim payment, 

and the final payment in full for the 

claim is made during the final 

settlement of the cost report. 

* * * * * 

(v) Adjustment for IPF with qualifying 

emergency departments. (A) CMS 

adjusts the Federal per diem base rate to 

account for the costs associated with 

maintaining a qualifying emergency 

department. A qualifying emergency 

department is staffed and equipped to 

furnish a comprehensive array of 

emergency services (medical and 

psychiatric) and meets the requirements 

of § 489.24(b) and § 413.65 of this 

chapter. 

(2) Patient-level adjustments. The 

inpatient psychiatric facility must 

identify a principal psychiatric 

diagnosis as specified in § 412.27(a) for 

each patient. CMS adjusts the Federal 

per diem base rate by a factor to account 

for the diagnosis-related group 

assignment associated with the 

principal diagnosis, as specified by 

CMS. 

* * * * * 

(3) Other adjustments. (i) Outlier 

payments. CMS provides an outlier 

payment if an inpatient psychiatric 

facility’s estimated total cost for a case 

exceeds a fixed dollar loss threshold 

amount for an inpatient psychiatric 

facility as defined in § 412.402 plus the 

Federal payment amount for the case. 

(A) The fixed dollar loss threshold 

amount is adjusted for the inpatient 

psychiatric facility’s adjustments for 

wage area, teaching, rural locations, and 

cost of living adjustment for facilities 

located in Alaska and Hawaii. 

* * * * * 

§ 412.426 [Amended] 

5. In § 412.426, paragraph (a) 

introductory text is amended by 

removing the reference ‘‘§ 412.424(c)’’

and adding the reference ‘‘§ 412.424(d)’’

in its place. 

6. Section 412.428 is amended by—

A. Republishing the introductory text. 

B. Revising paragraph (b) and (d). 

C. Adding a new paragraph (g). 

D. Adding a new paragraph (h). 

The revision and additions reads as 

follows: 

§ 412.428 Publication of updates to the 

inpatient psychiatric facility prospective 

payment system. 

CMS will publish annually in the 

Federal Register information pertaining 

to updates to the inpatient psychiatric 

facility prospective payment system. 

This information includes: 

* * * * * 

(b)(1) For discharges occurring on or 

after January 1, 2005 but before July 1, 

2006, the rate of increase factor, 

described in § 412.424(a)(2)(iii), for the 

Federal portion of the inpatient 

psychiatric facility’s payment is based 

on the excluded hospital with capital 

market basket under the update 

methodology described in section 

1886(b)(3)(B)(ii) of the Act for each year. 

(2) For discharges occurring on or 

after July 1, 2006, the rate of increase 

factor for the Federal portion of the 


cchase on PROD1PC60 with PROPOSALS2
3654 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

inpatient psychiatric facility’s payment 

is based on the Rehabilitation, 

Psychiatric, and Long-Term Care (RPL) 

market basket. 

(3) For discharges occurring on or 

after January 1, 2005 but before July 1, 

2006, the rate of increase factor, 

described in § 412.424(a)(2)(iii), for the 

reasonable cost portion of the inpatient 

psychiatric facility’s payment is based 

on the 1997-based excluded hospital 

market basket under the updated 

methodology described in section 

1886(b)(3)(B)(ii) of the Act for each year. 

(4) For discharges occurring on or 

after July 1, 2006, the rate of increase 

factor for the reasonable cost portion of 

the inpatient psychiatric facility’s 

payment is based on the 2002-based 

excluded hospital market basket. 

* * * * * 

(d) Updates to the fixed dollar loss 

threshold amount in order to maintain 

the appropriate outlier percentage. 

* * * * * 

(g) Update the national urban and 

rural cost to charge ratio median and 

ceilings. CMS will apply the national 

cost to charge ratio to—

(1) New inpatient psychiatric facilities 

that have not submitted their first 

Medicare cost report. 

(2) Inpatient psychiatric facilities 

whose operating or capital cost to 

charge ratio is in excess of 3 standard 

deviations above the corresponding 

national geometric mean. 

(3) Other inpatient psychiatric 

facilities for which the fiscal 

intermediary obtains inaccurate or 

incomplete date with which to calculate 

either an operating or capital cost to 

charge ratio or both. 

(h) Update the cost of living 

adjustment factor if appropriate. 

PART 424—CONDITIONS FOR 

MEDICARE PAYMENT 

1. The authority citation for part 424 

continues to read as follows: 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh). 

2. Section 424.14 is amended by—

A. Revising the heading. 

B. Adding a new paragraph (c)(3). 

C. Revising paragraph (d)(2). 

The addition and revisions read as 

follows: 

§ 424.14 Requirements for inpatient 

services of inpatient psychiatric facilities. 

* * * * * 

(c) * * * 

(3) The patient continues to need, on 

a daily basis, active inpatient 

psychiatric care (furnished directly by 

or requiring the supervision of inpatient 

psychiatric facility personnel) or other 

professional services that can only be 

provided on an inpatient basis. 

(d) * * * 

(2) The first recertification is required 

as of the 12th day of hospitalization. 

Subsequent recertifications are required 

at intervals established by the UR 

committee (on a case-by-case basis if it 

so chooses), but no less frequently than 

every 30 days. 

* * * * * 

(Catalog of Federal Domestic Assistance 

Program No. 93.778, Medical Assistance 

Program) 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: November 3, 2005. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: January 13, 2006. 

Michael O. Leavitt, 

Secretary. 

Note: The following addenda will not 

appear in the Code of Federal Regulations. 

Addendum A—Rate and Adjustment 

Factors 

PER DIEM RATE

Federal Per Diem Base Rate .................................................................................................................................................................. $594.66 

Labor Share (0.75923) ............................................................................................................................................................................ $451.48 

Non-Labor Share (0.24077) ..................................................................................................................................................................... $143.18 

FIXED DOLLAR LOSS THRESHOLD AMOUNT

$6200 

FACILITY ADJUSTMENTS

Rural Adjustment Factor ................................................................................................................................................. 1.17. 

Teaching Adjustment Factor ........................................................................................................................................... 0.5150. 

Wage Index ..................................................................................................................................................................... Pre-reclass Hospital Wage 

Index (FY2006). 

COST OF LIVING ADJUSTMENTS (COLAS) 

Alaska ...................................................................................................................................................................................................... 1.25 

Hawaii 

Honolulu County ............................................................................................................................................................................... 1.25 

Hawaii County .................................................................................................................................................................................. 1.165 

Kauai County .................................................................................................................................................................................... 1.2325 

Maui County ..................................................................................................................................................................................... 1.2375 

Kalawao County ............................................................................................................................................................................... 1.2375 

PATIENT ADJUSTMENTS

ECT—Per Treatment ............................................................................................................................................................................... $268.21 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3655 

VARIABLE PER DIEM ADJUSTMENTS

Adjustment 

Factor 

Day 1—Facility Without a 24/7 Full-service Emergency Department ..................................................................................................... 1.19 

Day 1—Facility With a 24/7 Full-service Emergency Department .......................................................................................................... 1.31 

Day 2 ....................................................................................................................................................................................................... 1.12 

Day 3 ....................................................................................................................................................................................................... 1.08 

Day 4 ....................................................................................................................................................................................................... 1.05 

Day 5 ....................................................................................................................................................................................................... 1.04 

Day 6 ....................................................................................................................................................................................................... 1.02 

Day 7 ....................................................................................................................................................................................................... 1.01 

Day 8 ....................................................................................................................................................................................................... 1.01 

Day 9 ....................................................................................................................................................................................................... 1.00 

Day 10 ..................................................................................................................................................................................................... 1.00 

Day 11 ..................................................................................................................................................................................................... 0.99 

Day 12 ..................................................................................................................................................................................................... 0.99 

Day 13 ..................................................................................................................................................................................................... 0.99 

Day 14 ..................................................................................................................................................................................................... 0.99 

Day 15 ..................................................................................................................................................................................................... 0.98 

Day 16 ..................................................................................................................................................................................................... 0.97 

Day 17 ..................................................................................................................................................................................................... 0.97 

Day 18 ..................................................................................................................................................................................................... 0.96 

Day 19 ..................................................................................................................................................................................................... 0.95 

Day 20 ..................................................................................................................................................................................................... 0.95 

Day 21 ..................................................................................................................................................................................................... 0.95 

After Day 21 ............................................................................................................................................................................................. 0.92 

AGE ADJUSTMENTS

Age (in years) Adjustment 

Factor 

Under 45 .................................................................................................................................................................................................. 1.00 

45 and under 50 ...................................................................................................................................................................................... 1.01 

50 and under 55 ...................................................................................................................................................................................... 1.02 

55 and under 60 ...................................................................................................................................................................................... 1.04 

60 and under 65 ...................................................................................................................................................................................... 1.07 

65 and under 70 ...................................................................................................................................................................................... 1.10 

70 and under 75 ...................................................................................................................................................................................... 1.13 

75 and under 80 ...................................................................................................................................................................................... 1.15 

80 and over .............................................................................................................................................................................................. 1.17 

DRG ADJUSTMENTS

DRG DRG Definition 

DRG 

Adjustment 

Factor 

DRG 424 Procedure with principal diagnosis of mental illness .......................................................................................................... 1.22 

DRG 425 Acute adjustment reaction .................................................................................................................................................. 1.05 

DRG 426 Depressive neurosis ........................................................................................................................................................... 0.99 

DRG 427 Neurosis, except depressive ............................................................................................................................................... 1.02 

DRG 428 Disorders of personality ...................................................................................................................................................... 1.02 

DRG 429 Organic disturbances .......................................................................................................................................................... 1.03 

DRG 430 Psychosis ............................................................................................................................................................................ 1.00 

DRG 431 Childhood disorders ............................................................................................................................................................ 0.99 

DRG 432 Other mental disorders ....................................................................................................................................................... 0.92 

DRG 433 Alcohol/Drug use Leave against Medical Advice (LAMA) .................................................................................................. 0.97 

DRG 521 Alcohol/Drug use with comorbid conditions ........................................................................................................................ 1.02 

DRG 522 Alcohol/Drug use without comorbid conditions ................................................................................................................... 0.98 

DRG 523 Alcohol/Drug use without rehabilitation .............................................................................................................................. 0.88 

DRG 12 Degenerative nervous system disorders ............................................................................................................................ 1.05 

DRG 23 Non-traumatic stupor & coma ............................................................................................................................................. 1.07 

COMORBIDITY ADJUSTMENTS

Comorbidity Adjustment 

Factor 

Developmental Disabilities ....................................................................................................................................................................... 1.04 

Coagulation Factor Deficit ....................................................................................................................................................................... 1.13 

Tracheostomy .......................................................................................................................................................................................... 1.06 


cchase on PROD1PC60 with PROPOSALS2
3656 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

COMORBIDITY ADJUSTMENTS—Continued 

Comorbidity Adjustment 

Factor 

Eating and Conduct Disorders ................................................................................................................................................................ 1.12 

Infectious Diseases .................................................................................................................................................................................. 1.07 

Renal Failure, Acute ................................................................................................................................................................................ 1.11 

Renal Failure, Chronic ............................................................................................................................................................................. 1.11 

Oncology Treatment ................................................................................................................................................................................ 1.07 

Uncontrolled Diabetes Mellitus ................................................................................................................................................................ 1.05 

Severe Protein Malnutrition ..................................................................................................................................................................... 1.13 

Drug/Alcohol Induced Mental Disorders .................................................................................................................................................. 1.03 

Cardiac Conditions .................................................................................................................................................................................. 1.11 

Gangrene ................................................................................................................................................................................................. 1.10 

Chronic Obstructive Pulmonary Disease ................................................................................................................................................. 1.12 

Artificial Openings - Digestive & Urinary ................................................................................................................................................. 1.08 

Musculoskeletal & Connective Tissue Diseases ..................................................................................................................................... 1.09 

Poisoning ................................................................................................................................................................................................. 1.11 

Addendum B—RY 2007 IPF PPS Wage 

Index Table 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

01000 ..... Autauga County, Alabama .............................................................. 5240 Urban ..... 0.8618 33860 Urban ..... 0.8618 

01010 ..... Baldwin County, Alabama ............................................................... 5160 Urban ..... 0.7861 99901 Rural ...... 0.7446 

01020 ..... Barbour County, Alabama .............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01030 ..... Bibb County, Alabama .................................................................... 01 Rural ...... 0.7432 13820 Urban ..... 0.8959 

01040 ..... Blount County, Alabama ................................................................. 1000 Urban ..... 0.9000 13820 Urban ..... 0.8959 

01050 ..... Bullock County, Alabama ................................................................ 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01060 ..... Butler County, Alabama .................................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01070 ..... Calhoun County, Alabama .............................................................. 0450 Urban ..... 0.7682 11500 Urban ..... 0.7682 

01080 ..... Chambers County, Alabama ........................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01090 ..... Cherokee County, Alabama ............................................................ 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01100 ..... Chilton County, Alabama ................................................................ 01 Rural ...... 0.7432 13820 Urban ..... 0.8959 

01110 ..... Choctaw County, Alabama ............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01120 ..... Clarke County, Alabama ................................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01130 ..... Clay County, Alabama .................................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01140 ..... Cleburne County, Alabama ............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01150 ..... Coffee County, Alabama ................................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01160 ..... Colbert County, Alabama ................................................................ 2650 Urban ..... 0.8272 22520 Urban ..... 0.8272 

01170 ..... Conecuh County, Alabama ............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01180 ..... Coosa County, Alabama ................................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01190 ..... Covington County, Alabama ........................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01200 ..... Crenshaw County, Alabama ........................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01210 ..... Cullman County, Alabama .............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01220 ..... Dale County, Alabama .................................................................... 2180 Urban ..... 0.7701 99901 Rural ...... 0.7446 

01230 ..... Dallas County, Alabama ................................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01240 ..... De Kalb County, Alabama .............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01250 ..... Elmore County, Alabama ................................................................ 5240 Urban ..... 0.8618 33860 Urban ..... 0.8618 

01260 ..... Escambia County, Alabama ........................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01270 ..... Etowah County, Alabama ............................................................... 2880 Urban ..... 0.7938 23460 Urban ..... 0.7938 

01280 ..... Fayette County, Alabama ............................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01290 ..... Franklin County, Alabama .............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01300 ..... Geneva County, Alabama ............................................................... 01 Rural ...... 0.7432 20020 Urban ..... 0.7721 

01310 ..... Greene County, Alabama ............................................................... 01 Rural ...... 0.7432 46220 Urban ..... 0.8645 

01320 ..... Hale County, Alabama .................................................................... 01 Rural ...... 0.7432 46220 Urban ..... 0.8645 

01330 ..... Henry County, Alabama .................................................................. 01 Rural ...... 0.7432 20020 Urban ..... 0.7721 

01340 ..... Houston County, Alabama .............................................................. 2180 Urban ..... 0.7701 20020 Urban ..... 0.7721 

01350 ..... Jackson County, Alabama .............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01360 ..... Jefferson County, Alabama ............................................................ 1000 Urban ..... 0.9000 13820 Urban ..... 0.8959 

01370 ..... Lamar County, Alabama ................................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01380 ..... Lauderdale County, Alabama ......................................................... 2650 Urban ..... 0.8272 22520 Urban ..... 0.8272 

01390 ..... Lawrence County, Alabama ............................................................ 2030 Urban ..... 0.8469 19460 Urban ..... 0.8469 

01400 ..... Lee County, Alabama ..................................................................... 0580 Urban ..... 0.8100 12220 Urban ..... 0.8100 

01410 ..... Limestone County, Alabama ........................................................... 3440 Urban ..... 0.9146 26620 Urban ..... 0.9146 

01420 ..... Lowndes County, Alabama ............................................................. 01 Rural ...... 0.7432 33860 Urban ..... 0.8618 

01430 ..... Macon County, Alabama ................................................................ 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01440 ..... Madison County, Alabama .............................................................. 3440 Urban ..... 0.9146 26620 Urban ..... 0.9146 

01450 ..... Marengo County, Alabama ............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01460 ..... Marion County, Alabama ................................................................ 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3657 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

01470 ..... Marshall County, Alabama .............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01480 ..... Mobile County, Alabama ................................................................. 5160 Urban ..... 0.7861 33660 Urban ..... 0.7891 

01490 ..... Monroe County, Alabama ............................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01500 ..... Montgomery County, Alabama ....................................................... 5240 Urban ..... 0.8618 33860 Urban ..... 0.8618 

01510 ..... Morgan County, Alabama ............................................................... 2030 Urban ..... 0.8469 19460 Urban ..... 0.8469 

01520 ..... Perry County, Alabama ................................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01530 ..... Pickens County, Alabama ............................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01540 ..... Pike County, Alabama .................................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01550 ..... Randolph County, Alabama ............................................................ 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01560 ..... Russell County, Alabama ............................................................... 1800 Urban ..... 0.8560 17980 Urban ..... 0.8560 

01570 ..... St Clair County, Alabama ............................................................... 1000 Urban ..... 0.9000 13820 Urban ..... 0.8959 

01580 ..... Shelby County, Alabama ................................................................ 1000 Urban ..... 0.9000 13820 Urban ..... 0.8959 

01590 ..... Sumter County, Alabama ................................................................ 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01600 ..... Talladega County, Alabama ........................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01610 ..... Tallapoosa County, Alabama .......................................................... 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01620 ..... Tuscaloosa County, Alabama ......................................................... 8600 Urban ..... 0.8764 46220 Urban ..... 0.8645 

01630 ..... Walker County, Alabama ................................................................ 01 Rural ...... 0.7432 13820 Urban ..... 0.8959 

01640 ..... Washington County, Alabama ........................................................ 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01650 ..... Wilcox County, Alabama ................................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

01660 ..... Winston County, Alabama .............................................................. 01 Rural ...... 0.7432 99901 Rural ...... 0.7446 

02013 ..... Aleutians County East, Alaska ....................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02016 ..... Aleutians County West, Alaska ...................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02020 ..... Anchorage County, Alaska ............................................................. 0380 Urban ..... 1.1784 11260 Urban ..... 1.1895 

02030 ..... Angoon County, Alaska .................................................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02040 ..... Barrow-North Slope County, Alaska ............................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02050 ..... Bethel County, Alaska .................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02060 ..... Bristol Bay Borough County, Alaska .............................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02068 ..... Denali County, Alaska .................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02070 ..... Bristol Bay County, Alaska ............................................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02080 ..... Cordova-Mc Carthy County, Alaska ............................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02090 ..... Fairbanks County, Alaska ............................................................... 02 Rural ...... 1.1888 21820 Urban ..... 1.1408 

02100 ..... Haines County, Alaska ................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02110 ..... Juneau County, Alaska ................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02120 ..... Kenai-Cook Inlet County, Alaska .................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02122 ..... Kenai Peninsula Borough, Alaska .................................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02130 ..... Ketchikan County, Alaska ............................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02140 ..... Kobuk County, Alaska .................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02150 ..... Kodiak County, Alaska .................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02160 ..... Kuskokwin County, Alaska ............................................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02164 ..... Lake and Peninsula Borough, Alaska ............................................ 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02170 ..... Matanuska County, Alaska ............................................................. 02 Rural ...... 1.1888 11260 Urban ..... 1.1895 

02180 ..... Nome County, Alaska ..................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02185 ..... North Slope Borough, Alaska ......................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02188 ..... Northwest Arctic Borough, Alaska .................................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02190 ..... Outer Ketchikan County, Alaska ..................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02200 ..... Prince Of Wales County, Alaska .................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02201 ..... Prince of Wales-Outer Ketchikan Census Area, Alaska ................ 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02210 ..... Seward County, Alaska .................................................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02220 ..... Sitka County, Alaska ....................................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02230 ..... Skagway-Yakutat County, Alaska ................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02231 ..... Skagway-Yakutat-Angoon Census Area, Alaska ........................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02232 ..... Skagway-Hoonah-Angoon Census Area, Alaska ........................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02240 ..... Southeast Fairbanks County, Alaska ............................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02250 ..... Upper Yukon County, Alaska ......................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02260 ..... Valdz-Chitna-Whitier County, Alaska .............................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02261 ..... Valdex-Cordove Census Area, Alaska ........................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02270 ..... Wade Hampton County, Alaska ..................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02280 ..... Wrangell-Petersburg County, Alaska .............................................. 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02282 ..... Yakutat Borough, Alaska ................................................................ 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

02290 ..... Yukon-Koyukuk County, Alaska ..................................................... 02 Rural ...... 1.1888 99902 Rural ...... 1.1977 

03000 ..... Apache County, Arizona ................................................................. 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03010 ..... Cochise County, Arizona ................................................................ 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03020 ..... Coconino County, Arizona .............................................................. 2620 Urban ..... 1.1845 22380 Urban ..... 1.2092 

03030 ..... Gila County, Arizona ....................................................................... 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03040 ..... Graham County, Arizona ................................................................ 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03050 ..... Greenlee County, Arizona .............................................................. 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03055 ..... La Paz County, Arizona .................................................................. 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03060 ..... Maricopa County, Arizona .............................................................. 6200 Urban ..... 1.0127 38060 Urban ..... 1.0127 

03070 ..... Mohave County, Arizona ................................................................ 4120 Urban ..... 1.1155 99903 Rural ...... 0.8768 

03080 ..... Navajo County, Arizona .................................................................. 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03090 ..... Pima County, Arizona ..................................................................... 8520 Urban ..... 0.9007 46060 Urban ..... 0.9007 


cchase on PROD1PC60 with PROPOSALS2
3658 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

03100 ..... Pinal County, Arizona ..................................................................... 6200 Urban ..... 1.0127 38060 Urban ..... 1.0127 

03110 ..... Santa Cruz County, Arizona ........................................................... 03 Rural ...... 0.9045 99903 Rural ...... 0.8768 

03120 ..... Yavapai County, Arizona ................................................................ 03 Rural ...... 0.9045 39140 Urban ..... 0.9869 

03130 ..... Yuma County, Arizona .................................................................... 9360 Urban ..... 0.9126 49740 Urban ..... 0.9126 

04000 ..... Arkansas County, Arkansas ........................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04010 ..... Ashley County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04020 ..... Baxter County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04030 ..... Benton County, Arkansas ............................................................... 2580 Urban ..... 0.8661 22220 Urban ..... 0.8661 

04040 ..... Boone County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04050 ..... Bradley County, Arkansas .............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04060 ..... Calhoun County, Arkansas ............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04070 ..... Carroll County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04080 ..... Chicot County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04090 ..... Clark County, Arkansas .................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04100 ..... Clay County, Arkansas ................................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04110 ..... Cleburne County, Arkansas ............................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04120 ..... Cleveland County, Arkansas .......................................................... 04 Rural ...... 0.7744 38220 Urban ..... 0.8680 

04130 ..... Columbia County, Arkansas ........................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04140 ..... Conway County, Arkansas ............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04150 ..... Craighead County, Arkansas .......................................................... 3700 Urban ..... 0.7911 27860 Urban ..... 0.7911 

04160 ..... Crawford County, Arkansas ............................................................ 2720 Urban ..... 0.8246 22900 Urban ..... 0.8230 

04170 ..... Crittenden County, Arkansas .......................................................... 4920 Urban ..... 0.9416 32820 Urban ..... 0.9397 

04180 ..... Cross County, Arkansas ................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04190 ..... Dallas County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04200 ..... Desha County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04210 ..... Drew County, Arkansas .................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04220 ..... Faulkner County, Arkansas ............................................................ 4400 Urban ..... 0.8747 30780 Urban ..... 0.8747 

04230 ..... Franklin County, Arkansas .............................................................. 04 Rural ...... 0.7744 22900 Urban ..... 0.8230 

04240 ..... Fulton County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04250 ..... Garland County, Arkansas .............................................................. 04 Rural ...... 0.7744 26300 Urban ..... 0.9005 

04260 ..... Grant County, Arkansas ................................................................. 04 Rural ...... 0.7744 30780 Urban ..... 0.8747 

04270 ..... Greene County, Arkansas .............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04280 ..... Hempstead County, Arkansas ........................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04290 ..... Hot Spring County, Arkansas ......................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04300 ..... Howard County, Arkansas .............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04310 ..... Independence County, Arkansas .................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04320 ..... Izard County, Arkansas .................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04330 ..... Jackson County, Arkansas ............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04340 ..... Jefferson County, Arkansas ............................................................ 6240 Urban ..... 0.8680 38220 Urban ..... 0.8680 

04350 ..... Johnson County, Arkansas ............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04360 ..... Lafayette County, Arkansas ............................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04370 ..... Lawrence County, Arkansas ........................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04380 ..... Lee County, Arkansas .................................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04390 ..... Lincoln County, Arkansas ............................................................... 04 Rural ...... 0.7744 38220 Urban ..... 0.8680 

04400 ..... Little River County, Arkansas ......................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04410 ..... Logan County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04420 ..... Lonoke County, Arkansas ............................................................... 4400 Urban ..... 0.8747 30780 Urban ..... 0.8747 

04430 ..... Madison County, Arkansas ............................................................. 04 Rural ...... 0.7744 22220 Urban ..... 0.8661 

04440 ..... Marion County, Arkansas ............................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04450 ..... Miller County, Arkansas .................................................................. 8360 Urban ..... 0.8283 45500 Urban ..... 0.8283 

04460 ..... Mississippi County, Arkansas ......................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04470 ..... Monroe County, Arkansas .............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04480 ..... Montgomery County, Arkansas ...................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04490 ..... Nevada County, Arkansas .............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04500 ..... Newton County, Arkansas .............................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04510 ..... Ouachita County, Arkansas ............................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04520 ..... Perry County, Arkansas .................................................................. 04 Rural ...... 0.7744 30780 Urban ..... 0.8747 

04530 ..... Phillips County, Arkansas ............................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04540 ..... Pike County, Arkansas ................................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04550 ..... Poinsett County, Arkansas ............................................................. 04 Rural ...... 0.7744 27860 Urban ..... 0.7911 

04560 ..... Polk County, Arkansas ................................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04570 ..... Pope County, Arkansas .................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04580 ..... Prairie County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04590 ..... Pulaski County, Arkansas ............................................................... 4400 Urban ..... 0.8747 30780 Urban ..... 0.8747 

04600 ..... Randolph County, Arkansas ........................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04610 ..... St Francis County, Arkansas .......................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04620 ..... Saline County, Arkansas ................................................................ 4400 Urban ..... 0.8747 30780 Urban ..... 0.8747 

04630 ..... Scott County, Arkansas .................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04640 ..... Searcy County, Arkansas ............................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04650 ..... Sebastian County, Arkansas .......................................................... 2720 Urban ..... 0.8246 22900 Urban ..... 0.8230 

04660 ..... Sevier County, Arkansas ................................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3659 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

04670 ..... Sharp County, Arkansas ................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04680 ..... Stone County, Arkansas ................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04690 ..... Union County, Arkansas ................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04700 ..... Van Buren County, Arkansas ......................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04710 ..... Washington County, Arkansas ....................................................... 2580 Urban ..... 0.8661 22220 Urban ..... 0.8661 

04720 ..... White County, Arkansas ................................................................. 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04730 ..... Woodruff County, Arkansas ............................................................ 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

04740 ..... Yell County, Arkansas .................................................................... 04 Rural ...... 0.7744 99904 Rural ...... 0.7466 

05000 ..... Alameda County, California ............................................................ 5775 Urban ..... 1.5346 36084 Urban ..... 1.5346 

05010 ..... Alpine County, California ................................................................ 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05020 ..... Amador County, California .............................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05030 ..... Butte County, California .................................................................. 1620 Urban ..... 1.0511 17020 Urban ..... 1.0511 

05040 ..... Calaveras County, California .......................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05050 ..... Colusa County, California ............................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05060 ..... Contra Costa County, California ..................................................... 5775 Urban ..... 1.5346 36084 Urban ..... 1.5346 

05070 ..... Del Norte County, California ........................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05080 ..... Eldorado County, California ............................................................ 6920 Urban ..... 1.3143 40900 Urban ..... 1.2969 

05090 ..... Fresno County, California ............................................................... 2840 Urban ..... 1.0428 23420 Urban ..... 1.0538 

05100 ..... Glenn County, California ................................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05110 ..... Humboldt County, California ........................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05120 ..... Imperial County, California ............................................................. 05 Rural ...... 1.0775 20940 Urban ..... 0.8906 

05130 ..... Inyo County, California ................................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05140 ..... Kern County, California ................................................................... 0680 Urban ..... 1.0470 12540 Urban ..... 1.0470 

05150 ..... Kings County, California ................................................................. 05 Rural ...... 1.0775 25260 Urban ..... 1.0036 

05160 ..... Lake County, California .................................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05170 ..... Lassen County, California ............................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05200 ..... Los Angeles County, California ...................................................... 4480 Urban ..... 1.1783 31084 Urban ..... 1.1783 

05210 ..... Los Angeles County, California ...................................................... 4480 Urban ..... 1.1783 31084 Urban ..... 1.1783 

05300 ..... Madera County, California .............................................................. 2840 Urban ..... 1.0428 31460 Urban ..... 0.8713 

05310 ..... Marin County, California ................................................................. 7360 Urban ..... 1.4994 41884 Urban ..... 1.4994 

05320 ..... Mariposa County, California ........................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05330 ..... Mendocino County, California ......................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05340 ..... Merced County, California .............................................................. 4940 Urban ..... 1.1109 32900 Urban ..... 1.1109 

05350 ..... Modoc County, California ............................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05360 ..... Mono County, California ................................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05370 ..... Monterey County, California ........................................................... 7120 Urban ..... 1.4128 41500 Urban ..... 1.4128 

05380 ..... Napa County, California .................................................................. 8720 Urban ..... 1.3983 34900 Urban ..... 1.2643 

05390 ..... Nevada County, California .............................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05400 ..... Orange County, California .............................................................. 5945 Urban ..... 1.1559 42044 Urban ..... 1.1559 

05410 ..... Placer County, California ................................................................ 6920 Urban ..... 1.3143 40900 Urban ..... 1.2969 

05420 ..... Plumas County, California .............................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05430 ..... Riverside County, California ........................................................... 6780 Urban ..... 1.1027 40140 Urban ..... 1.1027 

05440 ..... Sacramento County, California ....................................................... 6920 Urban ..... 1.3143 40900 Urban ..... 1.2969 

05450 ..... San Benito County, California ........................................................ 05 Rural ...... 1.0775 41940 Urban ..... 1.5099 

05460 ..... San Bernardino County, California ................................................. 6780 Urban ..... 1.1027 40140 Urban ..... 1.1027 

05470 ..... San Diego County, California ......................................................... 7320 Urban ..... 1.1413 41740 Urban ..... 1.1413 

05480 ..... San Francisco County, California ................................................... 7360 Urban ..... 1.4994 41884 Urban ..... 1.4994 

05490 ..... San Joaquin County, California ...................................................... 8120 Urban ..... 1.1307 44700 Urban ..... 1.1307 

05500 ..... San Luis Obispo County, California ............................................... 7460 Urban ..... 1.1349 42020 Urban ..... 1.1349 

05510 ..... San Mateo County, California ......................................................... 7360 Urban ..... 1.4994 41884 Urban ..... 1.4994 

05520 ..... Santa Barbara County, California ................................................... 7480 Urban ..... 1.1694 42060 Urban ..... 1.1694 

05530 ..... Santa Clara County, California ....................................................... 7400 Urban ..... 1.5118 41940 Urban ..... 1.5099 

05540 ..... Santa Cruz County, California ........................................................ 7485 Urban ..... 1.5166 42100 Urban ..... 1.5166 

05550 ..... Shasta County, California ............................................................... 6690 Urban ..... 1.2203 39820 Urban ..... 1.2203 

05560 ..... Sierra County, California ................................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05570 ..... Siskiyou County, California ............................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05580 ..... Solano County, California ............................................................... 8720 Urban ..... 1.3983 46700 Urban ..... 1.4936 

05590 ..... Sonoma County, California ............................................................. 7500 Urban ..... 1.3493 42220 Urban ..... 1.3493 

05600 ..... Stanislaus County, California .......................................................... 5170 Urban ..... 1.1885 33700 Urban ..... 1.1885 

05610 ..... Sutter County, California ................................................................. 9340 Urban ..... 1.0921 49700 Urban ..... 1.0921 

05620 ..... Tehama County, California ............................................................. 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05630 ..... Trinity County, California ................................................................ 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05640 ..... Tulare County, California ................................................................ 8780 Urban ..... 1.0123 47300 Urban ..... 1.0123 

05650 ..... Tuolumne County, California .......................................................... 05 Rural ...... 1.0775 99905 Rural ...... 1.1054 

05660 ..... Ventura County, California .............................................................. 8735 Urban ..... 1.1622 37100 Urban ..... 1.1622 

05670 ..... Yolo County, California ................................................................... 9270 Urban ..... 0.9950 40900 Urban ..... 1.2969 

05680 ..... Yuba County, California .................................................................. 9340 Urban ..... 1.0921 49700 Urban ..... 1.0921 

06000 ..... Adams County, Colorado ................................................................ 2080 Urban ..... 1.0723 19740 Urban ..... 1.0723 

