62124 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Part 484 

[CMS–1265–F] 

RIN 0938–AM93 

Medicare Program; Home Health 

Prospective Payment System Rate 

Update for Calendar Year 2005

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Final rule.

SUMMARY: This final rule sets forth an 

update to the 60-day national episode 

rates and the national per-visit amounts 

under the Medicare prospective 

payment system for home health 

agencies. As part of this final rule, we 

are also rebasing and revising the home 

health market basket to ensure it 

continues to adequately reflect the price 

changes of efficiently providing home 

health services. In addition, we are 

revising the fixed dollar loss ratio, 

which is used in the calculation of 

outlier payments. This final rule will be 

the first update of the home health 

prospective payment system (HH PPS) 

rates on a calendar year update cycle. 

HH PPS was moved to a calendar year 

update cycle as a result of the 

provisions of the Medicare Prescription 

Drug, Improvement, and Modernization 

Act of 2003.

EFFECTIVE DATE: These regulations are 

effective on January 1, 2005.

FOR FURTHER INFORMATION CONTACT:

Randy Throndset, (410) 786–0131. 

Debra Gillespie, (410) 786–4631. Mary 

Lee Seifert (Market Basket), (410) 786–

0030. Mollie Knight (Market Basket), 

(410) 786–7948.

SUPPLEMENTARY INFORMATION: 

Copies: To order copies of the Federal 

Register containing this document, send 

your request to: New Orders, 

Superintendent of Documents, P.O. Box 

371954, Pittsburgh, PA 15250–7954. 

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online database through GPO access, a 

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Office. The Web site address is http://

www.gpoaccess.gov/fr/index.html.

I. Background 

A. Statutory Background 

The Balanced Budget Act of 1997 

(BBA), (Pub. L. 105–33), enacted on 

August 5, 1997, significantly changed 

the way Medicare pays for Medicare 

home health services. Until the 

implementation of a home health 

prospective payment system (HH PPS) 

on October 1, 2000, home health 

agencies (HHAs) received payment 

under a cost-based reimbursement 

system. Section 4603 of the BBA 

governed the development of the HH 

PPS. 

Section 4603(a) of the BBA provides 

the authority for the development of a 

PPS for all Medicare-covered home 

health services provided under a plan of 

care that were paid on a reasonable cost 

basis by adding section 1895, entitled 

‘‘Prospective Payment For Home Health 

Services,’’ to the Social Security Act 

(the Act). 

Section 1895(b)(1) of the Act requires 

the Secretary to establish a PPS for all 

costs of home health services paid 

under Medicare. 

Section 1895(b)(3)(A) of the Act 

requires that (1) the computation of a 

standard prospective payment amount 

include all costs of home health services 

covered and paid for on a reasonable 

cost basis and be initially based on the 

most recent audited cost report data 

available to the Secretary, and (2) the 

prospective payment amounts be 

standardized to eliminate the effects of 

case-mix and wage levels among HHAs. 

Section 1895(b)(3)(B) of the Act 

addresses the annual update to the 

standard prospective payment amounts 

by the home health applicable increase 

percentage as specified in the statute. 

Section 1895(b)(4) of the Act governs 

the payment computation. Sections 

1895(b)(4)(A)(i) and (b)(4)(A)(ii) of the 

Act require the standard prospective 

payment amount to be adjusted for casemix and geographic differences in wage 

levels. Section 1895(b)(4)(B) of the Act 

requires the establishment of an 

appropriate case-mix adjustment factor 

that explains a significant amount of the 

variation in cost among different units 

of services. Similarly, section 

1895(b)(4)(C) of the Act requires the 

establishment of wage adjustment 

factors that reflect the relative level of 

wages and wage-related costs applicable 

to the furnishing of home health 

services in a geographic area compared 

to the national average applicable level. 

These wage-adjustment factors may be 

the factors used by the Secretary for the 

different area wage levels for purposes 

of section 1886(d)(3)(E) of the Act.

Section 1895(b)(5) of the Act gives the 

Secretary the option to grant additions 

or adjustments to the payment amount 

otherwise made in the case of outliers 

because of unusual variations in the 

type or amount of medically necessary 

care. Total outlier payments in a given 

fiscal year cannot exceed 5 percent of 

total payments projected or estimated. 

B. Updates 

On July 3, 2000, we published a final 

rule (65 FR 41128) in the Federal 

Register to implement the HH PPS 

legislation. That final rule established 

requirements for the new PPS for HHAs 

as required by section 4603 of the BBA, 

and as subsequently amended by 

section 5101 of the Omnibus 

Consolidated and Emergency 

Supplemental Appropriations Act 

(OCESAA) for Fiscal Year 1999, (Pub. L. 

105–277), enacted on October 21, 1998; 

and by sections 302, 305, and 306 of the 

Medicare, Medicaid, and SCHIP 

Balanced Budget Refinement Act 

(BBRA) of 1999, (Pub. L. 106–113), 

enacted on November 29, 1999. The 

requirements include the 

implementation of a PPS for HHAs, 

consolidated billing requirements, and a 

number of other related changes. The 

PPS described in that rule replaced the 

retrospective reasonable-cost-based 

system that was used by Medicare for 

the payment of home health services 

under Part A and Part B. 

As required by section 1895(b)(3)(B) 

of the Act, we have historically updated 

the HH PPS rates annually in a separate 

Federal Register document. 

C. System for Payment of Home Health 

Services 

Generally, Medicare makes payment 

under the HH PPS on the basis of a 

national standardized 60-day episode 

payment, adjusted for case mix and 

wage index. For episodes with four or 

fewer visits, Medicare pays on the basis 

of a national per-visit amount by 

discipline, referred to as a low 

utilization payment adjustment (LUPA). 

Medicare also adjusts the 60-day 

episode payment for certain intervening 

events that give rise to a partial episode 

payment adjustment (PEP adjustment) 

or a significant change in condition 

adjustment (SCIC). For certain cases that 

exceed a specific cost threshold, an 

outlier adjustment may also be 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62125

available. For a complete and full 

description of the HH PPS as required 

by the BBA and as amended by 

OCESAA and BBRA, see the July 3, 

2000 HH PPS final rule (65 FR 41128). 

D. Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 

On December 8, 2003, the Congress 

enacted the Medicare Prescription Drug, 

Improvement, and Modernization Act 

(MMA) of 2003 (Pub. L. 108–173). This 

new legislation affects our update to HH 

payment rates. Specifically, section 421 

of MMA requires, for home health 

services furnished in a rural area (as 

defined in section 1886(d)(2)(D) of the 

Act), with respect to episodes or visits 

ending on or after April 1, 2004 and 

before April 1, 2005, that the Secretary 

increase the payment amount that 

otherwise would have been made under 

section 1895 of the Act for the services 

by 5 percent. 

The statute waives budget neutrality 

for the purposes of this increase as it 

specifically states that the Secretary will 

not reduce the standard prospective 

payment amount (or amounts) under 

section 1895 of the Act applicable to 

home health services furnished during a 

period to offset the increase in payments 

resulting in the application of this 

section of the statute. 

Section 701 of the MMA changes the 

yearly update cycle of the HH PPS rates 

from that of a fiscal year to a calendar 

year update cycle for 2004 and any 

subsequent year. Generally, section 

701(a) of the MMA changes the 

references in the statute to refer to the 

calendar year for 2004 and any 

subsequent year. The changes result in 

updates to the HH PPS rates described 

as ‘‘fiscal year’’ updates for 2002 and 

2003 and as calendar ‘‘year’’ updates for 

2004 and any subsequent year (section 

1895(b)(3)(B)(i) of the Act). In light of 

these provisions, we will not be 

updating the HH PPS rates on October 

1, 2004 as HH PPS will now be updated 

on a calendar year update cycle.

In addition to changing the update 

cycle for HH PPS rates, section 701 of 

the MMA makes adjustments to the 

home health applicable increase 

percentage for 2004, 2005, and 2006. 

Specifically, section 701(a)(2)(D) of the 

MMA leaves unchanged the home 

health market basket increase for the 

last calendar year quarter of 2003 and 

the first calendar year quarter of 2004 

(section 1895(b)(3)(B)(ii)(II) of the Act). 

Furthermore, section 701(b)(4) of the 

MMA sets the home health applicable 

percentage increase for the last 3 

quarters of 2004 as the home health 

market basket (3.1 percent) minus 0.8 

percentage points (section 

1895(b)(3)(B)(ii)(III) of the Act). We 

implemented this provision through 

Pub. 100–20, One Time Notification, 

Transmittal 59, issued February 20, 

2004. Section 701(b)(4) of the MMA also 

provides that updates for CY 2005 and 

CY 2006 will equal the applicable home 

health market basket percentage 

increase minus 0.8 percentage points. 

Lastly, section 701(b)(3) of the MMA 

revises the statute to provide that HH 

PPS rates for CY 2007 and any 

subsequent year will be updated by that 

year’s home health market basket 

percentage increase (section 

1895(b)(3)(B)(ii)(IV) of the Act). 

E. Requirements for Issuance of 

Regulations 

Section 902 of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA) 

amended section 1871(a) of the Act and 

requires the Secretary, in consultation 

with the Director of the Office of 

Management and Budget, to establish 

and publish timelines for the 

publication of Medicare final 

regulations based on the previous 

publication of a Medicare proposed or 

interim final regulation. Section 902 of 

the MMA also states that the timelines 

for these regulations may vary but shall 

not exceed 3 years after publication of 

the preceding proposed or interim final 

regulation except under exceptional 

circumstances. 

This final rule finalizes provisions set 

forth in proposed rule published in the 

Federal Register (69 FR 31248) on June 

2, 2004. In addition, this final rule has 

been published within the 3-year time 

limit imposed by section 902 of the 

MMA. Therefore, we believe that the 

final rule is in accordance with the 

Congress’ intent to ensure timely 

publication of final regulations. 

II. Provisions of the Proposed 

Regulations 

On June 2, 2004, we published a 

proposed rule in the Federal Register

(69 FR 31248), proposing to update the 

60-day national episode rates and the 

national per-visit amounts under the 

Medicare prospective payment system 

for home health agencies. We also 

proposed to rebase and revise the home 

health market basket to ensure it 

continues to adequately reflect the price 

changes of efficiently providing home 

health services. We also proposed to 

revise the fixed dollar loss ratio, which 

is used in the calculation of outlier 

payments. 

A. National Standardized 60-Day 

Episode Rate 

Medicare HH PPS has been effective 

since October 1, 2000. As set forth in the 

final rule published July 3, 2000 in the 

Federal Register (65 FR 41128), the unit 

of payment under Medicare HH PPS is 

a national standardized 60-day episode 

rate. As set forth in 42 CFR 484.220, we 

adjust the national standardized 60-day 

episode rate by a case mix grouping and 

a wage index value based on the site of 

service for the beneficiary. The 

proposed CY 2005 HH PPS rates used 

the same case-mix methodology and 

application of the wage index 

adjustment to the labor portion of the 

HH PPS rates as set forth in the July 3, 

2000 final rule. We multiplied the 

national 60-day episode rate by the 

patient’s applicable case-mix weight. 

We divided the case-mix adjusted 

amount into a labor and non-labor 

portion. We multiplied the labor portion 

by the applicable wage index based on 

the site of service of the beneficiary. 

As required by section 1895(b)(3)(B) 

of the Act, we have updated the HH PPS 

rates annually in a separate Federal 

Register document. Section 484.225 sets 

forth the specific percentage update for 

fiscal years 2001, 2002, and 2003. To 

reflect the new statutory provisions 

enacted by section 701 of the MMA, in 

§ 484.225, we proposed to redesignate 

paragraph (d) as paragraph (g) and 

revise it to read as follows: 

(g) For 2007 and subsequent calendar 

years, the unadjusted national rate is 

equal to the rate for the previous 

calendar year increased by the 

applicable home health market basket 

index amount. 

We also proposed to add new 

paragraphs (d), (e), and (f) to read as 

follows: 

(d) For the last calendar quarter of 

2003 and the first calendar quarter of 

2004, the unadjusted national 

prospective 60-day episode payment 

rate is equal to the rate from the 

previous fiscal year (FY 2003) increased 

by the applicable home health market 

basket index amount. 

(e) For the last 3 calendar quarters of 

2004, the unadjusted national 

prospective 60-day episode payment 

rate is equal to the rate from the 

previous fiscal year (FY 2003) increased 

by the applicable home health market 

basket minus 0.8 percentage points. 

(f) For each of calendar years 2005 

and 2006, the unadjusted national 

prospective 60-day episode payment 

rate is equal to the rate from the 

previous calendar year, increased by the 

applicable home health market basket 

minus 0.8 percentage points. 

62126 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

We also proposed to rebase and revise 

the home health market basket. As 

proposed, the labor related portion of 

the rebased and revised home health 

market basket would be 76.775 percent, 

and the non-labor portion would be 

23.225 percent. We added the wageadjusted portion to the non-labor 

portion yielding the case-mix and wageadjusted 60-day episode rate subject to 

applicable adjustments. 

For CY 2005, we proposed to use 

again the design and case-mix 

methodology described in section III.G 

of the HH PPS July 3, 2000 final rule (65 

FR 41192 through 41203). For CY 2005, 

we proposed to base the wage index 

adjustment to the labor portion of the 

PPS rates on the most recent pre-floor 

and pre-reclassified hospital wage index 

that does not apply the core-based 

statistical area (CBSA) policy. As 

discussed in the July 3, 2000 HH PPS 

final rule, for episodes with four or 

fewer visits, Medicare pays the national 

per-visit amount by discipline, referred 

to as a LUPA. We update the national 

per-visit amounts by discipline annually 

by the applicable home health market 

basket percentage. We adjust the 

national per-visit amount by the 

appropriate wage index based on the 

site of service for the beneficiary as set 

forth in § 484.230. We proposed to 

adjust the labor portion of the updated 

national per-visit amounts by discipline 

used to calculate the LUPA by the most 

recent pre-floor and pre-reclassified 

hospital wage index that does not apply 

the CBSA policy. 

Medicare pays the 60-day case-mix 

and wage-adjusted episode payment on 

a split percentage payment approach. 

The split percentage payment approach 

includes an initial percentage payment 

and a final percentage payment as set 

forth in § 484.205(b)(1) and (b)(2). We 

may base the initial percentage payment 

on the submission of a request for 

anticipated payment and the final 

percentage payment on the submission 

of the claim for the episode, as 

discussed in § 409.43. The claim for the 

episode that the HHA submits for the 

final percentage payment determines 

the total payment amount for the 

episode and whether we make an 

applicable adjustment to the 60-day 

case-mix and wage-adjusted episode 

payment. The end date of the 60-day 

episode as reported on the claim 

determines the rate level at which 

Medicare will pay the claim for the 

fiscal period.

We may also adjust the 60-day casemix and wage-adjusted episode 

payment based on the information 

submitted on the claim to reflect the 

following: 

• A low utilization payment provided 

on a per-visit basis as set forth in 

§ 484.205(c) and § 484.230. 

• A partial episode payment 

adjustment as set forth in § 484.205(d) 

and § 484.235. 

• A significant change in condition 

adjustment as set forth in § 484.205(e) 

and § 484.237. 

• An outlier payment as set forth in 

§ 484.205(f) and § 484.240. 

The proposed rule reflected the 

updated CY 2005 rates that would be 

effective January 1, 2005. 

B. Rebasing and Revising of the Home 

Health Market Basket 

We also proposed to rebase and revise 

the home health market basket to ensure 

it continues to adequately reflect the 

price changes of efficiently providing 

home health services. In addition to 

rebasing the base year cost structure 

from FY 1993 to FY 2000, we also 

proposed to revise the market basket by 

modifying several categories in the 

market basket cost structure. The major 

revision to the proposed market basket 

was the combining of the 

Administrative and General and Other 

Expenses cost categories. [See 69 FR 

31251 for a more complete explanation 

of the market basket cost structure] 

C. Proposed CY 2005 Update to the 

Home Health Market Basket Index 

Section 1895(b)(3)(B) of the Act, as 

amended by section 701 of the MMA, 

requires for CY 2005 that the standard 

prospective payment amounts be 

increased by a factor equal to the 

applicable home health market basket 

increase minus 0.8 percentage points. 

We proposed to amend the regulations 

in § 484.225 to reflect this requirement. 

• Proposed CY 2005 Adjustments.

In calculating the annual update for 

the CY 2005 60-day episode rates, we 

proposed to first look at the CY 2004 

rates as a starting point. The CY 2004 

national 60-day episode rate, as 

modified by section 701 of the MMA 

and implemented through Pub. 100–20 

One Time Notification, Transmittal 59 

issued February 20, 2004 is $2,213.37. 

In order to calculate the CY 2005 

national 60-day episode rate, we 

proposed to multiply the CY 2004 

national 60-day episode rate ($2,213.37) 

by the applicable home health market 

basket update, at the time of publication 

of the proposed rule, of 3.3 percent for 

CY 2005 minus 0.8 percentage points. 

We proposed to increase the CY 2004 

60-day episode payment rate by the 

proposed home health market basket 

increase (3.3 percent) minus 0.8 

percentage points ($2,213.37 × 2.5 

percent) to yield the proposed updated 

CY 2005 national 60-day episode rate 

($2,268.70). 

• National Per-visit Amounts Used to 

Pay LUPAs and Compute Imputed Costs 

Used in Outlier Calculations.

The policies governing the LUPAs 

and outlier calculations set forth in the 

July 3, 2000 HH PPS final rule will 

continue during CY 2005. In calculating 

the annual update for the CY 2005 

national per-visit amounts we use to pay 

LUPAs and to compute the imputed 

costs in outlier calculations, we 

proposed to look again at the CY 2004 

rates as a starting point. We then 

proposed to multiply those amounts by 

the proposed home health market basket 

increase minus 0.8 percentage points for 

CY 2005 to yield the updated per-visit 

amounts for each home health 

discipline for CY 2005. For details as to 

the specific LUPA rates that we 

proposed for CY 2005, see the proposed 

rule (69 FR 31256) published on June 2, 

2004. 

D. Proposed Update to the Outlier Fixed 

Dollar Loss Ratio 

Outlier payments are payments made 

in addition to regular 60-day case-mix 

and wage-adjusted episode payments for 

episodes that incur unusually large 

costs due to patient home health care 

needs. Outlier payments are made for 

episodes whose estimated cost exceeds 

a threshold amount. The episode’s 

estimated cost is the sum of the national 

wage-adjusted per-visit payment 

amounts for all visits delivered during 

the episode. The outlier threshold for 

each case-mix group, PEP adjustment, or 

total SCIC adjustment is defined as the 

60-day episode payment amount, PEP 

adjustment, or total SCIC adjustment for 

that group plus a fixed dollar loss 

amount. Both components of the outlier 

threshold are wage-adjusted. 

The wage-adjusted fixed dollar loss 

amount (FDL) represents the amount of 

loss that an agency must bear before an 

episode becomes eligible for outlier 

payments. The FDL is computed by 

multiplying the wage-adjusted 60-day 

episode payment amount by the fixed 

dollar loss ratio, which is a proportion 

expressed in terms of the national 

standardized episode payment amount. 

The outlier payment is defined to be a 

proportion of the wage-adjusted 

estimated costs beyond the wageadjusted threshold. The proportion of 

additional costs paid as outlier 

payments is referred to as the losssharing ratio. 

Section 1895(b)(5) of the Act requires 

that estimated total outlier payments are 

no more than 5 percent of total 

estimated HH PPS payments. In 

response to the concerns about potential 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62127

financial losses that might result from 

unusually expensive cases expressed in 

comments to the October 28, 1999 

proposed rule (64 FR 58133), the July 

2000 final rule set the target for 

estimated outlier payments at the 5 

percent level. The fixed dollar loss ratio 

and the loss-sharing ratio were then 

selected so that estimated total outlier 

payments would meet the 5 percent 

target. 

For a given level of outlier payments, 

there is a trade-off between the values 

selected for the fixed dollar loss ratio 

and the loss-sharing ratio. A high fixed 

dollar loss ratio reduces the number of 

episodes that can receive outlier 

payments, but makes it possible to 

select a higher loss-sharing ratio and, 

therefore, increase outlier payments for 

outlier episodes. Alternatively, a lower 

fixed dollar loss ratio means that more 

episodes can qualify for outlier 

payments, but outlier payments per 

episode must be lower. As a result of 

public comments on the October 28, 

1999 proposed rule, in our July 2000 

final rule, we made the decision to 

attempt to cover a relatively high 

proportion of the costs of outlier cases 

for the most expensive episodes that 

would qualify for outlier payments 

within the 5 percent constraint. 

We chose a value of 0.80 for the losssharing ratio, which is relatively high, 

but which preserves incentives for 

agencies to attempt to provide care 

efficiently for outlier cases. It is also 

consistent with the loss-sharing ratios 

used in other Medicare PPS outlier 

policies. Having made this decision, we 

estimated the value of the fixed dollar 

loss ratio that would yield estimated 

total outlier payments that were 

projected to be no more than 5 percent 

of total home health PPS payments. The 

resulting value for the fixed dollar loss 

ratio was 1.13.

Analysis of 100 percent of CY 2001 

home health claims data reflected that 

outlier episodes represented 

approximately 3 percent of total 

episodes and 3 percent of total HH PPS 

payments. We proposed to make no 

change in the projected 5 percent target 

for outlier expenditures as a percent of 

total HH PPS payments. In addition, we 

proposed no change to the loss-sharing 

ratio of 0.80. Further, section 

1895(b)(3)(C) of the Act requires that the 

episode payment amounts be adjusted 

to effectively pay for outlier payments 

within the same level of estimated total 

spending. We proposed no change to the 

adjustment to the episode payment 

amounts for outlier payments. We 

proposed to change only the fixed dollar 

loss ratio, and in turn, the fixed dollar 

loss amount. 

For the proposed rule, we performed 

data analysis on CY 2001 HH PPS 

analytic data to update the fixed dollar 

loss ratio to enable the total estimated 

outlier payments to be 5 percent of total 

HH PPS payments. That analysis 

indicated that a fixed dollar loss ratio of 

0.72 was consistent with the existing 

loss-sharing ratio of 0.80 and a target 

percentage of estimated outlier 

payments of the projected 5 percent. 

Consequently, we proposed to update 

the fixed dollar loss ratio from the 

current ratio of 1.13 to the fixed dollar 

loss ratio of 0.72. It was estimated that 

a fixed dollar loss ratio of 0.72 would 

allow approximately 6.5 percent of 

episodes to qualify for outlier payments. 

The estimated 6.5 percent outlier 

episodes is greater than the 3.0 percent 

of episodes that currently qualify for 

outlier payments, and is about the same 

as the 6.8 percent for outlier episodes 

that we estimated in our July 2000 final 

rule. 

We believe that our proposed fixed 

dollar loss ratio of 0.72 preserved a 

reasonable degree of cost sharing, while 

allowing a greater number of episodes to 

qualify for outlier payments. In our 

proposed rule, we indicated our plan to 

update our estimate of the fixed dollar 

loss ratio using the most current, 

complete year of HH PPS data available. 

E. Rural Add-On as Required by the 

MMA 

Section 421 of the MMA requires, for 

home health services furnished in a 

rural area with respect to episodes and 

visits ending on or after April 1, 2004 

and before April 1, 2005, that we 

increase by 5 percent the payment 

amount that otherwise would be made 

for these services. The statute waives 

budget neutrality related to this 

provision. By statute, the 5 percent rural 

add-on applies to home health services 

furnished in a rural area (as defined in 

section 1886(d)(2)(D) of the Act) for 

episodes and visits ending on or after 

April 1, 2004 and before April 1, 2005. 

Therefore, the 5 percent rural add-on 

ends after the first quarter of CY 2005 

for episodes and visits ending before 

April 1, 2005. After the rural add-on is 

determined, the applicable case-mix and 

wage index adjustment is then 

subsequently applied for the provision 

of home health services where the site 

of service is the non-Metropolitan 

Statistical Area (MSA) of the 

beneficiary. Similarly, the applicable 

wage index adjustment is subsequently 

applied to the LUPA per visit amounts 

adjusted for the provision of home 

health services where the site of service 

for the beneficiary is a non-MSA area. 