06010 ..... Alamosa County, Colorado ............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06020 ..... Arapahoe County, Colorado ........................................................... 2080 Urban ..... 1.0723 19740 Urban ..... 1.0723 

06030 ..... Archuleta County, Colorado ............................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 


cchase on PROD1PC60 with PROPOSALS2
3660 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

06040 ..... Baca County, Colorado ................................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06050 ..... Bent County, Colorado ................................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06060 ..... Boulder County, Colorado .............................................................. 1125 Urban ..... 0.9734 14500 Urban ..... 0.9734 

06070 ..... Chaffee County, Colorado .............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06080 ..... Cheyenne County, Colorado .......................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06090 ..... Clear Creek County, Colorado ....................................................... 06 Rural ...... 0.9380 19740 Urban ..... 1.0723 

06100 ..... Conejos County, Colorado .............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06110 ..... Costilla County, Colorado ............................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06120 ..... Crowley County, Colorado .............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06130 ..... Custer County, Colorado ................................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06140 ..... Delta County, Colorado .................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06150 ..... Denver County, Colorado ............................................................... 2080 Urban ..... 1.0723 19740 Urban ..... 1.0723 

06160 ..... Dolores County, Colorado .............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06170 ..... Douglas County, Colorado .............................................................. 2080 Urban ..... 1.0723 19740 Urban ..... 1.0723 

06180 ..... Eagle County, Colorado .................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06190 ..... Elbert County, Colorado ................................................................. 06 Rural ...... 0.9380 19740 Urban ..... 1.0723 

06200 ..... El Paso County, Colorado .............................................................. 1720 Urban ..... 0.9468 17820 Urban ..... 0.9468 

06210 ..... Fremont County, Colorado ............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06220 ..... Garfield County, Colorado .............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06230 ..... Gilpin County, Colorado .................................................................. 06 Rural ...... 0.9380 19740 Urban ..... 1.0723 

06240 ..... Grand County, Colorado ................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06250 ..... Gunnison County, Colorado ........................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06260 ..... Hinsdale County, Colorado ............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06270 ..... Huerfano County, Colorado ............................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06280 ..... Jackson County, Colorado .............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06290 ..... Jefferson County, Colorado ............................................................ 2080 Urban ..... 1.0723 19740 Urban ..... 1.0723 

06300 ..... Kiowa County, Colorado ................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06310 ..... Kit Carson County, Colorado .......................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06320 ..... Lake County, Colorado ................................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06330 ..... La Plata County, Colorado ............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06340 ..... Larimer County, Colorado ............................................................... 2670 Urban ..... 1.0122 22660 Urban ..... 1.0122 

06350 ..... Las Animas County, Colorado ........................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06360 ..... Lincoln County, Colorado ............................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06370 ..... Logan County, Colorado ................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06380 ..... Mesa County, Colorado .................................................................. 2995 Urban ..... 0.9550 24300 Urban ..... 0.9550 

06390 ..... Mineral County, Colorado ............................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06400 ..... Moffat County, Colorado ................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06410 ..... Montezuma County, Colorado ........................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06420 ..... Montrose County, Colorado ............................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06430 ..... Morgan County, Colorado ............................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06440 ..... Otero County, Colorado .................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06450 ..... Ouray County, Colorado ................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06460 ..... Park County, Colorado ................................................................... 06 Rural ...... 0.9380 19740 Urban ..... 1.0723 

06470 ..... Phillips County, Colorado ............................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06480 ..... Pitkin County, Colorado .................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06490 ..... Prowers County, Colorado .............................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06500 ..... Pueblo County, Colorado ................................................................ 6560 Urban ..... 0.8623 39380 Urban ..... 0.8623 

06510 ..... Rio Blanco County, Colorado ......................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06520 ..... Rio Grande County, Colorado ........................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06530 ..... Routt County, Colorado .................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06540 ..... Saguache County, Colorado ........................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06550 ..... San Juan County, Colorado ........................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06560 ..... San Miguel County, Colorado ......................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06570 ..... Sedgwick County, Colorado ........................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06580 ..... Summit County, Colorado ............................................................... 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06590 ..... Teller County, Colorado .................................................................. 06 Rural ...... 0.9380 17820 Urban ..... 0.9468 

06600 ..... Washington County, Colorado ........................................................ 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06610 ..... Weld County, Colorado ................................................................... 3060 Urban ..... 0.9570 24540 Urban ..... 0.9570 

06620 ..... Yuma County, Colorado ................................................................. 06 Rural ...... 0.9380 99906 Rural ...... 0.9380 

06630 ..... Broomfield County, Colorado .......................................................... 2080 Urban ..... 1.0723 19740 Urban ..... 1.0723 

07000 ..... Fairfield County, Connecticut .......................................................... 5483 Urban ..... 1.2196 14860 Urban ..... 1.2592 

07010 ..... Hartford County, Connecticut ......................................................... 3283 Urban ..... 1.1073 25540 Urban ..... 1.1073 

07020 ..... Litchfield County, Connecticut ........................................................ 3283 Urban ..... 1.1073 25540 Urban ..... 1.1073 

07030 ..... Middlesex County, Connecticut ...................................................... 3283 Urban ..... 1.1073 25540 Urban ..... 1.1073 

07040 ..... New Haven County, Connecticut .................................................... 5483 Urban ..... 1.2196 35300 Urban ..... 1.1887 

07050 ..... New London County, Connecticut .................................................. 5523 Urban ..... 1.1345 35980 Urban ..... 1.1345 

07060 ..... Tolland County, Connecticut ........................................................... 3283 Urban ..... 1.1073 25540 Urban ..... 1.1073 

07070 ..... Windham County, Connecticut ....................................................... 07 Rural ...... 1.1730 99907 Rural ...... 1.1730 

08000 ..... Kent County, Delaware ................................................................... 2190 Urban ..... 0.9776 20100 Urban ..... 0.9776 

08010 ..... New Castle County, Delaware ........................................................ 9160 Urban ..... 1.0527 48864 Urban ..... 1.0471 

08020 ..... Sussex County, Delaware .............................................................. 08 Rural ...... 0.9579 99908 Rural ...... 0.9579 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3661 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

09000 ..... Washington DC County, Dist Of Col .............................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

10000 ..... Alachua County, Florida ................................................................. 2900 Urban ..... 0.9388 23540 Urban ..... 0.9388 

10010 ..... Baker County, Florida ..................................................................... 10 Rural ...... 0.8677 27260 Urban ..... 0.9290 

10020 ..... Bay County, Florida ........................................................................ 6015 Urban ..... 0.8005 37460 Urban ..... 0.8005 

10030 ..... Bradford County, Florida ................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10040 ..... Brevard County, Florida .................................................................. 4900 Urban ..... 0.9839 37340 Urban ..... 0.9839 

10050 ..... Broward County, Florida ................................................................. 2680 Urban ..... 1.0432 22744 Urban ..... 1.0432 

10060 ..... Calhoun County, Florida ................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10070 ..... Charlotte County, Florida ................................................................ 6580 Urban ..... 0.9255 39460 Urban ..... 0.9255 

10080 ..... Citrus County, Florida ..................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10090 ..... Clay County, Florida ....................................................................... 3600 Urban ..... 0.9299 27260 Urban ..... 0.9290 

10100 ..... Collier County, Florida .................................................................... 5345 Urban ..... 1.0139 34940 Urban ..... 1.0139 

10110 ..... Columbia County, Florida ............................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10120 ..... Dade County, Florida ...................................................................... 5000 Urban ..... 0.9750 33124 Urban ..... 0.9750 

10130 ..... De Soto County, Florida ................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10140 ..... Dixie County, Florida ...................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10150 ..... Duval County, Florida ..................................................................... 3600 Urban ..... 0.9299 27260 Urban ..... 0.9290 

10160 ..... Escambia County, Florida ............................................................... 6080 Urban ..... 0.8096 37860 Urban ..... 0.8096 

10170 ..... Flagler County, Florida ................................................................... 2020 Urban ..... 0.9325 99910 Rural ...... 0.8568 

10180 ..... Franklin County, Florida .................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10190 ..... Gadsden County, Florida ................................................................ 8240 Urban ..... 0.8688 45220 Urban ..... 0.8688 

10200 ..... Gilchrist County, Florida ................................................................. 10 Rural ...... 0.8677 23540 Urban ..... 0.9388 

10210 ..... Glades County, Florida ................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10220 ..... Gulf County, Florida ........................................................................ 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10230 ..... Hamilton County, Florida ................................................................ 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10240 ..... Hardee County, Florida ................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10250 ..... Hendry County, Florida ................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10260 ..... Hernando County, Florida ............................................................... 8280 Urban ..... 0.9233 45300 Urban ..... 0.9233 

10270 ..... Highlands County, Florida .............................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10280 ..... Hillsborough County, Florida .......................................................... 8280 Urban ..... 0.9233 45300 Urban ..... 0.9233 

10290 ..... Holmes County, Florida .................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10300 ..... Indian River County, Florida ........................................................... 10 Rural ...... 0.8677 46940 Urban ..... 0.9434 

10310 ..... Jackson County, Florida ................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10320 ..... Jefferson County, Florida ................................................................ 10 Rural ...... 0.8677 45220 Urban ..... 0.8688 

10330 ..... Lafayette County, Florida ................................................................ 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10340 ..... Lake County, Florida ....................................................................... 5960 Urban ..... 0.9464 36740 Urban ..... 0.9464 

10350 ..... Lee County, Florida ........................................................................ 2700 Urban ..... 0.9356 15980 Urban ..... 0.9356 

10360 ..... Leon County, Florida ...................................................................... 8240 Urban ..... 0.8688 45220 Urban ..... 0.8688 

10370 ..... Levy County, Florida ....................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10380 ..... Liberty County, Florida .................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10390 ..... Madison County, Florida ................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10400 ..... Manatee County, Florida ................................................................ 7510 Urban ..... 0.9639 42260 Urban ..... 0.9639 

10410 ..... Marion County, Florida ................................................................... 5790 Urban ..... 0.8925 36100 Urban ..... 0.8925 

10420 ..... Martin County, Florida .................................................................... 2710 Urban ..... 1.0123 38940 Urban ..... 1.0123 

10430 ..... Monroe County, Florida .................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10440 ..... Nassau County, Florida .................................................................. 3600 Urban ..... 0.9299 27260 Urban ..... 0.9290 

10450 ..... Okaloosa County, Florida ............................................................... 2750 Urban ..... 0.8872 23020 Urban ..... 0.8872 

10460 ..... Okeechobee County, Florida .......................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10470 ..... Orange County, Florida .................................................................. 5960 Urban ..... 0.9464 36740 Urban ..... 0.9464 

10480 ..... Osceola County, Florida ................................................................. 5960 Urban ..... 0.9464 36740 Urban ..... 0.9464 

10490 ..... Palm Beach County, Florida ........................................................... 8960 Urban ..... 1.0067 48424 Urban ..... 1.0067 

10500 ..... Pasco County, Florida .................................................................... 8280 Urban ..... 0.9233 45300 Urban ..... 0.9233 

10510 ..... Pinellas County, Florida .................................................................. 8280 Urban ..... 0.9233 45300 Urban ..... 0.9233 

10520 ..... Polk County, Florida ....................................................................... 3980 Urban ..... 0.8912 29460 Urban ..... 0.8912 

10530 ..... Putnam County, Florida .................................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10540 ..... Johns County, Florida ..................................................................... 3600 Urban ..... 0.9299 27260 Urban ..... 0.9290 

10550 ..... St Lucie County, Florida ................................................................. 2710 Urban ..... 1.0123 38940 Urban ..... 1.0123 

10560 ..... Santa Rosa County, Florida ........................................................... 6080 Urban ..... 0.8096 37860 Urban ..... 0.8096 

10570 ..... Sarasota County, Florida ................................................................ 7510 Urban ..... 0.9639 42260 Urban ..... 0.9639 

10580 ..... Seminole County, Florida ............................................................... 5960 Urban ..... 0.9464 36740 Urban ..... 0.9464 

10590 ..... Sumter County, Florida ................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10600 ..... Suwannee County, Florida ............................................................. 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10610 ..... Taylor County, Florida .................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10620 ..... Union County, Florida ..................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10630 ..... Volusia County, Florida ................................................................... 2020 Urban ..... 0.9325 19660 Urban ..... 0.9299 

10640 ..... Wakulla County, Florida .................................................................. 10 Rural ...... 0.8677 45220 Urban ..... 0.8688 

10650 ..... Walton County, Florida ................................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

10660 ..... Washington County, Florida ........................................................... 10 Rural ...... 0.8677 99910 Rural ...... 0.8568 

11000 ..... Appling County, Georgia ................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11010 ..... Atkinson County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11011 ..... Bacon County, Georgia .................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 


cchase on PROD1PC60 with PROPOSALS2
3662 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

11020 ..... Baker County, Georgia ................................................................... 11 Rural ...... 0.8166 10500 Urban ..... 0.8628 

11030 ..... Baldwin County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11040 ..... Banks County, Georgia ................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11050 ..... Barrow County, Georgia ................................................................. 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11060 ..... Bartow County, Georgia ................................................................. 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11070 ..... Ben Hill County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11080 ..... Berrien County, Georgia ................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11090 ..... Bibb County, Georgia ..................................................................... 4680 Urban ..... 0.9277 31420 Urban ..... 0.9443 

11100 ..... Bleckley County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11110 ..... Brantley County, Georgia ............................................................... 11 Rural ...... 0.8166 15260 Urban ..... 0.9311 

11120 ..... Brooks County, Georgia ................................................................. 11 Rural ...... 0.8166 46660 Urban ..... 0.8866 

11130 ..... Bryan County, Georgia ................................................................... 7520 Urban ..... 0.9461 42340 Urban ..... 0.9461 

11140 ..... Bulloch County, Georgia ................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11150 ..... Burke County, Georgia ................................................................... 11 Rural ...... 0.8166 12260 Urban ..... 0.9748 

11160 ..... Butts County, Georgia .................................................................... 11 Rural ...... 0.8166 12060 Urban ..... 0.9793 

11161 ..... Calhoun County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11170 ..... Camden County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11180 ..... Candler County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11190 ..... Carroll County, Georgia .................................................................. 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11200 ..... Catoosa County, Georgia ............................................................... 1560 Urban ..... 0.9088 16860 Urban ..... 0.9088 

11210 ..... Charlton County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11220 ..... Chatham County, Georgia .............................................................. 7520 Urban ..... 0.9461 42340 Urban ..... 0.9461 

11230 ..... Chattahoochee County, Georgia .................................................... 1800 Urban ..... 0.8560 17980 Urban ..... 0.8560 

11240 ..... Chattooga County, Georgia ............................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11250 ..... Cherokee County, Georgia ............................................................. 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11260 ..... Clarke County, Georgia .................................................................. 0500 Urban ..... 0.9855 12020 Urban ..... 0.9855 

11270 ..... Clay County, Georgia ..................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11280 ..... Clayton County, Georgia ................................................................ 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11281 ..... Clinch County, Georgia ................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11290 ..... Cobb County, Georgia .................................................................... 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11291 ..... Coffee County, Georgia .................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11300 ..... Colquitt County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11310 ..... Columbia County, Georgia ............................................................. 0600 Urban ..... 0.9808 12260 Urban ..... 0.9748 

11311 ..... Cook County, Georgia .................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11320 ..... Coweta County, Georgia ................................................................ 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11330 ..... Crawford County, Georgia .............................................................. 11 Rural ...... 0.8166 31420 Urban ..... 0.9443 

11340 ..... Crisp County, Georgia .................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11341 ..... Dade County, Georgia .................................................................... 1560 Urban ..... 0.9088 16860 Urban ..... 0.9088 

11350 ..... Dawson County, Georgia ................................................................ 11 Rural ...... 0.8166 12060 Urban ..... 0.9793 

11360 ..... Decatur County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11370 ..... De Kalb County, Georgia ................................................................ 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11380 ..... Dodge County, Georgia .................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11381 ..... Dooly County, Georgia ................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11390 ..... Dougherty County, Georgia ............................................................ 0120 Urban ..... 0.8628 10500 Urban ..... 0.8628 

11400 ..... Douglas County, Georgia ............................................................... 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11410 ..... Early County, Georgia .................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11420 ..... Echols County, Georgia .................................................................. 11 Rural ...... 0.8166 46660 Urban ..... 0.8866 

11421 ..... Effingham County, Georgia ............................................................ 7520 Urban ..... 0.9461 42340 Urban ..... 0.9461 

11430 ..... Elbert County, Georgia ................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11440 ..... Emanuel County, Georgia .............................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11441 ..... Evans County, Georgia ................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11450 ..... Fannin County, Georgia .................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11451 ..... Fayette County, Georgia ................................................................. 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11460 ..... Floyd County, Georgia .................................................................... 11 Rural ...... 0.8166 40660 Urban ..... 0.9414 

11461 ..... Forsyth County, Georgia ................................................................. 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11462 ..... Franklin County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11470 ..... Fulton County, Georgia ................................................................... 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11471 ..... Gilmer County, Georgia .................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11480 ..... Glascock County, Georgia .............................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11490 ..... Glynn County, Georgia ................................................................... 11 Rural ...... 0.8166 15260 Urban ..... 0.9311 

11500 ..... Gordon County, Georgia ................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11510 ..... Grady County, Georgia ................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11520 ..... Greene County, Georgia ................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11530 ..... Gwinnett County, Georgia .............................................................. 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11540 ..... Habersham County, Georgia .......................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11550 ..... Hall County, Georgia ...................................................................... 11 Rural ...... 0.8166 23580 Urban ..... 0.8874 

11560 ..... Hancock County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11570 ..... Haralson County, Georgia .............................................................. 11 Rural ...... 0.8166 12060 Urban ..... 0.9793 

11580 ..... Harris County, Georgia ................................................................... 1800 Urban ..... 0.8560 17980 Urban ..... 0.8560 

11581 ..... Hart County, Georgia ...................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11590 ..... Heard County, Georgia ................................................................... 11 Rural ...... 0.8166 12060 Urban ..... 0.9793 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3663 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

11591 ..... Henry County, Georgia ................................................................... 0520 Urban ..... 0.9793 12060 Urban ..... 0.9793 

11600 ..... Houston County, Georgia ............................................................... 4680 Urban ..... 0.9277 47580 Urban ..... 0.8645 

11601 ..... Irwin County, Georgia ..................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11610 ..... Jackson County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11611 ..... Jasper County, Georgia .................................................................. 11 Rural ...... 0.8166 12060 Urban ..... 0.9793 

11612 ..... Jeff Davis County, Georgia ............................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11620 ..... Jefferson County, Georgia .............................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11630 ..... Jenkins County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11640 ..... Johnson County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11650 ..... Jones County, Georgia ................................................................... 4680 Urban ..... 0.9277 31420 Urban ..... 0.9443 

11651 ..... Lamar County, Georgia .................................................................. 11 Rural ...... 0.8166 12060 Urban ..... 0.9793 

11652 ..... Lanier County, Georgia ................................................................... 11 Rural ...... 0.8166 46660 Urban ..... 0.8866 

11660 ..... Laurens County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11670 ..... Lee County, Georgia ....................................................................... 0120 Urban ..... 0.8628 10500 Urban ..... 0.8628 

11680 ..... Liberty County, Georgia .................................................................. 11 Rural ...... 0.8166 25980 Urban ..... 1 0.9198 

11690 ..... Lincoln County, Georgia ................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11691 ..... Long County, Georgia ..................................................................... 11 Rural ...... 0.8166 25980 Urban ..... 1 0.9198 

11700 ..... Lowndes County, Georgia .............................................................. 11 Rural ...... 0.8166 46660 Urban ..... 0.8866 

11701 ..... Lumpkin County, Georgia ............................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11702 ..... Mc Duffie County, Georgia ............................................................. 0600 Urban ..... 0.9808 12260 Urban ..... 0.9748 

11703 ..... Mc Intosh County, Georgia ............................................................. 11 Rural ...... 0.8166 15260 Urban ..... 0.9311 

11710 ..... Macon County, Georgia .................................................................. 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11720 ..... Madison County, Georgia ............................................................... 0500 Urban ..... 0.9855 12020 Urban ..... 0.9855 

11730 ..... Marion County, Georgia .................................................................. 11 Rural ...... 0.8166 17980 Urban ..... 0.8560 

11740 ..... Meriwether County, Georgia ........................................................... 11 Rural ...... 0.8166 12060 Urban ..... 0.9793 

11741 ..... Miller County, Georgia .................................................................... 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11750 ..... Mitchell County, Georgia ................................................................ 11 Rural ...... 0.8166 99911 Rural ...... 0.7662 

11760 ..... Monroe County, Georgia ................................................................ 11 Rural ...... .08166 31420 Urban ..... 0.9443 

11770 ..... Montgomery County, Georgia ......................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11771 ..... Morgan County, Georgia ................................................................ 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11772 ..... Murray County, Georgia ................................................................. 11 Rural ...... .08166 19140 Urban ..... 0.9079 

11780 ..... Muscogee County, Georgia ............................................................ 1800 Urban ..... .08560 17980 Urban ..... 0.8560 

11790 ..... Newton County, Georgia ................................................................ 0520 Urban ..... .09793 12060 Urban ..... 0.9793 

11800 ..... Oconee County, Georgia ................................................................ 0500 Urban ..... .09855 12020 Urban ..... 0.9855 

11801 ..... Oglethorpe County, Georgia ........................................................... 11 Rural ...... .08166 12020 Urban ..... 0.9855 

11810 ..... Paulding County, Georgia ............................................................... 0520 Urban ..... .09793 12060 Urban ..... 0.9793 

11811 ..... Peach County, Georgia .................................................................. 4680 Urban ..... .09277 99911 Rural ...... 0.7662 

11812 ..... Pickens County, Georgia ................................................................ 0520 Urban ..... .09793 12060 Urban ..... 0.9793 

11820 ..... Pierce County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11821 ..... Pike County, Georgia ...................................................................... 11 Rural ...... .08166 12060 Urban ..... 0.9793 

11830 ..... Polk County, Georgia ...................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11831 ..... Pulaski County, Georgia ................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11832 ..... Putnam County, Georgia ................................................................ 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11833 ..... Quitman County, Georgia ............................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11834 ..... Rabun County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11835 ..... Randolph County, Georgia ............................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11840 ..... Richmond County, Georgia ............................................................ 0600 Urban ..... .09808 12260 Urban ..... 0.9748 

11841 ..... Rockdale County, Georgia .............................................................. 0520 Urban ..... .09793 12060 Urban ..... 0.9793 

11842 ..... Schley County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11850 ..... Screven County, Georgia ............................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11851 ..... Seminole County, Georgia .............................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11860 ..... Spalding County, Georgia ............................................................... 0520 Urban ..... .09793 12060 Urban ..... 0.9793 

11861 ..... Stephens County, Georgia ............................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11862 ..... Stewart County, Georgia ................................................................ 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11870 ..... Sumter County, Georgia ................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11880 ..... Talbot County, Georgia ................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11881 ..... Taliaferro County, Georgia ............................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11882 ..... Tattnall County, Georgia ................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11883 ..... Taylor County, Georgia ................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11884 ..... Telfair County, Georgia ................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11885 ..... Terrell County, Georgia .................................................................. 11 Rural ...... .08166 10500 Urban ..... 0.8628 

11890 ..... Thomas County, Georgia ................................................................ 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11900 ..... Tift County, Georgia ........................................................................ 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11901 ..... Toombs County, Georgia ................................................................ 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11902 ..... Towns County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11903 ..... Treutlen County, Georgia ............................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11910 ..... Troup County, Georgia ................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11911 ..... Turner County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11912 ..... Twiggs County, Georgia ................................................................. 4680 Urban ..... .09277 31420 Urban ..... 0.9443 

11913 ..... Union County, Georgia ................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11920 ..... Upson County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 


cchase on PROD1PC60 with PROPOSALS2
3664 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

11921 ..... Walker County, Georgia ................................................................. 1560 Urban ..... .09088 16860 Urban ..... 0.9088 

11930 ..... Walton County, Georgia ................................................................. 0520 Urban ..... .09793 12060 Urban ..... 0.9793 

11940 ..... Ware County, Georgia .................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11941 ..... Warren County, Georgia ................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11950 ..... Washington County, Georgia .......................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11960 ..... Wayne County, Georgia ................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11961 ..... Webster County, Georgia ............................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11962 ..... Wheeler County, Georgia ............................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11963 ..... White County, Georgia ................................................................... 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11970 ..... Whitfield County, Georgia ............................................................... 11 Rural ...... .08166 19140 Urban ..... 0.9079 

11971 ..... Wilcox County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11972 ..... Wilkes County, Georgia .................................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11973 ..... Wilkinson County, Georgia ............................................................. 11 Rural ...... .08166 99911 Rural ...... 0.7662 

11980 ..... Worth County, Georgia ................................................................... 11 Rural ...... .08166 10500 Urban ..... 0.8628 

12005 ..... Kalawao County, Hawaii ................................................................. 12 Rural ...... 1.0551 99912 Rural ...... 1.0551 

12010 ..... Hawaii County, Hawaii .................................................................... 12 Rural ...... 1.0551 99912 Rural ...... 1.0551 

12020 ..... Honolulu County, Hawaii ................................................................ 3320 Urban ..... 1.1214 26180 Urban ..... 1.1214 

12040 ..... Kauai County, Hawaii ..................................................................... 12 Rural ...... 1.0551 99912 Rural ...... 1.0551 

12050 ..... Maui County, Hawaii ....................................................................... 12 Rural ...... 1.0551 99912 Rural ...... 1.0551 

13000 ..... Ada County, Idaho .......................................................................... 1080 Urban ..... 0.9052 14260 Urban ..... 0.9052 

13010 ..... Adams County, Idaho ..................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13020 ..... Bannock County, Idaho .................................................................. 6340 Urban ..... 0.9351 38540 Urban ..... 0.9351 

13030 ..... Bear Lake County, Idaho ................................................................ 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13040 ..... Benewah County, Idaho ................................................................. 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13050 ..... Bingham County, Idaho .................................................................. 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13060 ..... Blaine County, Idaho ...................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13070 ..... Boise County, Idaho ....................................................................... 13 Rural ...... 0.9097 14260 Urban ..... 0.9052 

13080 ..... Bonner County, Idaho ..................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13090 ..... Bonneville County, Idaho ................................................................ 13 Rural ...... 0.9097 26820 Urban ..... 0.9420 

13100 ..... Boundary County, Idaho ................................................................. 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13110 ..... Butte County, Idaho ........................................................................ 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13120 ..... Camas County, Idaho ..................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13130 ..... Canyon County, Idaho .................................................................... 1080 Urban ..... 0.9052 14260 Urban ..... 0.9052 

13140 ..... Caribou County, Idaho .................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13150 ..... Cassia County, Idaho ..................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13160 ..... Clark County, Idaho ........................................................................ 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13170 ..... Clearwater County, Idaho ............................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13180 ..... Custer County, Idaho ...................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13190 ..... Elmore County, Idaho ..................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13200 ..... Franklin County, Idaho .................................................................... 13 Rural ...... 0.9097 30860 Urban ..... 0.9164 

13210 ..... Fremont County, Idaho ................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13220 ..... Gem County, Idaho ......................................................................... 13 Rural ...... 0.9097 14260 Urban ..... 0.9052 

13230 ..... Gooding County, Idaho ................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13240 ..... Idaho County, Idaho ....................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13250 ..... Jefferson County, Idaho .................................................................. 13 Rural ...... 0.9097 26820 Urban ..... 0.9420 

13260 ..... Jerome County, Idaho .................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13270 ..... Kootenai County, Idaho .................................................................. 13 Rural ...... 0.9097 17660 Urban ..... 0.9647 

13280 ..... Latah County, Idaho ....................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13290 ..... Lemhi County, Idaho ....................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13300 ..... Lewis County, Idaho ....................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13310 ..... Lincoln County, Idaho ..................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13320 ..... Madison County, Idaho ................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13330 ..... Minidoka County, Idaho .................................................................. 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13340 ..... Nez Perce County, Idaho ............................................................... 13 Rural ...... 0.9097 30300 Urban ..... 0.9886 

13350 ..... Oneida County, Idaho ..................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13360 ..... Owyhee County, Idaho ................................................................... 13 Rural ...... 0.9097 14260 Urban ..... 0.9052 

13370 ..... Payette County, Idaho .................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13380 ..... Power County, Idaho ...................................................................... 13 Rural ...... 0.9097 38540 Urban ..... 0.9351 

13390 ..... Shoshone County, Idaho ................................................................ 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13400 ..... Teton County, Idaho ....................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13410 ..... Twin Falls County, Idaho ................................................................ 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13420 ..... Valley County, Idaho ....................................................................... 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

13430 ..... Washington County, Idaho ............................................................. 13 Rural ...... 0.9097 99913 Rural ...... 0.8037 

14000 ..... Adams County, Illinois .................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14010 ..... Alexander County, Illinois ............................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14020 ..... Bond County, Illinois ....................................................................... 14 Rural ...... 0.8301 41180 Urban ..... 0.8954 

14030 ..... Boone County, Illinois ..................................................................... 6880 Urban ..... 0.9984 40420 Urban ..... 0.9984 

14040 ..... Brown County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14050 ..... Bureau County, Illinois .................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14060 ..... Calhoun County, Illinois .................................................................. 14 Rural ...... 0.8301 41180 Urban ..... 0.8954 

14070 ..... Carroll County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3665 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

14080 ..... Cass County, Illinois ....................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14090 ..... Champaign County, Illinois ............................................................. 1400 Urban ..... 0.9594 16580 Urban ..... 0.9594 

14100 ..... Christian County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14110 ..... Clark County, Illinois ....................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14120 ..... Clay County, Illinois ........................................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14130 ..... Clinton County, Illinois .................................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

14140 ..... Coles County, Illinois ...................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14141 ..... Cook County, Illinois ....................................................................... 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14150 ..... Crawford County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14160 ..... Cumberland County, Illinois ............................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14170 ..... De Kalb County, Illinois .................................................................. 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14180 ..... De Witt County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14190 ..... Douglas County, Illinois .................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14250 ..... Du Page County, Illinois ................................................................. 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14310 ..... Edgar County, Illinois ...................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14320 ..... Edwards County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14330 ..... Effingham County, Illinois ............................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14340 ..... Fayette County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14350 ..... Ford County, Illinois ........................................................................ 14 Rural ...... 0.8301 16580 Urban ..... 0.9594 

14360 ..... Franklin County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14370 ..... Fulton County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14380 ..... Gallatin County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14390 ..... Greene County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14400 ..... Grundy County, Illinois .................................................................... 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14410 ..... Hamilton County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14420 ..... Hancock County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14421 ..... Hardin County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14440 ..... Henderson County, Illinois .............................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14450 ..... Henry County, Illinois ...................................................................... 1960 Urban ..... 0.8724 19340 Urban ..... 0.8724 

14460 ..... Iroquois County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14470 ..... Jackson County, Illinois .................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14480 ..... Jasper County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14490 ..... Jefferson County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14500 ..... Jersey County, Illinois ..................................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

14510 ..... Jo Daviess County, Illinois .............................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14520 ..... Johnson County, Illinois .................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14530 ..... Kane County, Illinois ....................................................................... 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14540 ..... Kankakee County, Illinois ............................................................... 3740 Urban ..... 1.0721 28100 Urban ..... 1.0721 

14550 ..... Kendall County, Illinois ................................................................... 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14560 ..... Knox County, Illinois ....................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14570 ..... Lake County, Illinois ........................................................................ 1600 Urban ..... 1.0783 29404 Urban ..... 1.0429 

14580 ..... La Salle County, Illinois .................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14590 ..... Lawrence County, Illinois ................................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14600 ..... Lee County, Illinois ......................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14610 ..... Livingston County, Illinois ............................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14620 ..... Logan County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14630 ..... Mc Donough County, Illinois ........................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14640 ..... Mc Henry County, Illinois ................................................................ 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14650 ..... Mclean County, Illinois .................................................................... 1040 Urban ..... 0.9075 14060 Urban ..... 0.9075 

14660 ..... Macon County, Illinois ..................................................................... 2040 Urban ..... 0.8067 19500 Urban ..... 0.8067 

14670 ..... Macoupin County, Illinois ................................................................ 14 Rural ...... 0.8301 41180 Urban ..... 0.8954 

14680 ..... Madison County, Illinois .................................................................. 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

14690 ..... Marion County, Illinois .................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14700 ..... Marshall County, Illinois .................................................................. 14 Rural ...... 0.8301 37900 Urban ..... 0.8870 

14710 ..... Mason County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14720 ..... Massac County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14730 ..... Menard County, Illinois ................................................................... 7880 Urban ..... 0.8792 44100 Urban ..... 0.8792 

14740 ..... Mercer County, Illinois .................................................................... 14 Rural ...... 0.8301 19340 Urban ..... 0.8724 

14750 ..... Monroe County, Illinois ................................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

14760 ..... Montgomery County, Illinois ........................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14770 ..... Morgan County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14780 ..... Moultrie County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14790 ..... Ogle County, Illinois ........................................................................ 6880 Urban ..... 0.9984 99914 Rural ...... 0.8271 