We implemented this provision for CY 

2004 on April 1, 2004 through Pub. 

100–20 One Time Notification, 

Transmittal 59 issued February 20, 

2004. For further details as to the 

specific rates for HH PPS payments to 

beneficiaries in rural areas, see the 

proposed rule (69 FR 31259) published 

on June 2, 2004.

F. Hospital Wage Index 

Sections 1895(b)(4)(A)(ii) and (b)(4)(C) 

of the Act require the Secretary to 

establish area wage adjustment factors 

that reflect the relative level of wages 

and wage-related costs applicable to the 

furnishing of home health services and 

to provide appropriate adjustments to 

the episode payment amounts under HH 

PPS to account for area wage 

differences. We applied the appropriate 

wage index value to the labor portion of 

the HH PPS rates based on the 

geographic area in which the beneficiary 

received home health services. We 

determined each HHA’s labor market 

area based on definitions of 

Metropolitan Statistical Areas (MSAs) 

issued by the Office of Management and 

Budget (OMB). We recognize that on 

June 6, 2003, the Office of Management 

and Budget (OMB) issued OMB Bulletin 

No. 03–04, announcing revised 

definitions of Metropolitan Statistical 

Areas, and new definitions of 

Micropolitan Statistical Areas, and 

Combined Statistical Areas. A copy of 

the Bulletin may be obtained at the 

following Internet address: http://

www.whitehouse.gov/omb/bulletins/

b03–04.html. We indicated in our 

proposed rule, that these new 

definitions would not be applied to the 

CY 2005 wage index used in the 

proposed update to the HH payment 

rates. 

On May 18, 2004, we published a 

proposed rule entitled ‘‘Medicare 

Program; Changes to the Hospital 

Inpatient Prospective Payment Systems 

and FY 2005 Rates’’ (69 FR 28195), 

which discusses some of the issues 

associated with using these new 

definitions and proposes to use these 

new definitions for the Inpatient 

Hospital PPS for FY 2005. We indicated 

that we believed it would be appropriate 

to wait until the public comments on 

that proposed rule had been submitted 

and analyzed before we considered 

proposing any new labor market 

definitions in the home health context. 

As discussed previously and set forth 

in the July 3, 2000 final rule, the statute 

provides that the wage adjustment 

factors may be the factors used by the 

Secretary for purposes of section 

1886(d)(3)(E) of the Act for hospital 

wage adjustment factors. Again, as 

discussed in the July 3, 2000 final rule, 

62128 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

we proposed to use the pre-floor and 

pre-reclassified hospital wage index to 

adjust the labor portion of the HH PPS 

rates based on the geographic area in 

which the beneficiary receives the home 

health services. We believe the use of 

the pre-floor and pre-reclassified 

hospital wage index results in the 

appropriate adjustment to the labor 

portion of the costs as required by 

statute. The most recent pre-floor and 

pre-reclassified hospital wage index 

available for this update of the CY 2005 

home health rates was determined to be 

that of the 2005 pre-floor and prereclassified hospital wage index. Due to 

the mandated change from a fiscal year 

update cycle to that of a calendar year 

update cycle, the most recent pre-floor 

and pre-reclassified hospital wage index 

available for this update of the CY 2005 

home health payment rates was 

determined to be that of the 2005 prefloor and pre-reclassified hospital wage 

index. 

Under previous fiscal year updates, 

the most recent pre-floor and prereclassified hospital wage index 

available at the time of publication of 

the HH PPS fiscal year update was that 

of the previous year. Beginning with the 

CY 2005 update to home health 

payment rates, the most recent pre-floor 

and pre-reclassified hospital wage index 

available at the time of publication will 

be that of the current year. 

Consequently, for our proposed CY 2005 

update to the home health payment 

rates, we proposed to continue to use 

the most recent pre-floor and prereclassified hospital wage index 

available at the time of publication. We 

recognized that this change to a 

calendar year update cycle results in 

using the current year’s wage index 

values. We also note that for HH PPS 

rates addressed in the proposed rule, we 

inadvertently published the 2004 prefloor and pre-reclassified hospital wage 

index. Consequently, we published a 

correction notice in the Federal Register

on July 30, 2004 (69 FR 45640), 

replacing the inadvertently published 

2004 pre-floor and pre-reclassified 

hospital wage index with a preliminary 

2005 pre-floor and pre-reclassified 

hospital wage index that does not apply 

the CBSA policy. 

III. Analysis of and Responses to Public 

Comments 

We received approximately 25 timely 

comments on the Home Health 

Prospective Payment System Rate 

Update for Calendar Year 2005 

proposed rule (CMS–1265–P), published 

on June 2, 2004 (69 FR 31248). We have 

also received approximately 6 

additional timely comments on the 

Home Health Prospective Payment 

System Rate Update for FY 2004 Notice 

(CMS–1473–NC), published on July 2, 

2003 (68 FR 39764). We received 

comments from HHAs and other health 

care providers, national industry 

associations, suppliers and 

practitioners, State associations, health 

care consulting firms, and private 

citizens. The comments centered on 

issues such as the wage index used to 

update rates, home health market basket 

analysis, metropolitan statistical areas 

as they relate to the wage index, 

reduction in the fixed dollar loss ratio 

for outlier episodes, home health 

resource group (HHRG) payment 

inadequacies, responsibility of and 

payment for supplies in the home health 

episode, cost reporting requirements, 

and finally refinements to the HH PPS 

in the areas of: Case mix, LUPAs, RAPs, 

SCICs, PEPs, outliers, supplies, and 

OASIS items (that is, M0175). We have 

considered all comments received 

during the 60-day public comment 

period on the June 2, 2004 proposed 

rule, as well as from the July 2, 2003 

notice. Our responses to the comments 

from both Federal Register publications, 

the June 2, 2004 proposed rule and the 

July 2, 2003 notice are set forth in the 

following section.

As noted in the proposed rule 

published in the Federal Register on 

June 2, 2004 (69 FR 31248), because of 

the large number of items of 

correspondence we normally receive on 

Federal Register documents published 

for comment, we are unable to respond 

to them individually. In this final rule, 

we address the concerns of the 

commenters that are related to the 

proposed rule and the notice with 

comment period published on July 2, 

2003 (68 FR 39764). Summaries of the 

major concerns and our responses to 

these comments are set forth below. 

Refinements 

Comment: There were several 

comments regarding refinement of the 

many different features of the HH PPS 

outside of the payment update such as 

outliers, supplies, PEPs, SCICs, LUPAs, 

and OASIS that make up the HH PPS, 

as well as other related issues such as 

dual-eligibles, long-term care patients, 

and telemedicine. 

Response: These comments were 

generally outside the scope of the 

proposed payment updates. Our 

ongoing research agenda on HH PPS 

refinements encompasses review of case 

mix adjustment and other payment 

adjustment provisions introduced as 

part of the PPS system. Our continuing 

work also includes review of overall 

system performance to the extent data 

permit analysis of this topic. 

We intend to address the aspects of 

the HH PPS that are subject to 

administrative revision when we initiate 

a refinement regulation. We believe it is 

prudent to avoid piecemeal revisions 

addressing one provision or another in 

isolation. Also, we believe it is common 

with new payment systems for 

providers to go through a period of 

adaptation. The adaptation process 

influences the data we use to study 

refinements, and those data lag by a year 

or more. We believe it is appropriate to 

base recommendations on data that 

reflect the end point of the provider 

adaptation process. Our study results 

will be more effective and provide a 

better basis for policy proposals when 

the data used in the studies reflect the 

end point of the adaptation period. 

Furthermore, we believe the best 

approach would be one that allows for 

analyzing interrelationships among 

payment features on the system in 

general. Moreover, it is more efficient to 

make numerous changes at the same 

time. Past experience with changes in 

systems and data collection for 

providers has shown that providers 

believe it is more burdensome when 

frequent changes are made to a payment 

system. 

Comment: There were a few 

comments requesting that ostomy 

supplies be exempt from the 

consolidated billing requirements 

because of their high cost. 

Response: The Medicare statute 

governing the home health PPS is 

specific to the type of items and services 

bundled to the HHA. Section 

1842(b)(6)(F) of the Act requires that all 

home health items and services, 

including medical supplies, furnished 

to a beneficiary under a plan of care are 

subject to consolidated billing. For 

example, if a patient is admitted for a 

condition that is related to a chronic 

condition which requires medical 

supplies (such as ostomy supplies), the 

HHA is required to provide those 

medical supplies while the patient is 

under a home health plan of care during 

an episode of care. We also note that 

costs of medical supplies are included 

in the HH PPS payment rate as the 

statute required that all services, 

including medical supplies, that would 

have been covered under the cost-based 

reimbursement system be bundled and 

paid under HH PPS.

Comment: There were a few 

comments regarding supplies not 

covered under Part B, and a question 

was posed whether the HHAs are 

responsible to bundle these supplies 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62129

while a beneficiary is under a home 

health plan of care. 

Response: Section 1895(b)(1) of the 

Act specifies that under the HH PPS 

system, all services covered and paid for 

on a reasonable cost basis under the 

Medicare home health benefit as of the 

date of enactment of this section, 

including medical supplies, shall be 

paid for on the basis of a prospective 

payment amount determined under that 

subsection and applicable to the 

services involved. In the past, HH PPS 

home health agencies provided, and 

were reimbursed for, non-routine 

medical supplies for which Part B codes 

existed as well as for non-routine 

medical supplies for which Part B codes 

did not exist. The costs of those 

supplies are included in the HH PPS 

rates, as those costs were built into the 

visit rates before the implementation of 

HH PPS and were part of the calculation 

of the base HH PPS rates. The 

implementation of the HH PPS did not 

change what home health agencies are 

required to provide to their beneficiaries 

under a plan of care. 

Comment: Some commenters 

requested clarification of the terms 

‘‘significant change in condition’’ and 

‘‘significant change in plan of care.’’

Response: As stated in 42 CFR 

484.205(a)(3), a significant change in 

condition (SCIC) payment adjustment 

due to the intervening event is defined 

as a significant change in the patient’s 

condition during an existing 60-day 

episode. The SCIC adjustment occurs 

when a beneficiary experiences a 

significant change in condition during a 

60-day episode that was not envisioned 

in the original plan of care. 

Comment: One commenter asserted 

that the requirement to claim an SCIC 

with an improvement in an expected 

outcome of care would lead to a system 

that could result in having a lower 

payment despite a greater resource use. 

Response: As stated in our Pub. 100–

2; Medicare Benefit Policy Manual, 

Chapter 7, ‘‘Home Health Services’’ 10.9 

‘‘Significant Change in Condition (SCIC) 

Payment Adjustment’’ the agency is not 

constrained to bill for a SCIC for a 

higher home health resource group 

(HHRG) if the net effect is a lower 

payment for the episode than if the SCIC 

had not occurred. Because the intent of 

the SCIC was not to lower the total 

episode payment when patients actually 

required more intensive services, the 

HHA is not forced to bill for an SCIC in 

this circumstance. However, where the 

SCIC reflects a lower HHRG due to 

unanticipated improvement in patient 

condition, the SCIC must be billed. This 

policy is restated in our Pub. 100–4; 

Medicare Claims Processing Manual, 

Chapter 10, ‘‘Home Health Agency 

Billing’’, 10.1.20 ‘‘Adjustments of 

Episode Payment Significant Change in 

Condition (SCIC).’’

Comment: Commenters supported the 

adjustment of the outlier policy and 

encouraged us to regularly/annually 

monitor outlier expenditures so that 

further adjustments can be made 

promptly should the full amount of 

outlier funds not be used. 

Response: We plan to continue to 

monitor the outlier expenditures on a 

yearly basis and to make adjustments as 

necessary. 

Comment: A commenter requested 

that we conduct a thorough review of 

the PPS over the next year to improve 

its validity as outlier episodes were 

‘‘underpaid’’ in previous years. The 

commenter also recommended that we 

increase the CY 2005 national 60-day 

episode rate and per visit amounts by 2 

percent in light of the ‘‘underpayments’’

of outliers. 

Response: We will continue to closely 

monitor the outlier expenditures. In 

accordance with section 1895(b)(5) of 

the Act, we have set thresholds and 

ratios in the outlier calculations so that 

outlier payments for the year are 

projected to be no more than 5 percent 

of the total payments projected or 

estimated for the HH PPS. In doing so, 

we use the best Medicare data available. 

Many of the factors used to set 

prospective payment amounts for a 

given year are based on estimates. These 

factors include not only the outlier 

threshold, but also the market basket 

rate of increases used to establish the 

update factor to the HH PPS rates. We 

do not believe that the Congress 

intended that the standardized amounts 

for a given year should be adjusted 

(upward or downward) to reflect any 

difference between projected and actual 

outlier payments for a past year. 

Under the policy we have maintained 

since the inception of the HH PPS, we 

do not make retroactive adjustments to 

reconcile differences between the 

percentage of outlier payments 

projected before a given year and the 

‘‘actual’’ outlier payments for that year. 

Definition of Non-Metropolitan 

Statistical Area (MSA)/Wage Index 

Comment: In general, commenters 

appreciated that a change to the new 

CBSAs will not be undertaken for HH 

payments this year. Some commenters 

went so far as to express their 

opposition to ever adopting the CBSAs 

for HH PPS. There were also requests 

that if we were to implement CBSAs for 

HH PPS, we phase in the CBSAs in a 

similar fashion as is being done in the 

hospital setting. One commenter 

recommended using a blended wage 

index value, stating that HHAs in a 

given CBSA would receive the higher of 

either the wage index value based on 

data from hospitals in the new CBSA or 

the blended wage index value based on 

data from all hospitals in counties 

formerly included in the NECMA but 

now in separate CBSAs. The commenter 

believes that using such a blended wage 

index would also smooth out anomalies 

associated with an HHA serving patients 

in two or more different CBSAs. 

Commenters further urged us to 

postpone any change until the proposed 

IPPS wage index values could be 

evaluated. 

Response: We will review and analyze 

the comments to the proposed rule 

titled ‘‘Medicare Program; Changes to 

the Hospital Inpatient Prospective 

Payment Systems and FY 2005 Rates’’

(69 FR 28195) published on May 18, 

2004 in which the new CBSAs are used 

before we consider adopting any new 

labor market definitions for HH PPS. In 

addition, we are currently analyzing the 

estimated impact that a move to CBSAs 

under the HH PPS would have on the 

home health industry. We plan to 

conduct a full study and consider the 

estimated impact that CBSAs would 

have on the home health industry before 

any revisions to the wage index are 

made.

Comment: Commenters wished to see 

geographic area reclassification and 

wage index floors (such as those 

provided to hospitals) become available 

to HHAs. Commenters generally stated 

that the HHAs should be allowed to use 

the reclassified version of the wage 

index. 

Response: We continue to believe that 

the most recent available pre-floor and 

pre-reclassified hospital wage index 

data results in the appropriate 

adjustment to the labor portion of the 

costs as required by statute. 

Comment: Commenters supported 

using the most recent hospital wage 

index available for HH PPS in CY 2005. 

Response: We appreciate the 

commenters’ support. As explained in 

the June 2, 2004 proposed rule, we have 

always used the most recent hospital 

wage index available in determining the 

HH PPS payment rates. However, as 

noted previously, the HH PPS update 

cycle was revised from that of a fiscal 

year update to a calendar year update, 

resulting in the most recent hospital 

wage index available at the time of 

publication being the current year’s 

hospital wage index. 

Comment: One commenter urged us 

to use the 2004 pre-floor and prereclassified wage index as opposed to 

using the current year’s hospital wage 

62130 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

index data to provide a more equitable 

wage index transition and avoid abrupt 

changes due to skipping an update year. 

Response: As noted in the previous 

comment, we have always used the 

most recent available hospital wage 

index data in determining the HH PPS 

update. We continue to believe using 

the most recent available wage index 

better reflects current wages and 

salaries. 

Comment: Commenters supported 

creating a joint HH industry/CMS 

technical advisory group to explore the 

accuracy of the current wage index as 

well as options for a refined wage index 

that more accurately reflects the true 

wage costs experienced by the HH 

industry. 

Response: We appreciate the 

comment, however, we do not believe 

such a group is necessary. We have 

always received input from the industry 

on various aspects of our Medicare 

payment systems, and we anticipate this 

practice will continue into the future. 

More recently, the ‘‘open-door’’ forums, 

initiated by CMS, provide the public 

with an opportunity to provide input 

and comment on the wage index used 

in the HH PPS. 

Comment: Commenters wished to see 

a comprehensive impact analysis before 

instituting wage index changes. They 

believe that no changes in the wage 

index should be implemented without 

adequate (one full year’s) notice. 

Response: To provide a more 

comprehensive impact analysis and one 

year’s notice of wage index changes 

would necessitate that we not use the 

most recent available hospital wage 

index for HH PPS. As noted previously, 

we have always used the most recent 

available pre-floor and pre-reclassified 

hospital wage index at the time of 

publication as we believe it better 

reflects current wages and salaries. 

Comment: Commenters were 

concerned about the time to comment 

on the wage index that was published 

in the correction notice. One commenter 

suggested that the comment period be 

extended 30 days with respect to the 

wage index. 

Response: We believe commenters 

were given adequate notice to timely 

comment on the wage index. As stated 

in the proposed rule, the proposed wage 

indices were not final. The final wage 

index values are in the addendum to 

this final rule. The inadvertent 

inclusion of the wrong wage index was 

a technical error. We published the 

correct wage index on our Web site and 

as soon as possible thereafter in the 

Federal Register, once the inadvertent 

technical error was noted. 

Comment: Commenters are concerned 

about treatment of wage index values in 

Connecticut, and other parts of New 

England, and requested a 

reconsideration of the proposed 

decreases to the wage indices. The 

commenters were specifically 

concerned that we unilaterally changed 

the designation of three hospitals in 

Litchfield County from their placement 

in the Hartford MSA to the rural region, 

thereby lowering both regions’ wage 

indices. Commenters requested that this 

be reversed and those three hospitals be 

designated to the Hartford MSA as per 

previous longstanding CMS policy. One 

commenter also suggested that the redesignation of hospitals in Hartford was 

done as part of our proposal for revised 

MSA definitions. If so, then this is in 

conflict with our stated intent not to 

apply expanded MSA definitions for 

HHAs in CY 2005. 

Response: We did not intend to 

implement any of the CBSA 

designations for CY 2005 in the HH PPS. 

Upon thorough review of the 

commenter’s concern, we have 

determined that only Sharon Hospital of 

Litchfield County, Connecticut was 

inadvertently designated to the rural 

Connecticut area in our July 30, 2004 

correction notice (69 FR 45640). In this 

final rule, we are publishing an updated 

and corrected pre-floor and prereclassified hospital wage index that 

reflects Sharon Hospital’s correct 

designation to the Hartford MSA (3283). 

In doing so, rural Connecticut’s wage 

index value changes from 1.1586 in the 

proposed CY 2005 wage index 

published in the above correction 

notice, to 1.1917 in the final wage index 

published in this final rule. Conversely, 

the Hartford MSA wage index value 

changes from a value of 1.1068 to 

1.1055. In addition, our review 

determined that there were technical 

errors in the hospital wage index 

calculation process for FY 2005 that had 

a slight overall impact to the wage index 

that we published in our correction 

notice (69 FR 45640). These technical 

errors have been corrected in the wage 

index published in this final rule.

Comment: Commenters questioned 

how their wage index values could 

decrease so dramatically at a time when 

the wages they pay their staff have 

increased and their health insurance 

and dental insurance have increased. 

Commenters further requested to see our 

assessment of the impact of those 

declines, as agencies are already having 

trouble covering costs of serving 

isolated elders, as well as information as 

to how we arrived at the wage data used 

to compute the proposed wage index 

values. 

Response: As we noted in the final 

HH PPS rule on July 3, 2000 (65 FR 

41165), we do not have a home health 

specific wage index because of industry 

concerns with the methodology used to 

develop a HH specific wage index and 

the lack of applicable home health 

specific data. Accordingly, we use the 

hospital wage index as we believe it 

results in the most appropriate 

adjustment to the labor portion of the 

cost and best reflects the current wages 

and salaries. 

For the convenience of the public, we 

have recently published in the HH PPS 

rate updates, a comparison of wage 

index values from the current year to 

the upcoming year, as an illustration of 

the changes in the wage index from year 

to year. We are publishing a comparison 

table as part of this rule in Addendum 

C. 

For specifics regarding the 

information on the hospital wage data 

used in computing the hospital wage 

index, please refer to the August 11, 

2004 IPPS final rule (69 FR 48915). 

Comment: Commenters stated that a 

‘‘hold harmless’’ provision should be 

available to HHAs to limit a wage index 

reduction (specifically to 2 percent from 

one year to the next) where there is a 

sudden reduction in the local wage 

index. Relief for providers that are 

negatively impacted should not come at 

the expense of providers that benefit 

from the changes. 

Response: Although we have 

sometimes implemented ‘‘hold 

harmless’’ provisions for groups of 

hospitals that are negatively impacted 

by significant changes in the wage index 

calculation or geographic classification, 

no such changes in methodology have 

taken place under the HH PPS. We note 

that, even for hospitals, there exists no 

precedent for a ‘‘hold harmless’’

provision based solely on percentage 

decreases in wage index values. 

Home Health Market Basket 

Comment: Several commenters 

claimed the proposed rule had 

inadequate detail to evaluate the 

accuracy of the proposed changes. 

Specifically, they were unable to 

determine whether the market basket 

captures the costs of HIPAA compliance 

and outcome-based quality assurance 

activities and whether the blending of 

the price proxies accurately captures the 

growth of nursing wage costs. 

Response: We believe the detail 

provided in the proposed rule was 

adequate for the public to meaningfully 

comment on the proposed changes to 

the market basket. The proposed rule 

described the methodology, provided 

data sources, and discussed alternatives 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62131

considered for the proposed rebasing of 

the market basket. 

As for the HIPAA compliance and 

quality assurance activities, the HH 

market basket will only reflect these 

costs since they impact the rate of 

change in prices. For example, if there 

are overall increases in wage levels due 

to staffing changes associated with 

HIPAA compliance and/or quality 

assurance activities, these price changes 

may be reflected in the price proxies. 

However, costs associated with 

purchasing new equipment or hiring 

more staff for HIPAA compliance and/

or quality assurance activities will only 

be reflected in the base year weights 

when the index is rebased to reflect a 

year in which these costs were present. 

We also believe the blending of the 

price proxies accurately captures the 

growth of nursing wage costs. We 

continued to use a 50/50 split of ECI for 

Professional Specialty & Technical 

Workers and Civilian Hospital Workers 

for both wages and benefits in order to 

reflect the competition between HHAs 

and hospitals for registered nurses, 

while still capturing the overall wage 

trends for professional and technical 

workers. We explained the need for this 

process as there is no specific wage or 

benefit measure for HHAs that holds 

skill mix constant. The increase in the 

Skilled Nursing & Therapist & Other 

Professional/Technical wages cost 

weight from the 1993-based (45.758 of 

the total wage cost category or 29.389 

percent of the total index) to the 

proposed 2000-based HH market basket 

(53.816 percent of the wage cost 

category or 35.393 percent of the total 

index) is a reflection of the increase in 

skilled nursing, therapist, and other 

professional/technical wage costs 

relative to other market basket costs. 

The blended home health wage proxy, 

composed of ECIs which keep the skill 

mix constant, increased 35 percent from 

1995 through 2003, while the Average 

Hourly Earnings for Nonsupervisory 

Home Health Workers grew by 24 

percent. 

The market basket is an important 

component of the PPS system, but it is 

also important to review total provider 

reimbursement and costs when 

assessing the adequacy of Medicare 

payments. In April 2004, MedPAC 

reported that the Medicare margin for 

home health providers was 16.8 percent 

in 2004, and recommended that no 

update be provided for 2005. The MMA, 

however, requires the market basket 

update minus 0.8 percent, which results 

in a 2.3 percent increase for 2005, which 

this final rule implements. 

Comment: Several commenters 

strongly supported the rebasing and 

revising of the home health market 

basket and hoped that CMS would be 

capable of rebasing more frequently. 