14800 ..... Peoria County, Illinois ..................................................................... 6120 Urban ..... 0.8870 37900 Urban ..... 0.8870 

14810 ..... Perry County, Illinois ....................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14820 ..... Piatt County, Illinois ........................................................................ 14 Rural ...... 0.8301 16580 Urban ..... 0.9594 

14830 ..... Pike County, Illinois ........................................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14831 ..... Pope County, Illinois ....................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14850 ..... Pulaski County, Illinois .................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14860 ..... Putnam County, Illinois ................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14870 ..... Randolph County, Illinois ................................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 


cchase on PROD1PC60 with PROPOSALS2
3666 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

14880 ..... Richland County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14890 ..... Rock Island County, Illinois ............................................................ 1960 Urban ..... 0.8724 19340 Urban ..... 0.8724 

14900 ..... St Clair County, Illinois ................................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

14910 ..... Saline County, Illinois ..................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14920 ..... Sangamon County, Illinois .............................................................. 7880 Urban ..... 0.8792 44100 Urban ..... 0.8792 

14921 ..... Schuyler County, Illinois ................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14940 ..... Scott County, Illinois ....................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14950 ..... Shelby County, Illinois .................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14960 ..... Stark County, Illinois ....................................................................... 14 Rural ...... 0.8301 37900 Urban ..... 0.8870 

14970 ..... Stephenson County, Illinois ............................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14980 ..... Tazewell County, Illinois ................................................................. 6120 Urban ..... 0.8870 37900 Urban ..... 0.8870 

14981 ..... Union County, Illinois ...................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14982 ..... Vermilion County, Illinois ................................................................ 14 Rural ...... 0.8301 19180 Urban ..... 0.9028 

14983 ..... Wabash County, Illinois .................................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14984 ..... Warren County, Illinois .................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14985 ..... Washington County, Illinois ............................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14986 ..... Wayne County, Illinois .................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14987 ..... White County, Illinois ...................................................................... 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14988 ..... Whiteside County, Illinois ................................................................ 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14989 ..... Will County, Illinois .......................................................................... 1600 Urban ..... 1.0783 16974 Urban ..... 1.0790 

14990 ..... Williamson County, Illinois .............................................................. 14 Rural ...... 0.8301 99914 Rural ...... 0.8271 

14991 ..... Winnebago County, Illinois ............................................................. 6880 Urban ..... 0.9984 40420 Urban ..... 0.9984 

14992 ..... Woodford County, Illinois ................................................................ 6120 Urban ..... 0.8870 37900 Urban ..... 0.8870 

15000 ..... Adams County, Indiana .................................................................. 2760 Urban ..... 0.9706 99915 Rural ...... 0.8624 

15010 ..... Allen County, Indiana ...................................................................... 2760 Urban ..... 0.9706 23060 Urban ..... 0.9793 

15020 ..... Bartholomew County, Indiana ......................................................... 15 Rural ...... 0.8739 18020 Urban ..... 0.9588 

15030 ..... Benton County, Indiana .................................................................. 15 Rural ...... 0.8739 29140 Urban ..... 0.8736 

15040 ..... Blackford County, Indiana ............................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15050 ..... Boone County, Indiana ................................................................... 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15060 ..... Brown County, Indiana ................................................................... 15 Rural ...... 0.8739 26900 Urban ..... 0.9920 

15070 ..... Carroll County, Indiana ................................................................... 15 Rural ...... 0.8739 29140 Urban ..... 0.8736 

15080 ..... Cass County, Indiana ..................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15090 ..... Clark County, Indiana ..................................................................... 4520 Urban ..... 0.9293 31140 Urban ..... 0.9251 

15100 ..... Clay County, Indiana ...................................................................... 8320 Urban ..... 0.8337 45460 Urban ..... 0.8304 

15110 ..... Clinton County, Indiana .................................................................. 3920 Urban ..... 0.8736 99915 Rural ...... 0.8624 

15120 ..... Crawford County, Indiana ............................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15130 ..... Daviess County, Indiana ................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15140 ..... Dearborn County, Indiana ............................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

15150 ..... Decatur County, Indiana ................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15160 ..... De Kalb County, Indiana ................................................................. 2760 Urban ..... 0.9706 99915 Rural ...... 0.8624 

15170 ..... Delaware County, Indiana .............................................................. 5280 Urban ..... 0.8930 34620 Urban ..... 0.8930 

15180 ..... Dubois County, Indiana .................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15190 ..... Elkhart County, Indiana .................................................................. 2330 Urban ..... 0.9627 21140 Urban ..... 0.9627 

15200 ..... Fayette County, Indiana .................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15210 ..... Floyd County, Indiana ..................................................................... 4520 Urban ..... 0.9293 31140 Urban ..... 0.9251 

15220 ..... Fountain County, Indiana ................................................................ 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15230 ..... Franklin County, Indiana ................................................................. 15 Rural ...... 0.8739 17140 Urban ..... 0.9615 

15240 ..... Fulton County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15250 ..... Gibson County, Indiana .................................................................. 15 Rural ...... 0.8739 21780 Urban ..... 0.8713 

15260 ..... Grant County, Indiana ..................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15270 ..... Greene County, Indiana .................................................................. 15 Rural ...... 0.8739 14020 Urban ..... 0.8447 

15280 ..... Hamilton County, Indiana ............................................................... 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15290 ..... Hancock County, Indiana ................................................................ 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15300 ..... Harrison County, Indiana ................................................................ 4520 Urban ..... 0.9293 31140 Urban ..... 0.9251 

15310 ..... Hendricks County, Indiana .............................................................. 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15320 ..... Henry County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15330 ..... Howard County, Indiana ................................................................. 3850 Urban ..... 0.9508 29020 Urban ..... 0.9508 

15340 ..... Huntington County, Indiana ............................................................ 2760 Urban ..... 0.9706 99915 Rural ...... 0.8624 

15350 ..... Jackson County, Indiana ................................................................ 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15360 ..... Jasper County, Indiana ................................................................... 15 Rural ...... 0.8739 23844 Urban ..... 0.9395 

15370 ..... Jay County, Indiana ........................................................................ 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15380 ..... Jefferson County, Indiana ............................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15390 ..... Jennings County, Indiana ............................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15400 ..... Johnson County, Indiana ................................................................ 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15410 ..... Knox County, Indiana ..................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15420 ..... Kosciusko County, Indiana ............................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15430 ..... Lagrange County, Indiana .............................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15440 ..... Lake County, Indiana ...................................................................... 2960 Urban ..... 0.9395 23844 Urban ..... 0.9395 

15450 ..... La Porte County, Indiana ................................................................ 15 Rural ...... 0.8739 33140 Urban ..... 0.9399 

15460 ..... Lawrence County, Indiana .............................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15470 ..... Madison County, Indiana ................................................................ 3480 Urban ..... 0.9865 11300 Urban ..... 0.8586 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3667 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

15480 ..... Marion County, Indiana ................................................................... 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15490 ..... Marshall County, Indiana ................................................................ 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15500 ..... Martin County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15510 ..... Miami County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15520 ..... Monroe County, Indiana ................................................................. 1020 Urban ..... 0.8447 14020 Urban ..... 0.8447 

15530 ..... Montgomery County, Indiana .......................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15540 ..... Morgan County, Indiana ................................................................. 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15550 ..... Newton County, Indiana ................................................................. 15 Rural ...... 0.8739 23844 Urban ..... 0.9395 

15560 ..... Noble County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15570 ..... Ohio County, Indiana ...................................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

15580 ..... Orange County, Indiana .................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15590 ..... Owen County, Indiana .................................................................... 15 Rural ...... 0.8739 14020 Urban ..... 0.8447 

15600 ..... Parke County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15610 ..... Perry County, Indiana ..................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15620 ..... Pike County, Indiana ....................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15630 ..... Porter County, Indiana .................................................................... 2960 Urban ..... 0.9395 23844 Urban ..... 0.9395 

15640 ..... Posey County, Indiana .................................................................... 2440 Urban ..... 0.8713 21780 Urban ..... 0.8713 

15650 ..... Pulaski County, Indiana .................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15660 ..... Putnam County, Indiana ................................................................. 15 Rural ...... 0.8739 26900 Urban ..... 0.9920 

15670 ..... Randolph County, Indiana .............................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15680 ..... Ripley County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15690 ..... Rush County, Indiana ..................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15700 ..... St Joseph County, Indiana ............................................................. 7800 Urban ..... 0.9788 43780 Urban ..... 0.9788 

15710 ..... Scott County, Indiana ..................................................................... 4520 Urban ..... 0.9293 99915 Rural ...... 0.8624 

15720 ..... Shelby County, Indiana ................................................................... 3480 Urban ..... 0.9865 26900 Urban ..... 0.9920 

15730 ..... Spencer County, Indiana ................................................................ 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15740 ..... Starke County, Indiana ................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15750 ..... Steuben County, Indiana ................................................................ 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15760 ..... Sullivan County, Indiana ................................................................. 15 Rural ...... 0.8739 45460 Urban ..... 0.8304 

15770 ..... Switzerland County, Indiana ........................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15780 ..... Tippecanoe County, Indiana ........................................................... 3920 Urban ..... 0.8736 29140 Urban ..... 0.8736 

15790 ..... Tipton County, Indiana .................................................................... 3850 Urban ..... 0.9508 29020 Urban ..... 0.9508 

15800 ..... Union County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15810 ..... Vanderburgh County, Indiana ......................................................... 2440 Urban ..... 0.8713 21780 Urban ..... 0.8713 

15820 ..... Vermillion County, Indiana .............................................................. 8320 Urban ..... 0.8337 45460 Urban ..... 0.8304 

15830 ..... Vigo County, Indiana ...................................................................... 8320 Urban ..... 0.8337 45460 Urban ..... 0.8304 

15840 ..... Wabash County, Indiana ................................................................ 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15850 ..... Warren County, Indiana .................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15860 ..... Warrick County, Indiana ................................................................. 2440 Urban ..... 0.8713 21780 Urban ..... 0.8713 

15870 ..... Washington County, Indiana ........................................................... 15 Rural ...... 0.8739 31140 Urban ..... 0.9251 

15880 ..... Wayne County, Indiana .................................................................. 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15890 ..... Wells County, Indiana ..................................................................... 2760 Urban ..... 0.9706 23060 Urban ..... 0.9793 

15900 ..... White County, Indiana .................................................................... 15 Rural ...... 0.8739 99915 Rural ...... 0.8624 

15910 ..... Whitley County, Indiana .................................................................. 2760 Urban ..... 0.9706 23060 Urban ..... 0.9793 

16000 ..... Adair County, Iowa ......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16010 ..... Adams County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16020 ..... Allamakee County, Iowa ................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16030 ..... Appanoose County, Iowa ................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16040 ..... Audubon County, Iowa ................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16050 ..... Benton County, Iowa ...................................................................... 16 Rural ...... 0.8594 16300 Urban ..... 0.8825 

16060 ..... Black Hawk County, Iowa ............................................................... 8920 Urban ..... 0.8557 47940 Urban ..... 0.8557 

16070 ..... Boone County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16080 ..... Bremer County, Iowa ...................................................................... 16 Rural ...... 0.8594 47940 Urban ..... 0.8557 

16090 ..... Buchanan County, Iowa .................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16100 ..... Buena Vista County, Iowa .............................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16110 ..... Butler County, Iowa ........................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16120 ..... Calhoun County, Iowa .................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16130 ..... Carroll County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16140 ..... Cass County, Iowa .......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16150 ..... Cedar County, Iowa ........................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16160 ..... Cerro Gordo County, Iowa .............................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16170 ..... Cherokee County, Iowa .................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16180 ..... Chickasaw County, Iowa ................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16190 ..... Clarke County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16200 ..... Clay County, Iowa ........................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16210 ..... Clayton County, Iowa ...................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16220 ..... Clinton County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16230 ..... Crawford County, Iowa ................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16240 ..... Dallas County, Iowa ........................................................................ 2120 Urban ..... 0.9669 19780 Urban ..... 0.9669 

16250 ..... Davis County, Iowa ......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16260 ..... Decatur County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 


cchase on PROD1PC60 with PROPOSALS2
3668 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

16270 ..... Delaware County, Iowa ................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16280 ..... Des Moines County, Iowa ............................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16290 ..... Dickinson County, Iowa .................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16300 ..... Dubuque County, Iowa ................................................................... 2200 Urban ..... 0.9024 20220 Urban ..... 0.9024 

16310 ..... Emmet County, Iowa ...................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16320 ..... Fayette County, Iowa ...................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16330 ..... Floyd County, Iowa ......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16340 ..... Franklin County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16350 ..... Fremont County, Iowa .................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16360 ..... Greene County, Iowa ...................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16370 ..... Grundy County, Iowa ...................................................................... 16 Rural ...... 0.8594 47940 Urban ..... 0.8557 

16380 ..... Guthrie County, Iowa ...................................................................... 16 Rural ...... 0.8594 19780 Urban ..... 0.9669 

16390 ..... Hamilton County, Iowa .................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16400 ..... Hancock County, Iowa .................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16410 ..... Hardin County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16420 ..... Harrison County, Iowa .................................................................... 16 Rural ...... 0.8594 36540 Urban ..... 0.9560 

16430 ..... Henry County, Iowa ........................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16440 ..... Howard County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16450 ..... Humboldt County, Iowa .................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16460 ..... Ida County, Iowa ............................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16470 ..... Iowa County, Iowa .......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16480 ..... Jackson County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16490 ..... Jasper County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16500 ..... Jefferson County, Iowa ................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16510 ..... Johnson County, Iowa .................................................................... 3500 Urban ..... 0.9747 26980 Urban ..... 0.9747 

16520 ..... Jones County, Iowa ........................................................................ 16 Rural ...... 0.8594 16300 Urban ..... 0.8825 

16530 ..... Keokuk County, Iowa ...................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16540 ..... Kossuth County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16550 ..... Lee County, Iowa ............................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16560 ..... Linn County, Iowa ........................................................................... 1360 Urban ..... 0.8825 16300 Urban ..... 0.8825 

16570 ..... Louisa County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16580 ..... Lucas County, Iowa ........................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16590 ..... Lyon County, Iowa .......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16600 ..... Madison County, Iowa .................................................................... 16 Rural ...... 0.8594 19780 Urban ..... 0.9669 

16610 ..... Mahaska County, Iowa ................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16620 ..... Marion County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16630 ..... Marshall County, Iowa .................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16640 ..... Mills County, Iowa ........................................................................... 16 Rural ...... 0.8594 36540 Urban ..... 0.9560 

16650 ..... Mitchell County, Iowa ...................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16660 ..... Monona County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16670 ..... Monroe County, Iowa ...................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16680 ..... Montgomery County, Iowa .............................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16690 ..... Muscatine County, Iowa ................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16700 ..... O Brien County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16710 ..... Osceola County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16720 ..... Page County, Iowa ......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16730 ..... Palo Alto County, Iowa ................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16740 ..... Plymouth County, Iowa ................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16750 ..... Pocahontas County, Iowa ............................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16760 ..... Polk County, Iowa ........................................................................... 2120 Urban ..... 0.9669 19780 Urban ..... 0.9669 

16770 ..... Pottawattamie County, Iowa ........................................................... 5920 Urban ..... 0.9560 36540 Urban ..... 0.9560 

16780 ..... Poweshiek County, Iowa ................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16790 ..... Ringgold County, Iowa .................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16800 ..... Sac County, Iowa ............................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16810 ..... Scott County, Iowa .......................................................................... 1960 Urban ..... 0.8724 19340 Urban ..... 0.8724 

16820 ..... Shelby County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16830 ..... Sioux County, Iowa ......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16840 ..... Story County, Iowa ......................................................................... 16 Rural ...... 0.8594 11180 Urban ..... 0.9536 

16850 ..... Tama County, Iowa ......................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16860 ..... Taylor County, Iowa ........................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16870 ..... Union County, Iowa ........................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16880 ..... Van Buren County, Iowa ................................................................. 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16890 ..... Wapello County, Iowa ..................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16900 ..... Warren County, Iowa ...................................................................... 2120 Urban ..... 0.9669 19780 Urban ..... 0.9669 

16910 ..... Washington County, Iowa ............................................................... 16 Rural ...... 0.8594 26980 Urban ..... 0.9747 

16920 ..... Wayne County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16930 ..... Webster County, Iowa .................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16940 ..... Winnebago County, Iowa ................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16950 ..... Winneshiek County, Iowa ............................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

16960 ..... Woodbury County, Iowa ................................................................. 7720 Urban ..... 0.9416 43580 Urban ..... 0.9381 

16970 ..... Worth County, Iowa ........................................................................ 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3669 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

16980 ..... Wright County, Iowa ....................................................................... 16 Rural ...... 0.8594 99916 Rural ...... 0.8509 

17000 ..... Allen County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17010 ..... Anderson County, Kansas .............................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17020 ..... Atchison County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17030 ..... Barber County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17040 ..... Barton County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17050 ..... Bourbon County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17060 ..... Brown County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17070 ..... Butler County, Kansas .................................................................... 9040 Urban ..... 0.9175 48620 Urban ..... 0.9153 

17080 ..... Chase County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17090 ..... Chautauqua County, Kansas .......................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17100 ..... Cherokee County, Kansas .............................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17110 ..... Cheyenne County, Kansas ............................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17120 ..... Clark County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17130 ..... Clay County, Kansas ...................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17140 ..... Cloud County, Kansas .................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17150 ..... Coffey County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17160 ..... Comanche County, Kansas ............................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17170 ..... Cowley County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17180 ..... Crawford County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17190 ..... Decatur County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17200 ..... Dickinson County, Kansas .............................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17210 ..... Doniphan County, Kansas .............................................................. 17 Rural ...... 0.8040 41140 Urban ..... 0.9519 

17220 ..... Douglas County, Kansas ................................................................ 4150 Urban ..... 0.8537 29940 Urban ..... 0.8537 

17230 ..... Edwards County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17240 ..... Elk County, Kansas ........................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17250 ..... Ellis County, Kansas ....................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17260 ..... Ellsworth County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17270 ..... Finney County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17280 ..... Ford County, Kansas ...................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17290 ..... Franklin County, Kansas ................................................................. 17 Rural ...... 0.8040 28140 Urban ..... 0.9476 

17300 ..... Geary County, Kansas .................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17310 ..... Gove County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17320 ..... Graham County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17330 ..... Grant County, Kansas .................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17340 ..... Gray County, Kansas ...................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17350 ..... Greeley County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17360 ..... Greenwood County, Kansas ........................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17370 ..... Hamilton County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17380 ..... Harper County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17390 ..... Harvey County, Kansas .................................................................. 9040 Urban ..... 0.9175 48620 Urban ..... 0.9153 

17391 ..... Haskell County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17410 ..... Hodgeman County, Kansas ............................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17420 ..... Jackson County, Kansas ................................................................ 17 Rural ...... 0.8040 45820 Urban ..... 0.8920 

17430 ..... Jefferson County, Kansas ............................................................... 17 Rural ...... 0.8040 45820 Urban ..... 0.8920 

17440 ..... Jewell County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17450 ..... Johnson County, Kansas ................................................................ 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

17451 ..... Kearny County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17470 ..... Kingman County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17480 ..... Kiowa County, Kansas .................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17490 ..... Labette County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17500 ..... Lane County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17510 ..... Leavenworth County, Kansas ......................................................... 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

17520 ..... Lincoln County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17530 ..... Linn County, Kansas ....................................................................... 17 Rural ...... 0.8040 28140 Urban ..... 0.9476 

17540 ..... Logan County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17550 ..... Lyon County, Kansas ...................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17560 ..... Mc Pherson County, Kansas .......................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17570 ..... Marion County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17580 ..... Marshall County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17590 ..... Meade County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17600 ..... Miami County, Kansas .................................................................... 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

17610 ..... Mitchell County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17620 ..... Montgomery County, Kansas ......................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17630 ..... Morris County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17640 ..... Morton County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17650 ..... Nemaha County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17660 ..... Neosho County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17670 ..... Ness County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17680 ..... Norton County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17690 ..... Osage County, Kansas ................................................................... 17 Rural ...... 0.8040 45820 Urban ..... 0.8920 


cchase on PROD1PC60 with PROPOSALS2
3670 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

17700 ..... Osborne County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17710 ..... Ottawa County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17720 ..... Pawnee County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17730 ..... Phillips County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17740 ..... Pottawatomie County, Kansas ........................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17750 ..... Pratt County, Kansas ...................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17760 ..... Rawlins County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17770 ..... Reno County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17780 ..... Republic County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17790 ..... Rice County, Kansas ...................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17800 ..... Riley County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17810 ..... Rooks County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17820 ..... Rush County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17830 ..... Russell County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17840 ..... Saline County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17841 ..... Scott County, Kansas ..................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17860 ..... Sedgwick County, Kansas .............................................................. 9040 Urban ..... 0.9175 48620 Urban ..... 0.9153 

17870 ..... Seward County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17880 ..... Shawnee County, Kansas .............................................................. 8440 Urban ..... 0.8920 45820 Urban ..... 0.8920 

17890 ..... Sheridan County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17900 ..... Sherman County, Kansas ............................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17910 ..... Smith County, Kansas .................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17920 ..... Stafford County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17921 ..... Stanton County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17940 ..... Stevens County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17950 ..... Sumner County, Kansas ................................................................. 17 Rural ...... 0.8040 48620 Urban ..... 0.9153 

17960 ..... Thomas County, Kansas ................................................................ 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17970 ..... Trego County, Kansas .................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17980 ..... Wabaunsee County, Kansas .......................................................... 17 Rural ...... 0.8040 45820 Urban ..... 0.8920 

17981 ..... Wallace County, Kansas ................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17982 ..... Washington County, Kansas .......................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17983 ..... Wichita County, Kansas .................................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17984 ..... Wilson County, Kansas ................................................................... 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17985 ..... Woodson County, Kansas .............................................................. 17 Rural ...... 0.8040 99917 Rural ...... 0.8035 

17986 ..... Wyandotte County, Kansas ............................................................ 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

18000 ..... Adair County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18010 ..... Allen County, Kentucky ................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18020 ..... Anderson County, Kentucky ........................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18030 ..... Ballard County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18040 ..... Barren County, Kentucky ................................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18050 ..... Bath County, Kentucky ................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18060 ..... Bell County, Kentucky ..................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18070 ..... Boone County, Kentucky ................................................................ 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

18080 ..... Bourbon County, Kentucky ............................................................. 4280 Urban ..... 0.8988 30460 Urban ..... 0.9075 

18090 ..... Boyd County, Kentucky .................................................................. 3400 Urban ..... 0.9477 26580 Urban ..... 0.9477 

18100 ..... Boyle County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18110 ..... Bracken County, Kentucky ............................................................. 18 Rural ...... 0.7858 17140 Urban ..... 0.9615 

18120 ..... Breathitt County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18130 ..... Breckinridge County, Kentucky ....................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18140 ..... Bullitt County, Kentucky .................................................................. 4520 Urban ..... 0.9293 31140 Urban ..... 0.9251 

18150 ..... Butler County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18160 ..... Caldwell County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18170 ..... Calloway County, Kentucky ............................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18180 ..... Campbell County, Kentucky ........................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

18190 ..... Carlisle County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18191 ..... Carroll County, Kentucky ................................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18210 ..... Carter County, Kentucky ................................................................. 3400 Urban ..... 0.9477 99918 Rural ...... 0.7766 

18220 ..... Casey County, Kentucky ................................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18230 ..... Christian County, Kentucky ............................................................ 1660 Urban ..... 0.8284 17300 Urban ..... 0.8284 

18240 ..... Clark County, Kentucky .................................................................. 4280 Urban ..... 0.8988 30460 Urban ..... 0.9075 

18250 ..... Clay County, Kentucky ................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18260 ..... Clinton County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18270 ..... Crittenden County, Kentucky .......................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18271 ..... Cumberland County, Kentucky ....................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18290 ..... Daviess County, Kentucky .............................................................. 5990 Urban ..... 0.8780 36980 Urban ..... 0.8780 

18291 ..... Edmonson County, Kentucky ......................................................... 18 Rural ...... 0.7858 14540 Urban ..... 0.8211 

18310 ..... Elliott County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18320 ..... Estill County, Kentucky ................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18330 ..... Fayette County, Kentucky ............................................................... 4280 Urban ..... 0.8988 30460 Urban ..... 0.9075 

18340 ..... Fleming County, Kentucky .............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18350 ..... Floyd County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3671 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

18360 ..... Franklin County, Kentucky .............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18361 ..... Fulton County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18362 ..... Gallatin County, Kentucky .............................................................. 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

18390 ..... Garrard County, Kentucky .............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18400 ..... Grant County, Kentucky .................................................................. 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

18410 ..... Graves County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18420 ..... Grayson County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18421 ..... Green County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18440 ..... Greenup County, Kentucky ............................................................. 3400 Urban ..... 0.9477 26580 Urban ..... 0.9477 

18450 ..... Hancock County, Kentucky ............................................................. 18 Rural ...... 0.7858 36980 Urban ..... 0.8780 

18460 ..... Hardin County, Kentucky ................................................................ 18 Rural ...... 0.7858 21060 Urban ..... 0.8802 

18470 ..... Harlan County, Kentucky ................................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18480 ..... Harrison County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18490 ..... Hart County, Kentucky .................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18500 ..... Henderson County, Kentucky ......................................................... 2440 Urban ..... 0.8713 21780 Urban ..... 0.8713 

18510 ..... Henry County, Kentucky ................................................................. 18 Rural ...... 0.7858 31140 Urban ..... 0.9251 

18511 ..... Hickman County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18530 ..... Hopkins County, Kentucky .............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18540 ..... Jackson County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18550 ..... Jefferson County, Kentucky ............................................................ 4520 Urban ..... 0.9293 31140 Urban ..... 0.9251 

18560 ..... Jessamine County, Kentucky ......................................................... 4280 Urban ..... 0.8988 30460 Urban ..... 0.9075 

18570 ..... Johnson County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18580 ..... Kenton County, Kentucky ............................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

18590 ..... Knott County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18600 ..... Knox County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18610 ..... Larue County, Kentucky ................................................................. 18 Rural ...... 0.7858 21060 Urban ..... 0.8802 

18620 ..... Laurel County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18630 ..... Lawrence County, Kentucky ........................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18640 ..... Lee County, Kentucky ..................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18650 ..... Leslie County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18660 ..... Letcher County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18670 ..... Lewis County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18680 ..... Lincoln County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18690 ..... Livingston County, Kentucky .......................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18700 ..... Logan County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18710 ..... Lyon County, Kentucky ................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18720 ..... Mc Cracken County, Kentucky ....................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18730 ..... Mc Creary County, Kentucky .......................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18740 ..... Mc Lean County, Kentucky ............................................................. 18 Rural ...... 0.7858 36980 Urban ..... 0.8780 

18750 ..... Madison County, Kentucky ............................................................. 4280 Urban ..... 0.8988 99918 Rural ...... 0.7766 

18760 ..... Magoffin County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18770 ..... Marion County, Kentucky ................................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18780 ..... Marshall County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18790 ..... Martin County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18800 ..... Mason County, Kentucky ................................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18801 ..... Meade County, Kentucky ................................................................ 18 Rural ...... 0.7858 31140 Urban ..... 0.9251 

18802 ..... Menifee County, Kentucky .............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18830 ..... Mercer County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18831 ..... Metcalfe County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18850 ..... Monroe County, Kentucky .............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18860 ..... Montgomery County, Kentucky ....................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18861 ..... Morgan County, Kentucky .............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18880 ..... Muhlenberg County, Kentucky ........................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18890 ..... Nelson County, Kentucky ............................................................... 18 Rural ...... 0.7858 31140 Urban ..... 0.9251 

18900 ..... Nicholas County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18910 ..... Ohio County, Kentucky ................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18920 ..... Oldham County, Kentucky .............................................................. 4520 Urban ..... 0.9293 31140 Urban ..... 0.9251 

18930 ..... Owen County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18931 ..... Owsley County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18932 ..... Pendleton County, Kentucky .......................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

18960 ..... Perry County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18970 ..... Pike County, Kentucky .................................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18971 ..... Powell County, Kentucky ................................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18972 ..... Pulaski County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18973 ..... Robertson County, Kentucky .......................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18974 ..... Rockcastle County, Kentucky ......................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18975 ..... Rowan County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18976 ..... Russell County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18977 ..... Scott County, Kentucky .................................................................. 4280 Urban ..... 0.8988 30460 Urban ..... 0.9075 

18978 ..... Shelby County, Kentucky ................................................................ 18 Rural ...... 0.7858 31140 Urban ..... 0.9251 

18979 ..... Simpson County, Kentucky ............................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 


cchase on PROD1PC60 with PROPOSALS2
3672 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

18980 ..... Spencer County, Kentucky ............................................................. 18 Rural ...... 0.7858 31140 Urban ..... 0.9251 

18981 ..... Taylor County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18982 ..... Todd County, Kentucky .................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18983 ..... Trigg County, Kentucky .................................................................. 18 Rural ...... 0.7858 17300 Urban ..... 0.8284 

18984 ..... Trimble County, Kentucky ............................................................... 18 Rural ...... 0.7858 31140 Urban ..... 0.9251 

18985 ..... Union County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18986 ..... Warren County, Kentucky ............................................................... 18 Rural ...... 0.7858 14540 Urban ..... 0.8211 

18987 ..... Washington County, Kentucky ........................................................ 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18988 ..... Wayne County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18989 ..... Webster County, Kentucky ............................................................. 18 Rural ...... 0.7858 21780 Urban ..... 0.8713 

18990 ..... Whitley County, Kentucky ............................................................... 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18991 ..... Wolfe County, Kentucky ................................................................. 18 Rural ...... 0.7858 99918 Rural ...... 0.7766 

18992 ..... Woodford County, Kentucky ........................................................... 4280 Urban ..... 0.8988 30460 Urban ..... 0.9075 

19000 ..... Acadia County, Louisiana ............................................................... 3880 Urban ..... 0.8251 99919 Rural ...... 0.7411 

19010 ..... Allen County, Louisiana .................................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19020 ..... Ascension County, Louisiana ......................................................... 0760 Urban ..... 0.8643 12940 Urban ..... 0.8593 

19030 ..... Assumption County, Louisiana ....................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19040 ..... Avoyelles County, Louisiana ........................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19050 ..... Beauregard County, Louisiana ....................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19060 ..... Bienville County, Louisiana ............................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19070 ..... Bossier County, Louisiana .............................................................. 7680 Urban ..... 0.8737 43340 Urban ..... 0.8760 

19080 ..... Caddo County, Louisiana ............................................................... 7680 Urban ..... 0.8737 43340 Urban ..... 0.8760 

19090 ..... Calcasieu County, Louisiana .......................................................... 3960 Urban ..... 0.7858 29340 Urban ..... 0.7833 

19100 ..... Caldwell County, Louisiana ............................................................ 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19110 ..... Cameron County, Louisiana ........................................................... 19 Rural ...... 0.7340 29340 Urban ..... 0.7833 

19120 ..... Catahoula County, Louisiana .......................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19130 ..... Claiborne County, Louisiana ........................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19140 ..... Concordia County, Louisiana .......................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19150 ..... De Soto County, Louisiana ............................................................. 19 Rural ...... 0.7340 43340 Urban ..... 0.8760 

19160 ..... East Baton Rouge County, Louisiana ............................................ 0760 Urban ..... 0.8643 12940 Urban ..... 0.8593 

19170 ..... East Carroll County, Louisiana ....................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19180 ..... East Feliciana County, Louisiana ................................................... 19 Rural ...... 0.7340 12940 Urban ..... 0.8593 

19190 ..... Evangeline County, Louisiana ........................................................ 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19200 ..... Franklin County, Louisiana ............................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19210 ..... Grant County, Louisiana ................................................................. 19 Rural ...... 0.7340 10780 Urban ..... 0.8033 

19220 ..... Iberia County, Louisiana ................................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19230 ..... Iberville County, Louisiana .............................................................. 19 Rural ...... 0.7340 12940 Urban ..... 0.8593 

19240 ..... Jackson County, Louisiana ............................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19250 ..... Jefferson County, Louisiana ........................................................... 5560 Urban ..... 0.8995 35380 Urban ..... 0.8995 

19260 ..... Jefferson Davis County, Louisiana ................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19270 ..... Lafayette County, Louisiana ........................................................... 3880 Urban ..... 0.8251 29180 Urban ..... 0.8428 

19280 ..... Lafourche County, Louisiana .......................................................... 3350 Urban ..... 0.7894 26380 Urban ..... 0.7894 

19290 ..... La Salle County, Louisiana ............................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19300 ..... Lincoln County, Louisiana ............................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19310 ..... Livingston County, Louisiana .......................................................... 0760 Urban ..... 0.8643 12940 Urban ..... 0.8593 

19320 ..... Madison County, Louisiana ............................................................ 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19330 ..... Morehouse County, Louisiana ........................................................ 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19340 ..... Natchitoches County, Louisiana ..................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19350 ..... Orleans County, Louisiana ............................................................. 5560 Urban ..... 0.8995 35380 Urban ..... 0.8995 