Response: Section 404 of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003 (MMA) mandated that we study 

and report on the possibility of rebasing 

the Inpatient Prospective Payment 

System hospital market basket more 

often than once every 5 years. After our 

report is completed, we plan to study 

the rebasing frequency for our other 

market baskets, such as the Skilled 

Nursing Facility and the Home Health 

market basket. We plan to use that 

information to determine an appropriate 

frequency for rebasing the home health 

market basket. It has always been our 

policy to rebase an index when 

appropriate. We will continue to 

monitor the home health market basket 

index to ensure it continues to 

adequately reflect the price of goods and 

services purchased by HHAs in 

providing an efficient level of home 

health care services.

Comment: Some commenters 

questioned whether the home health 

market basket reflects current market 

forces. Specifically, they questioned 

whether the market basket captured the 

increase in worker’s compensation, 

transportation, and professional liability 

insurance costs. 

Response: While all cost categories 

are not identified specifically and 

separately in the market basket, they are 

included in the weights, and the proxies 

attempt to reflect price changes 

associated with them. The price proxies 

are forecasted based on current price 

trends, thus reflecting current market 

forces. For the CY 2005 update, the 

forecasted price proxies include 

historical percent changes through 2004, 

2nd quarter. 

Comment: One commenter suggested 

that we convene a technical panel of 

industry and government experts in 

order to develop a more representative 

market basket. In addition, a few 

suggested that our use of the Medicare 

cost reports for home health agencies 

yields a flawed market basket and 

suggested combining cost report data 

and inputs from industry sources to 

develop the home health market basket. 

Response: In the past we have worked 

with industry, academic, government, 

and private sector experts on the 

development and update of the market 

basket, and we will continue to do so 

when necessary. When we rebase or 

revise the market, we generally provide 

a 60-day comment period for the rule 

which gives an opportunity for public 

input as do ‘‘open-door’’ forums. We 

have always considered input from 

industry sources and evaluated them 

against other data sources based on our 

requirements of reliability, relevance, 

timeliness, and public availability. 

The Medicare cost reports provide 

actual cost share data for home health 

agencies serving Medicare patients. We 

believe that home health agencies 

understand the value we place upon 

accurate cost report data, and have 

provided us with reliable cost data, 

which aid our rebasing and revising of 

the home health market basket. 

Comment: Some commenters 

questioned if the market basket increase 

(in CY 2005 3.1 percent) is supposed to 

cover the costs of an efficient home 

health agency, then why is the HH PPS 

update equal to the home health market 

basket increase minus 0.8 percentage 

points. 

Response: The HH PPS update is 

dictated by statute. Section 701 of the 

MMA mandated that the CY 2005 HH 

PPS update be equal to the HH market 

basket increase minus 0.8 percentage 

points. Therefore, the update factor for 

CY 2005 was required to be reduced. 

While the deduction from the market 

basket increase is mandated in the 

MMA, we believe the market basket, as 

revised and rebased, is a technically 

accurate measure for price changes that 

reflect the true costs to a home health 

agency for efficiently providing services. 

This methodology is consistent with the 

market basket methodologies for 

Hospital, Skilled Nursing Facility, and 

Physician. 

Comment: A commenter was 

concerned about services such as 

telemonitoring/telehealth that are not 

included in the margin analysis. The 

commenter requested that the cost 

report be simplified to allow all costs 

associated with Medicare home care 

patients to be included in the cost 

report. 

Response: The instructions to Form 

1728–94 were modified in June 2001 to 

identify the direct and indirect costs of 

telemedicine services (including 

telemonitoring and telehealth) as a nonreimbursable cost center on the home 

health agency cost report to aide in 

trend analysis of telemedicine costs. 

However, as a non-reimbursable cost 

center these services are not a 

recognized visit or service under HH 

PPS. Specifically, in section 

1895(e)(1)(B) of the Act, 

telecommunications services are not 

considered a home health visit for the 

purposes of eligibility or payment under 

this title. 

62132 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

Rural 5 Percent Rural Add-On 

Comment: Commenters questioned 

why the 5 percent increase is only for 

1 year. 

Response: The statute is very specific 

as to the time frame for the rural addon. Section 421 of the MMA requires, 

for home health services furnished in a 

rural area with respect to episodes and 

visits ending on or after April 1, 2004 

and before April 1, 2005, an increase by 

5 percent of the payment amount that 

otherwise would be made for these 

services. Therefore, the 5 percent rural 

add-on ends after the first quarter of CY 

2005, that is, for episodes and visits 

ending before April 1, 2005. 

General Comments 

Comment: A commenter requested 

that we consider the issuance of public 

status reports regarding our efforts 

concerning the HH PPS, such as a 

rebasing of the HH PPS payment rates, 

revisions to the payment structure, and 

revisions to the HHRG case mix 

adjuster. This would provide an early 

opportunity for input and comment 

relative to the potential direction in that 

regard.

Response: We appreciate the 

comment. Any significant changes to 

the HH PPS will continue to be 

provided with sufficient notice to the 

public. In addition, our ‘‘open door’’

forum is an opportunity for the public 

to express concerns and have issues 

addressed. 

IPPS-Related Comments 

Comment: We received a small 

number of comments that were 

particular to the Inpatient Hospital PPS 

proposed rule of May 18, 2004 (69 FR 

28196). Issues ranged from expanded 

wage areas that would change status due 

to the redefinition of rural and urban 

areas, to suggestions of modernizing the 

geographic reclassification criteria to 

protect providers when they are 

‘‘redistricted’’ out of a high wage area, 

to issues regarding Critical Access 

Hospital status and the applicable wage 

index calculation. 

Response: These comments are 

specific to IPPS and outside the scope 

of the HH PPS update. 

Comments on Home Health Prospective 

Payment System Rate Update for FY 

2004 Notice, Published on July 2, 2003 

(68 FR 39764) 

As noted previously, we received 6 

comments on the 2004 update notice for 

HH PPS. A summary of those comments 

and our responses are noted below. 

Comment: Commenters requested that 

we publish the pre-floor and prereclassified hospital wage index 

annually as part of the notice and 

comment rulemaking for inpatient 

hospital PPS. This would allow for prior 

public comment on the wage index 

applied to HHAs. 

Response: The methodology as to how 

wage indicies are used in the 

calculation of the HH PPS payment rates 

has not changed since the 

implementation of the HH PPS. Because 

it is only the updating of data used to 

determine the wage index values 

between versions of a particular year’s 

wage index file, and not the changing of 

methodology, we do not believe that 

prior public notice or a separate 

publication (outside the publication of 

the HH PPS update) is warranted. As to 

the specific wage index tables for the 

HH PPS for a given year, although it 

applies a rural floor and 

reclassifications, generally the hospital 

wage index files published in the IPPS 

rules, (which are published before the 

HH PPS update) would provide a good 

indication of the wage index used in a 

HH PPS update. 

Comment: One commenter had 

several comments on potential 

legislation, including urging us to assert 

to Congressional leadership that HHAs 

need to receive the full market basket 

increase of 3.3 percent. The commenter 

also criticized the loss of the rural addon and the threat of copayments.

Response: We note that recently 

passed legislation addresses the 

commenters’ concerns regarding market 

basket updates and the rural add-on. 

The MMA addresses the market basket 

increase in section 701. Specifically, 

section 701(b) of the MMA states that 

for the last 3 calendar quarters of 2004, 

the unadjusted prospective 60-day 

episode payment rate is equal to the rate 

from the previous fiscal year (FY 2003) 

increased by the applicable home health 

market basket minus 0.8 percentage 

points. For each of calendar years 2005 

and 2006, the unadjusted national 

prospective 60-day episode payment 

rate is equal to the rate from the 

previous calendar year, increased by the 

applicable home health market basket 

minus 0.8 percentage points. Regarding 

the rural add-on, section 421 of the 

MMA requires, for home health services 

furnished in a rural area with respect to 

episodes and visits ending on or after 

April 1, 2004 and before April 1, 2005, 

that we increase by 5 percent the 

payment amount that otherwise would 

be made for the services. The MMA did 

not include copayments for Medicare 

home health services. 

IV. Provisions of the Final Regulations 

This final rule incorporates the 

provisions of the regulations text of the 

proposed rule [69 FR 31248]. We have 

adopted the proposed changes from the 

above captioned proposed rule with 

regards to the rebasing and revising of 

the home health market basket, differing 

only in that through the use of updated 

data, the final CY 2005 market basket 

increase is 3.1 percent, as compared to 

3.3 percent in the proposed rule. 

Consequently, we will update the 

national 60-day episode rate and the 

per-visit payment amounts per 

discipline for CY 2005 for LUPAs by the 

final determined market basket 

percentage of 3.1 percent minus 0.8 

percentage points for an update to the 

HH PPS rates of 2.3 percent. In addition, 

we will update, by 5 percent, the 60-day 

episode payment amounts and the 

LUPA, per-visit payment amounts for 

services furnished in a rural area with 

respect to episodes and visits ending on 

or after April 1, 2004 and before April 

1, 2005. We have also updated the fixed 

dollar loss (FDL) ratio, used in the 

determination of outlier payments, from 

the proposed ratio of 0.72 in the 

proposed rule to 0.70, using the most 

recent available HH PPS data. Finally, 

this final rule includes the most recent 

version of the pre-floor and prereclassified hospital wage index, that 

does not apply the CBSA policy, used 

by the HH PPS. 

A. Rebasing and Revising of the Home 

Health Market Basket 

1. Rebasing Results 

Section 1895(b)(3)(B) of the Act, as 

amended by the MMA, requires the 

standard prospective payment amounts 

to be paid on a calendar year basis for 

2004 and any subsequent year. Previous 

market basket updates were calculated 

on a fiscal year basis. Table 1 shows that 

the forecasted rate of growth for CY 

2005, beginning January 1, 2005, for the 

rebased and revised home health market 

basket is 3.1 percent, while the 

forecasted rate of growth for the current 

1993-based home health market basket 

is also 3.1 percent. This final update for 

CY 2005 is based on the Global Insight, 

Inc 2004, 3rd quarter forecast with 

historical data through 2004, 2nd 

quarter. The proposed CY 2005 update 

was based on a forecast with historical 

data through 2003, 3rd quarter. As 

previously mentioned, we rebase the 

home health market basket periodically 

so the cost category weights continue to 

reflect changes in the mix of goods and 

services that HHAs purchase in 

furnishing home health care.

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62133

TABLE 1.—FORECASTED ANNUAL PERCENT CHANGE IN THE 1993-BASED AND 2000-BASED HOME HEALTH MARKET

BASKETS

Calendar year beginning January 1 

Home health 

market basket, 

1993-based 

Home health 

market basket, 

2000-based 

Difference 

(2000-based 

less 1993-

based) 

January 2005, CY 2005 ............................................................................................................... 3.1 3.1 0.0 

Source: Global Insight, Inc, 3rd Qtr, 2004; @USMACRO/CONTROL0804 @CISSIM/TL0804.SIM. 

Table 2 shows the percent changes for 

CY 2005 based on the 2004, 3rd quarter 

forecast for each cost category in the 

home health market basket.

TABLE 2.—CY 2005 FORECASTED ANNUAL PERCENT CHANGE FOR ALL COST CATEGORIES IN THE 2000-BASED HOME

HEALTH MARKET BASKET

Cost categories Weight Price proxy 

Forecasted 

annual percent 

change for

CY 2005 

Total .............................................................................. 100.000 ....................................................................................... 3.1 

Compensation ............................................................... 76.775 ....................................................................................... 3.3 

Wages and Salaries .............................................. 65.766 Home Health Occupational Wage Index ...................... 3.0 

Employee Benefits ................................................ 11.009 Home Health Occupational Benefits Index .................. 5.0 

Operations & Maintenance ........................................... 0.825 CPI Fuel & Other Utilities ............................................. 2.8 

Administrative & General & Other Expenses ............... 16.633 ....................................................................................... 2.6 

Telephone .............................................................. 0.850 CPI Telephone Services ............................................... 0.9 

Postage ................................................................. 0.563 CPI Postage ................................................................. 2.0 

Professional Fees* ................................................ 1.405 ECI for Compensation for Professional and Technical 

Workers.