19360 ..... Ouachita County, Louisiana ............................................................ 5200 Urban ..... 0.8044 33740 Urban ..... 0.8031 

19370 ..... Plaquemines County, Louisiana ..................................................... 5560 Urban ..... 0.8995 35380 Urban ..... 0.8995 

19380 ..... Pointe Coupee County, Louisiana .................................................. 19 Rural ...... 0.7340 12940 Urban ..... 0.8593 

19390 ..... Rapides County, Louisiana ............................................................. 0220 Urban ..... 0.8033 10780 Urban ..... 0.8033 

19400 ..... Red River County, Louisiana .......................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19410 ..... Richland County, Louisiana ............................................................ 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19420 ..... Sabine County, Louisiana ............................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19430 ..... St Bernard County, Louisiana ......................................................... 5560 Urban ..... 0.8995 35380 Urban ..... 0.8995 

19440 ..... St Charles County, Louisiana ......................................................... 5560 Urban ..... 0.8995 35380 Urban ..... 0.8995 

19450 ..... St Helena County, Louisiana .......................................................... 19 Rural ...... 0.7340 12940 Urban ..... 0.8593 

19460 ..... St James County, Louisiana ........................................................... 5560 Urban ..... 0.8995 99919 Rural ...... 0.7411 

19470 ..... St John Baptist County, Louisiana ................................................. 5560 Urban ..... 0.8995 35380 Urban ..... 0.8995 

19480 ..... St Landry County, Louisiana .......................................................... 3880 Urban ..... 0.8251 99919 Rural ...... 0.7411 

19490 ..... St Martin County, Louisiana ........................................................... 3880 Urban ..... 0.8251 29180 Urban ..... 0.8428 

19500 ..... St Mary County, Louisiana ............................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19510 ..... St Tammany County, Louisiana ..................................................... 5560 Urban ..... 0.8995 35380 Urban ..... 0.8995 

19520 ..... Tangipahoa County, Louisiana ....................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19530 ..... Tensas County, Louisiana .............................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19540 ..... Terrebonne County, Louisiana ....................................................... 3350 Urban ..... 0.7894 26380 Urban ..... 0.7894 

19550 ..... Union County, Louisiana ................................................................. 19 Rural ...... 0.7340 33740 Urban ..... 0.8031 

19560 ..... Vermilion County, Louisiana ........................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19570 ..... Vernon County, Louisiana .............................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3673 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

19580 ..... Washington County, Louisiana ....................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19590 ..... Webster County, Louisiana ............................................................. 7680 Urban ..... 0.8737 99919 Rural ...... 0.7411 

19600 ..... West Baton Rouge County, Louisiana ........................................... 0760 Urban ..... 0.8643 12940 Urban ..... 0.8593 

19610 ..... West Carroll County, Louisiana ...................................................... 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

19620 ..... West Feliciana County, Louisiana .................................................. 19 Rural ...... 0.7340 12940 Urban ..... 0.8593 

19630 ..... Winn County, Louisiana .................................................................. 19 Rural ...... 0.7340 99919 Rural ...... 0.7411 

20000 ..... Androscoggin County, Maine .......................................................... 4243 Urban ..... 0.9331 30340 Urban ..... 0.9331 

20010 ..... Aroostook County, Maine ............................................................... 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20020 ..... Cumberland County, Maine ............................................................ 6403 Urban ..... 1.0382 38860 Urban ..... 1.0382 

20030 ..... Franklin County, Maine ................................................................... 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20040 ..... Hancock County, Maine .................................................................. 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20050 ..... Kennebec County, Maine ............................................................... 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20060 ..... Knox County, Maine ....................................................................... 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20070 ..... Lincoln County, Maine .................................................................... 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20080 ..... Oxford County, Maine ..................................................................... 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20090 ..... Penobscot County, Maine ............................................................... 0733 Urban ..... 0.9993 12620 Urban ..... 0.9993 

20100 ..... Piscataquis County, Maine ............................................................. 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20110 ..... Sagadahoc County, Maine ............................................................. 6403 Urban ..... 1.0382 38860 Urban ..... 1.0382 

20120 ..... Somerset County, Maine ................................................................ 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20130 ..... Waldo County, Maine ..................................................................... 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20140 ..... Washington County, Maine ............................................................. 20 Rural ...... 0.8843 99920 Rural ...... 0.8843 

20150 ..... York County, Maine ........................................................................ 6403 Urban ..... 1.0382 38860 Urban ..... 1.0382 

21000 ..... Allegany County, Maryland ............................................................. 1900 Urban ..... 0.9317 19060 Urban ..... 0.9317 

21010 ..... Anne Arundel County, Maryland ..................................................... 0720 Urban ..... 0.9897 12580 Urban ..... 0.9897 

21020 ..... Baltimore County, Maryland ........................................................... 0720 Urban ..... 0.9897 12580 Urban ..... 0.9897 

21030 ..... Baltimore City County, Maryland .................................................... 0720 Urban ..... 0.9897 12580 Urban ..... 0.9897 

21040 ..... Calvert County, Maryland ............................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

21050 ..... Caroline County, Maryland ............................................................. 21 Rural ...... 0.9230 99921 Rural ...... 0.9353 

21060 ..... Carroll County, Maryland ................................................................ 0720 Urban ..... 0.9897 12580 Urban ..... 0.9897 

21070 ..... Cecil County, Maryland ................................................................... 9160 Urban ..... 1.0527 48864 Urban ..... 1.0471 

21080 ..... Charles County, Maryland .............................................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

21090 ..... Dorchester County, Maryland ......................................................... 21 Rural ...... 0.9230 99921 Rural ...... 0.9353 

21100 ..... Frederick County, Maryland ............................................................ 8840 Urban ..... 1.0976 13644 Urban ..... 1.1483 

21110 ..... Garrett County, Maryland ............................................................... 21 Rural ...... 0.9230 99921 Rural ...... 0.9353 

21120 ..... Harford County, Maryland ............................................................... 0720 Urban ..... 0.9897 12580 Urban ..... 0.9897 

21130 ..... Howard County, Maryland .............................................................. 0720 Urban ..... 0.9897 12580 Urban ..... 0.9897 

21140 ..... Kent County, Maryland ................................................................... 21 Rural ...... 0.9230 99921 Rural ...... 0.9353 

21150 ..... Montgomery County, Maryland ....................................................... 8840 Urban ..... 1.0976 13644 Urban ..... 1.1483 

21160 ..... Prince Georges County, Maryland ................................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

21170 ..... Queen Annes County, Maryland .................................................... 0720 Urban ..... 0.9897 12580 Urban ..... 0.9897 

21180 ..... St Marys County, Maryland ............................................................ 21 Rural ...... 0.9230 99921 Rural ...... 0.9353 

21190 ..... Somerset County, Maryland ........................................................... 21 Rural ...... 0.9230 41540 Urban ..... 0.9064 

21200 ..... Talbot County, Maryland ................................................................. 21 Rural ...... 0.9230 99921 Rural ...... 0.9353 

21210 ..... Washington County, Maryland ........................................................ 3180 Urban ..... 0.9869 25180 Urban ..... 0.9489 

21220 ..... Wicomico County, Maryland ........................................................... 21 Rural ...... 0.9230 41540 Urban ..... 0.9064 

21230 ..... Worcester County, Maryland .......................................................... 21 Rural ...... 0.9230 99921 Rural ...... 0.9353 

22000 ..... Barnstable County, Massachusetts ................................................ 0743 Urban ..... 1.2600 12700 Urban ..... 1.2600 

22010 ..... Berkshire County, Massachusetts .................................................. 6323 Urban ..... 1.0181 38340 Urban ..... 1.0181 

22020 ..... Bristol County, Massachusetts ....................................................... 1123 Urban ..... 1.1178 39300 Urban ..... 1.0966 

22030 ..... Dukes County, Massachusetts ....................................................... 22 Rural ...... 1.0216 99922 Rural ...... 1.0216 

22040 ..... Essex County, Massachusetts ........................................................ 1123 Urban ..... 1.1178 21604 Urban ..... 1.0538 

22060 ..... Franklin County, Massachusetts ..................................................... 22 Rural ...... 1.0216 44140 Urban ..... 1.0248 

22070 ..... Hampden County, Massachusetts .................................................. 8003 Urban ..... 1.0263 44140 Urban ..... 1.0248 

22080 ..... Hampshire County, Massachusetts ................................................ 8003 Urban ..... 1.0263 44140 Urban ..... 1.0248 

22090 ..... Middlesex County, Massachusetts ................................................. 1123 Urban ..... 1.1178 15764 Urban ..... 1.1172 

22120 ..... Nantucket County, Massachusetts ................................................. 22 Rural ...... 1.0216 99922 Rural ...... 1.0216 

22130 ..... Norfolk County, Massachusetts ...................................................... 1123 Urban ..... 1.1178 14484 Urban ..... 1.1558 

22150 ..... Plymouth County, Massachusetts .................................................. 1123 Urban ..... 1.1178 14484 Urban ..... 1.1558 

22160 ..... Suffolk County, Massachusetts ...................................................... 1123 Urban ..... 1.1178 14484 Urban ..... 1.1558 

22170 ..... Worcester County, Massachusetts ................................................. 1123 Urban ..... 1.1178 49340 Urban ..... 1.1028 

23000 ..... Alcona County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23010 ..... Alger County, Michigan ................................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23020 ..... Allegan County, Michigan ............................................................... 3000 Urban ..... 0.9445 99923 Rural ...... 0.8895 

23030 ..... Alpena County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23040 ..... Antrim County, Michigan ................................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23050 ..... Arenac County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23060 ..... Baraga County, Michigan ............................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23070 ..... Barry County, Michigan .................................................................. 23 Rural ...... 0.8824 24340 Urban ..... 0.9390 

23080 ..... Bay County, Michigan ..................................................................... 6960 Urban ..... 0.9241 13020 Urban ..... 0.9343 

23090 ..... Benzie County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23100 ..... Berrien County, Michigan ............................................................... 0870 Urban ..... 0.8879 35660 Urban ..... 0.8879 


cchase on PROD1PC60 with PROPOSALS2
3674 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

23110 ..... Branch County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23120 ..... Calhoun County, Michigan .............................................................. 3720 Urban ..... 1.0143 12980 Urban ..... 0.9508 

23130 ..... Cass County, Michigan ................................................................... 23 Rural ...... 0.8824 43780 Urban ..... 0.9788 

23140 ..... Charlevoix County, Michigan .......................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23150 ..... Cheboygan County, Michigan ......................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23160 ..... Chippewa County, Michigan ........................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23170 ..... Clare County, Michigan .................................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23180 ..... Clinton County, Michigan ................................................................ 4040 Urban ..... 0.9794 29620 Urban ..... 0.9794 

23190 ..... Crawford County, Michigan ............................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23200 ..... Delta County, Michigan ................................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23210 ..... Dickinson County, Michigan ........................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23220 ..... Eaton County, Michigan .................................................................. 4040 Urban ..... 0.9794 29620 Urban ..... 0.9794 

23230 ..... Emmet County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23240 ..... Genesee County, Michigan ............................................................ 2640 Urban ..... 1.0655 22420 Urban ..... 1.0655 

23250 ..... Gladwin County, Michigan .............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23260 ..... Gogebic County, Michigan .............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23270 ..... Grand Traverse County, Michigan .................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23280 ..... Gratiot County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23290 ..... Hillsdale County, Michigan ............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23300 ..... Houghton County, Michigan ........................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23310 ..... Huron County, Michigan ................................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23320 ..... Ingham County, Michigan ............................................................... 4040 Urban ..... 0.9794 29620 Urban ..... 0.9794 

23330 ..... Ionia County, Michigan ................................................................... 23 Rural ...... 0.8824 24340 Urban ..... 0.9390 

23340 ..... Iosco County, Michigan .................................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23350 ..... Iron County, Michigan ..................................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23360 ..... Isabella County, Michigan ............................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23370 ..... Jackson County, Michigan .............................................................. 3520 Urban ..... 0.9304 27100 Urban ..... 0.9304 

23380 ..... Kalamazoo County, Michigan ......................................................... 3720 Urban ..... 1.0143 28020 Urban ..... 1.0381 

23390 ..... Kalkaska County, Michigan ............................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23400 ..... Kent County, Michigan .................................................................... 3000 Urban ..... 0.9445 24340 Urban ..... 0.9390 

23410 ..... Keweenaw County, Michigan ......................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23420 ..... Lake County, Michigan ................................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23430 ..... Lapeer County, Michigan ................................................................ 2160 Urban ..... 1.0147 47644 Urban ..... 0.9871 

23440 ..... Leelanau County, Michigan ............................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23450 ..... Lenawee County, Michigan ............................................................ 0440 Urban ..... 1.0707 99923 Rural ...... 0.8895 

23460 ..... Livingston County, Michigan ........................................................... 0440 Urban ..... 1.0707 47644 Urban ..... 0.9871 

23470 ..... Luce County, Michigan ................................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23480 ..... Mackinac County, Michigan ............................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23490 ..... Macomb County, Michigan ............................................................. 2160 Urban ..... 1.0147 47644 Urban ..... 0.9871 

23500 ..... Manistee County, Michigan ............................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23510 ..... Marquette County, Michigan ........................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23520 ..... Mason County, Michigan ................................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23530 ..... Mecosta County, Michigan ............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23540 ..... Menominee County, Michigan ........................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23550 ..... Midland County, Michigan .............................................................. 6960 Urban ..... 0.9241 99923 Rural ...... 0.8895 

23560 ..... Missaukee County, Michigan .......................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23570 ..... Monroe County, Michigan ............................................................... 2160 Urban ..... 1.0147 33780 Urban ..... 0.9468 

23580 ..... Montcalm County, Michigan ........................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23590 ..... Montmorency County, Michigan ..................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23600 ..... Muskegon County, Michigan .......................................................... 3000 Urban ..... 0.9445 34740 Urban ..... 0.9664 

23610 ..... Newaygo County, Michigan ............................................................ 23 Rural ...... 0.8824 24340 Urban ..... 0.9390 

23620 ..... Oakland County, Michigan .............................................................. 2160 Urban ..... 1.0147 47644 Urban ..... 0.9871 

23630 ..... Oceana County, Michigan .............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23640 ..... Ogemaw County, Michigan ............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23650 ..... Ontonagon County, Michigan ......................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23660 ..... Osceola County, Michigan .............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23670 ..... Oscoda County, Michigan ............................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23680 ..... Otsego County, Michigan ............................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23690 ..... Ottawa County, Michigan ................................................................ 3000 Urban ..... 0.9445 26100 Urban ..... 0.9055 

23700 ..... Presque Isle County, Michigan ....................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23710 ..... Roscommon County, Michigan ....................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23720 ..... Saginaw County, Michigan ............................................................. 6960 Urban ..... 0.9241 40980 Urban ..... 0.9088 

23730 ..... St Clair County, Michigan ............................................................... 2160 Urban ..... 1.0147 47644 Urban ..... 0.9871 

23740 ..... St Joseph County, Michigan ........................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23750 ..... Sanilac County, Michigan ............................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23760 ..... Schoolcraft County, Michigan ......................................................... 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23770 ..... Shiawassee County, Michigan ........................................................ 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23780 ..... Tuscola County, Michigan .............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

23790 ..... Van Buren County, Michigan .......................................................... 3720 Urban ..... 1.0143 28020 Urban ..... 1.0381 

23800 ..... Washtenaw County, Michigan ........................................................ 0440 Urban ..... 1.0707 11460 Urban ..... 1.0859 

23810 ..... Wayne County, Michigan ................................................................ 2160 Urban ..... 1.0147 19804 Urban ..... 1.0424 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3675 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

23830 ..... Wexford County, Michigan .............................................................. 23 Rural ...... 0.8824 99923 Rural ...... 0.8895 

24000 ..... Aitkin County, Minnesota ................................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24010 ..... Anoka County, Minnesota ............................................................... 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24020 ..... Becker County, Minnesota .............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24030 ..... Beltrami County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24040 ..... Benton County, Minnesota ............................................................. 6980 Urban ..... 0.9965 41060 Urban ..... 0.9965 

24050 ..... Big Stone County, Minnesota ......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24060 ..... Blue Earth County, Minnesota ........................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24070 ..... Brown County, Minnesota ............................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24080 ..... Carlton County, Minnesota ............................................................. 24 Rural ...... 0.9132 20260 Urban ..... 1.0213 

24090 ..... Carver County, Minnesota .............................................................. 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24100 ..... Cass County, Minnesota ................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24110 ..... Chippewa County, Minnesota ......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24120 ..... Chisago County, Minnesota ............................................................ 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24130 ..... Clay County, Minnesota .................................................................. 2520 Urban ..... 0.8486 22020 Urban ..... 0.8486 

24140 ..... Clearwater County, Minnesota ....................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24150 ..... Cook County, Minnesota ................................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24160 ..... Cottonwood County, Minnesota ...................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24170 ..... Crow Wing County, Minnesota ....................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24180 ..... Dakota County, Minnesota ............................................................. 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24190 ..... Dodge County, Minnesota .............................................................. 24 Rural ...... 0.9132 40340 Urban ..... 1.1131 

24200 ..... Douglas County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24210 ..... Faribault County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24220 ..... Fillmore County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24230 ..... Freeborn County, Minnesota .......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24240 ..... Goodhue County, Minnesota .......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24250 ..... Grant County, Minnesota ................................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24260 ..... Hennepin County, Minnesota ......................................................... 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24270 ..... Houston County, Minnesota ........................................................... 3870 Urban ..... 0.9564 29100 Urban ..... 0.9564 

24280 ..... Hubbard County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24290 ..... Isanti County, Minnesota ................................................................ 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24300 ..... Itasca County, Minnesota ............................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24310 ..... Jackson County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24320 ..... Kanabec County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24330 ..... Kandiyohi County, Minnesota ......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24340 ..... Kittson County, Minnesota .............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24350 ..... Koochiching County, Minnesota ..................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24360 ..... Lac Qui Parle County, Minnesota ................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24370 ..... Lake County, Minnesota ................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24380 ..... Lake Of Woods County, Minnesota ................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24390 ..... Le Sueur County, Minnesota .......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24400 ..... Lincoln County, Minnesota ............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24410 ..... Lyon County, Minnesota ................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24420 ..... Mc Leod County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24430 ..... Mahnomen County, Minnesota ....................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24440 ..... Marshall County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24450 ..... Martin County, Minnesota ............................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24460 ..... Meeker County, Minnesota ............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24470 ..... Mille Lacs County, Minnesota ......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24480 ..... Morrison County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24490 ..... Mower County, Minnesota .............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24500 ..... Murray County, Minnesota .............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24510 ..... Nicollet County, Minnesota ............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24520 ..... Nobles County, Minnesota .............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24530 ..... Norman County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24540 ..... Olmsted County, Minnesota ........................................................... 6820 Urban ..... 1.1131 40340 Urban ..... 1.1131 

24550 ..... Otter Tail County, Minnesota .......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24560 ..... Pennington County, Minnesota ....................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24570 ..... Pine County, Minnesota .................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24580 ..... Pipestone County, Minnesota ......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24590 ..... Polk County, Minnesota .................................................................. 2985 Urban ..... 0.7901 24220 Urban ..... 0.7901 

24600 ..... Pope County, Minnesota ................................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24610 ..... Ramsey County, Minnesota ............................................................ 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24620 ..... Red Lake County, Minnesota ......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24630 ..... Redwood County, Minnesota .......................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24640 ..... Renville County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24650 ..... Rice County, Minnesota .................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24660 ..... Rock County, Minnesota ................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24670 ..... Roseau County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24680 ..... St Louis County, Minnesota ............................................................ 2240 Urban ..... 1.0213 20260 Urban ..... 1.0213 

24690 ..... Scott County, Minnesota ................................................................. 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 


cchase on PROD1PC60 with PROPOSALS2
3676 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

24700 ..... Sherburne County, Minnesota ........................................................ 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24710 ..... Sibley County, Minnesota ............................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24720 ..... Stearns County, Minnesota ............................................................ 6980 Urban ..... 0.9965 41060 Urban ..... 0.9965 

24730 ..... Steele County, Minnesota ............................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24740 ..... Stevens County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24750 ..... Swift County, Minnesota ................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24760 ..... Todd County, Minnesota ................................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24770 ..... Traverse County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24780 ..... Wabasha County, Minnesota .......................................................... 24 Rural ...... 0.9132 40340 Urban ..... 1.1131 

24790 ..... Wadena County, Minnesota ........................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24800 ..... Waseca County, Minnesota ............................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24810 ..... Washington County, Minnesota ...................................................... 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24820 ..... Watonwan County, Minnesota ........................................................ 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24830 ..... Wilkin County, Minnesota ............................................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24840 ..... Winona County, Minnesota ............................................................. 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

24850 ..... Wright County, Minnesota .............................................................. 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

24860 ..... Yellow Medicine County, Minnesota ............................................... 24 Rural ...... 0.9132 99924 Rural ...... 0.9132 

25000 ..... Adams County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25010 ..... Alcorn County, Mississippi .............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25020 ..... Amite County, Mississippi ............................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25030 ..... Attala County, Mississippi ............................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25040 ..... Benton County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25050 ..... Bolivar County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25060 ..... Calhoun County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25070 ..... Carroll County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25080 ..... Chickasaw County, Mississippi ....................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25090 ..... Choctaw County, Mississippi .......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25100 ..... Claiborne County, Mississippi ......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25110 ..... Clarke County, Mississippi .............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25120 ..... Clay County, Mississippi ................................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25130 ..... Coahoma County, Mississippi ........................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25140 ..... Copiah County, Mississippi ............................................................. 25 Rural ...... 0.7634 27140 Urban ..... 0.8311 

25150 ..... Covington County, Mississippi ........................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25160 ..... Desoto County, Mississippi ............................................................. 4920 Urban ..... 0.9416 32820 Urban ..... 0.9397 

25170 ..... Forrest County, Mississippi ............................................................. 3285 Urban ..... 0.7601 25620 Urban ..... 0.7601 

25180 ..... Franklin County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25190 ..... George County, Mississippi ............................................................ 25 Rural ...... 0.7634 37700 Urban ..... 0.8156 

25200 ..... Greene County, Mississippi ............................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25210 ..... Grenada County, Mississippi .......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25220 ..... Hancock County, Mississippi .......................................................... 0920 Urban ..... 0.8706 25060 Urban ..... 0.8929 

25230 ..... Harrison County, Mississippi .......................................................... 0920 Urban ..... 0.8706 25060 Urban ..... 0.8929 

25240 ..... Hinds County, Mississippi ............................................................... 3560 Urban ..... 0.8382 27140 Urban ..... 0.8311 

25250 ..... Holmes County, Mississippi ............................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25260 ..... Humphreys County, Mississippi ...................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25270 ..... Issaquena County, Mississippi ....................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25280 ..... Itawamba County, Mississippi ........................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25290 ..... Jackson County, Mississippi ........................................................... 0920 Urban ..... 0.8706 37700 Urban ..... 0.8156 

25300 ..... Jasper County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25310 ..... Jefferson County, Mississippi ......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25320 ..... Jefferson Davis County, Mississippi ............................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25330 ..... Jones County, Mississippi .............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25340 ..... Kemper County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25350 ..... Lafayette County, Mississippi ......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25360 ..... Lamar County, Mississippi .............................................................. 3285 Urban ..... 0.7601 25620 Urban ..... 0.7601 

25370 ..... Lauderdale County, Mississippi ...................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25380 ..... Lawrence County, Mississippi ........................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25390 ..... Leake County, Mississippi .............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25400 ..... Lee County, Mississippi .................................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25410 ..... Leflore County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25420 ..... Lincoln County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25430 ..... Lowndes County, Mississippi .......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25440 ..... Madison County, Mississippi .......................................................... 3560 Urban ..... 0.8382 27140 Urban ..... 0.8311 

25450 ..... Marion County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25460 ..... Marshall County, Mississippi .......................................................... 25 Rural ...... 0.7634 32820 Urban ..... 0.9397 

25470 ..... Monroe County, Mississippi ............................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25480 ..... Montgomery County, Mississippi .................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25490 ..... Neshoba County, Mississippi .......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25500 ..... Newton County, Mississippi ............................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25510 ..... Noxubee County, Mississippi .......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25520 ..... Oktibbeha County, Mississippi ........................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25530 ..... Panola County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3677 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

25540 ..... Pearl River County, Mississippi ...................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25550 ..... Perry County, Mississippi ............................................................... 25 Rural ...... 0.7634 25620 Urban ..... 0.7601 

25560 ..... Pike County, Mississippi ................................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25570 ..... Pontotoc County, Mississippi .......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25580 ..... Prentiss County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25590 ..... Quitman County, Mississippi .......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25600 ..... Rankin County, Mississippi ............................................................. 3560 Urban ..... 0.8382 27140 Urban ..... 0.8311 

25610 ..... Scott County, Mississippi ................................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25620 ..... Sharkey County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25630 ..... Simpson County, Mississippi .......................................................... 25 Rural ...... 0.7634 27140 Urban ..... 0.8311 

25640 ..... Smith County, Mississippi ............................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25650 ..... Stone County, Mississippi ............................................................... 25 Rural ...... 0.7634 25060 Urban ..... 0.8929 

25660 ..... Sunflower County, Mississippi ........................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25670 ..... Tallahatchie County, Mississippi ..................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25680 ..... Tate County, Mississippi ................................................................. 25 Rural ...... 0.7634 32820 Urban ..... 0.9397 

25690 ..... Tippah County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25700 ..... Tishomingo County, Mississippi ..................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25710 ..... Tunica County, Mississippi ............................................................. 25 Rural ...... 0.7634 32820 Urban ..... 0.9397 

25720 ..... Union County, Mississippi ............................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25730 ..... Walthall County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25740 ..... Warren County, Mississippi ............................................................ 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25750 ..... Washington County, Mississippi ..................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25760 ..... Wayne County, Mississippi ............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25770 ..... Webster County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25780 ..... Wilkinson County, Mississippi ......................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25790 ..... Winston County, Mississippi ........................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25800 ..... Yalobusha County, Mississippi ....................................................... 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

25810 ..... Yazoo County, Mississippi .............................................................. 25 Rural ...... 0.7634 99925 Rural ...... 0.7674 

26000 ..... Adair County, Missouri .................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26010 ..... Andrew County, Missouri ................................................................ 7000 Urban ..... 0.9519 41140 Urban ..... 0.9519 

26020 ..... Atchison County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26030 ..... Audrain County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26040 ..... Barry County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26050 ..... Barton County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26060 ..... Bates County, Missouri ................................................................... 26 Rural ...... 0.7959 28140 Urban ..... 0.9476 

26070 ..... Benton County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26080 ..... Bollinger County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26090 ..... Boone County, Missouri .................................................................. 1740 Urban ..... 0.8345 17860 Urban ..... 0.8345 

26100 ..... Buchanan County, Missouri ............................................................ 7000 Urban ..... 0.9519 41140 Urban ..... 0.9519 

26110 ..... Butler County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26120 ..... Caldwell County, Missouri .............................................................. 26 Rural ...... 0.7959 28140 Urban ..... 0.9476 

26130 ..... Callaway County, Missouri ............................................................. 26 Rural ...... 0.7959 27620 Urban ..... 0.8387 

26140 ..... Camden County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26150 ..... Cape Girardeau County, Missouri .................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26160 ..... Carroll County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26170 ..... Carter County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26180 ..... Cass County, Missouri .................................................................... 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

26190 ..... Cedar County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26200 ..... Chariton County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26210 ..... Christian County, Missouri .............................................................. 7920 Urban ..... 0.8250 44180 Urban ..... 0.8237 

26220 ..... Clark County, Missouri .................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26230 ..... Clay County, Missouri ..................................................................... 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

26240 ..... Clinton County, Missouri ................................................................. 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

26250 ..... Cole County, Missouri ..................................................................... 26 Rural ...... 0.7959 27620 Urban ..... 0.8387 

26260 ..... Cooper County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26270 ..... Crawford County, Missouri ............................................................. 26 Rural ...... 0.7959 41180 Urban ..... 0.8954 

26280 ..... Dade County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26290 ..... Dallas County, Missouri .................................................................. 26 Rural ...... 0.7959 44180 Urban ..... 0.8237 

26300 ..... Daviess County, Missouri ............................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26310 ..... De Kalb County, Missouri ............................................................... 26 Rural ...... 0.7959 41140 Urban ..... 0.9519 

26320 ..... Dent County, Missouri .................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26330 ..... Douglas County, Missouri ............................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26340 ..... Dunklin County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26350 ..... Franklin County, Missouri ............................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

26360 ..... Gasconade County, Missouri .......................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26370 ..... Gentry County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26380 ..... Greene County, Missouri ................................................................ 7920 Urban ..... 0.8250 44180 Urban ..... 0.8237 

26390 ..... Grundy County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26400 ..... Harrison County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26410 ..... Henry County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26411 ..... Hickory County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 


cchase on PROD1PC60 with PROPOSALS2
3678 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

26412 ..... Holt County, Missouri ...................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26440 ..... Howard County, Missouri ................................................................ 26 Rural ...... 0.7959 17860 Urban ..... 0.8345 

26450 ..... Howell County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26460 ..... Iron County, Missouri ...................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26470 ..... Jackson County, Missouri ............................................................... 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

26480 ..... Jasper County, Missouri ................................................................. 3710 Urban ..... 0.8582 27900 Urban ..... 0.8582 

26490 ..... Jefferson County, Missouri ............................................................. 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

26500 ..... Johnson County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26510 ..... Knox County, Missouri .................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26520 ..... Laclede County, Missouri ............................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26530 ..... Lafayette County, Missouri ............................................................. 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

26540 ..... Lawrence County, Missouri ............................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26541 ..... Lewis County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26560 ..... Lincoln County, Missouri ................................................................. 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

26570 ..... Linn County, Missouri ..................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26580 ..... Livingston County, Missouri ............................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26590 ..... Mc Donald County, Missouri ........................................................... 26 Rural ...... 0.7959 22220 Urban ..... 0.8661 

26600 ..... Macon County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26601 ..... Madison County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26620 ..... Maries County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26630 ..... Marion County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26631 ..... Mercer County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26650 ..... Miller County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26660 ..... Mississippi County, Missouri ........................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26670 ..... Moniteau County, Missouri ............................................................. 26 Rural ...... 0.7959 27620 Urban ..... 0.8387 

26680 ..... Monroe County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26690 ..... Montgomery County, Missouri ........................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26700 ..... Morgan County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26710 ..... New Madrid County, Missouri ......................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26720 ..... Newton County, Missouri ................................................................ 3710 Urban ..... 0.8582 27900 Urban ..... 0.8582 

26730 ..... Nodaway County, Missouri ............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26740 ..... Oregon County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26750 ..... Osage County, Missouri ................................................................. 26 Rural ...... 0.7959 27620 Urban ..... 0.8387 

26751 ..... Ozark County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26770 ..... Pemiscot County, Missouri ............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26780 ..... Perry County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26790 ..... Pettis County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26800 ..... Phelps County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26810 ..... Pike County, Missouri ..................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26820 ..... Platte County, Missouri ................................................................... 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

26821 ..... Polk County, Missouri ..................................................................... 26 Rural ...... 0.7959 44180 Urban ..... 0.8237 

26840 ..... Pulaski County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26850 ..... Putnam County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26860 ..... Ralls County, Missouri .................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26870 ..... Randolph County, Missouri ............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26880 ..... Ray County, Missouri ...................................................................... 3760 Urban ..... 0.9490 28140 Urban ..... 0.9476 

26881 ..... Reynolds County, Missouri ............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26900 ..... Ripley County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26910 ..... St Charles County, Missouri ........................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

26911 ..... St Clair County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26930 ..... St Francois County, Missouri .......................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26940 ..... St Louis County, Missouri ............................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

26950 ..... St Louis City County, Missouri ....................................................... 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

26960 ..... Ste Genevieve County, Missouri .................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26970 ..... Saline County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26980 ..... Schuyler County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26981 ..... Scotland County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26982 ..... Scott County, Missouri .................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26983 ..... Shannon County, Missouri .............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26984 ..... Shelby County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26985 ..... Stoddard County, Missouri ............................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26986 ..... Stone County, Missouri ................................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26987 ..... Sullivan County, Missouri ............................................................... 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26988 ..... Taney County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26989 ..... Texas County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26990 ..... Vernon County, Missouri ................................................................ 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26991 ..... Warren County, Missouri ................................................................ 7040 Urban ..... 0.8962 41180 Urban ..... 0.8954 

26992 ..... Washington County, Missouri ......................................................... 26 Rural ...... 0.7959 41180 Urban ..... 0.8954 

26993 ..... Wayne County, Missouri ................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

26994 ..... Webster County, Missouri ............................................................... 7920 Urban ..... 0.8250 44180 Urban ..... 0.8237 

26995 ..... Worth County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3679 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

26996 ..... Wright County, Missouri .................................................................. 26 Rural ...... 0.7959 99926 Rural ...... 0.7900 

27000 ..... Beaverhead County, Montana ........................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27010 ..... Big Horn County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27020 ..... Blaine County, Montana ................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27030 ..... Broadwater County, Montana ......................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27040 ..... Carbon County, Montana ................................................................ 27 Rural ...... 0.8762 13740 Urban ..... 0.8834 

27050 ..... Carter County, Montana ................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27060 ..... Cascade County, Montana ............................................................. 3040 Urban ..... 0.9052 24500 Urban ..... 0.9052 

27070 ..... Chouteau County, Montana ............................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27080 ..... Custer County, Montana ................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27090 ..... Daniels County, Montana ............................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27100 ..... Dawson County, Montana .............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27110 ..... Deer Lodge County, Montana ........................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27113 ..... Yellowstone National Park, Montana .............................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27120 ..... Fallon County, Montana .................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27130 ..... Fergus County, Montana ................................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27140 ..... Flathead County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27150 ..... Gallatin County, Montana ............................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27160 ..... Garfield County, Montana ............................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27170 ..... Glacier County, Montana ................................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27180 ..... Golden Valley County, Montana ..................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27190 ..... Granite County, Montana ................................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27200 ..... Hill County, Montana ...................................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27210 ..... Jefferson County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27220 ..... Judith Basin County, Montana ........................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27230 ..... Lake County, Montana .................................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27240 ..... Lewis And Clark County, Montana ................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27250 ..... Liberty County, Montana ................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27260 ..... Lincoln County, Montana ................................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27270 ..... Mc Cone County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27280 ..... Madison County, Montana .............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27290 ..... Meagher County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27300 ..... Mineral County, Montana ................................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27310 ..... Missoula County, Montana ............................................................. 5140 Urban ..... 0.9473 33540 Urban ..... 0.9473 

27320 ..... Musselshell County, Montana ......................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27330 ..... Park County, Montana .................................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27340 ..... Petroleum County, Montana ........................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27350 ..... Phillips County, Montana ................................................................ 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27360 ..... Pondera County, Montana .............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27370 ..... Powder River County, Montana ...................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27380 ..... Powell County, Montana ................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27390 ..... Prairie County, Montana ................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27400 ..... Ravalli County, Montana ................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27410 ..... Richland County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27420 ..... Roosevelt County, Montana ........................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27430 ..... Rosebud County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27440 ..... Sanders County, Montana .............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27450 ..... Sheridan County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27460 ..... Silver Bow County, Montana .......................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27470 ..... Stillwater County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27480 ..... Sweet Grass County, Montana ....................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27490 ..... Teton County, Montana .................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27500 ..... Toole County, Montana .................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27510 ..... Treasure County, Montana ............................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27520 ..... Valley County, Montana .................................................................. 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27530 ..... Wheatland County, Montana .......................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27540 ..... Wibaux County, Montana ............................................................... 27 Rural ...... 0.8762 99927 Rural ...... 0.8762 

27550 ..... Yellowstone County, Montana ........................................................ 0880 Urban ..... 0.8834 13740 Urban ..... 0.8834 

28000 ..... Adams County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28010 ..... Antelope County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28020 ..... Arthur County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28030 ..... Banner County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28040 ..... Blaine County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28050 ..... Boone County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28060 ..... Box Butte County, Nebraska .......................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28070 ..... Boyd County, Nebraska .................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28080 ..... Brown County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28090 ..... Buffalo County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28100 ..... Burt County, Nebraska ................................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28110 ..... Butler County, Nebraska ................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28120 ..... Cass County, Nebraska .................................................................. 5920 Urban ..... 0.9560 36540 Urban ..... 0.9560 


cchase on PROD1PC60 with PROPOSALS2
3680 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

28130 ..... Cedar County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28140 ..... Chase County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28150 ..... Cherry County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28160 ..... Cheyenne County, Nebraska .......................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28170 ..... Clay County, Nebraska ................................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28180 ..... Colfax County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28190 ..... Cuming County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28200 ..... Custer County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28210 ..... Dakota County, Nebraska ............................................................... 7720 Urban ..... 0.9416 43580 Urban ..... 0.9381 

28220 ..... Dawes County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28230 ..... Dawson County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28240 ..... Deuel County, Nebraska ................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28250 ..... Dixon County, Nebraska ................................................................. 28 Rural ...... 0.8657 43580 Urban ..... 0.9381 

28260 ..... Dodge County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28270 ..... Douglas County, Nebraska ............................................................. 5920 Urban ..... 0.9560 36540 Urban ..... 0.9560 

28280 ..... Dundy County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28290 ..... Fillmore County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28300 ..... Franklin County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28310 ..... Frontier County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28320 ..... Furnas County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28330 ..... Gage County, Nebraska ................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28340 ..... Garden County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28350 ..... Garfield County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28360 ..... Gosper County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28370 ..... Grant County, Nebraska ................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28380 ..... Greeley County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28390 ..... Hall County, Nebraska .................................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28400 ..... Hamilton County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28410 ..... Harlan County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28420 ..... Hayes County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28430 ..... Hitchcock County, Nebraska .......................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28440 ..... Holt County, Nebraska .................................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28450 ..... Hooker County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28460 ..... Howard County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28470 ..... Jefferson County, Nebraska ........................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28480 ..... Johnson County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28490 ..... Kearney County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28500 ..... Keith County, Nebraska .................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28510 ..... Keya Paha County, Nebraska ........................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28520 ..... Kimball County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28530 ..... Knox County, Nebraska .................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28540 ..... Lancaster County, Nebraska .......................................................... 4360 Urban ..... 1.0214 30700 Urban ..... 1.0214 

28550 ..... Lincoln County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28560 ..... Logan County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28570 ..... Loup County, Nebraska .................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28580 ..... Mc Pherson County, Nebraska ....................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28590 ..... Madison County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28600 ..... Merrick County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28610 ..... Morrill County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28620 ..... Nance County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28630 ..... Nemaha County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28640 ..... Nuckolls County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28650 ..... Otoe County, Nebraska .................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28660 ..... Pawnee County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28670 ..... Perkins County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28680 ..... Phelps County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28690 ..... Pierce County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28700 ..... Platte County, Nebraska ................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28710 ..... Polk County, Nebraska ................................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28720 ..... Redwillow County, Nebraska .......................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28730 ..... Richardson County, Nebraska ........................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28740 ..... Rock County, Nebraska .................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28750 ..... Saline County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28760 ..... Sarpy County, Nebraska ................................................................. 5920 Urban ..... 0.9560 36540 Urban ..... 0.9560 

28770 ..... Saunders County, Nebraska ........................................................... 28 Rural ...... 0.8657 36540 Urban ..... 0.9560 

28780 ..... Scotts Bluff County, Nebraska ........................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28790 ..... Seward County, Nebraska .............................................................. 28 Rural ...... 0.8657 30700 Urban ..... 1.0214 

28800 ..... Sheridan County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28810 ..... Sherman County, Nebraska ........................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28820 ..... Sioux County, Nebraska ................................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28830 ..... Stanton County, Nebraska .............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3681 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

28840 ..... Thayer County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28850 ..... Thomas County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28860 ..... Thurston County, Nebraska ............................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28870 ..... Valley County, Nebraska ................................................................ 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28880 ..... Washington County, Nebraska ....................................................... 5920 Urban ..... 0.9560 36540 Urban ..... 0.9560 

28890 ..... Wayne County, Nebraska ............................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28900 ..... Webster County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28910 ..... Wheeler County, Nebraska ............................................................. 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

28920 ..... York County, Nebraska ................................................................... 28 Rural ...... 0.8657 99928 Rural ...... 0.8657 

29000 ..... Churchill County, Nevada ............................................................... 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29010 ..... Clark County, Nevada ..................................................................... 4120 Urban ..... 1.1155 29820 Urban ..... 1.1437 

29020 ..... Douglas County, Nevada ................................................................ 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29030 ..... Elko County, Nevada ...................................................................... 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29040 ..... Esmeralda County, Nevada ............................................................ 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29050 ..... Eureka County, Nevada .................................................................. 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29060 ..... Humboldt County, Nevada .............................................................. 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29070 ..... Lander County, Nevada .................................................................. 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29080 ..... Lincoln County, Nevada .................................................................. 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29090 ..... Lyon County, Nevada ..................................................................... 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29100 ..... Mineral County, Nevada ................................................................. 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29110 ..... Nye County, Nevada ....................................................................... 4120 Urban ..... 1.1155 99929 Rural ...... 0.9065 

29120 ..... Carson City County, Nevada .......................................................... 29 Rural ...... 0.9687 16180 Urban ..... 1.0234 

29130 ..... Pershing County, Nevada ............................................................... 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

29140 ..... Storey County, Nevada ................................................................... 29 Rural ...... 0.9687 39900 Urban ..... 1.0982 

29150 ..... Washoe County, Nevada ................................................................ 6720 Urban ..... 1.0982 39900 Urban ..... 1.0982 

29160 ..... White Pine County, Nevada ........................................................... 29 Rural ...... 0.9687 99929 Rural ...... 0.9065 

30000 ..... Belknap County, New Hampshire ................................................... 30 Rural ...... 1.0817 99930 Rural ...... 1.0817 

30010 ..... Carroll County, New Hampshire ..................................................... 30 Rural ...... 1.0817 99930 Rural ...... 1.0817 

30020 ..... Cheshire County, New Hampshire ................................................. 30 Rural ...... 1.0817 99930 Rural ...... 1.0817 

30030 ..... Coos County, New Hampshire ....................................................... 30 Rural ...... 1.0817 99930 Rural ...... 1.0817 

30040 ..... Grafton County, New Hampshire .................................................... 30 Rural ...... 1.0817 99930 Rural ...... 1.0817 

30050 ..... Hillsboro County, New Hampshire .................................................. 1123 Urban ..... 1.1178 31700 Urban ..... 1.0354 

30060 ..... Merrimack County, New Hampshire ............................................... 1123 Urban ..... 1.1178 31700 Urban ..... 1.0354 

30070 ..... Rockingham County, New Hampshire ............................................ 1123 Urban ..... 1.1178 40484 Urban ..... 1.0374 

30080 ..... Strafford County, New Hampshire .................................................. 1123 Urban ..... 1.1178 40484 Urban ..... 1.0374 

30090 ..... Sullivan County, New Hampshire ................................................... 30 Rural ...... 1.0817 99930 Rural ...... 1.0817 

31000 ..... Atlantic County, New Jersey ........................................................... 0560 Urban ..... 1.1496 12100 Urban ..... 1.1615 

31100 ..... Bergen County, New Jersey ........................................................... 0875 Urban ..... 1.1651 35644 Urban ..... 1.3188 

31150 ..... Burlington County, New Jersey ...................................................... 6160 Urban ..... 1.0922 15804 Urban ..... 1.0517 

31160 ..... Camden County, New Jersey ......................................................... 6160 Urban ..... 1.0922 15804 Urban ..... 1.0517 

31180 ..... Cape May County, New Jersey ...................................................... 0560 Urban ..... 1.1496 36140 Urban ..... 1.1011 

31190 ..... Cumberland County, New Jersey ................................................... 8760 Urban ..... 0.9827 47220 Urban ..... 0.9827 

31200 ..... Essex County, New Jersey ............................................................. 5640 Urban ..... 1.1834 35084 Urban ..... 1.1883 

31220 ..... Gloucester County, New Jersey ..................................................... 6160 Urban ..... 1.0922 15804 Urban ..... 1.0517 

31230 ..... Hudson County, New Jersey .......................................................... 3640 Urban ..... 1.1338 35644 Urban ..... 1.3188 

31250 ..... Hunterdon County, New Jersey ...................................................... 5015 Urban ..... 1.1167 35084 Urban ..... 1.1883 

31260 ..... Mercer County, New Jersey ........................................................... 8480 Urban ..... 1.0834 45940 Urban ..... 1.0834 

31270 ..... Middlesex County, New Jersey ...................................................... 5015 Urban ..... 1.1167 20764 Urban ..... 1.1249 

31290 ..... Monmouth County, New Jersey ..................................................... 5190 Urban ..... 1.1260 20764 Urban ..... 1.1249 

31300 ..... Morris County, New Jersey ............................................................ 5640 Urban ..... 1.1834 35084 Urban ..... 1.1883 

31310 ..... Ocean County, New Jersey ............................................................ 5190 Urban ..... 1.1260 20764 Urban ..... 1.1249 

31320 ..... Passaic County, New Jersey .......................................................... 0875 Urban ..... 1.1651 35644 Urban ..... 1.3188 

31340 ..... Salem County, New Jersey ............................................................ 6160 Urban ..... 1.0922 48864 Urban ..... 1.0471 

31350 ..... Somerset County, New Jersey ....................................................... 5015 Urban ..... 1.1167 20764 Urban ..... 1.1249 

31360 ..... Sussex County, New Jersey ........................................................... 5640 Urban ..... 1.1834 35084 Urban ..... 1.1883 

31370 ..... Union County, New Jersey ............................................................. 5640 Urban ..... 1.1834 35084 Urban ..... 1.1883 

31390 ..... Warren County, New Jersey ........................................................... 5640 Urban ..... 1.1834 10900 Urban ..... 0.9818 

32000 ..... Bernalillo County, New Mexico ....................................................... 0200 Urban ..... 0.9684 10740 Urban ..... 0.9684 

32010 ..... Catron County, New Mexico ........................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32020 ..... Chaves County, New Mexico ......................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32025 ..... Cibola County, New Mexico ........................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32030 ..... Colfax County, New Mexico ........................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32040 ..... Curry County, New Mexico ............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32050 ..... De Baca County, New Mexico ........................................................ 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32060 ..... Dona Ana County, New Mexico ..................................................... 4100 Urban ..... 0.8467 29740 Urban ..... 0.8467 

32070 ..... Eddy County, New Mexico ............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32080 ..... Grant County, New Mexico ............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32090 ..... Guadalupe County, New Mexico .................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32100 ..... Harding County, New Mexico ......................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32110 ..... Hidalgo County, New Mexico ......................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32120 ..... Lea County, New Mexico ................................................................ 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 


cchase on PROD1PC60 with PROPOSALS2
3682 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

32130 ..... Lincoln County, New Mexico .......................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32131 ..... Los Alamos County, New Mexico ................................................... 7490 Urban ..... 1.0748 99932 Rural ...... 0.8635 

32140 ..... Luna County, New Mexico .............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32150 ..... Mc Kinley County, New Mexico ...................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32160 ..... Mora County, New Mexico ............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32170 ..... Otero County, New Mexico ............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32180 ..... Quay County, New Mexico ............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32190 ..... Rio Arriba County, New Mexico ..................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32200 ..... Roosevelt County, New Mexico ...................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32210 ..... Sandoval County, New Mexico ....................................................... 0200 Urban ..... 0.9684 10740 Urban ..... 0.9684 

32220 ..... San Juan County, New Mexico ...................................................... 32 Rural ...... 0.8563 22140 Urban ..... 0.8509 

32230 ..... San Miguel County, New Mexico ................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32240 ..... Santa Fe County, New Mexico ....................................................... 7490 Urban ..... 1.0748 42140 Urban ..... 1.0920 

32250 ..... Sierra County, New Mexico ............................................................ 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32260 ..... Socorro County, New Mexico ......................................................... 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32270 ..... Taos County, New Mexico .............................................................. 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32280 ..... Torrance County, New Mexico ....................................................... 32 Rural ...... 0.8563 10740 Urban ..... 0.9684 

32290 ..... Union County, New Mexico ............................................................ 32 Rural ...... 0.8563 99932 Rural ...... 0.8635 

32300 ..... Valencia County, New Mexico ........................................................ 0200 Urban ..... 0.9684 10740 Urban ..... 0.9684 

33000 ..... Albany County, New York ............................................................... 0160 Urban ..... 0.8559 10580 Urban ..... 0.8589 

33010 ..... Allegany County, New York ............................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33020 ..... Bronx County, New York ................................................................ 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33030 ..... Broome County, New York ............................................................. 0960 Urban ..... 0.8562 13780 Urban ..... 0.8562 

33040 ..... Cattaraugus County, New York ...................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33050 ..... Cayuga County, New York ............................................................. 8160 Urban ..... 0.9492 99933 Rural ...... 0.8154 

33060 ..... Chautauqua County, New York ...................................................... 3610 Urban ..... 0.7544 99933 Rural ...... 0.8154 

33070 ..... Chemung County, New York .......................................................... 2335 Urban ..... 0.8250 21300 Urban ..... 0.8250 

33080 ..... Chenango County, New York ......................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33090 ..... Clinton County, New York .............................................................. 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33200 ..... Columbia County, New York .......................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33210 ..... Cortland County, New York ............................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33220 ..... Delaware County, New York .......................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33230 ..... Dutchess County, New York ........................................................... 2281 Urban ..... 1.0475 39100 Urban ..... 1.0891 

33240 ..... Erie County, New York ................................................................... 1280 Urban ..... 0.9511 15380 Urban ..... 0.9511 

33260 ..... Essex County, New York ................................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33270 ..... Franklin County, New York ............................................................. 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33280 ..... Fulton County, New York ................................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33290 ..... Genesee County, New York ........................................................... 6840 Urban ..... 0.9049 99933 Rural ...... 0.8154 

33300 ..... Greene County, New York .............................................................. 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33310 ..... Hamilton County, New York ........................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33320 ..... Herkimer County, New York ........................................................... 8680 Urban ..... 0.8358 46540 Urban ..... 0.8358 

33330 ..... Jefferson County, New York ........................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33331 ..... Kings County, New York ................................................................. 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33340 ..... Lewis County, New York ................................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33350 ..... Livingston County, New York ......................................................... 6840 Urban ..... 0.9049 40380 Urban ..... 0.9121 

33360 ..... Madison County, New York ............................................................ 8160 Urban ..... 0.9492 45060 Urban ..... 0.9574 

33370 ..... Monroe County, New York ............................................................. 6840 Urban ..... 0.9049 40380 Urban ..... 0.9121 

33380 ..... Montgomery County, New York ...................................................... 0160 Urban ..... 0.8559 99933 Rural ...... 0.8154 

33400 ..... Nassau County, New York ............................................................. 5380 Urban ..... 1.2719 35004 Urban ..... 1.2719 

33420 ..... New York County, New York .......................................................... 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33500 ..... Niagara County, New York ............................................................. 1280 Urban ..... 0.9511 15380 Urban ..... 0.9511 

33510 ..... Oneida County, New York .............................................................. 8680 Urban ..... 0.8358 46540 Urban ..... 0.8358 

33520 ..... Onondaga County, New York ......................................................... 8160 Urban ..... 0.9492 45060 Urban ..... 0.9574 

33530 ..... Ontario County, New York .............................................................. 6840 Urban ..... 0.9049 40380 Urban ..... 0.9121 

33540 ..... Orange County, New York .............................................................. 5660 Urban ..... 1.1207 39100 Urban ..... 1.0891 

33550 ..... Orleans County, New York ............................................................. 6840 Urban ..... 0.9049 40380 Urban ..... 0.9121 

33560 ..... Oswego County, New York ............................................................ 8160 Urban ..... 0.9492 45060 Urban ..... 0.9574 

33570 ..... Otsego County, New York .............................................................. 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33580 ..... Putnam County, New York ............................................................. 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33590 ..... Queens County, New York ............................................................. 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33600 ..... Rensselaer County, New York ....................................................... 0160 Urban ..... 0.8559 10580 Urban ..... 0.8589 

33610 ..... Richmond County, New York ......................................................... 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33620 ..... Rockland County, New York ........................................................... 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33630 ..... St Lawrence County, New York ..................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33640 ..... Saratoga County, New York ........................................................... 0160 Urban ..... 0.8559 10580 Urban ..... 0.8589 

33650 ..... Schenectady County, New York ..................................................... 0160 Urban ..... 0.8559 10580 Urban ..... 0.8589 

33660 ..... Schoharie County, New York ......................................................... 0160 Urban ..... 0.8559 10580 Urban ..... 0.8589 

33670 ..... Schuyler County, New York ............................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33680 ..... Seneca County, New York ............................................................. 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33690 ..... Steuben County, New York ............................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33700 ..... Suffolk County, New York ............................................................... 5380 Urban ..... 1.2719 35004 Urban ..... 1.2719 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3683 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

33710 ..... Sullivan County, New York ............................................................. 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33720 ..... Tioga County, New York ................................................................. 0960 Urban ..... 0.8562 13780 Urban ..... 0.8562 

33730 ..... Tompkins County, New York .......................................................... 33 Rural ...... 0.8395 27060 Urban ..... 0.9793 

33740 ..... Ulster County, New York ................................................................ 33 Rural ...... 0.8395 28740 Urban ..... 0.9255 

33750 ..... Warren County, New York .............................................................. 2975 Urban ..... 0.8559 24020 Urban ..... 0.8559 

33760 ..... Washington County, New York ....................................................... 2975 Urban ..... 0.8559 24020 Urban ..... 0.8559 

33770 ..... Wayne County, New York .............................................................. 6840 Urban ..... 0.9049 40380 Urban ..... 0.9121 

33800 ..... Westchester County, New York ...................................................... 5600 Urban ..... 1.3464 35644 Urban ..... 1.3188 

33900 ..... Wyoming County, New York ........................................................... 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

33910 ..... Yates County, New York ................................................................ 33 Rural ...... 0.8395 99933 Rural ...... 0.8154 

34000 ..... Alamance County, N Carolina ........................................................ 3120 Urban ..... 0.9018 15500 Urban ..... 0.8905 

34010 ..... Alexander County, N Carolina ........................................................ 3290 Urban ..... 0.8921 25860 Urban ..... 0.8921 

34020 ..... Alleghany County, N Carolina ........................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34030 ..... Anson County, N Carolina .............................................................. 34 Rural ...... 0.8462 16740 Urban ..... 0.9750 

34040 ..... Ashe County, N Carolina ................................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34050 ..... Avery County, N Carolina ............................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34060 ..... Beaufort County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34070 ..... Bertie County, N Carolina ............................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34080 ..... Bladen County, N Carolina ............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34090 ..... Brunswick County, N Carolina ........................................................ 9200 Urban ..... 0.9582 48900 Urban ..... 0.9582 

34100 ..... Buncombe County, N Carolina ....................................................... 0480 Urban ..... 0.9737 11700 Urban ..... 0.9285 

34110 ..... Burke County, N Carolina ............................................................... 3290 Urban ..... 0.8921 25860 Urban ..... 0.8921 

34120 ..... Cabarrus County, N Carolina ......................................................... 1520 Urban ..... 0.9715 16740 Urban ..... 0.9750 

34130 ..... Caldwell County, N Carolina ........................................................... 3290 Urban ..... 0.8921 25860 Urban ..... 0.8921 

34140 ..... Camden County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34150 ..... Carteret County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34160 ..... Caswell County, N Carolina ............................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34170 ..... Catawba County, N Carolina .......................................................... 3290 Urban ..... 0.8921 25860 Urban ..... 0.8921 

34180 ..... Chatham County, N Carolina .......................................................... 6640 Urban ..... 1.0034 20500 Urban ..... 1.0244 

34190 ..... Cherokee County, N Carolina ......................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34200 ..... Chowan County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34210 ..... Clay County, N Carolina ................................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34220 ..... Cleveland County, N Carolina ........................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34230 ..... Columbus County, N Carolina ........................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34240 ..... Craven County, N Carolina ............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34250 ..... Cumberland County, N Carolina ..................................................... 2560 Urban ..... 0.9416 22180 Urban ..... 0.9416 

34251 ..... Currituck County, N Carolina .......................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

34270 ..... Dare County, N Carolina ................................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34280 ..... Davidson County, N Carolina ......................................................... 3120 Urban ..... 0.9018 99934 Rural ...... 0.8540 

34290 ..... Davie County, N Carolina ............................................................... 3120 Urban ..... 0.9018 49180 Urban ..... 0.8944 

34300 ..... Duplin County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34310 ..... Durham County, N Carolina ........................................................... 6640 Urban ..... 1.0034 20500 Urban ..... 1.0244 

34320 ..... Edgecombe County, N Carolina ..................................................... 6895 Urban ..... 0.8915 40580 Urban ..... 0.8915 

34330 ..... Forsyth County, N Carolina ............................................................ 3120 Urban ..... 0.9018 49180 Urban ..... 0.8944 

34340 ..... Franklin County, N Carolina ........................................................... 6640 Urban ..... 1.0034 39580 Urban ..... 0.9691 

34350 ..... Gaston County, N Carolina ............................................................. 1520 Urban ..... 0.9715 16740 Urban ..... 0.9750 

34360 ..... Gates County, N Carolina ............................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34370 ..... Graham County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34380 ..... Granville County, N Carolina .......................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34390 ..... Greene County, N Carolina ............................................................ 34 Rural ...... 0.8462 24780 Urban ..... 0.9425 

34400 ..... Guilford County, N Carolina ............................................................ 3120 Urban ..... 0.9018 24660 Urban ..... 0.9104 

34410 ..... Halifax County, N Carolina ............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34420 ..... Harnett County, N Carolina ............................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34430 ..... Haywood County, N Carolina ......................................................... 34 Rural ...... 0.8462 11700 Urban ..... 0.9285 

34440 ..... Henderson County, N Carolina ....................................................... 34 Rural ...... 0.8462 11700 Urban ..... 0.9285 

34450 ..... Hertford County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34460 ..... Hoke County, N Carolina ................................................................ 34 Rural ...... 0.8462 22180 Urban ..... 0.9416 

34470 ..... Hyde County, N Carolina ................................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34480 ..... Iredell County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34490 ..... Jackson County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34500 ..... Johnston County, N Carolina .......................................................... 6640 Urban ..... 1.0034 39580 Urban ..... 0.9691 

34510 ..... Jones County, N Carolina ............................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34520 ..... Lee County, N Carolina .................................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34530 ..... Lenoir County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34540 ..... Lincoln County, N Carolina ............................................................. 1520 Urban ..... 0.9715 99934 Rural ...... 0.8540 

34550 ..... Mc Dowell County, N Carolina ....................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34560 ..... Macon County, N Carolina ............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34570 ..... Madison County, N Carolina ........................................................... 0480 Urban ..... 0.9737 11700 Urban ..... 0.9285 

34580 ..... Martin County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34590 ..... Mecklenburg County, N Carolina .................................................... 1520 Urban ..... 0.9715 16740 Urban ..... 0.9750 

34600 ..... Mitchell County, N Carolina ............................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 


cchase on PROD1PC60 with PROPOSALS2
3684 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

34610 ..... Montgomery County, N Carolina .................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34620 ..... Moore County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34630 ..... Nash County, N Carolina ................................................................ 6895 Urban ..... 0.8915 40580 Urban ..... 0.8915 

34640 ..... New Hanover County, N Carolina .................................................. 9200 Urban ..... 0.9582 48900 Urban ..... 0.9582 

34650 ..... Northampton County, N Carolina ................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34660 ..... Onslow County, N Carolina ............................................................ 3605 Urban ..... 0.8236 27340 Urban ..... 0.8236 

34670 ..... Orange County, N Carolina ............................................................ 6640 Urban ..... 1.0034 20500 Urban ..... 1.0244 

34680 ..... Pamlico County, N Carolina ........................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34690 ..... Pasquotank County, N Carolina ..................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34700 ..... Pender County, N Carolina ............................................................. 34 Rural ...... 0.8462 48900 Urban ..... 0.9582 

34710 ..... Perquimans County, N Carolina ..................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34720 ..... Person County, N Carolina ............................................................. 34 Rural ...... 0.8462 20500 Urban ..... 1.0244 

34730 ..... Pitt County, N Carolina ................................................................... 3150 Urban ..... 0.9425 24780 Urban ..... 0.9425 

34740 ..... Polk County, N Carolina ................................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34750 ..... Randolph County, N Carolina ......................................................... 3120 Urban ..... 0.9018 24660 Urban ..... 0.9104 

34760 ..... Richmond County, N Carolina ........................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34770 ..... Robeson County, N Carolina .......................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34780 ..... Rockingham County, N Carolina .................................................... 34 Rural ...... 0.8462 24660 Urban ..... 0.9104 

34790 ..... Rowan County, N Carolina ............................................................. 1520 Urban ..... 0.9715 99934 Rural ...... 0.8540 

34800 ..... Rutherford County, N Carolina ....................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34810 ..... Sampson County, N Carolina ......................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34820 ..... Scotland County, N Carolina .......................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34830 ..... Stanly County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34840 ..... Stokes County, N Carolina ............................................................. 3120 Urban ..... 0.9018 49180 Urban ..... 0.8944 

34850 ..... Surry County, N Carolina ................................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34860 ..... Swain County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34870 ..... Transylvania County, N Carolina .................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34880 ..... Tyrrell County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34890 ..... Union County, N Carolina ............................................................... 1520 Urban ..... 0.9715 16740 Urban ..... 0.9750 

34900 ..... Vance County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34910 ..... Wake County, N Carolina ............................................................... 6640 Urban ..... 1.0034 39580 Urban ..... 0.9691 

34920 ..... Warren County, N Carolina ............................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34930 ..... Washington County, N Carolina ..................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34940 ..... Watauga County, N Carolina .......................................................... 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34950 ..... Wayne County, N Carolina ............................................................. 2980 Urban ..... 0.8775 24140 Urban ..... 0.8775 

34960 ..... Wilkes County, N Carolina .............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34970 ..... Wilson County, N Carolina ............................................................. 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

34980 ..... Yadkin County, N Carolina ............................................................. 3120 Urban ..... 0.9018 49180 Urban ..... 0.8944 

34981 ..... Yancey County, N Carolina ............................................................ 34 Rural ...... 0.8462 99934 Rural ...... 0.8540 

35000 ..... Adams County, N Dakota ............................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35010 ..... Barnes County, N Dakota ............................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35020 ..... Benson County, N Dakota .............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35030 ..... Billings County, N Dakota ............................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35040 ..... Bottineau County, N Dakota ........................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35050 ..... Bowman County, N Dakota ............................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35060 ..... Burke County, N Dakota ................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35070 ..... Burleigh County, N Dakota ............................................................. 1010 Urban ..... 0.7574 13900 Urban ..... 0.7574 

35080 ..... Cass County, N Dakota .................................................................. 2520 Urban ..... 0.8486 22020 Urban ..... 0.8486 

35090 ..... Cavalier County, N Dakota ............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35100 ..... Dickey County, N Dakota ............................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35110 ..... Divide County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35120 ..... Dunn County, N Dakota .................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35130 ..... Eddy County, N Dakota .................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35140 ..... Emmons County, N Dakota ............................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35150 ..... Foster County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35160 ..... Golden Valley County, N Dakota .................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35170 ..... Grand Forks County, N Dakota ...................................................... 2985 Urban ..... 0.7901 24220 Urban ..... 0.7901 

35180 ..... Grant County, N Dakota ................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35190 ..... Griggs County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35200 ..... Hettinger County, N Dakota ............................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35210 ..... Kidder County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35220 ..... La Moure County, N Dakota ........................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35230 ..... Logan County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35240 ..... Mc Henry County, N Dakota ........................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35250 ..... Mc Intosh County, N Dakota .......................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35260 ..... Mc Kenzie County, N Dakota ......................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35270 ..... Mc Lean County, N Dakota ............................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35280 ..... Mercer County, N Dakota ............................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35290 ..... Morton County, N Dakota ............................................................... 1010 Urban ..... 0.7574 13900 Urban ..... 0.7574 

35300 ..... Mountrail County, N Dakota ........................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35310 ..... Nelson County, N Dakota ............................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3685 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

35320 ..... Oliver County, N Dakota ................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35330 ..... Pembina County, N Dakota ............................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35340 ..... Pierce County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35350 ..... Ramsey County, N Dakota ............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35360 ..... Ransom County, N Dakota ............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35370 ..... Renville County, N Dakota ............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35380 ..... Richland County, N Dakota ............................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35390 ..... Rolette County, N Dakota ............................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35400 ..... Sargent County, N Dakota .............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35410 ..... Sheridan County, N Dakota ............................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35420 ..... Sioux County, N Dakota ................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35430 ..... Slope County, N Dakota ................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35440 ..... Stark County, N Dakota .................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35450 ..... Steele County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35460 ..... Stutsman County, N Dakota ........................................................... 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35470 ..... Towner County, N Dakota .............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35480 ..... Traill County, N Dakota .................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35490 ..... Walsh County, N Dakota ................................................................ 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35500 ..... Ward County, N Dakota .................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35510 ..... Wells County, N Dakota ................................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

35520 ..... Williams County, N Dakota ............................................................. 35 Rural ...... 0.7261 99935 Rural ...... 0.7261 

36000 ..... Adams County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36010 ..... Allen County, Ohio .......................................................................... 4320 Urban ..... 0.9119 30620 Urban ..... 0.9225 

36020 ..... Ashland County, Ohio ..................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36030 ..... Ashtabula County, Ohio .................................................................. 1680 Urban ..... 0.9183 99936 Rural ...... 0.8826 

36040 ..... Athens County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36050 ..... Auglaize County, Ohio .................................................................... 4320 Urban ..... 0.9119 99936 Rural ...... 0.8826 