3.6 

Other Products* ..................................................... 6.419 CPI All Items Less Food and Energy ........................... 2.1 

Other Services* ..................................................... 7.396 ECI for Compensation for Service Workers ................. 3.1 

Transportation ............................................................... 2.744 CPI Private Transportation ........................................... 0.3 

Capital-Related ............................................................. 3.023 ....................................................................................... 2.5 

Insurance ............................................................... 0.275 CPI Household Insurance ............................................ 3.3 

Fixed Capital ......................................................... 1.777 CPI Owner’s Equivalent Rent ....................................... 3.1 

Movable Capital ..................................................... 0.971 PPI Machinery & Equipment ........................................ 1.0 

*New break-out in cost structure when compared with the 1993-based home health market basket. 

Source: Global Insight, Inc, 3rd Qtr, 2004; @USMACRO/CONTROL0804 @CISSIM/TL0804.SIM. 

B. CY 2005 Update to the Home Health 

Market Basket Index 

Section 1895(b)(3)(B) of the Act, as 

amended by section 701 of the MMA, 

requires for CY 2005 that the standard 

prospective payment amounts be 

increased by a factor equal to the 

applicable home health market basket 

increase minus 0.8 percentage points. 

As previously noted, we are amending 

the regulations in § 484.225 to reflect 

this requirement. 

CY 2005 Adjustments 

To calculate the CY 2005 national 60-

day episode rate, we multiply the CY 

2004 (as of April 1, 2004) national 60-

day episode rate ($2,213.37) by the 

applicable home health market basket 

update of 3.1 percent for CY 2005 minus 

0.8 percentage points. 

We increase the CY 2004 60-day 

episode payment rate by the proposed 

home health market basket increase (3.1 

percent) minus 0.8 percentage points 

($2,213.37 × 2.3 percent) to yield the 

updated CY 2005 national 60-day 

episode rate ($2,264.28) (see Table 4 

below).

TABLE 4.—NATIONAL 60-DAY EPISODE AMOUNTS UPDATED BY THE APPLICABLE HOME HEALTH MARKET BASKET CY 

2005, MINUS 0.8 PERCENTAGE POINTS, BEFORE CASE-MIX ADJUSTMENT, WAGE INDEX ADJUSTMENT BASED ON THE

SITE OF SERVICE FOR THE BENEFICIARY OR APPLICABLE PAYMENT ADJUSTMENT

Total prospective payment amount per 60-day episode for CY 2004 (as of 04/01/04) 

Multiply by the

applicable home 

health market basket increase (3.1 

percent) minus 0.8 

percentage points 

CY 2005 updated 

national 60-day

episode rate 

$2,213.37 ................................................................................................................................................. × 1.023 $2,264.28 

62134 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

C. National Per-Visit Amounts Used To 

Pay LUPAs and Compute Imputed Costs 

Used in Outlier Calculations 

As discussed previously in this final 

rule, the policies governing the LUPAs 

and outlier calculations set forth in the 

July 3, 2000 HH PPS final rule will 

continue during CY 2005. In calculating 

the annual update for the CY 2005 

national per-visit amounts we use to pay 

LUPAs and to compute the imputed 

costs in outlier calculations, we look 

again at the CY 2004 (as of April 1, 

2004) rates as a starting point. We then 

multiply those amounts by the home 

health market basket increase minus 0.8 

percentage points for CY 2005 to yield 

the updated per-visit amounts for each 

home health discipline for CY 2005. 

(See Table 5 below.)

TABLE 5.—NATIONAL PER-VISIT AMOUNTS FOR LUPAS AND OUTLIER CALCULATIONS UPDATED BY THE APPLICABLE HOME

HEALTH MARKET BASKET INCREASE FOR CY 2005, MINUS 0.8 PERCENTAGE POINTS, BEFORE WAGE INDEX ADJUSTMENT BASED ON THE SITE OF SERVICE FOR THE BENEFICIARY

Home health discipline type 

Final per-visit 

amounts per

60-day episode 

for

CY 2004

for LUPAs

(as of 04/01/04) 

Multiply by the 

applicable home 

health market 

basket

(3.1 percent)

minus 0.8

percentage 

points 

Per-visit payment 

amount per

discipline for CY 

2005 for LUPAs 

Home Health Aide ........................................................................................................... $43.75 × 1.023 $44.76 

Medical Social Services ................................................................................................... 154.89 × 1.023 158.45 

Occupational Therapy ...................................................................................................... 106.36 × 1.023 108.81 

Physical Therapy ............................................................................................................. 105.65 × 1.023 108.08 

Skilled Nursing ................................................................................................................. 96.63 × 1.023 98.85 

Speech-Language Pathology .......................................................................................... 114.80 × 1.023 117.44 

D. Update to the Outlier Fixed Dollar 

Loss Ratio 

For the rule, we performed analysis of 

CY 2001 home health claims data. The 

results of that analysis reflected that 

outlier episodes represented 

approximately 3 percent of total 

episodes and 3 percent of total HH PPS 

payments. For this final rule, we have 

performed the same analysis on CY 

2002 and CY 2003 home health claims 

data and have found the number of 

outlier episodes and payments to 

continue to hold at approximately 3 

percent of total episodes and total HH 

PPS payments, respectively. 

In the rule, we also performed data 

analysis on CY 2001 HH PPS analytic 

data to update the fixed dollar loss 

(FDL) ratio to enable the total estimated 

outlier payments to be a projected 5 

percent of total HH PPS payments. The 

results of that analysis indicated that a 

fixed dollar loss ratio of 0.72 was 

consistent with the existing loss-sharing 

ratio of 0.80 and a projected target 

percentage of estimated outlier 

payments of 5 percent. For this final 

rule, we have performed the same 

analysis on CY 2003 HH PPS analytic 

data to update the fixed dollar loss ratio. 

The results of this analysis indicate that 

a fixed dollar loss ratio of 0.70 is 

consistent with the existing loss-sharing 

ratio of 0.80 and a projected target 

percentage of estimated outlier 

payments of 5 percent. Consequently, 

we are updating the fixed dollar loss 

ratio from the current ratio of 1.13 to the 

fixed dollar loss ratio of 0.70. Our 

analysis shows that reducing the fixed 

dollar loss ratio from 1.13 to 0.70 will 

allow approximately 5.9 percent of 

episodes to qualify for outlier payments. 

The estimated 5.9 percent outlier 

episodes are greater than the 3.0 percent 

of episodes that currently qualify for 

outlier payments. 

Expressed in terms of a fixed dollar 

loss amount, the fixed dollar loss ratio 

of 0.70 implies that providers would 

absorb approximately $1,585 of their 

costs (before wage adjustment), in 

addition to their loss-sharing portion of 

the estimated cost in excess of the 

outlier threshold. This fixed dollar loss 

amount of approximately $1,585 is 

computed by multiplying the standard 

60-day episode payment amount 

($2,264.28) by the fixed dollar loss ratio 

(0.70). Using the current fixed dollar 

loss ratio (1.13), the fixed dollar loss 

amount would be approximately $2,558 

($2,264.28 × 1.13). 

We believe that a fixed dollar loss 

ratio of 0.70 preserves a reasonable 

degree of cost sharing, while allowing a 

greater number of episodes to qualify for 

outlier payments. 

The following analytical Tables 6–a 

through 6–d, derived from analysis of 

CY 2003 HH PPS claims data, 

characterize outlier episodes, and 

estimate how different types of 

providers and providers in different 

parts of the country will do under an 

outlier scenario that employs a fixed 

dollar loss ratio of 0.70 as compared to 

the current fixed dollar loss ratio of 

1.13. 

The new FDL of 0.70 will increase 

outlier payments to all types of home 

health providers in all areas of the 

country. Generally speaking, it has been 

estimated that, under a scenario where 

the FDL is equal to 0.70, for home 

health providers whose outlier 

payments are historically a lesser 

percentage of their total HH PPS 

payments, their outlier payments will 

increase at a greater rate than will 

outlier payments for home health 

providers whose outlier payments are 

historically of a greater percentage of 

their total HH PPS payments. 

For example, non-profit home health 

agencies were estimated to receive 

outlier payments equal to approximately 

1.9 percent of their total HH PPS 

payments under the current scenario 

where the FDL = 1.13. Under the same 

scenario, for-profit home health 

agencies were estimated to receive 

outlier payments equal to approximately 

5.1 percent of their total HH PPS 

payments. While a scenario where the 

FDL = 0.70 increases the percentage of 

outlier payments to total HH PPS 

payments, the overall increase in outlier 

payments to non-profit home health 

agencies increases by an estimated 77.6 

percent while the outlier payments for 

for-profit home health agencies increase 

by approximately 33.8 percent. 

Similarly, while outlier payments to 

both provider-based and free-standing 

home health agencies will increase 

under a scenario where FDL = 0.70, 

outlier payments to provider-based 

home health agencies are estimated to 

increase by approximately 97.3 percent, 

while payments to free-standing home 

health agencies are estimated to increase 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62135

by approximately 41 percent. For areas 

of the county where outlier payments 

are estimated to be of a lesser percentage 

to their total HH PPS payments, their 

overall percentage increase in outlier 

payments is estimated to be greater than 

for those areas of the country where 

outlier payments have been estimated to 

be of a greater percentage of their total 

HH PPS payments. Finally, while both 

urban and rural providers will benefit 

from increased outlier payments under 

the FDL of 0.70 scenario, rural providers 

will see their outlier payments increase 

by an estimated 81.5 percent, while 

urban providers will see an estimated 

increase of approximately 43.2 percent.

TABLE 6–A.—COMPARISON OF ESTIMATED OUTLIER PAYMENTS AS A PERCENTAGE OF TOTAL HH PPS PAYMENTS UNDER

THE CURRENT FDL = 1.13 TO ESTIMATED OUTLIER PAYMENTS AS PERCENTAGE OF TOTAL HH PPS UNDER THE FDL 

= 0.70 BY TYPE OF CONTROL

Type of control 

Percentage of outlier payments to 

total HH PPS payments 

Percent change 

in outlier

payments from

FDL = 1.13 to

FDL = 0.70 FDL = 1.13 FDL = 0.70 

Non-Profit ......................................................................................................................... 1.9 3.4 77.6 

Profit ................................................................................................................................. 5.1 6.7 33.8 

Government ..................................................................................................................... 2.1 3.1 77.5 

TABLE 6–B.—COMPARISON OF ESTIMATED OUTLIER PAYMENTS AS A PERCENTAGE OF TOTAL HH PPS PAYMENTS UNDER

THE CURRENT FDL = 1.13 TO ESTIMATED OUTLIER PAYMENTS AS PERCENTAGE OF TOTAL HH PPS UNDER THE FDL 

= 0.70 BY TYPE OF FACILITY

Type of control 

Percentage of outlier payments to 

total HH PPS payments 

Percent change 

in outlier

payments from

FDL = 1.13 to

FDL = 0.70 FDL = 1.13 FDL = 0.70 

Free Standing .................................................................................................................. 4.1 5.7 41.0 

Provider Based ................................................................................................................ 1.4 2.7 97.3 

TABLE 6–C.—COMPARISON OF ESTIMATED OUTLIER PAYMENTS AS A PERCENTAGE OF TOTAL HH PPS PAYMENTS UNDER

THE CURRENT FDL = 1.13 TO ESTIMATED OUTLIER PAYMENTS AS PERCENTAGE OF TOTAL HH PPS UNDER THE FDL 

= 0.70 BY REGION

Region 

Percentage of outlier payments to 

total HH PPS payments 

Percent change 

in outlier

payments from

FDL = 1.13 to

FDL = 0.70 FDL = 1.13 FDL = 0.70 

Region I: Boston .............................................................................................................. 2.8 4.9 76.6 

Region II: New York ........................................................................................................ 3.3 5.4 66.6 

Region III: Philadelphia .................................................................................................... 1.0 2.0 97.5 

Region IV: Atlanta ............................................................................................................ 3.5 4.9 43.6 

Region V: Chicago ........................................................................................................... 1.1 2.1 96.9 

Region VI: Dallas ............................................................................................................. 3.7 5.2 41.5 

Region VII: Kansas City .................................................................................................. 1.2 2.3 102.5 

Region VIII: Denver ......................................................................................................... 3.5 5.1 47.6 

Region IX: San Francisco ................................................................................................ 9.9 12.0 24.6 

Region X: Seattle ............................................................................................................. 0.5 1.3 151.7 

TABLE 6–D.—COMPARISON OF ESTIMATED OUTLIER PAYMENTS AS A PERCENTAGE OF TOTAL HH PPS PAYMENTS UNDER

THE CURRENT FDL = 1.13 TO ESTIMATED OUTLIER PAYMENTS AS PERCENTAGE OF TOTAL HH PPS UNDER THE FDL 

= 0.70 BY URBAN/RURAL

Urban/rural 

Percentage of outlier payments to 

total HH PPS payments 

Percent change 

in outlier

payments from

FDL = 1.13 to

FDL = 0.70 FDL = 1.13 FDL = 0.70 

Urban ............................................................................................................................... 4.0 5.6 43.2 

Rural ................................................................................................................................ 1.4 2.5 81.5 

62136 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

E. Rural Add-On as Required by MMA 

As discussed in the proposed rule, 

section 421 of the MMA requires, for 

home health services furnished in a 

rural area with respect to episodes and 

visits ending on or after April 1, 2004 

and before April 1, 2005, that we 

increase by 5 percent the payment 

amount that otherwise would be made 

for the services. 