36060 ..... Belmont County, Ohio ..................................................................... 9000 Urban ..... 0.7161 48540 Urban ..... 0.7161 

36070 ..... Brown County, Ohio ........................................................................ 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

36080 ..... Butler County, Ohio ........................................................................ 3200 Urban ..... 0.8951 17140 Urban ..... 0.9615 

36090 ..... Carroll County, Ohio ....................................................................... 1320 Urban ..... 0.8935 15940 Urban ..... 0.8935 

36100 ..... Champaign County, Ohio ............................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36110 ..... Clark County, Ohio ......................................................................... 2000 Urban ..... 0.8980 44220 Urban ..... 0.8396 

36120 ..... Clermont County, Ohio ................................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

36130 ..... Clinton County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36140 ..... Columbiana County, Ohio ............................................................... 9320 Urban ..... 0.8848 99936 Rural ...... 0.8826 

36150 ..... Coshocton County, Ohio ................................................................. 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36160 ..... Crawford County, Ohio ................................................................... 4800 Urban ..... 0.9891 99936 Rural ...... 0.8826 

36170 ..... Cuyahoga County, Ohio ................................................................. 1680 Urban ..... 0.9183 17460 Urban ..... 0.9213 

36190 ..... Darke County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36200 ..... Defiance County, Ohio .................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36210 ..... Delaware County, Ohio ................................................................... 1840 Urban ..... 0.9874 18140 Urban ..... 0.9860 

36220 ..... Erie County, Ohio ........................................................................... 36 Rural ...... 0.8921 41780 Urban ..... 0.9019 

36230 ..... Fairfield County, Ohio ..................................................................... 1840 Urban ..... 0.9874 18140 Urban ..... 0.9860 

36240 ..... Fayette County, Ohio ...................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36250 ..... Franklin County, Ohio ..................................................................... 1840 Urban ..... 0.9874 18140 Urban ..... 0.9860 

36260 ..... Fulton County, Ohio ........................................................................ 8400 Urban ..... 0.9574 45780 Urban ..... 0.9574 

36270 ..... Gallia County, Ohio ......................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36280 ..... Geauga County, Ohio ..................................................................... 1680 Urban ..... 0.9183 17460 Urban ..... 0.9213 

36290 ..... Greene County, Ohio ...................................................................... 2000 Urban ..... 0.8980 19380 Urban ..... 0.9064 

36300 ..... Guernsey County, Ohio .................................................................. 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36310 ..... Hamilton County, Ohio .................................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

36330 ..... Hancock County, Ohio .................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36340 ..... Hardin County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36350 ..... Harrison County, Ohio .................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36360 ..... Henry County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36370 ..... Highland County, Ohio .................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36380 ..... Hocking County, Ohio ..................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36390 ..... Holmes County, Ohio ...................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36400 ..... Huron County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36410 ..... Jackson County, Ohio ..................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36420 ..... Jefferson County, Ohio ................................................................... 8080 Urban ..... 0.7819 48260 Urban ..... 0.7819 

36430 ..... Knox County, Ohio .......................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36440 ..... Lake County, Ohio .......................................................................... 1680 Urban ..... 0.9183 17460 Urban ..... 0.9213 

36450 ..... Lawrence County, Ohio .................................................................. 3400 Urban ..... 0.9477 26580 Urban ..... 0.9477 

36460 ..... Licking County, Ohio ....................................................................... 1840 Urban ..... 0.9874 18140 Urban ..... 0.9860 

36470 ..... Logan County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36480 ..... Lorain County, Ohio ........................................................................ 1680 Urban ..... 0.9183 17460 Urban ..... 0.9213 

36490 ..... Lucas County, Ohio ........................................................................ 8400 Urban ..... 0.9574 45780 Urban ..... 0.9574 

36500 ..... Madison County, Ohio .................................................................... 1840 Urban ..... 0.9874 18140 Urban ..... 0.9860 

36510 ..... Mahoning County, Ohio .................................................................. 9320 Urban ..... 0.8848 49660 Urban ..... 0.8603 


cchase on PROD1PC60 with PROPOSALS2
3686 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

36520 ..... Marion County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36530 ..... Medina County, Ohio ...................................................................... 1680 Urban ..... 0.9183 17460 Urban ..... 0.9213 

36540 ..... Meigs County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36550 ..... Mercer County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36560 ..... Miami County, Ohio ........................................................................ 2000 Urban ..... 0.8980 19380 Urban ..... 0.9064 

36570 ..... Monroe County, Ohio ...................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36580 ..... Montgomery County, Ohio .............................................................. 2000 Urban ..... 0.8980 19380 Urban ..... 0.9064 

36590 ..... Morgan County, Ohio ...................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36600 ..... Morrow County, Ohio ...................................................................... 36 Rural ...... 0.8921 18140 Urban ..... 0.9860 

36610 ..... Muskingum County, Ohio ............................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36620 ..... Noble County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36630 ..... Ottawa County, Ohio ...................................................................... 36 Rural ...... 0.8921 45780 Urban ..... 0.9574 

36640 ..... Paulding County, Ohio .................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36650 ..... Perry County, Ohio ......................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36660 ..... Pickaway County, Ohio ................................................................... 1840 Urban ..... 0.9874 18140 Urban ..... 0.9860 

36670 ..... Pike County, Ohio ........................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36680 ..... Portage County, Ohio ..................................................................... 0080 Urban ..... 0.8982 10420 Urban ..... 0.8982 

36690 ..... Preble County, Ohio ....................................................................... 36 Rural ...... 0.8921 19380 Urban ..... 0.9064 

36700 ..... Putnam County, Ohio ..................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36710 ..... Richland County, Ohio .................................................................... 4800 Urban ..... 0.9891 31900 Urban ..... 0.9891 

36720 ..... Ross County, Ohio .......................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36730 ..... Sandusky County, Ohio .................................................................. 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36740 ..... Scioto County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36750 ..... Seneca County, Ohio ...................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36760 ..... Shelby County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36770 ..... Stark County, Ohio ......................................................................... 1320 Urban ..... 0.8935 15940 Urban ..... 0.8935 

36780 ..... Summit County, Ohio ...................................................................... 0080 Urban ..... 0.8982 10420 Urban ..... 0.8982 

36790 ..... Trumbull County, Ohio .................................................................... 9320 Urban ..... 0.8848 49660 Urban ..... 0.8603 

36800 ..... Tuscarawas County, Ohio .............................................................. 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36810 ..... Union County, Ohio ........................................................................ 36 Rural ...... 0.8921 18140 Urban ..... 0.9860 

36820 ..... Van Wert County, Ohio ................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36830 ..... Vinton County, Ohio ........................................................................ 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36840 ..... Warren County, Ohio ...................................................................... 1640 Urban ..... 0.9734 17140 Urban ..... 0.9615 

36850 ..... Washington County, Ohio ............................................................... 6020 Urban ..... 0.8270 37620 Urban ..... 0.8270 

36860 ..... Wayne County, Ohio ....................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36870 ..... Williams County, Ohio .................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

36880 ..... Wood County, Ohio ........................................................................ 8400 Urban ..... 0.9574 45780 Urban ..... 0.9574 

36890 ..... Wyandot County, Ohio .................................................................... 36 Rural ...... 0.8921 99936 Rural ...... 0.8826 

37000 ..... Adair County, Oklahoma ................................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37010 ..... Alfalfa County, Oklahoma ............................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37020 ..... Atoka County, Oklahoma ................................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37030 ..... Beaver County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37040 ..... Beckham County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37050 ..... Blaine County, Oklahoma ............................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37060 ..... Bryan County, Oklahoma ................................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37070 ..... Caddo County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37080 ..... Canadian County, Oklahoma .......................................................... 5880 Urban ..... 0.9025 36420 Urban ..... 0.9031 

37090 ..... Carter County, Oklahoma ............................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37100 ..... Cherokee County, Oklahoma ......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37110 ..... Choctaw County, Oklahoma ........................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37120 ..... Cimarron County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37130 ..... Cleveland County, Oklahoma ......................................................... 5880 Urban ..... 0.9025 36420 Urban ..... 0.9031 

37140 ..... Coal County, Oklahoma .................................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37150 ..... Comanche County, Oklahoma ........................................................ 4200 Urban ..... 0.7872 30020 Urban ..... 0.7872 

37160 ..... Cotton County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37170 ..... Craig County, Oklahoma ................................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37180 ..... Creek County, Oklahoma ............................................................... 8560 Urban ..... 0.8587 46140 Urban ..... 0.8543 

37190 ..... Custer County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37200 ..... Delaware County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37210 ..... Dewey County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37220 ..... Ellis County, Oklahoma .................................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37230 ..... Garfield County, Oklahoma ............................................................ 2340 Urban ..... 0.8666 99937 Rural ...... 0.7581 

37240 ..... Garvin County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37250 ..... Grady County, Oklahoma ............................................................... 37 Rural ...... 0.7442 36420 Urban ..... 0.9031 

37260 ..... Grant County, Oklahoma ................................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37270 ..... Greer County, Oklahoma ................................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37280 ..... Harmon County, Oklahoma ............................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37290 ..... Harper County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37300 ..... Haskell County, Oklahoma ............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37310 ..... Hughes County, Oklahoma ............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37320 ..... Jackson County, Oklahoma ............................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3687 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

37330 ..... Jefferson County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37340 ..... Johnston County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37350 ..... Kay County, Oklahoma ................................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37360 ..... Kingfisher County, Oklahoma ......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37370 ..... Kiowa County, Oklahoma ............................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37380 ..... Latimer County, Oklahoma ............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37390 ..... Le Flore County, Oklahoma ............................................................ 37 Rural ...... 0.7442 22900 Urban ..... 0.8230 

37400 ..... Lincoln County, Oklahoma .............................................................. 37 Rural ...... 0.7442 36420 Urban ..... 0.9031 

37410 ..... Logan County, Oklahoma ............................................................... 5880 Urban ..... 0.9025 36420 Urban ..... 0.9031 

37420 ..... Love County, Oklahoma ................................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37430 ..... Mc Clain County, Oklahoma ........................................................... 5880 Urban ..... 0.9025 36420 Urban ..... 0.9031 

37440 ..... Mc Curtain County, Oklahoma ....................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37450 ..... Mc Intosh County, Oklahoma ......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37460 ..... Major County, Oklahoma ................................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37470 ..... Marshall County, Oklahoma ........................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37480 ..... Mayes County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37490 ..... Murray County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37500 ..... Muskogee County, Oklahoma ........................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37510 ..... Noble County, Oklahoma ................................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37520 ..... Nowata County, Oklahoma ............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37530 ..... Okfuskee County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37540 ..... Oklahoma County, Oklahoma ......................................................... 5880 Urban ..... 0.9025 36420 Urban ..... 0.9031 

37550 ..... Okmulgee County, Oklahoma ......................................................... 37 Rural ...... 0.7442 46140 Urban ..... 0.8543 

37560 ..... Osage County, Oklahoma .............................................................. 8560 Urban ..... 0.8587 46140 Urban ..... 0.8543 

37570 ..... Ottawa County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37580 ..... Pawnee County, Oklahoma ............................................................ 37 Rural ...... 0.7442 46140 Urban ..... 0.8543 

37590 ..... Payne County, Oklahoma ............................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37600 ..... Pittsburg County, Oklahoma ........................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37610 ..... Pontotoc County, Oklahoma ........................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37620 ..... Pottawatomie County, Oklahoma ................................................... 5880 Urban ..... 0.9025 99937 Rural ...... 0.7581 

37630 ..... Pushmataha County, Oklahoma ..................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37640 ..... Roger Mills County, Oklahoma ....................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37650 ..... Rogers County, Oklahoma ............................................................. 8560 Urban ..... 0.8587 46140 Urban ..... 0.8543 

37660 ..... Seminole County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37670 ..... Sequoyah County, Oklahoma ......................................................... 2720 Urban ..... 0.8246 22900 Urban ..... 0.8230 

37680 ..... Stephens County, Oklahoma .......................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37690 ..... Texas County, Oklahoma ............................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37700 ..... Tillman County, Oklahoma ............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37710 ..... Tulsa County, Oklahoma ................................................................ 8560 Urban ..... 0.8587 46140 Urban ..... 0.8543 

37720 ..... Wagoner County, Oklahoma .......................................................... 8560 Urban ..... 0.8587 46140 Urban ..... 0.8543 

37730 ..... Washington County, Oklahoma ...................................................... 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37740 ..... Washita County, Oklahoma ............................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37750 ..... Woods County, Oklahoma .............................................................. 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

37760 ..... Woodward County, Oklahoma ........................................................ 37 Rural ...... 0.7442 99937 Rural ...... 0.7581 

38000 ..... Baker County, Oregon .................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38010 ..... Benton County, Oregon .................................................................. 1890 Urban ..... 1.0729 18700 Urban ..... 1.0729 

38020 ..... Clackamas County, Oregon ............................................................ 6440 Urban ..... 1.1266 38900 Urban ..... 1.1266 

38030 ..... Clatsop County, Oregon ................................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38040 ..... Columbia County, Oregon .............................................................. 6440 Urban ..... 1.1266 38900 Urban ..... 1.1266 

38050 ..... Coos County, Oregon ..................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38060 ..... Crook County, Oregon .................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38070 ..... Curry County, Oregon ..................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38080 ..... Deschutes County, Oregon ............................................................ 38 Rural ...... 1.0052 13460 Urban ..... 1.0786 

38090 ..... Douglas County, Oregon ................................................................ 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38100 ..... Gilliam County, Oregon .................................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38110 ..... Grant County, Oregon .................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38120 ..... Harney County, Oregon .................................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38130 ..... Hood River County, Oregon ........................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38140 ..... Jackson County, Oregon ................................................................ 4890 Urban ..... 1.0225 32780 Urban ..... 1.0225 

38150 ..... Jefferson County, Oregon ............................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38160 ..... Josephine County, Oregon ............................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38170 ..... Klamath County, Oregon ................................................................ 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38180 ..... Lake County, Oregon ...................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38190 ..... Lane County, Oregon ..................................................................... 2400 Urban ..... 1.0818 21660 Urban ..... 1.0818 

38200 ..... Lincoln County, Oregon .................................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38210 ..... Linn County, Oregon ....................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38220 ..... Malheur County, Oregon ................................................................ 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38230 ..... Marion County, Oregon .................................................................. 7080 Urban ..... 1.0442 41420 Urban ..... 1.0442 

38240 ..... Morrow County, Oregon ................................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38250 ..... Multnomah County, Oregon ............................................................ 6440 Urban ..... 1.1266 38900 Urban ..... 1.1266 

38260 ..... Polk County, Oregon ...................................................................... 7080 Urban ..... 1.0442 41420 Urban ..... 1.0442 


cchase on PROD1PC60 with PROPOSALS2
3688 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

38270 ..... Sherman County, Oregon ............................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38280 ..... Tillamook County, Oregon .............................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38290 ..... Umatilla County, Oregon ................................................................ 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38300 ..... Union County, Oregon .................................................................... 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38310 ..... Wallowa County, Oregon ................................................................ 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38320 ..... Wasco County, Oregon .................................................................. 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38330 ..... Washington County, Oregon .......................................................... 6440 Urban ..... 1.1266 38900 Urban ..... 1.1266 

38340 ..... Wheeler County, Oregon ................................................................ 38 Rural ...... 1.0052 99938 Rural ...... 0.9826 

38350 ..... Yamhill County, Oregon .................................................................. 6440 Urban ..... 1.1266 38900 Urban ..... 1.1266 

39000 ..... Adams County, Pennsylvania ......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39010 ..... Allegheny County, Pennsylvania .................................................... 6280 Urban ..... 0.8860 38300 Urban ..... 0.8845 

39070 ..... Armstrong County, Pennsylvania ................................................... 39 Rural ...... 0.8319 38300 Urban ..... 0.8845 

39080 ..... Beaver County, Pennsylvania ......................................................... 6280 Urban ..... 0.8860 38300 Urban ..... 0.8845 

39100 ..... Bedford County, Pennsylvania ....................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39110 ..... Berks County, Pennsylvania ........................................................... 6680 Urban ..... 0.9686 39740 Urban ..... 0.9686 

39120 ..... Blair County, Pennsylvania ............................................................. 0280 Urban ..... 0.8944 11020 Urban ..... 0.8944 

39130 ..... Bradford County, Pennsylvania ...................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39140 ..... Bucks County, Pennsylvania .......................................................... 6160 Urban ..... 1.0922 37964 Urban ..... 1.1038 

39150 ..... Butler County, Pennsylvania ........................................................... 6280 Urban ..... 0.8860 38300 Urban ..... 0.8845 

39160 ..... Cambria County, Pennsylvania ...................................................... 3680 Urban ..... 0.8086 27780 Urban ..... 0.8354 

39180 ..... Cameron County, Pennsylvania ..................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39190 ..... Carbon County, Pennsylvania ........................................................ 0240 Urban ..... 0.9845 10900 Urban ..... 0.9818 

39200 ..... Centre County, Pennsylvania ......................................................... 8050 Urban ..... 0.8356 44300 Urban ..... 0.8356 

39210 ..... Chester County, Pennsylvania ....................................................... 6160 Urban ..... 1.0922 37964 Urban ..... 1.1038 

39220 ..... Clarion County, Pennsylvania ......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39230 ..... Clearfield County, Pennsylvania ..................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39240 ..... Clinton County, Pennsylvania ......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39250 ..... Columbia County, Pennsylvania ..................................................... 7560 Urban ..... 0.8524 99939 Rural ...... 0.8291 

39260 ..... Crawford County, Pennsylvania ..................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39270 ..... Cumberland County, Pennsylvania ................................................ 3240 Urban ..... 0.9233 25420 Urban ..... 0.9313 

39280 ..... Dauphin County, Pennsylvania ....................................................... 3240 Urban ..... 0.9233 25420 Urban ..... 0.9313 

39290 ..... Delaware County, Pennsylvania ..................................................... 6160 Urban ..... 1.0922 37964 Urban ..... 1.1038 

39310 ..... Elk County, Pennsylvania ............................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39320 ..... Erie County, Pennsylvania .............................................................. 2360 Urban ..... 0.8737 21500 Urban ..... 0.8737 

39330 ..... Fayette County, Pennsylvania ........................................................ 6280 Urban ..... 0.8860 38300 Urban ..... 0.8845 

39340 ..... Forest County, Pennsylvania .......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39350 ..... Franklin County, Pennsylvania ....................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39360 ..... Fulton County, Pennsylvania .......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39370 ..... Greene County, Pennsylvania ........................................................ 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39380 ..... Huntingdon County, Pennsylvania .................................................. 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39390 ..... Indiana County, Pennsylvania ........................................................ 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39400 ..... Jefferson County, Pennsylvania ..................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39410 ..... Juniata County, Pennsylvania ........................................................ 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39420 ..... Lackawanna County, Pennsylvania ................................................ 7560 Urban ..... 0.8524 42540 Urban ..... 0.8540 

39440 ..... Lancaster County, Pennsylvania .................................................... 4000 Urban ..... 0.9694 29540 Urban ..... 0.9694 

39450 ..... Lawrence County, Pennsylvania .................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39460 ..... Lebanon County, Pennsylvania ...................................................... 3240 Urban ..... 0.9233 30140 Urban ..... 0.8459 

39470 ..... Lehigh County, Pennsylvania ......................................................... 0240 Urban ..... 0.9845 10900 Urban ..... 0.9818 

39480 ..... Luzerne County, Pennsylvania ....................................................... 7560 Urban ..... 0.8524 42540 Urban ..... 0.8540 

39510 ..... Lycoming County, Pennsylvania ..................................................... 9140 Urban ..... 0.8364 48700 Urban ..... 0.8364 

39520 ..... Mc Kean County, Pennsylvania ...................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39530 ..... Mercer County, Pennsylvania ......................................................... 7610 Urban ..... 0.7793 49660 Urban ..... 0.8603 

39540 ..... Mifflin County, Pennsylvania ........................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39550 ..... Monroe County, Pennsylvania ........................................................ 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39560 ..... Montgomery County, Pennsylvania ................................................ 6160 Urban ..... 1.0922 37964 Urban ..... 1.1038 

39580 ..... Montour County, Pennsylvania ....................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39590 ..... Northampton County, Pennsylvania ............................................... 0240 Urban ..... 0.9845 10900 Urban ..... 0.9818 

39600 ..... Northumberland County, Pennsylvania .......................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39610 ..... Perry County, Pennsylvania ........................................................... 3240 Urban ..... 0.9233 25420 Urban ..... 0.9313 

39620 ..... Philadelphia County, Pennsylvania ................................................ 6160 Urban ..... 1.0922 37964 Urban ..... 1.1038 

39630 ..... Pike County, Pennsylvania ............................................................. 5660 Urban ..... 1.1207 35084 Urban ..... 1.1883 

39640 ..... Potter County, Pennsylvania .......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39650 ..... Schuylkill County, Pennsylvania ..................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39670 ..... Snyder County, Pennsylvania ......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39680 ..... Somerset County, Pennsylvania ..................................................... 3680 Urban ..... 0.8086 99939 Rural ...... 0.8291 

39690 ..... Sullivan County, Pennsylvania ....................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39700 ..... Susquehanna County, Pennsylvania .............................................. 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39710 ..... Tioga County, Pennsylvania ........................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39720 ..... Union County, Pennsylvania ........................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39730 ..... Venango County, Pennsylvania ...................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39740 ..... Warren County, Pennsylvania ........................................................ 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3689 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

39750 ..... Washington County, Pennsylvania ................................................. 6280 Urban ..... 0.8860 38300 Urban ..... 0.8845 

39760 ..... Wayne County, Pennsylvania ......................................................... 39 Rural ...... 0.8319 99939 Rural ...... 0.8291 

39770 ..... Westmoreland County, Pennsylvania ............................................. 6280 Urban ..... 0.8860 38300 Urban ..... 0.8845 

39790 ..... Wyoming County, Pennsylvania ..................................................... 7560 Urban ..... 0.8524 42540 Urban ..... 0.8540 

39800 ..... York County, Pennsylvania ............................................................. 9280 Urban ..... 0.9347 49620 Urban ..... 0.9347 

40010 ..... Adjuntas County, Puerto Rico ........................................................ 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40020 ..... Aguada County, Puerto Rico .......................................................... 0060 Urban ..... 0.4876 10380 Urban ..... 0.4738 

40030 ..... Aguadilla County, Puerto Rico ........................................................ 0060 Urban ..... 0.4876 10380 Urban ..... 0.4738 

40040 ..... Aguas Buenas County, Puerto Rico ............................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40050 ..... Aibonito County, Puerto Rico ......................................................... 40 Rural ...... 0.3604 41980 Urban ..... 0.4621 

40060 ..... Anasco County, Puerto Rico .......................................................... 4840 Urban ..... 0.4243 10380 Urban ..... 0.4738 

40070 ..... Arecibo County, Puerto Rico .......................................................... 0470 Urban ..... 0.4112 41980 Urban ..... 0.4621 

40080 ..... Arroyo County, Puerto Rico ............................................................ 40 Rural ...... 0.3604 25020 Urban ..... 0.3181 

40090 ..... Barceloneta County, Puerto Rico ................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40100 ..... Barranquitas County, Puerto Rico .................................................. 40 Rural ...... 0.3604 41980 Urban ..... 0.4621 

40110 ..... Bayamon County, Puerto Rico ....................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40120 ..... Cabo Rojo County, Puerto Rico ..................................................... 4840 Urban ..... 0.4243 41900 Urban ..... 0.4650 

40130 ..... Caguas County, Puerto Rico .......................................................... 1310 Urban ..... 0.4120 41980 Urban ..... 0.4621 

40140 ..... Camuy County, Puerto Rico ........................................................... 0470 Urban ..... 0.4112 41980 Urban ..... 0.4621 

40145 ..... Canovanas County, Puerto Rico .................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40150 ..... Carolina County, Puerto Rico ......................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40160 ..... Catano County, Puerto Rico ........................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40170 ..... Cayey County, Puerto Rico ............................................................ 1310 Urban ..... 0.4120 41980 Urban ..... 0.4621 

40180 ..... Ceiba County, Puerto Rico ............................................................. 7440 Urban ..... 0.4752 21940 Urban ..... 0.4153 

40190 ..... Ciales County, Puerto Rico ............................................................ 40 Rural ...... 0.3604 41980 Urban ..... 0.4621 

40200 ..... Cidra County, Puerto Rico .............................................................. 1310 Urban ..... 0.4120 41980 Urban ..... 0.4621 

40210 ..... Coamo County, Puerto Rico ........................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40220 ..... Comerio County, Puerto Rico ......................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40230 ..... Corozal County, Puerto Rico .......................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40240 ..... Culebra County, Puerto Rico .......................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40250 ..... Dorado County, Puerto Rico ........................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40260 ..... Fajardo County, Puerto Rico .......................................................... 7440 Urban ..... 0.4752 21940 Urban ..... 0.4153 

40265 ..... Florida County, Puerto Rico ........................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40270 ..... Guanica County, Puerto Rico ......................................................... 40 Rural ...... 0.3604 49500 Urban ..... 0.4408 

40280 ..... Guayama County, Puerto Rico ....................................................... 40 Rural ...... 0.3604 25020 Urban ..... 0.3181 

40290 ..... Guayanilla County, Puerto Rico ..................................................... 6360 Urban ..... 0.4881 49500 Urban ..... 0.4408 

40300 ..... Guaynabo County, Puerto Rico ...................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40310 ..... Gurabo County, Puerto Rico .......................................................... 1310 Urban ..... 0.4120 41980 Urban ..... 0.4621 

40320 ..... Hatillo County, Puerto Rico ............................................................ 0470 Urban ..... 0.4112 41980 Urban ..... 0.4621 

40330 ..... Hormigueros County, Puerto Rico .................................................. 4840 Urban ..... 0.4243 32420 Urban ..... 0.4020 

40340 ..... Humacao County, Puerto Rico ....................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40350 ..... Isabela County, Puerto Rico ........................................................... 40 Rural ...... 0.3604 10380 Urban ..... 0.4738 

40360 ..... Jayuya County, Puerto Rico ........................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40370 ..... Juana Diaz County, Puerto Rico .................................................... 6360 Urban ..... 0.4881 38660 Urban ..... 0.4939 

40380 ..... Juncos County, Puerto Rico ........................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40390 ..... Lajas County, Puerto Rico .............................................................. 40 Rural ...... 0.3604 41900 Urban ..... 0.4650 

40400 ..... Lares County, Puerto Rico ............................................................. 40 Rural ...... 0.3604 10380 Urban ..... 0.4738 

40410 ..... Las Marias County, Puerto Rico ..................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40420 ..... Las Piedras County, Puerto Rico ................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40430 ..... Loiza County, Puerto Rico .............................................................. 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40440 ..... Luquillo County, Puerto Rico .......................................................... 7440 Urban ..... 0.4752 21940 Urban ..... 0.4153 

40450 ..... Manati County, Puerto Rico ............................................................ 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40460 ..... Maricao County, Puerto Rico .......................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40470 ..... Maunabo County, Puerto Rico ....................................................... 40 Rural ...... 0.3604 41980 Urban ..... 0.4621 

40480 ..... Mayaguez County, Puerto Rico ...................................................... 4840 Urban ..... 0.4243 32420 Urban ..... 0.4020 

40490 ..... Moca County, Puerto Rico .............................................................. 0060 Urban ..... 0.4876 10380 Urban ..... 0.4738 

40500 ..... Morovis County, Puerto Rico .......................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40510 ..... Naguabo County, Puerto Rico ........................................................ 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40520 ..... Naranjito County, Puerto Rico ........................................................ 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40530 ..... Orocovis County, Puerto Rico ........................................................ 40 Rural ...... 0.3604 41980 Urban ..... 0.4621 

40540 ..... Patillas County, Puerto Rico ........................................................... 40 Rural ...... 0.3604 25020 Urban ..... 0.3181 

40550 ..... Penuelas County, Puerto Rico ....................................................... 6360 Urban ..... 0.4881 49500 Urban ..... 0.4408 

40560 ..... Ponce County, Puerto Rico ............................................................ 6360 Urban ..... 0.4881 38660 Urban ..... 0.4939 

40570 ..... Quebradillas County, Puerto Rico .................................................. 40 Rural ...... 0.3604 41980 Urban ..... 0.4621 

40580 ..... Rincon County, Puerto Rico ........................................................... 40 Rural ...... 0.3604 10380 Urban ..... 0.4738 

40590 ..... Rio Grande County, Puerto Rico .................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40610 ..... Sabana Grande County, Puerto Rico ............................................. 4840 Urban ..... 0.4243 41900 Urban ..... 0.4650 

40620 ..... Salinas County, Puerto Rico ........................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40630 ..... San German County, Puerto Rico .................................................. 4840 Urban ..... 0.4243 41900 Urban ..... 0.4650 

40640 ..... San Juan County, Puerto Rico ....................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40650 ..... San Lorenzo County, Puerto Rico .................................................. 1310 Urban ..... 0.4120 41980 Urban ..... 0.4621 


cchase on PROD1PC60 with PROPOSALS2
3690 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

40660 ..... San Sebastian County, Puerto Rico ............................................... 40 Rural ...... 0.3604 10380 Urban ..... 0.4738 

40670 ..... Santa Isabel County, Puerto Rico .................................................. 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40680 ..... Toa Alta County, Puerto Rico ......................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40690 ..... Toa Baja County, Puerto Rico ........................................................ 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40700 ..... Trujillo Alto County, Puerto Rico .................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40710 ..... Utuado County, Puerto Rico ........................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40720 ..... Vega Alta County, Puerto Rico ....................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40730 ..... Vega Baja County, Puerto Rico ...................................................... 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40740 ..... Vieques County, Puerto Rico ......................................................... 40 Rural ...... 0.3604 99940 Rural ...... 0.4047 

40750 ..... Villalba County, Puerto Rico ........................................................... 6360 Urban ..... 0.4881 38660 Urban ..... 0.4939 

40760 ..... Yabucoa County, Puerto Rico ........................................................ 7440 Urban ..... 0.4752 41980 Urban ..... 0.4621 

40770 ..... Yauco County, Puerto Rico ............................................................ 6360 Urban ..... 0.4881 49500 Urban ..... 0.4408 

41000 ..... Bristol County, Rhode Island .......................................................... 6483 Urban ..... 1.1058 39300 Urban ..... 1.0966 

41010 ..... Kent County, Rhode Island ............................................................. 6483 Urban ..... 1.1058 39300 Urban ..... 1.0966 

41020 ..... Newport County, Rhode Island ....................................................... 6483 Urban ..... 1.1058 39300 Urban ..... 1.0966 

41030 ..... Providence County, Rhode Island .................................................. 6483 Urban ..... 1.1058 39300 Urban ..... 1.0966 

41050 ..... Washington County, Rhode Island ................................................. 6483 Urban ..... 1.1058 39300 Urban ..... 1.0966 

42000 ..... Abbeville County, S Carolina .......................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42010 ..... Aiken County, S Carolina ............................................................... 0600 Urban ..... 0.9808 12260 Urban ..... 0.9748 

42020 ..... Allendale County, S Carolina .......................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42030 ..... Anderson County, S Carolina ......................................................... 3160 Urban ..... 0.9615 11340 Urban ..... 0.8997 

42040 ..... Bamberg County, S Carolina .......................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42050 ..... Barnwell County, S Carolina ........................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42060 ..... Beaufort County, S Carolina ........................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42070 ..... Berkeley County, S Carolina .......................................................... 1440 Urban ..... 0.9245 16700 Urban ..... 0.9245 

42080 ..... Calhoun County, S Carolina ........................................................... 42 Rural ...... 0.8631 17900 Urban ..... 0.9057 

42090 ..... Charleston County, S Carolina ....................................................... 1440 Urban ..... 0.9245 16700 Urban ..... 0.9245 

42100 ..... Cherokee County, S Carolina ......................................................... 3160 Urban ..... 0.9615 99942 Rural ...... 0.8638 

42110 ..... Chester County, S Carolina ............................................................ 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42120 ..... Chesterfield County, S Carolina ..................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42130 ..... Clarendon County, S Carolina ........................................................ 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42140 ..... Colleton County, S Carolina ........................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42150 ..... Darlington County, S Carolina ........................................................ 42 Rural ...... 0.8631 22500 Urban ..... 0.8947 

42160 ..... Dillon County, S Carolina ............................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42170 ..... Dorchester County, S Carolina ....................................................... 1440 Urban ..... 0.9245 16700 Urban ..... 0.9245 

42180 ..... Edgefield County, S Carolina ......................................................... 0600 Urban ..... 0.9808 12260 Urban ..... 0.9748 

42190 ..... Fairfield County, S Carolina ............................................................ 42 Rural ...... 0.8631 17900 Urban ..... 0.9057 

42200 ..... Florence County, S Carolina .......................................................... 2655 Urban ..... 0.9042 22500 Urban ..... 0.8947 

42210 ..... Georgetown County, S Carolina ..................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42220 ..... Greenville County, S Carolina ........................................................ 3160 Urban ..... 0.9615 24860 Urban ..... 1.0027 