The CY 2005 5 percent rural add-on 

to the 60-day episode standardized 

payment and the per-visit LUPA 

payments, as required by section 421 of 

the MMA, is noted in tables 7 and 8 

below.

TABLE 7.—CY 2005 RURAL ADD-ON TO 60-DAY EPISODE PAYMENT AMOUNTS ENDING ON OR AFTER APRIL 1, 2004 AND

BEFORE APRIL 1, 2005 FOR BENEFICIARIES WHO RESIDE IN A NON-MSA AREA BEFORE CASE-MIX ADJUSTMENT, 

WAGE INDEX ADJUSTMENT BASED ON THE SITE OF SERVICE FOR THE BENEFICIARY OR APPLICABLE PAYMENT ADJUSTMENT

Total prospective payment amount per 60-day episode for CY 2005 5 percent rural 

add-on 

CY 2005 final 

payment amount 

per 60-day episode ending before April 1, 2005 

for a beneficiary 

who resides in a 

Non-MSA area 

$2,264.28 ......................................................................................................................................................... × 1.05 $2,377.49 

TABLE 8.—CY 2005 ADD-ON TO LUPA PER-VISIT AMOUNTS FOR VISITS ENDING ON OR AFTER APRIL 1, 2004 AND BEFORE APRIL 1, 2005, BEFORE WAGE INDEX ADJUSTMENT BASED ON THE SITE OF SERVICE OF THE BENEFICIARY

WHO RESIDES IN A NON-MSA AREA OR PAYMENT APPLICABLE ADJUSTMENT

Home health discipline type 

Per-visit payment 

amounts per 60-

day episode for 

CY 2005 for 

LUPAs 

5 percent rural 

add-on 

CY 2005 per-visit 

payment 

amounts per

60-day episode

ending before

April 1, 2005 for 

LUPAs for a

beneficiary who

resides in a

non-MSA area 

Home Health Aide ........................................................................................................... $44.76 × 1.05 $47.00 

Medical Social Services ................................................................................................... 158.45 × 1.05 166.37 

Occupational Therapy ...................................................................................................... 108.81 × 1.05 114.25 

Physical Therapy ............................................................................................................. 108.08 × 1.05 113.48 

Skilled Nursing ................................................................................................................. 98.85 × 1.05 103.79 

Speech-Language Pathology .......................................................................................... 117.44 × 1.05 123.31 

F. Hospital Wage Index 

Sections 1895(b)(4)(A)(ii) and (b)(4)(C) 

of the Act require the Secretary to 

establish area wage adjustment factors 

that reflect the relative level of wages 

and wage-related costs applicable to the 

furnishing of home health services and 

to provide appropriate adjustments to 

the episode payment amounts under HH 

PPS to account for area wage 

differences. We have consistently used 

the most recent pre-floor and prereclassified hospital wage index 

available in determining HH PPS 

updates. 

In our June 2, 2004 proposed rule (69 

FR 31260), we proposed to continue to 

use the most recent pre-floor and prereclassified hospital wage index 

available at the time of the final rule. At 

the time of publication of the proposed 

rule, only preliminary versions of the 

wage index used by HH PPS were 

available. We indicated in the proposed 

rule that we would incorporate updated 

wage data for the wage index to be used 

in the final rule for the CY 2005 HH PPS 

update. Subsequent to the proposed 

rule, we published a correction notice 

on July 30, 2004 (69 FR 45640) in which 

we indicated that in our publishing of 

the proposed rule, we inadvertently 

published the 2004 pre-floor and prereclassified wage index tables instead of 

the intended 2005 pre-floor and prereclassified wage index tables. As part 

of that correction notice, we published 

the appropriate 2005 pre-floor and prereclassified wage index tables. 

Since the publication of the correction 

notice, we have determined that there 

exists some labeling and other technical 

errors in the proposed wage index.

We note a labeling error in the wage 

index tables used in the HH PPS. That 

labeling error is the listing of Stanly 

County, NC as one of the areas under 

MSA 1520 when, in fact, we consider 

Stanly County, NC to be a rural area in 

North Carolina. Stanly County wage 

data have always been correctly treated 

as rural in the actual creation of the 

home health wage index values, and it 

has only been the listing of Stanly 

County under MSA 1520 that was in 

error. Consequently, the wage index 

table in this final rule correctly removes 

Stanly County from the list of areas that 

fall under the MSA 1520 wage index. As 

this is strictly a labeling correction that 

does not affect the actual computation 

of the wage index values, home health 

providers in Stanly County, NC will 

continue to fall under, and use, the 

wage index for rural North Carolina. 

In addition, we have determined that 

Sharon Hospital of Litchfield County, 

Connecticut was inadvertently 

designated to the rural Connecticut area 

in our July 30, 2004 correction notice 

(69 FR 45640). Consequently, the 

updated CY 2005 pre-floor and prereclassified hospital wage index 

published in this final rule correctly 

designates Sharon Hospital to the 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62137

Hartford MSA (3283). In doing so, rural 

Connecticut’s wage index value 

increases from 1.1586 in the proposed 

CY 2005 wage index to 1.1917 in the 

final CY 2005 wage index published in 

this final rule. Conversely, the Hartford 

MSA wage index value changes from a 

value of 1.1068 to 1.1055. In addition, 

our review determined that there were 

technical errors in the hospital wage 

index calculation process for FY 2005 

that had a slight overall impact to the 

wage index that we published in our 

correction notice (69 FR 45640). These 

technical errors have been corrected in 

the wage index published in this final 

rule. 

See Addenda A and B of this final 

rule, respectively, for the rural and 

urban hospital wage indexes. 

Furthermore, we have added an 

Addendum C that shows a side-by-side 

comparison of the FY 2003 pre-floor and 

pre-reclassified hospital wage index and 

the CY 2005 pre-floor and prereclassified hospital wage index, that 

does not apply the CBSA policy, for CY 

2005 HH PPS. 

V. Collection of Information 

Requirements 

This document does not impose 

information collection and recordkeeping requirements. Consequently, it 

need not be reviewed by the Office of 

Management and Budget under the 

authority of the Paperwork Reduction 

Act of 1995 (44 U.S.C. 3501 et seq.).

VI. Regulatory Impact Analysis 

A. Overall Impact 

We have examined the impacts of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 16, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act, the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4), and Executive Order 13132. 

Executive Order 12866 (as amended 

by Executive Order 13258, which 

merely reassigns responsibility of 

duties) directs agencies to assess all 

costs and benefits of available regulatory 

alternatives and, if regulation is 

necessary, to select regulatory 

approaches that maximize net benefits 

(including potential economic, 

environmental, public health and safety 

effects, distributive impacts, and 

equity). A regulatory impact analysis 

(RIA) must be prepared for major rules 

with economically significant effects 

($100 million or more in any 1 year). 

The update set forth in this final rule 

would apply to Medicare payments 

under HH PPS in CY 2005. Accordingly, 

the following analysis describes the 

impact in CY 2005 only. We estimate 

that there will be an additional $250 

million in CY 2005 expenditures 

attributable to the CY 2005 market 

basket (3.1 percent), minus 0.8 

percentage points, an estimated increase 

of 2.3 percent. 

Section 421 of the MMA provides for 

a 5 percent increase in home health 

payments to rural providers for episodes 

and visits ending after April 1, 2004 and 

before April 1, 2005. This increase is not 

subject to budget neutrality. 

Consequently, this increase in payments 

to rural providers will result in an 

estimated increase in expenditures of 

$50 million in CY 2004 and $60 million 

in CY 2005. 

Section 701 of the MMA includes a 

provision that changes the update cycle 

for HH PPS, and thus the home health 

market basket update, from a fiscal year 

basis to that of a calendar year basis in 

2004. This results in a projected 

reduction in expenditures of 

approximately $90 million in FY 2005. 

The RFA requires agencies to analyze 

options for regulatory relief of small 

businesses. For purposes of the RFA, 

small entities include small businesses, 

nonprofit organizations, and 

government agencies. Most hospitals 

and most other providers and suppliers 

are small entities, either by nonprofit 

status or by having revenues of $6 

million to $29 million or less annually 

(for details, see the Small Business 

Administration’s regulation that set 

forth size standards for health care 

industries at 65 FR 69432). For purposes 

of the RFA, approximately 75 percent of 

HHAs are considered small businesses 

according to the Small Business 

Administration’s size standards with 

total revenues of $11.5 million or less in 

1 year. Individuals and States are not 

included in the definition of a small 

entity. As stated above, this final rule 

updates all of the HHAs for CY 2005 as 

required by statute. This rule will have 

a significant positive effect upon small 

entities. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 603 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside of 

a metropolitan statistical area (MSA) 

and has fewer than 100 beds. We have 

determined that this final rule would 

not have a significant economic impact 

on the operations of a substantial 

number of small rural hospitals. 

Section 202 of the Unfunded 

Mandates Reform Act of 1995 also 

requires that agencies assess anticipated 

costs and benefits before issuing any 

rule that may result in expenditure in 

any 1 year by State, local, or tribal 

governments, in the aggregate, or by the 

private sector, of $110 million. We 

believe that this final rule would not 

mandate expenditures in that amount. 

Executive Order 13132 establishes 

certain requirements that an agency 

must meet when it promulgates a 

proposed rule (and subsequent final 

rule) that imposes substantial direct 

requirement costs on State and local 

governments, preempts State law, or 

otherwise has Federalism implications. 

We have reviewed this rule under the 

threshold criteria of Executive Order 

13132, Federalism. We have determined 

that this final rule would not have 

substantial direct effects on the rights, 

roles, and responsibilities of States. 

B. Anticipated Effects 

In accordance with the requirements 

of section 1895(b)(3) of the Act, we 

publish an update for each subsequent 

fiscal year that will provide an update 

to the payment rates. Section 

1895(b)(3)(B) of the Act, as amended by 

section 701 of the MMA, requires us, for 

CY 2005, to increase the prospective 

payment amounts by the applicable 

home health market basket increase 

minus 0.8 percentage points. We 

estimate that with a home health market 

basket of 3.1 percent minus 0.8 

percentage points, the increase for CY 

2005 is 2.3 percent.

1. Effects on the Medicare Program 

This final rule provides a percentage 

update to all Medicare HHAs. Therefore, 

we have not furnished any impact 

tables. We increased the payment to 

each Medicare HHA equally by the 

home health market basket update for 

CY 2005, minus 0.8 percentage points, 

as required by statute. There is no 

differential impact among provider 

types. The impact is in the aggregate. 

We can show the impact that the CY 

2005 wage index would have on 

providers. Addendum C shows a sideby-side comparison of the FY 2003 prefloor and pre-reclassified hospital wage 

index and the CY 2005 pre-floor and 

pre-reclassified hospital wage index, 

that does not apply the CBSA policy, for 

the CY 2005 HH PPS update final rule. 

We estimate that there would be an 

additional $250 million in CY 2005 

expenditures attributable to the CY 2005 

market basket (3.1 percent), minus 0.8 

percentage points, resulting in a 2.3 

percent increase. Thus, the anticipated 

expenditures outlined in this final rule 

62138 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

would exceed the $100 million annual 

threshold for a major rule as defined in 

Title 5, U.S.C., section 804(2). 