42230 ..... Greenwood County, S Carolina ...................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42240 ..... Hampton County, S Carolina .......................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42250 ..... Horry County, S Carolina ................................................................ 5330 Urban ..... 0.8934 34820 Urban ..... 0.8934 

42260 ..... Jasper County, S Carolina .............................................................. 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42270 ..... Kershaw County, S Carolina .......................................................... 42 Rural ...... 0.8631 17900 Urban ..... 0.9057 

42280 ..... Lancaster County, S Carolina ......................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42290 ..... Laurens County, S Carolina ........................................................... 42 Rural ...... 0.8631 24860 Urban ..... 1.0027 

42300 ..... Lee County, S Carolina .................................................................. 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42310 ..... Lexington County, S Carolina ......................................................... 1760 Urban ..... 0.9082 17900 Urban ..... 0.9057 

42320 ..... Mc Cormick County, S Carolina ..................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42330 ..... Marion County, S Carolina ............................................................. 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42340 ..... Marlboro County, S Carolina .......................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42350 ..... Newberry County, S Carolina ......................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42360 ..... Oconee County, S Carolina ............................................................ 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42370 ..... Orangeburg County, S Carolina ..................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42380 ..... Pickens County, S Carolina ............................................................ 3160 Urban ..... 0.9615 24860 Urban ..... 1.0027 

42390 ..... Richland County, S Carolina .......................................................... 1760 Urban ..... 0.9082 17900 Urban ..... 0.9057 

42400 ..... Saluda County, S Carolina ............................................................. 42 Rural ...... 0.8631 17900 Urban ..... 0.9057 

42410 ..... Spartanburg County, S Carolina ..................................................... 3160 Urban ..... 0.9615 43900 Urban ..... 0.9172 

42420 ..... Sumter County, S Carolina ............................................................. 8140 Urban ..... 0.8377 44940 Urban ..... 0.8377 

42430 ..... Union County, S Carolina ............................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42440 ..... Williamsburg County, S Carolina .................................................... 42 Rural ...... 0.8631 99942 Rural ...... 0.8638 

42450 ..... York County, S Carolina ................................................................. 1520 Urban ..... 0.9715 16740 Urban ..... 0.9750 

43010 ..... Aurora County, S Dakota ................................................................ 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43020 ..... Beadle County, S Dakota ............................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43030 ..... Bennett County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43040 ..... Bon Homme County, S Dakota ...................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43050 ..... Brookings County, S Dakota .......................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43060 ..... Brown County, S Dakota ................................................................ 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43070 ..... Brule County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43080 ..... Buffalo County, S Dakota ............................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3691 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

43090 ..... Butte County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43100 ..... Campbell County, S Dakota ........................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43110 ..... Charles Mix County, S Dakota ....................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43120 ..... Clark County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43130 ..... Clay County, S Dakota ................................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43140 ..... Codington County, S Dakota .......................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43150 ..... Corson County, S Dakota ............................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43160 ..... Custer County, S Dakota ................................................................ 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43170 ..... Davison County, S Dakota ............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43180 ..... Day County, S Dakota .................................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43190 ..... Deuel County, S Dakota ................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43200 ..... Dewey County, S Dakota ............................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43210 ..... Douglas County, S Dakota ............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43220 ..... Edmunds County, S Dakota ........................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43230 ..... Fall River County, S Dakota ........................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43240 ..... Faulk County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43250 ..... Grant County, S Dakota ................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43260 ..... Gregory County, S Dakota ............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43270 ..... Haakon County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43280 ..... Hamlin County, S Dakota ............................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43290 ..... Hand County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43300 ..... Hanson County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43310 ..... Harding County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43320 ..... Hughes County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43330 ..... Hutchinson County, S Dakota ........................................................ 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43340 ..... Hyde County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43350 ..... Jackson County, S Dakota ............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43360 ..... Jerauld County, S Dakota ............................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43370 ..... Jones County, S Dakota ................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43380 ..... Kingsbury County, S Dakota .......................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43390 ..... Lake County, S Dakota ................................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43400 ..... Lawrence County, S Dakota ........................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43410 ..... Lincoln County, S Dakota ............................................................... 7760 Urban ..... 0.9635 43620 Urban ..... 0.9635 

43420 ..... Lyman County, S Dakota ................................................................ 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43430 ..... Mc Cook County, S Dakota ............................................................ 43 Rural ...... 0.8551 43620 Urban ..... 0.9635 

43440 ..... Mc Pherson County, S Dakota ....................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43450 ..... Marshall County, S Dakota ............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43460 ..... Meade County, S Dakota ............................................................... 43 Rural ...... 0.8551 39660 Urban ..... 0.8987 

43470 ..... Mellette County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43480 ..... Miner County, S Dakota ................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43490 ..... Minnehaha County, S Dakota ......................................................... 7760 Urban ..... 0.9635 43620 Urban ..... 0.9635 

43500 ..... Moody County, S Dakota ................................................................ 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43510 ..... Pennington County, S Dakota ........................................................ 6660 Urban ..... 0.8987 39660 Urban ..... 0.8987 

43520 ..... Perkins County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43530 ..... Potter County, S Dakota ................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43540 ..... Roberts County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43550 ..... Sanborn County, S Dakota ............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43560 ..... Shannon County, S Dakota ............................................................ 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43570 ..... Spink County, S Dakota ................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43580 ..... Stanley County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43590 ..... Sully County, S Dakota ................................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43600 ..... Todd County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43610 ..... Tripp County, S Dakota .................................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43620 ..... Turner County, S Dakota ................................................................ 43 Rural ...... 0.8551 43620 Urban ..... 0.9635 

43630 ..... Union County, S Dakota ................................................................. 43 Rural ...... 0.8551 43580 Urban ..... 0.9381 

43640 ..... Walworth County, S Dakota ........................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43650 ..... Washabaugh County, S Dakota ..................................................... 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43670 ..... Yankton County, S Dakota ............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

43680 ..... Ziebach County, S Dakota .............................................................. 43 Rural ...... 0.8551 99943 Rural ...... 0.8560 

44000 ..... Anderson County, Tennessee ........................................................ 3840 Urban ..... 0.8397 28940 Urban ..... 0.8441 

44010 ..... Bedford County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44020 ..... Benton County, Tennessee ............................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44030 ..... Bledsoe County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44040 ..... Blount County, Tennessee ............................................................. 3840 Urban ..... 0.8397 28940 Urban ..... 0.8441 

44050 ..... Bradley County, Tennessee ........................................................... 44 Rural ...... 0.7935 17420 Urban ..... 0.8139 

44060 ..... Campbell County, Tennessee ........................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44070 ..... Cannon County, Tennessee ........................................................... 44 Rural ...... 0.7935 34980 Urban ..... 0.9790 

44080 ..... Carroll County, Tennessee ............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44090 ..... Carter County, Tennessee .............................................................. 3660 Urban ..... 0.8007 27740 Urban ..... 0.7937 

44100 ..... Cheatham County, Tennessee ....................................................... 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 

44110 ..... Chester County, Tennessee ........................................................... 3580 Urban ..... 0.8964 27180 Urban ..... 0.8964 


cchase on PROD1PC60 with PROPOSALS2
3692 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

44120 ..... Claiborne County, Tennessee ........................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44130 ..... Clay County, Tennessee ................................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44140 ..... Cocke County, Tennessee ............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44150 ..... Coffee County, Tennessee ............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44160 ..... Crockett County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44170 ..... Cumberland County, Tennessee .................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44180 ..... Davidson County, Tennessee ......................................................... 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 

44190 ..... Decatur County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44200 ..... De Kalb County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44210 ..... Dickson County, Tennessee ........................................................... 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 

44220 ..... Dyer County, Tennessee ................................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44230 ..... Fayette County, Tennessee ............................................................ 4920 Urban ..... 0.9416 32820 Urban ..... 0.9397 

44240 ..... Fentress County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44250 ..... Franklin County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44260 ..... Gibson County, Tennessee ............................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44270 ..... Giles County, Tennessee ............................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44280 ..... Grainger County, Tennessee .......................................................... 44 Rural ...... 0.7935 34100 Urban ..... 0.7961 

44290 ..... Greene County, Tennessee ............................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44300 ..... Grundy County, Tennessee ............................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44310 ..... Hamblen County, Tennessee ......................................................... 44 Rural ...... 0.7935 34100 Urban ..... 0.7961 

44320 ..... Hamilton County, Tennessee ......................................................... 1560 Urban ..... 0.9088 16860 Urban ..... 0.9088 

44330 ..... Hancock County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44340 ..... Hardeman County, Tennessee ....................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44350 ..... Hardin County, Tennessee ............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44360 ..... Hawkins County, Tennessee .......................................................... 3660 Urban ..... 0.8007 28700 Urban ..... 0.8054 

44370 ..... Haywood County, Tennessee ......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44380 ..... Henderson County, Tennessee ...................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44390 ..... Henry County, Tennessee .............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44400 ..... Hickman County, Tennessee .......................................................... 44 Rural ...... 0.7935 34980 Urban ..... 0.9790 

44410 ..... Houston County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44420 ..... Humphreys County, Tennessee ..................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44430 ..... Jackson County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44440 ..... Jefferson County, Tennessee ......................................................... 44 Rural ...... 0.7935 34100 Urban ..... 0.7961 

44450 ..... Johnson County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44460 ..... Knox County, Tennessee ............................................................... 3840 Urban ..... 0.8397 28940 Urban ..... 0.8441 

44470 ..... Lake County, Tennessee ................................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44480 ..... Lauderdale County, Tennessee ...................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44490 ..... Lawrence County, Tennessee ........................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44500 ..... Lewis County, Tennessee .............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44510 ..... Lincoln County, Tennessee ............................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44520 ..... Loudon County, Tennessee ............................................................ 3840 Urban ..... 0.8397 28940 Urban ..... 0.8441 

44530 ..... Mc Minn County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44540 ..... Mc Nairy County, Tennessee ......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44550 ..... Macon County, Tennessee ............................................................. 44 Rural ...... 0.7935 34980 Urban ..... 0.9790 

44560 ..... Madison County, Tennessee .......................................................... 3580 Urban ..... 0.8964 27180 Urban ..... 0.8964 

44570 ..... Marion County, Tennessee ............................................................. 1560 Urban ..... 0.9088 16860 Urban ..... 0.9088 

44580 ..... Marshall County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44590 ..... Maury County, Tennessee .............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44600 ..... Meigs County, Tennessee .............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44610 ..... Monroe County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44620 ..... Montgomery County, Tennessee .................................................... 1660 Urban ..... 0.8284 17300 Urban ..... 0.8284 

44630 ..... Moore County, Tennessee ............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44640 ..... Morgan County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44650 ..... Obion County, Tennessee .............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44660 ..... Overton County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44670 ..... Perry County, Tennessee ............................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44680 ..... Pickett County, Tennessee ............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44690 ..... Polk County, Tennessee ................................................................. 44 Rural ...... 0.7935 17420 Urban ..... 0.8139 

44700 ..... Putnam County, Tennessee ........................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44710 ..... Rhea County, Tennessee ............................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44720 ..... Roane County, Tennessee ............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44730 ..... Robertson County, Tennessee ....................................................... 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 

44740 ..... Rutherford County, Tennessee ....................................................... 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 

44750 ..... Scott County, Tennessee ............................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44760 ..... Sequatchie County, Tennessee ...................................................... 44 Rural ...... 0.7935 16860 Urban ..... 0.9088 

44770 ..... Sevier County, Tennessee ............................................................. 3840 Urban ..... 0.8397 99944 Rural ...... 0.7895 

44780 ..... Shelby County, Tennessee ............................................................. 4920 Urban ..... 0.9416 32820 Urban ..... 0.9397 

44790 ..... Smith County, Tennessee .............................................................. 44 Rural ...... 0.7935 34980 Urban ..... 0.9790 

44800 ..... Stewart County, Tennessee ........................................................... 44 Rural ...... 0.7935 17300 Urban ..... 0.8284 

44810 ..... Sullivan County, Tennessee ........................................................... 3660 Urban ..... 0.8007 28700 Urban ..... 0.8054 

44820 ..... Sumner County, Tennessee ........................................................... 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3693 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

44830 ..... Tipton County, Tennessee .............................................................. 4920 Urban ..... 0.9416 32820 Urban ..... 0.9397 

44840 ..... Trousdale County, Tennessee ........................................................ 44 Rural ...... 0.7935 34980 Urban ..... 0.9790 

44850 ..... Unicoi County, Tennessee .............................................................. 3660 Urban ..... 0.8007 27740 Urban ..... 0.7937 

44860 ..... Union County, Tennessee .............................................................. 3840 Urban ..... 0.8397 28940 Urban ..... 0.8441 

44870 ..... Van Buren County, Tennessee ...................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44880 ..... Warren County, Tennessee ............................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44890 ..... Washington County, Tennessee ..................................................... 3660 Urban ..... 0.8007 27740 Urban ..... 0.7937 

44900 ..... Wayne County, Tennessee ............................................................ 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44910 ..... Weakley County, Tennessee .......................................................... 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44920 ..... White County, Tennessee .............................................................. 44 Rural ...... 0.7935 99944 Rural ...... 0.7895 

44930 ..... Williamson County, Tennessee ...................................................... 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 

44940 ..... Wilson County, Tennessee ............................................................. 5360 Urban ..... 0.9808 34980 Urban ..... 0.9790 

45000 ..... Anderson County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45010 ..... Andrews County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45020 ..... Angelina County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45030 ..... Aransas County, Texas .................................................................. 45 Rural ...... 0.7931 18580 Urban ..... 0.8550 

45040 ..... Archer County, Texas ..................................................................... 9080 Urban ..... 0.8365 48660 Urban ..... 0.8285 

45050 ..... Armstrong County, Texas ............................................................... 45 Rural ...... 0.7931 11100 Urban ..... 0.9156 

45060 ..... Atascosa County, Texas ................................................................. 45 Rural ...... 0.7931 41700 Urban ..... 0.8980 

45070 ..... Austin County, Texas ...................................................................... 45 Rural ...... 0.7931 26420 Urban ..... 0.9996 

45080 ..... Bailey County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45090 ..... Bandera County, Texas .................................................................. 45 Rural ...... 0.7931 41700 Urban ..... 0.8980 

45100 ..... Bastrop County, Texas ................................................................... 0640 Urban ..... 0.9437 12420 Urban ..... 0.9437 

45110 ..... Baylor County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45113 ..... Bee County, Texas ......................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45120 ..... Bell County, Texas .......................................................................... 3810 Urban ..... 0.8526 28660 Urban ..... 0.8526 

45130 ..... Bexar County, Texas ...................................................................... 7240 Urban ..... 0.8984 41700 Urban ..... 0.8980 

45140 ..... Blanco County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45150 ..... Borden County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45160 ..... Bosque County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45170 ..... Bowie County, Texas ...................................................................... 8360 Urban ..... 0.8283 45500 Urban ..... 0.8283 

45180 ..... Brazoria County, Texas .................................................................. 1145 Urban ..... 0.8563 26420 Urban ..... 0.9996 

45190 ..... Brazos County, Texas .................................................................... 1260 Urban ..... 0.8900 17780 Urban ..... 0.8900 

45200 ..... Brewster County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45201 ..... Briscoe County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45210 ..... Brooks County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45220 ..... Brown County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45221 ..... Burleson County, Texas ................................................................. 45 Rural ...... 0.7931 17780 Urban ..... 0.8900 

45222 ..... Burnet County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45223 ..... Caldwell County, Texas .................................................................. 0640 Urban ..... 0.9437 12420 Urban ..... 0.9437 

45224 ..... Calhoun County, Texas .................................................................. 45 Rural ...... 0.7931 47020 Urban ..... 0.8160 

45230 ..... Callahan County, Texas ................................................................. 45 Rural ...... 0.7931 10180 Urban ..... 0.7896 

45240 ..... Cameron County, Texas ................................................................. 1240 Urban ..... 0.9804 15180 Urban ..... 0.9804 

45250 ..... Camp County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45251 ..... Carson County, Texas .................................................................... 45 Rural ...... 0.7931 11100 Urban ..... 0.9156 

45260 ..... Cass County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45270 ..... Castro County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45280 ..... Chambers County, Texas ............................................................... 3360 Urban ..... 1.0091 26420 Urban ..... 0.9996 

45281 ..... Cherokee County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45290 ..... Childress County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45291 ..... Clay County, Texas ........................................................................ 45 Rural ...... 0.7931 48660 Urban ..... 0.8285 

45292 ..... Cochran County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45300 ..... Coke County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45301 ..... Coleman County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45310 ..... Collin County, Texas ....................................................................... 1920 Urban ..... 1.0205 19124 Urban ..... 1.0228 

45311 ..... Collingsworth County, Texas .......................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45312 ..... Colorado County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45320 ..... Comal County, Texas ..................................................................... 7240 Urban ..... 0.8984 41700 Urban ..... 0.8980 

45321 ..... Comanche County, Texas .............................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45330 ..... Concho County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45340 ..... Cooke County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45341 ..... Coryell County, Texas .................................................................... 3810 Urban ..... 0.8526 28660 Urban ..... 0.8526 

45350 ..... Cottle County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45360 ..... Crane County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45361 ..... Crockett County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45362 ..... Crosby County, Texas .................................................................... 45 Rural ...... 0.7931 31180 Urban ..... 0.8783 

45370 ..... Culberson County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45380 ..... Dallam County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45390 ..... Dallas County, Texas ...................................................................... 1920 Urban ..... 1.0205 19124 Urban ..... 1.0228 

45391 ..... Dawson County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45392 ..... Deaf Smith County, Texas .............................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 


cchase on PROD1PC60 with PROPOSALS2
3694 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

45400 ..... Delta County, Texas ....................................................................... 45 Rural ...... 0.7931 19124 Urban ..... 1.0228 

45410 ..... Denton County, Texas .................................................................... 1920 Urban ..... 1.0205 19124 Urban ..... 1.0228 

45420 ..... De Witt County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45421 ..... Dickens County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45430 ..... Dimmit County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45431 ..... Donley County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45440 ..... Duval County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45450 ..... Eastland County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45451 ..... Ector County, Texas ....................................................................... 5800 Urban ..... 0.9741 36220 Urban ..... 0.9884 

45460 ..... Edwards County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45470 ..... Ellis County, Texas ......................................................................... 1920 Urban ..... 1.0205 19124 Urban ..... 1.0228 

45480 ..... El Paso County, Texas ................................................................... 2320 Urban ..... 0.8977 21340 Urban ..... 0.8977 

45490 ..... Erath County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45500 ..... Falls County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45510 ..... Fannin County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45511 ..... Fayette County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45520 ..... Fisher County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45521 ..... Floyd County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45522 ..... Foard County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45530 ..... Fort Bend County, Texas ................................................................ 3360 Urban ..... 1.0091 26420 Urban ..... 0.9996 

45531 ..... Franklin County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45540 ..... Freestone County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45541 ..... Frio County, Texas ......................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45542 ..... Gaines County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45550 ..... Galveston County, Texas ............................................................... 2920 Urban ..... 0.9635 26420 Urban ..... 0.9996 

45551 ..... Garza County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45552 ..... Gillespie County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45560 ..... Glasscock County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45561 ..... Goliad County, Texas ..................................................................... 45 Rural ...... 0.7931 47020 Urban ..... 0.8160 

45562 ..... Gonzales County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45563 ..... Gray County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45564 ..... Grayson County, Texas .................................................................. 7640 Urban ..... 0.9507 43300 Urban ..... 0.9507 

45570 ..... Gregg County, Texas ...................................................................... 4420 Urban ..... 0.8888 30980 Urban ..... 0.8730 

45580 ..... Grimes County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45581 ..... Guadaloupe County, Texas ............................................................ 7240 Urban ..... 0.8984 41700 Urban ..... 0.8980 

45582 ..... Hale County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45583 ..... Hall County, Texas ......................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45590 ..... Hamilton County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45591 ..... Hansford County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45592 ..... Hardeman County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45600 ..... Hardin County, Texas ..................................................................... 0840 Urban ..... 0.8412 13140 Urban ..... 0.8412 

45610 ..... Harris County, Texas ...................................................................... 3360 Urban ..... 1.0091 26420 Urban ..... 0.9996 

45620 ..... Harrison County, Texas .................................................................. 4420 Urban ..... 0.8888 99945 Rural ...... 0.8003 

45621 ..... Hartley County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45630 ..... Haskell County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45631 ..... Hays County, Texas ....................................................................... 0640 Urban ..... 0.9437 12420 Urban ..... 0.9437 

45632 ..... Hemphill County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45640 ..... Henderson County, Texas .............................................................. 1920 Urban ..... 1.0205 99945 Rural ...... 0.8003 

45650 ..... Hidalgo County, Texas ................................................................... 4880 Urban ..... 0.8934 32580 Urban ..... 0.8934 

45651 ..... Hill County, Texas ........................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45652 ..... Hockley County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45653 ..... Hood County, Texas ....................................................................... 2800 Urban ..... 0.9522 99945 Rural ...... 0.8003 

45654 ..... Hopkins County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45660 ..... Houston County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45661 ..... Howard County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45662 ..... Hudspeth County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45670 ..... Hunt County, Texas ........................................................................ 1920 Urban ..... 1.0205 19124 Urban ..... 1.0228 

45671 ..... Hutchinson County, Texas .............................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45672 ..... Irion County, Texas ......................................................................... 45 Rural ...... 0.7931 41660 Urban ..... 0.8271 

45680 ..... Jack County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45681 ..... Jackson County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45690 ..... Jasper County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45691 ..... Jeff Davis County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45700 ..... Jefferson County, Texas ................................................................. 0840 Urban ..... 0.8412 13140 Urban ..... 0.8412 

45710 ..... Jim Hogg County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45711 ..... Jim Wells County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45720 ..... Johnson County, Texas .................................................................. 2800 Urban ..... 0.9522 23104 Urban ..... 0.9486 

45721 ..... Jones County, Texas ...................................................................... 45 Rural ...... 0.7931 10180 Urban ..... 0.7896 

45722 ..... Karnes County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45730 ..... Kaufman County, Texas ................................................................. 1920 Urban ..... 1.0205 19124 Urban ..... 1.0228 

45731 ..... Kendall County, Texas .................................................................... 45 Rural ...... 0.7931 41700 Urban ..... 0.8980 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3695 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

45732 ..... Kenedy County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45733 ..... Kent County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45734 ..... Kerr County, Texas ......................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45740 ..... Kimble County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45741 ..... King County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45742 ..... Kinney County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45743 ..... Kleberg County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45744 ..... Knox County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45750 ..... Lamar County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45751 ..... Lamb County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45752 ..... Lampasas County, Texas ............................................................... 45 Rural ...... 0.7931 28660 Urban ..... 0.8526 

45753 ..... La Salle County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45754 ..... Lavaca County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45755 ..... Lee County, Texas .......................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45756 ..... Leon County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45757 ..... Liberty County, Texas ..................................................................... 3360 Urban ..... 1.0091 26420 Urban ..... 0.9996 

45758 ..... Limestone County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45759 ..... Lipscomb County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45760 ..... Live Oak County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45761 ..... Llano County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45762 ..... Loving County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45770 ..... Lubbock County, Texas .................................................................. 4600 Urban ..... 0.8783 31180 Urban ..... 0.8783 

45771 ..... Lynn County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45772 ..... Mc Culloch County, Texas .............................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45780 ..... Mc Lennan County, Texas .............................................................. 8800 Urban ..... 0.8518 47380 Urban ..... 0.8518 

45781 ..... Mc Mullen County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45782 ..... Madison County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45783 ..... Marion County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45784 ..... Martin County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45785 ..... Mason County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45790 ..... Matagorda County, Texas .............................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45791 ..... Maverick County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45792 ..... Medina County, Texas .................................................................... 45 Rural ...... 0.7931 41700 Urban ..... 0.8980 

45793 ..... Menard County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45794 ..... Midland County, Texas ................................................................... 5800 Urban ..... 0.9741 33260 Urban ..... 0.9514 

45795 ..... Milam County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45796 ..... Mills County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45797 ..... Mitchell County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45800 ..... Montague County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45801 ..... Montgomery County, Texas ............................................................ 3360 Urban ..... 1.0091 26420 Urban ..... 0.9996 

45802 ..... Moore County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45803 ..... Morris County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45804 ..... Motley County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45810 ..... Nacogdoches County, Texas .......................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45820 ..... Navarro County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45821 ..... Newton County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45822 ..... Nolan County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45830 ..... Nueces County, Texas ................................................................... 1880 Urban ..... 0.8550 18580 Urban ..... 0.8550 

45831 ..... Ochiltree County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45832 ..... Oldham County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45840 ..... Orange County, Texas .................................................................... 0840 Urban ..... 0.8412 13140 Urban ..... 0.8412 

45841 ..... Palo Pinto County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45842 ..... Panola County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45843 ..... Parker County, Texas ..................................................................... 2800 Urban ..... 0.9522 23104 Urban ..... 0.9486 

45844 ..... Parmer County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45845 ..... Pecos County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45850 ..... Polk County, Texas ......................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45860 ..... Potter County, Texas ...................................................................... 0320 Urban ..... 0.9156 11100 Urban ..... 0.9156 

45861 ..... Presidio County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45870 ..... Rains County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45871 ..... Randall County, Texas ................................................................... 0320 Urban ..... 0.9156 11100 Urban ..... 0.9156 

45872 ..... Reagan County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45873 ..... Real County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45874 ..... Red River County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45875 ..... Reeves County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45876 ..... Refugio County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45877 ..... Roberts County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45878 ..... Robertson County, Texas ............................................................... 45 Rural ...... 0.7931 17780 Urban ..... 0.8900 

45879 ..... Rockwall County, Texas ................................................................. 1920 Urban ..... 1.0205 19124 Urban ..... 1.0228 

45880 ..... Runnels County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45881 ..... Rusk County, Texas ....................................................................... 45 Rural ...... 0.7931 30980 Urban ..... 0.8730 


cchase on PROD1PC60 with PROPOSALS2
3696 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

45882 ..... Sabine County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45883 ..... San Augustine County, Texas ........................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45884 ..... San Jacinto County, Texas ............................................................. 45 Rural ...... 0.7931 26420 Urban ..... 0.9996 

45885 ..... San Patricio County, Texas ............................................................ 1880 Urban ..... 0.8550 18580 Urban ..... 0.8550 

45886 ..... San Saba County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45887 ..... Schleicher County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45888 ..... Scurry County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45889 ..... Shackelford County, Texas ............................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45890 ..... Shelby County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45891 ..... Sherman County, Texas ................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45892 ..... Smith County, Texas ...................................................................... 8640 Urban ..... 0.9168 46340 Urban ..... 0.9168 

45893 ..... Somervell County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45900 ..... Starr County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45901 ..... Stephens County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45902 ..... Sterling County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45903 ..... Stonewall County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45904 ..... Sutton County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45905 ..... Swisher County, Texas ................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45910 ..... Tarrant County, Texas .................................................................... 2800 Urban ..... 0.9522 23104 Urban ..... 0.9486 

45911 ..... Taylor County, Texas ...................................................................... 0040 Urban ..... 0.8054 10180 Urban ..... 0.7896 

45912 ..... Terrell County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45913 ..... Terry County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45920 ..... Throckmorton County, Texas ......................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45921 ..... Titus County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45930 ..... Tom Green County, Texas ............................................................. 7200 Urban ..... 0.8271 41660 Urban ..... 0.8271 

45940 ..... Travis County, Texas ...................................................................... 0640 Urban ..... 0.9437 12420 Urban ..... 0.9437 

45941 ..... Trinity County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45942 ..... Tyler County, Texas ........................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45943 ..... Upshur County, Texas .................................................................... 4420 Urban ..... 0.8888 30980 Urban ..... 0.8730 

45944 ..... Upton County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45945 ..... Uvalde County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45946 ..... Val Verde County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45947 ..... Van Zandt County, Texas ............................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45948 ..... Victoria County, Texas .................................................................... 8750 Urban ..... 0.8160 47020 Urban ..... 0.8160 

45949 ..... Walker County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45950 ..... Waller County, Texas ..................................................................... 3360 Urban ..... 1.0091 26420 Urban ..... 0.9996 

45951 ..... Ward County, Texas ....................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45952 ..... Washington County, Texas ............................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45953 ..... Webb County, Texas ...................................................................... 4080 Urban ..... 0.8068 29700 Urban ..... 0.8068 

45954 ..... Wharton County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45955 ..... Wheeler County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45960 ..... Wichita County, Texas .................................................................... 9080 Urban ..... 0.8365 48660 Urban ..... 0.8285 

45961 ..... Wilbarger County, Texas ................................................................ 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45962 ..... Willacy County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45970 ..... Williamson County, Texas .............................................................. 0640 Urban ..... 0.9437 12420 Urban ..... 0.9437 

45971 ..... Wilson County, Texas ..................................................................... 7240 Urban ..... 0.8984 41700 Urban ..... 0.8980 

45972 ..... Winkler County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45973 ..... Wise County, Texas ........................................................................ 45 Rural ...... 0.7931 23104 Urban ..... 0.9486 

45974 ..... Wood County, Texas ...................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45980 ..... Yoakum County, Texas .................................................................. 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45981 ..... Young County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45982 ..... Zapata County, Texas .................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

45983 ..... Zavala County, Texas ..................................................................... 45 Rural ...... 0.7931 99945 Rural ...... 0.8003 

46000 ..... Beaver County, Utah ...................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46010 ..... Box Elder County, Utah .................................................................. 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46020 ..... Cache County, Utah ....................................................................... 46 Rural ...... 0.8762 30860 Urban ..... 0.9164 

46030 ..... Carbon County, Utah ...................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46040 ..... Daggett County, Utah ..................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46050 ..... Davis County, Utah ......................................................................... 7160 Urban ..... 0.9340 36260 Urban ..... 0.9029 

46060 ..... Duchesne County, Utah .................................................................. 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46070 ..... Emery County, Utah ....................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46080 ..... Garfield County, Utah ..................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46090 ..... Grand County, Utah ........................................................................ 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46100 ..... Iron County, Utah ............................................................................ 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46110 ..... Juab County, Utah .......................................................................... 46 Rural ...... 0.8762 39340 Urban ..... 0.9500 

46120 ..... Kane County, Utah ......................................................................... 2620 Urban ..... 1.1845 99946 Rural ...... 0.8118 

46130 ..... Millard County, Utah ....................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46140 ..... Morgan County, Utah ...................................................................... 46 Rural ...... 0.8762 36260 Urban ..... 0.9029 

46150 ..... Piute County, Utah .......................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46160 ..... Rich County, Utah ........................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46170 ..... Salt Lake County, Utah ................................................................... 7160 Urban ..... 0.9340 41620 Urban ..... 0.9421 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3697 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

46180 ..... San Juan County, Utah .................................................................. 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46190 ..... Sanpete County, Utah .................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46200 ..... Sevier County, Utah ........................................................................ 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46210 ..... Summit County, Utah ...................................................................... 46 Rural ...... 0.8762 41620 Urban ..... 0.9421 

46220 ..... Tooele County, Utah ....................................................................... 46 Rural ...... 0.8762 41620 Urban ..... 0.9421 

46230 ..... Uintah County, Utah ....................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46240 ..... Utah County, Utah .......................................................................... 6520 Urban ..... 0.9500 39340 Urban ..... 0.9500 

46250 ..... Wasatch County, Utah .................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46260 ..... Washington County, Utah ............................................................... 46 Rural ...... 0.8762 41100 Urban ..... 0.9392 

46270 ..... Wayne County, Utah ....................................................................... 46 Rural ...... 0.8762 99946 Rural ...... 0.8118 

46280 ..... Weber County, Utah ....................................................................... 7160 Urban ..... 0.9340 36260 Urban ..... 0.9029 

47000 ..... Addison County, Vermont ............................................................... 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47010 ..... Bennington County, Vermont .......................................................... 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47020 ..... Caledonia County, Vermont ............................................................ 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47030 ..... Chittenden County, Vermont .......................................................... 1303 Urban ..... 0.9410 15540 Urban ..... 0.9410 

47040 ..... Essex County, Vermont .................................................................. 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47050 ..... Franklin County, Vermont ............................................................... 1303 Urban ..... 0.9410 15540 Urban ..... 0.9410 

47060 ..... Grand Isle County, Vermont ........................................................... 1303 Urban ..... 0.9410 15540 Urban ..... 0.9410 

47070 ..... Lamoille County, Vermont .............................................................. 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47080 ..... Orange County, Vermont ................................................................ 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47090 ..... Orleans County, Vermont ............................................................... 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47100 ..... Rutland County, Vermont ............................................................... 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47110 ..... Washington County, Vermont ......................................................... 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47120 ..... Windham County, Vermont ............................................................. 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

47130 ..... Windsor County, Vermont ............................................................... 47 Rural ...... 0.9830 99947 Rural ...... 0.9830 

48010 ..... St Croix County, Virgin Islands ....................................................... 48 Rural ...... 0.7615 99948 Rural ...... 0.7615 

48020 ..... St Thomas-John County, Virgin Islands ......................................... 48 Rural ...... 0.7615 99948 Rural ...... 0.7615 

49000 ..... Accomack County, Virginia ............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49010 ..... Albemarle County, Virginia ............................................................. 1540 Urban ..... 1.0187 16820 Urban ..... 1.0187 

49011 ..... Alexandria City County, Virginia ..................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49020 ..... Alleghany County, Virginia .............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49030 ..... Amelia County, Virginia .................................................................. 49 Rural ...... 0.8417 40060 Urban ..... 0.9328 

49040 ..... Amherst County, Virginia ................................................................ 4640 Urban ..... 0.8691 31340 Urban ..... 0.8691 

49050 ..... Appomattox County, Virginia .......................................................... 49 Rural ...... 0.8417 31340 Urban ..... 0.8691 

49060 ..... Arlington County, Virginia ............................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49070 ..... Augusta County, Virginia ................................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49080 ..... Bath County, Virginia ...................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49088 ..... Bedford City County, Virginia ......................................................... 4640 Urban ..... 0.8691 31340 Urban ..... 0.8691 

49090 ..... Bedford County, Virginia ................................................................. 4640 Urban ..... 0.8691 31340 Urban ..... 0.8691 

49100 ..... Bland County, Virginia .................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49110 ..... Botetourt County, Virginia ............................................................... 6800 Urban ..... 0.8387 40220 Urban ..... 0.8374 

49111 ..... Bristol City County, Virginia ............................................................ 3660 Urban ..... 0.8007 28700 Urban ..... 0.8054 

49120 ..... Brunswick County, Virginia ............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49130 ..... Buchanan County, Virginia ............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49140 ..... Buckingham County, Virginia .......................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49141 ..... Buena Vista City County, Virginia .................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49150 ..... Campbell County, Virginia .............................................................. 4640 Urban ..... 0.8691 31340 Urban ..... 0.8691 

49160 ..... Caroline County, Virginia ................................................................ 49 Rural ...... 0.8417 40060 Urban ..... 0.9328 

49170 ..... Carroll County, Virginia ................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49180 ..... Charles City County, Virginia .......................................................... 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49190 ..... Charlotte County, Virginia ............................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49191 ..... Charlottesville City County, Virginia ............................................... 1540 Urban ..... 1.0187 16820 Urban ..... 1.0187 

49194 ..... Chesapeake County, Virginia ......................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49200 ..... Chesterfield County, Virginia .......................................................... 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49210 ..... Clarke County, Virginia ................................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49211 ..... Clifton Forge City County, Virginia ................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49212 ..... Colonial Heights County, Virginia ................................................... 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49213 ..... Covington City County, Virginia ...................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49220 ..... Craig County, Virginia ..................................................................... 49 Rural ...... 0.8417 40220 Urban ..... 0.8374 

49230 ..... Culpeper County, Virginia ............................................................... 8840 Urban ..... 1.0976 99949 Rural ...... 0.8013 

49240 ..... Cumberland County, Virginia .......................................................... 49 Rural ...... 0.8417 40060 Urban ..... 0.9328 

49241 ..... Danville City County, Virginia ......................................................... 1950 Urban ..... 0.8489 19260 Urban ..... 0.8489 

49250 ..... Dickenson County, Virginia ............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49260 ..... Dinniddie County, Virginia .............................................................. 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49270 ..... Emporia County, Virginia ................................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49280 ..... Essex County, Virginia .................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49288 ..... Fairfax City County, Virginia ........................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49290 ..... Fairfax County, Virginia .................................................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49291 ..... Falls Church City County, Virginia .................................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49300 ..... Fauquier County, Virginia ............................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49310 ..... Floyd County, Virginia ..................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 


cchase on PROD1PC60 with PROPOSALS2
3698 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

49320 ..... Fluvanna County, Virginia ............................................................... 1540 Urban ..... 1.0187 16820 Urban ..... 1.0187 

49328 ..... Franklin City County, Virginia ......................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49330 ..... Franklin County, Virginia ................................................................. 49 Rural ...... 0.8417 40220 Urban ..... 0.8374 

49340 ..... Frederick County, Virginia .............................................................. 49 Rural ...... 0.8417 49020 Urban ..... 1.0214 

49342 ..... Fredericksburg City County, Virginia .............................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49343 ..... Galax City County, Virginia ............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49350 ..... Giles County, Virginia ..................................................................... 49 Rural ...... 0.8417 13980 Urban ..... 0.7954 

49360 ..... Gloucester County, Virginia ............................................................ 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49370 ..... Goochland County, Virginia ............................................................ 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49380 ..... Grayson County, Virginia ................................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49390 ..... Greene County, Virginia ................................................................. 1540 Urban ..... 1.0187 16820 Urban ..... 1.0187 

49400 ..... Greensville County, Virginia ........................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49410 ..... Halifax County, Virginia .................................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49411 ..... Hampton City County, Virginia ....................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49420 ..... Hanover County, Virginia ................................................................ 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49421 ..... Harrisonburg City County, Virginia ................................................. 49 Rural ...... 0.8417 25500 Urban ..... 0.9088 

49430 ..... Henrico County, Virginia ................................................................. 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49440 ..... Henry County, Virginia .................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49450 ..... Highland County, Virginia ............................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49451 ..... Hopewell City County, Virginia ....................................................... 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49460 ..... Isle Of Wight County, Virginia ........................................................ 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49470 ..... James City Co County, Virginia ...................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49480 ..... King And Queen County, Virginia ................................................... 49 Rural ...... 0.8417 40060 Urban ..... 0.9328 

49490 ..... King George County, Virginia ......................................................... 8840 Urban ..... 1.0976 99949 Rural ...... 0.8013 

49500 ..... King William County, Virginia ......................................................... 49 Rural ...... 0.8417 40060 Urban ..... 0.9328 

49510 ..... Lancaster County, Virginia .............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49520 ..... Lee County, Virginia ....................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49522 ..... Lexington County, Virginia .............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49530 ..... Loudoun County, Virginia ............................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49540 ..... Louisa County, Virginia ................................................................... 49 Rural ...... 0.8417 40060 Urban ..... 0.9328 

49550 ..... Lunenburg County, Virginia ............................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49551 ..... Lynchburg City County, Virginia ..................................................... 4640 Urban ..... 0.8691 31340 Urban ..... 0.8691 

49560 ..... Madison County, Virginia ................................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49561 ..... Martinsville City County, Virginia .................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49563 ..... Manassas City County, Virginia ...................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49565 ..... Manassas Park City County, Virginia ............................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49570 ..... Mathews County, Virginia ............................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49580 ..... Mecklenburg County, Virginia ......................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49590 ..... Middlesex County, Virginia ............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49600 ..... Montgomery County, Virginia ......................................................... 49 Rural ...... 0.8417 13980 Urban ..... 0.7954 

49610 ..... Nansemond County, Virginia .......................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49620 ..... Nelson County, Virginia .................................................................. 49 Rural ...... 0.8417 16820 Urban ..... 1.0187 

49621 ..... New Kent County, Virginia .............................................................. 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49622 ..... Newport News City County, Virginia .............................................. 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49641 ..... Norfolk City County, Virginia ........................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49650 ..... Northampton County, Virginia ......................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49660 ..... Northumberland County, Virginia .................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49661 ..... Norton City County, Virginia ........................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49670 ..... Nottoway County, Virginia .............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49680 ..... Orange County, Virginia ................................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49690 ..... Page County, Virginia ..................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49700 ..... Patrick County, Virginia .................................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49701 ..... Petersburg City County, Virginia .................................................... 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49710 ..... Pittsylvania County, Virginia ........................................................... 1950 Urban ..... 0.8489 19260 Urban ..... 0.8489 

49711 ..... Portsmouth City County, Virginia .................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49712 ..... Poquoson City County, Virginia ...................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49720 ..... Powhatan County, Virginia ............................................................. 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49730 ..... Prince Edward County, Virginia ...................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49740 ..... Prince George County, Virginia ...................................................... 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49750 ..... Prince William County, Virginia ...................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49770 ..... Pulaski County, Virginia .................................................................. 49 Rural ...... 0.8417 13980 Urban ..... 0.7954 

49771 ..... Radford City County, Virginia ......................................................... 49 Rural ...... 0.8417 13980 Urban ..... 0.7954 

49780 ..... Rappahannock County, Virginia ..................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49790 ..... Richmond County, Virginia ............................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49791 ..... Richmond City County, Virginia ...................................................... 6760 Urban ..... 0.9328 40060 Urban ..... 0.9328 

49800 ..... Roanoke County, Virginia ............................................................... 6800 Urban ..... 0.8387 40220 Urban ..... 0.8374 

49801 ..... Roanoke City County, Virginia ........................................................ 6800 Urban ..... 0.8387 40220 Urban ..... 0.8374 

49810 ..... Rockbridge County, Virginia ........................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49820 ..... Rockingham County, Virginia ......................................................... 49 Rural ...... 0.8417 25500 Urban ..... 0.9088 

49830 ..... Russell County, Virginia .................................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49838 ..... Salem County, Virginia ................................................................... 6800 Urban ..... 0.8387 40220 Urban ..... 0.8374 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3699 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

49840 ..... Scott County, Virginia ..................................................................... 3660 Urban ..... 0.8007 28700 Urban ..... 0.8054 

49850 ..... Shenandoah County, Virginia ......................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49860 ..... Smyth County, Virginia ................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49867 ..... South Boston City County, Virginia ................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49870 ..... Southampton County, Virginia ........................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49880 ..... Spotsylvania County, Virginia ......................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49890 ..... Stafford County, Virginia ................................................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49891 ..... Staunton City County, Virginia ........................................................ 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49892 ..... Suffolk City County, Virginia ........................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49900 ..... Surry County, Virginia ..................................................................... 49 Rural ...... 0.8417 47260 Urban ..... 0.8799 

49910 ..... Sussex County, Virginia .................................................................. 49 Rural ...... 0.8417 40060 Urban ..... 0.9328 

49920 ..... Tazewell County, Virginia ............................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49921 ..... Virginia Beach City County, Virginia ............................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49930 ..... Warren County, Virginia .................................................................. 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

49950 ..... Washington County, Virginia .......................................................... 3660 Urban ..... 0.8007 28700 Urban ..... 0.8054 

49951 ..... Waynesboro City County, Virginia .................................................. 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49960 ..... Westmoreland County, Virginia ...................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49961 ..... Williamsburg City County, Virginia ................................................. 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

49962 ..... Winchester City County, Virginia .................................................... 49 Rural ...... 0.8417 49020 Urban ..... 1.0214 

49970 ..... Wise County, Virginia ..................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49980 ..... Wythe County, Virginia ................................................................... 49 Rural ...... 0.8417 99949 Rural ...... 0.8013 

49981 ..... York County, Virginia ...................................................................... 5720 Urban ..... 0.8799 47260 Urban ..... 0.8799 

50000 ..... Adams County, Washington ........................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50010 ..... Asotin County, Washington ............................................................ 50 Rural ...... 1.0217 30300 Urban ..... 0.9886 

50020 ..... Benton County, Washington ........................................................... 6740 Urban ..... 1.0619 28420 Urban ..... 1.0619 

50030 ..... Chelan County, Washington ........................................................... 50 Rural ...... 1.0217 48300 Urban ..... 1.0070 

50040 ..... Clallam County, Washington .......................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50050 ..... Clark County, Washington .............................................................. 6440 Urban ..... 1.1266 38900 Urban ..... 1.1266 

50060 ..... Columbia County, Washington ....................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50070 ..... Cowlitz County, Washington ........................................................... 50 Rural ...... 1.0217 31020 Urban ..... 0.9579 

50080 ..... Douglas County, Washington ......................................................... 50 Rural ...... 1.0217 48300 Urban ..... 1.0070 

50090 ..... Ferry County, Washington .............................................................. 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50100 ..... Franklin County, Washington .......................................................... 6740 Urban ..... 1.0619 28420 Urban ..... 1.0619 

50110 ..... Garfield County, Washington .......................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50120 ..... Grant County, Washington ............................................................. 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50130 ..... Grays Harbor County, Washington ................................................. 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50140 ..... Island County, Washington ............................................................. 7600 Urban ..... 1.1567 99950 Rural ...... 1.0510 

50150 ..... Jefferson County, Washington ........................................................ 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50160 ..... King County, Washington ............................................................... 7600 Urban ..... 1.1567 42644 Urban ..... 1.1577 

50170 ..... Kitsap County, Washington ............................................................ 1150 Urban ..... 1.0675 14740 Urban ..... 1.0675 

50180 ..... Kittitas County, Washington ............................................................ 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50190 ..... Klickitat County, Washington .......................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50200 ..... Lewis County, Washington ............................................................. 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50210 ..... Lincoln County, Washington ........................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50220 ..... Mason County, Washington ............................................................ 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50230 ..... Okanogan County, Washington ...................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50240 ..... Pacific County, Washington ............................................................ 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50250 ..... Pend Oreille County, Washington .................................................. 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50260 ..... Pierce County, Washington ............................................................ 8200 Urban ..... 1.0742 45104 Urban ..... 1.0742 

50270 ..... San Juan County, Washington ....................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50280 ..... Skagit County, Washington ............................................................ 50 Rural ...... 1.0217 34580 Urban ..... 1.0454 

50290 ..... Skamania County, Washington ...................................................... 50 Rural ...... 1.0217 38900 Urban ..... 1.1266 

50300 ..... Snohomish County, Washington .................................................... 7600 Urban ..... 1.1567 42644 Urban ..... 1.1577 

50310 ..... Spokane County, Washington ........................................................ 7840 Urban ..... 1.0905 44060 Urban ..... 1.0905 

50320 ..... Stevens County, Washington ......................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50330 ..... Thurston County, Washington ........................................................ 5910 Urban ..... 1.0927 36500 Urban ..... 1.0927 

50340 ..... Wahkiakum County, Washington .................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50350 ..... Walla Walla County, Washington ................................................... 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50360 ..... Whatcom County, Washington ....................................................... 0860 Urban ..... 1.1731 13380 Urban ..... 1.1731 

50370 ..... Whitman County, Washington ........................................................ 50 Rural ...... 1.0217 99950 Rural ...... 1.0510 

50380 ..... Yakima County, Washington .......................................................... 9260 Urban ..... 1.0155 49420 Urban ..... 1.0155 

51000 ..... Barbour County, W Virginia ............................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51010 ..... Berkeley County, W Virginia ........................................................... 8840 Urban ..... 1.0976 25180 Urban ..... 0.9489 

51020 ..... Boone County, W Virginia .............................................................. 51 Rural ...... 0.7900 16620 Urban ..... 0.8445 

51030 ..... Braxton County, W Virginia ............................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51040 ..... Brooke County, W Virginia ............................................................. 8080 Urban ..... 0.7819 48260 Urban ..... 0.7819 

51050 ..... Cabell County, W Virginia ............................................................... 3400 Urban ..... 0.9477 26580 Urban ..... 0.9477 

51060 ..... Calhoun County, W Virginia ........................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51070 ..... Clay County, W Virginia .................................................................. 51 Rural ...... 0.7900 16620 Urban ..... 0.8445 

51080 ..... Doddridge County, W Virginia ........................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51090 ..... Fayette County, W Virginia ............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 


cchase on PROD1PC60 with PROPOSALS2
3700 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

51100 ..... Gilmer County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51110 ..... Grant County, W Virginia ................................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51120 ..... Greenbrier County, W Virginia ........................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51130 ..... Hampshire County, W Virginia ....................................................... 51 Rural ...... 0.7900 49020 Urban ..... 1.0214 

51140 ..... Hancock County, W Virginia ........................................................... 8080 Urban ..... 0.7819 48260 Urban ..... 0.7819 

51150 ..... Hardy County, W Virginia ............................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51160 ..... Harrison County, W Virginia ........................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51170 ..... Jackson County, W Virginia ............................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51180 ..... Jefferson County, W Virginia .......................................................... 8840 Urban ..... 1.0976 47894 Urban ..... 1.0926 

51190 ..... Kanawha County, W Virginia .......................................................... 1480 Urban ..... 0.8445 16620 Urban ..... 0.8445 

51200 ..... Lewis County, W Virginia ................................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51210 ..... Lincoln County, W Virginia ............................................................. 51 Rural ...... 0.7900 16620 Urban ..... 0.8445 

51220 ..... Logan County, W Virginia ............................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51230 ..... Mc Dowell County, W Virginia ........................................................ 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51240 ..... Marion County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51250 ..... Marshall County, W Virginia ........................................................... 9000 Urban ..... 0.7161 48540 Urban ..... 0.7161 

51260 ..... Mason County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51270 ..... Mercer County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51280 ..... Mineral County, W Virginia ............................................................. 1900 Urban ..... 0.9317 19060 Urban ..... 0.9317 

51290 ..... Mingo County, W Virginia ............................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51300 ..... Monongalia County, W Virginia ...................................................... 51 Rural ...... 0.7900 34060 Urban ..... 0.8420 

51310 ..... Monroe County, W Virginia ............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51320 ..... Morgan County, W Virginia ............................................................. 51 Rural ...... 0.7900 25180 Urban ..... 0.9489 

51330 ..... Nicholas County, W Virginia ........................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51340 ..... Ohio County, W Virginia ................................................................. 9000 Urban ..... 0.7161 48540 Urban ..... 0.7161 

51350 ..... Pendleton County, W Virginia ......................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51360 ..... Pleasants County, W Virginia ......................................................... 51 Rural ...... 0.7900 37620 Urban ..... 0.8270 

51370 ..... Pocahontas County, W Virginia ...................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51380 ..... Preston County, W Virginia ............................................................ 51 Rural ...... 0.7900 34060 Urban ..... 0.8420 

51390 ..... Putnam County, W Virginia ............................................................ 1480 Urban ..... 0.8445 16620 Urban ..... 0.8445 

51400 ..... Raleigh County, W Virginia ............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51410 ..... Randolph County, W Virginia ......................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51420 ..... Ritchie County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51430 ..... Roane County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51440 ..... Summers County, W Virginia ......................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51450 ..... Taylor County, W Virginia ............................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51460 ..... Tucker County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51470 ..... Tyler County, W Virginia ................................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51480 ..... Upshur County, W Virginia ............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51490 ..... Wayne County, W Virginia .............................................................. 3400 Urban ..... 0.9477 26580 Urban ..... 0.9477 

51500 ..... Webster County, W Virginia ........................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51510 ..... Wetzel County, W Virginia .............................................................. 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

51520 ..... Wirt County, W Virginia .................................................................. 51 Rural ...... 0.7900 37620 Urban ..... 0.8270 

51530 ..... Wood County, W Virginia ............................................................... 6020 Urban ..... 0.8270 37620 Urban ..... 0.8270 

51540 ..... Wyoming County, W Virginia .......................................................... 51 Rural ...... 0.7900 99951 Rural ...... 0.7717 

52000 ..... Adams County, Wisconsin .............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52010 ..... Ashland County, Wisconsin ............................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52020 ..... Barron County, Wisconsin .............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52030 ..... Bayfield County, Wisconsin ............................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52040 ..... Brown County, Wisconsin ............................................................... 3080 Urban ..... 0.9483 24580 Urban ..... 0.9483 

52050 ..... Buffalo County, Wisconsin .............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52060 ..... Burnett County, Wisconsin ............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52070 ..... Calumet County, Wisconsin ............................................................ 0460 Urban ..... 0.9239 11540 Urban ..... 0.9288 

52080 ..... Chippewa County, Wisconsin ......................................................... 2290 Urban ..... 0.9201 20740 Urban ..... 0.9201 

52090 ..... Clark County, Wisconsin ................................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52100 ..... Columbia County, Wisconsin .......................................................... 52 Rural ...... 0.9478 31540 Urban ..... 1.0659 

52110 ..... Crawford County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52120 ..... Dane County, Wisconsin ................................................................ 4720 Urban ..... 1.0754 31540 Urban ..... 1.0659 

52130 ..... Dodge County, Wisconsin .............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52140 ..... Door County, Wisconsin ................................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52150 ..... Douglas County, Wisconsin ............................................................ 2240 Urban ..... 1.0213 20260 Urban ..... 1.0213 

52160 ..... Dunn County, Wisconsin ................................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52170 ..... Eau Claire County, Wisconsin ........................................................ 2290 Urban ..... 0.9201 20740 Urban ..... 0.9201 

52180 ..... Florence County, Wisconsin ........................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52190 ..... Fond Du Lac County, Wisconsin .................................................... 52 Rural ...... 0.9478 22540 Urban ..... 0.9640 

52200 ..... Forest County, Wisconsin ............................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52210 ..... Grant County, Wisconsin ................................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52220 ..... Green County, Wisconsin ............................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52230 ..... Green Lake County, Wisconsin ...................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52240 ..... Iowa County, Wisconsin ................................................................. 52 Rural ...... 0.9478 31540 Urban ..... 1.0659 

52250 ..... Iron County, Wisconsin ................................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3701 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

52260 ..... Jackson County, Wisconsin ............................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52270 ..... Jefferson County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52280 ..... Juneau County, Wisconsin ............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52290 ..... Kenosha County, Wisconsin ........................................................... 3800 Urban ..... 0.9760 29404 Urban ..... 1.0429 

52300 ..... Kewaunee County, Wisconsin ........................................................ 52 Rural ...... 0.9478 24580 Urban ..... 0.9483 

52310 ..... La Crosse County, Wisconsin ........................................................ 3870 Urban ..... 0.9564 29100 Urban ..... 0.9564 

52320 ..... Lafayette County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52330 ..... Langlade County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52340 ..... Lincoln County, Wisconsin .............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52350 ..... Manitowoc County, Wisconsin ........................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52360 ..... Marathon County, Wisconsin .......................................................... 8940 Urban ..... 0.9590 48140 Urban ..... 0.9590 

52370 ..... Marinette County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52380 ..... Marquette County, Wisconsin ......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52381 ..... Menominee County, Wisconsin ...................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52390 ..... Milwaukee County, Wisconsin ........................................................ 5080 Urban ..... 1.0146 33340 Urban ..... 1.0146 

52400 ..... Monroe County, Wisconsin ............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52410 ..... Oconto County, Wisconsin ............................................................. 52 Rural ...... 0.9478 24580 Urban ..... 0.9483 

52420 ..... Oneida County, Wisconsin ............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52430 ..... Outagamie County, Wisconsin ....................................................... 0460 Urban ..... 0.9239 11540 Urban ..... 0.9288 

52440 ..... Ozaukee County, Wisconsin ........................................................... 5080 Urban ..... 1.0146 33340 Urban ..... 1.0146 

52450 ..... Pepin County, Wisconsin ................................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52460 ..... Pierce County, Wisconsin ............................................................... 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

52470 ..... Polk County, Wisconsin .................................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52480 ..... Portage County, Wisconsin ............................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52490 ..... Price County, Wisconsin ................................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52500 ..... Racine County, Wisconsin .............................................................. 6600 Urban ..... 0.8997 39540 Urban ..... 0.8997 

52510 ..... Richland County, Wisconsin ........................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52520 ..... Rock County, Wisconsin ................................................................. 3620 Urban ..... 0.9538 27500 Urban ..... 0.9538 

52530 ..... Rusk County, Wisconsin ................................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52540 ..... St Croix County, Wisconsin ............................................................ 5120 Urban ..... 1.1075 33460 Urban ..... 1.1075 

52550 ..... Sauk County, Wisconsin ................................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52560 ..... Sawyer County, Wisconsin ............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52570 ..... Shawano County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52580 ..... Sheboygan County, Wisconsin ....................................................... 7620 Urban ..... 0.8911 43100 Urban ..... 0.8911 

52590 ..... Taylor County, Wisconsin ............................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52600 ..... Trempealeau County, Wisconsin .................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52610 ..... Vernon County, Wisconsin ............................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52620 ..... Vilas County, Wisconsin ................................................................. 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52630 ..... Walworth County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52640 ..... Washburn County, Wisconsin ......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52650 ..... Washington County, Wisconsin ...................................................... 5080 Urban ..... 1.0146 33340 Urban ..... 1.0146 

52660 ..... Waukesha County, Wisconsin ........................................................ 5080 Urban ..... 1.0146 33340 Urban ..... 1.0146 

52670 ..... Waupaca County, Wisconsin .......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52680 ..... Waushara County, Wisconsin ......................................................... 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

52690 ..... Winnebago County, Wisconsin ....................................................... 0460 Urban ..... 0.9239 36780 Urban ..... 0.9183 

52700 ..... Wood County, Wisconsin ................................................................ 52 Rural ...... 0.9478 99952 Rural ...... 0.9509 

53000 ..... Albany County, Wyoming ............................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53010 ..... Big Horn County, Wyoming ............................................................ 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53020 ..... Campbell County, Wyoming ........................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53030 ..... Carbon County, Wyoming ............................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53040 ..... Converse County, Wyoming ........................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53050 ..... Crook County, Wyoming ................................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53060 ..... Fremont County, Wyoming ............................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53070 ..... Goshen County, Wyoming .............................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53080 ..... Hot Springs County, Wyoming ....................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53090 ..... Johnson County, Wyoming ............................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53100 ..... Laramie County, Wyoming ............................................................. 1580 Urban ..... 0.8775 16940 Urban ..... 0.8775 

53110 ..... Lincoln County, Wyoming ............................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53120 ..... Natrona County, Wyoming .............................................................. 1350 Urban ..... 0.9026 16220 Urban ..... 0.9026 

53130 ..... Niobrara County, Wyoming ............................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53140 ..... Park County, Wyoming ................................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53150 ..... Platte County, Wyoming ................................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53160 ..... Sheridan County, Wyoming ............................................................ 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53170 ..... Sublette County, Wyoming ............................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53180 ..... Sweetwater County, Wyoming ........................................................ 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53190 ..... Teton County, Wyoming ................................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53200 ..... Uinta County, Wyoming .................................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53210 ..... Washakie County, Wyoming ........................................................... 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

53220 ..... Weston County, Wyoming .............................................................. 53 Rural ...... 0.9257 99953 Rural ...... 0.9257 

65010 ..... Agana County, Guam ..................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65020 ..... Agana Heights County, Guam ........................................................ 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 


cchase on PROD1PC60 with PROPOSALS2
3702 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

SSA 

State/ 

County 

Code 

County name 

MSA 

Number 

MSA 

Urban/ 

Rural 

2006 

MSAbased 

WI 

CBSA 

Number 

CBSA 

Urban/ 

Rural 

2006 

CBSAbased WI 

65030 ..... Agat County, Guam ........................................................................ 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65040 ..... Asan County, Guam ....................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65050 ..... Barrigada County, Guam ................................................................ 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65060 ..... Chalan Pago County, Guam ........................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65070 ..... Dededo County, Guam ................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65080 ..... Inarajan County, Guam ................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65090 ..... Maite County, Guam ....................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65100 ..... Mangilao County, Guam ................................................................. 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65110 ..... Merizo County, Guam ..................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65120 ..... Mongmong County, Guam .............................................................. 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65130 ..... Ordot County, Guam ....................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65140 ..... Piti County, Guam ........................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65150 ..... Santa Rita County, Guam ............................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65160 ..... Sinajana County, Guam .................................................................. 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65170 ..... Talofofo County, Guam ................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65180 ..... Tamuning County, Guam ................................................................ 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65190 ..... Toto County, Guam ........................................................................ 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65200 ..... Umatac County, Guam ................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65210 ..... Yigo County, Guam ........................................................................ 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

65220 ..... Yona County, Guam ....................................................................... 65 Rural ...... 0.9611 99965 Rural ...... 0.9611 

*Transition wage index value should be used with the CBSA urban/rural designation for rate calculation purposes. 

1At this time, there are no hospitals located in these CBSA-based urban areas on which to base a wage index. Therefore, the transition wage 

index value is based on the average transition wage index for all urban areas within the state. 


cchase on PROD1PC60 with PROPOSALS2
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3703 

Addendum C—Wage Index Tables 

In this addendum, we provide the 

tables referred to throughout the 

preamble to this proposed rule. Tables 

1 and 2 below provide the proposed 

CBSA-based wage index values for 

urban and rural providers. 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.000</GPH>
3704 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.001</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3705 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.002</GPH>
3706 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.003</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3707 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.004</GPH>
3708 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.005</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3709 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.006</GPH>
3710 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.007</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3711 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.008</GPH>
3712 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.009</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3713 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.010</GPH>
3714 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.011</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3715 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.012</GPH>
3716 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.013</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3717 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.014</GPH>
3718 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.015</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3719 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.016</GPH>
3720 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.017</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3721 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.018</GPH>
3722 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.019</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3723 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.020</GPH>
3724 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.021</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3725 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.022</GPH>
3726 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.023</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3727 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.024</GPH>
3728 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.025</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3729 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.026</GPH>
3730 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.027</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3731 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.028</GPH>
3732 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.029</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3733 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.030</GPH>
3734 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.031</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3735 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.032</GPH>
3736 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.033</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3737 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.034</GPH>
3738 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.035</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3739 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.036</GPH>
3740 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.037</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3741 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.038</GPH>
3742 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.039</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3743 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.040</GPH>
3744 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.041</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3745 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.042</GPH>
3746 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.043</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3747 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.044</GPH>
3748 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.045</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3749 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.046</GPH>
3750 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.047</GPH>
Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 3751 


cchase on PROD1PC60 with PROPOSALS2EP23JA06.048</GPH>
3752 Federal Register / Vol. 71, No. 14 / Monday, January 23, 2006 / Proposed Rules 

TABLE 2.—PROPOSED WAGE INDEX

BASED ON CBSA LABOR MARKET

AREAS FOR RURAL AREAS

CBSA 

Code Nonurban Area Wage Index 

01 ....... Alabama ........................... 0.7446 

02 ....... Alaska ............................... 1.1977 

03 ....... Arizona ............................. 0.8768 

04 ....... Arkansas ........................... 0.7466 

05 ....... California .......................... 1.1054 

06 ....... Colorado ........................... 0.9380 

07 ....... Connecticut ....................... 1.1730 

08 ....... Delaware .......................... 0.9579 

10 ....... Florida ............................... 0.8568 

11 ....... Georgia ............................. 0.7662 

12 ....... Hawaii ............................... 1.0551 

13 ....... Idaho ................................. 0.8037 

14 ....... Illinois ................................ 0.8271 

15 ....... Indiana .............................. 0.8624 

16 ....... Iowa .................................. 0.8509 

17 ....... Kansas .............................. 0.8035 

18 ....... Kentucky ........................... 0.7766 

19 ....... Louisiana .......................... 0.7411 

20 ....... Maine ................................ 0.8843 

21 ....... Maryland ........................... 0.9353 

22 ....... Massachusetts .................. 1.0216 

23 ....... Michigan ........................... 0.8895 

TABLE 2.—PROPOSED WAGE INDEX

BASED ON CBSA LABOR MARKET

AREAS FOR RURAL AREAS—Continued 

CBSA 

Code Nonurban Area Wage Index 

24 ....... Minnesota ......................... 0.9132 

25 ....... Mississippi ........................ 0.7674 

26 ....... Missouri ............................ 0.7900 

27 ....... Montana ............................ 0.8762 

28 ....... Nebraska .......................... 0.8657 

29 ....... Nevada ............................. 0.9065 

30 ....... New Hampshire ................ 1.0817 

31 ....... New Jersey1.

32 ....... New Mexico ...................... 0.8635 

33 ....... New York .......................... 0.8154 

34 ....... North Carolina .................. 0.8540 

35 ....... North Dakota .................... 0.7261 

36 ....... Ohio .................................. 0.8826 

37 ....... Oklahoma ......................... 0.7581 

38 ....... Oregon .............................. 0.9826 

39 ....... Pennsylvania .................... 0.8291 

40 ....... Puerto Rico1 ..................... 0.4047 

41 ....... Rhode Island1.

42 ....... South Carolina .................. 0.8638 

43 ....... South Dakota .................... 0.8560 

44 ....... Tennessee ........................ 0.7895 

TABLE 2.—PROPOSED WAGE INDEX

BASED ON CBSA LABOR MARKET

AREAS FOR RURAL AREAS—Continued 

CBSA 

Code Nonurban Area Wage Index 

45 ....... Texas ................................ 0.8003 

46 ....... Utah .................................. 0.8118 

47 ....... Vermont ............................ 0.9830 

48 ....... Virgin Islands .................... 0.7615 

49 ....... Virginia .............................. 0.8013 

50 ....... Washington ....................... 1.0510 

51 ....... West Virginia .................... 0.7717 

52 ....... Wisconsin ......................... 0.9509 

53 ....... Wyoming ........................... 0.9257 

65 ....... Guam ................................ 0.9611 

1All counties within the State are classified 

as urban, with the exception of Massachusetts 

and Puerto Rico. Massachusetts and Puerto 

Rico have areas designated as rural, however, 

no short-term, acute care hospitals are located 

in the area(s) for FY 2006. Because more recent data is not available for those areas, we 

are using last year’s wage index value. 

[FR Doc. 06–488 Filed 1–13–06; 4:01 pm] 

BILLING CODE 4120–01–P 


cchase on PROD1PC60 with PROPOSALS2