The applicable home health market 

basket (minus 0.8 percentage points) 

increase of 2.3 percent for CY 2005 

applies to all Medicare-participating 

HHAs. We do not believe there is a 

differential impact due to the aggregate 

nature of the update.

TABLE 9 

CY 2005 update to Home Health PPS rates required by the Act 

Additional CY 

2005 Medicare 

Home Health estimated expenditures due to

annual update

required by law 

Section 1895(b)(3)(B) of the Act requires HH PPS rates increased by applicable home health market basket increase (3.1 

percent) minus 0.8 percentage points, yielding 2.3 percent ..................................................................................................... $250 Million. 

Source: President’s FY 2004 Budget. 

2. Effects on Providers 

We believe that this rule would have 

a positive effect on providers of 

Medicare home health services by 

increasing their rate of Medicare 

payments. We do not anticipate specific 

effects on other providers. This final 

rule reflects the statutorily required 

annual update to the HH PPS rates. We 

do not believe there is a differential 

impact due to the consistent and 

aggregate nature of the update. 

C. Alternatives Considered 

This final rule reflects an annual 

update to the HH PPS rates as required 

by statute. We believe that the statute 

provides no latitude for alternatives 

other than the approach set forth in this 

final rule reflecting the CY 2005 annual 

update to the HH PPS rates. Other than 

the positive effect of the market basket 

increase, this final rule would not have 

a significant economic impact nor 

would it impose an additional burden 

on small entities. When a regulation or 

notice imposes additional burden on 

small entities, we are required under the 

RFA to examine alternatives for 

reducing burden. 

This final rule rebases and revises the 

home health market basket by moving 

the base year from FY 1993 to FY 2000 

to reflect the latest available, thorough 

data on the structure of HHA costs. We 

periodically rebase and revise market 

baskets for multiple types of health care 

providers, generally on a 5-year cycle. 

We continue to believe that by rebasing 

and revising the home health market 

basket periodically, cost category 

weights will better reflect changes in the 

mix of goods and services that HHAs 

purchase in furnishing home health 

care. The alternative to not rebase and 

revise the market basket would be to 

delay the inevitable task of rebasing and 

revising the home health market basket 

to some later date. For this final rule, 

the forecasted rate of growth for CY 

2005 for both the rebased and revised 

home health market basket and the 

current 1993-based home health market 

basket is 3.1 percent (see Table 1 of this 

rule). Future updates will be better 

served by using a more up-to-date cost 

structure, as is accomplished in the 

revised and rebased home health market 

basket. 

Section 1895(b)(5) of the Act states 

that the total amount of payments for 

outliers, under HH PPS, may not exceed 

5 percent of the total payments 

projected or estimated to be made for a 

given fiscal year or year. As discussed 

in section IV, ‘‘Provisions of the Final 

Regulations’’, we are reducing the fixed 

dollar loss ratio used in the formula to 

determine outlier cases in HH PPS, from 

that of 1.13 to 0.70. Analysis indicates 

that a fixed dollar loss ratio of 0.70 is 

consistent with the existing loss-sharing 

ratio of 0.80 and our target percentage 

of estimated outlier payments of 5 

percent of total home health payments. 

Other alternatives considered in the 

updating of the formula for determining 

outlier cases included updating/

changing the loss-sharing ratio from that 

of 0.80 as well as changing the outlier 

payment target of to less than 5 percent 

of total home health payments. We 

believe that a value of 0.80 for the losssharing ratio is appropriate in that it 

preserves incentives for agencies to 

provide care efficiently for outlier cases. 

Similarly, we continue to believe that 

the total outlier payment target of 5 

percent of total home health payments 

appropriately targets the most costly 

cases under HH PPS. 

D. Conclusion 

We have examined the economic 

impact of this final rule on small 

entities and have determined that the 

economic impact is positive, significant, 

and that all HHAs would be affected. To 

the extent that small rural hospitals are 

affiliated with HHAs, the impact on 

these facilities would also be positive. 

Finally, we have determined that the 

economic effects described above are 

largely the result of the specific 

statutory provisions, which this final 

rule serves to announce. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was reviewed by the Office of 

Management and Budget.

List of Subjects in 42 CFR Part 484 

Health facilities, Health professions, 

Medicare, Reporting and record-keeping 

requirements.

■ For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services amends 42 CFR 

chapter IV as set forth below:

PART 484—HOME HEALTH SERVICES

■ 1. The authority citation for part 484 

continues to read as follows:

Authority: Secs. 1102 and 1871 of the 

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

1395(hh)) unless otherwise indicated.

■ 2. Section 484.225 is amended as 

follow:

■ A. Paragraph (d) is redesignated as 

paragraph (g) and is revised.

■ B. New paragraph (d) is added.

■ C. New paragraph (e) is added.

■ D. New paragraph (f) is added.

The revisions and additions read as 

follows:

§ 484.225 Annual update of the unadjusted 

national prospective 60-day episode 

payment rate.

* * * * *

(d) For the last calendar quarter of 

2003 and the first calendar quarter of 

2004, the unadjusted national 

prospective 60-day episode payment 

rate is equal to the rate from the 

previous fiscal year (FY 2003) increased 

by the applicable home health market 

basket index amount. 

(e) For the last the 3 calendar quarters 

of 2004, the unadjusted national 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62139

prospective 60-day episode payment 

rate is equal to the rate from the 

previous fiscal year (FY 2003) increased 

by the applicable home health market 

basket minus 0.8 percentage points. 

(f) For each calendar year of 2005 and 

2006, the unadjusted national 

prospective 60-day episode payment 

rate is equal to the rate from the 

previous calendar year, increased by the 

applicable home health market basket 

minus 0.8 percentage points. 

(g) For 2007 and subsequent calendar 

years, the unadjusted national rate is 

equal to the rate for the previous 

calendar year increased by the 

applicable home health market basket 

index amount.

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program)

Dated: September 14, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Dated: October 7, 2004. 

Tommy G. Thompson, 

Secretary.

Note: The following addenda will not be 

published in the Code of Federal Regulations.

ADDENDUM A.—WAGE INDEX FOR

RURAL AREAS-APPLICABLE PREFLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX

[CY 2005] 

MSA name Wage 

index 

Alabama ........................................ 0.7637 

Alaska ........................................... 1.1637 

Arizona .......................................... 0.9140 

Arkansas ....................................... 0.7704 

California ....................................... 1.0297 

Colorado ....................................... 0.9368 

Connecticut ................................... 1.1917 

Delaware ....................................... 0.9504 

Florida ........................................... 0.8789 

Georgia ......................................... 0.8247 

Guam ............................................ 0.9611 

Hawaii ........................................... 1.0522 

Idaho ............................................. 0.8826 

Illinois ............................................ 0.8341 

Indiana .......................................... 0.8736 

Iowa .............................................. 0.8550 

Kansas .......................................... 0.8088 

Kentucky ....................................... 0.7844 

Louisiana ...................................... 0.7291 

Maine ............................................ 0.9039 

Maryland ....................................... 0.9179 

Massachusetts .............................. 1.0217 

Michigan ....................................... 0.8741 

Minnesota ..................................... 0.9339 

Mississippi .................................... 0.7583 

Missouri ........................................ 0.7829 

Montana ........................................ 0.8701 

Nebraska ...................................... 0.9035 

ADDENDUM A.—WAGE INDEX FOR

RURAL AREAS-APPLICABLE PREFLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued

[CY 2005] 

MSA name Wage 

index 

Nevada ......................................... 0.9833 

New Hampshire ............................ 0.9940 

New Jersey 1 ................................. ................

New Mexico .................................. 0.8529 

New York ...................................... 0.8403 

North Carolina .............................. 0.8501 

North Dakota ................................ 0.7743 

Ohio .............................................. 0.8760 

Oklahoma ..................................... 0.7537 

Oregon .......................................... 1.0050 

Pennsylvania ................................ 0.8348 

Puerto Rico ................................... 0.4047 

Rhode Island 1 .............................. ................

South Carolina .............................. 0.8640 

South Dakota ................................ 0.8393 

Tennessee .................................... 0.7876 

Texas ............................................ 0.7910 

Utah .............................................. 0.8843 

Vermont ........................................ 0.9375 

Virginia .......................................... 0.8480 

Virgin Islands ................................ 0.7457 

Washington ................................... 1.0072 

West Virginia ................................ 0.8084 

Wisconsin ..................................... 0.9498 

Wyoming ....................................... 0.9182 

1All counties within the State are classified 

urban. 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE INDEX

MSA Urban area (constituent counties or county equivalents) Wage 

index 

0040 .................. Abilene, TX ..................................................................................................................................................................... 0.8009

Taylor, TX 

0060 .................. Aguadilla, PR .................................................................................................................................................................. 0.4294 

Aguada, PR 

Aguadilla, PR 

Moca, PR 

0080 .................. Akron, OH ....................................................................................................................................................................... 0.9055 

Portage, OH 

Summit, OH 

0120 .................. Albany, GA ..................................................................................................................................................................... 1.1266 

Dougherty, GA 

Lee, GA 

0160 .................. Albany-Schenectady-Troy, NY ....................................................................................................................................... 0.8570 

Albany, NY 

Montgomery, NY 

Rensselaer, NY 

Saratoga, NY 

Schenectady, NY 

Schoharie, NY 

0200 .................. Albuquerque, NM ............................................................................................................................................................ 1.0485 

Bernalillo, NM 

Sandoval, NM 

Valencia, NM 

0220 .................. Alexandria, LA ................................................................................................................................................................ 0.8171 

Rapides, LA 

0240 .................. Allentown-Bethlehem-Easton, PA .................................................................................................................................. 0.9536 

Carbon, PA 

Lehigh, PA 

Northampton, PA 

0280 .................. Altoona, PA ..................................................................................................................................................................... 0.8462 

Blair, PA 

0320 .................. Amarillo, TX .................................................................................................................................................................... 0.9178 

62140 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Potter, TX 

Randall, TX 

0380 .................. Anchorage, AK ............................................................................................................................................................... 1.2109 

Anchorage, AK 

0440 .................. Ann Arbor, MI ................................................................................................................................................................. 1.0817 

Lenawee, MI 

Livingston, MI 

Washtenaw, MI 

0450 .................. Anniston,AL .................................................................................................................................................................... 0.7881 

Calhoun, AL 

0460 .................. Appleton-Oshkosh-Neenah, WI ...................................................................................................................................... 0.9115 

Calumet, WI 

Outagamie, WI 

Winnebago, WI 

0470 .................. Arecibo, PR .................................................................................................................................................................... 0.3757 

Arecibo, PR 

Camuy, PR 

Hatillo, PR 

0480 .................. Asheville, NC .................................................................................................................................................................. 0.9502 

Buncombe, NC 

Madison, NC 

0500 .................. Athens, GA ..................................................................................................................................................................... 1.0203 

Clarke, GA 

Madison, GA 

Oconee, GA 

0520 .................. Atlanta, GA ..................................................................................................................................................................... 0.9971 

Barrow, GA 

Bartow, GA 

Carroll, GA 

Cherokee, GA 

Clayton, GA 

Cobb, GA 

Coweta, GA 

De Kalb, GA 

Douglas, GA 

Fayette, GA 

Forsyth, GA 

Fulton, GA 

Gwinnett, GA 

Henry, GA 

Newton, GA 

Paulding, GA 

Pickens, GA 

Rockdale, GA 

Spalding, GA 

Walton, GA 

0560 .................. Atlantic City-Cape May, NJ ............................................................................................................................................ 1.0907 

Atlantic City, NJ 

Cape May, NJ 

0580 .................. Auburn-Opelika, AL ........................................................................................................................................................ 0.8215 

Lee, AL 

0600 .................. Augusta-Aiken, GA-SC ................................................................................................................................................... 0.9208 

Columbia, GA 

McDuffie, GA 

Richmond, GA 

Aiken, SC 

Edgefield, SC 

0640 .................. Austin-San Marcos, TX .................................................................................................................................................. 0.9596 

Bastrop, TX 

Caldwell, TX 

Hays, TX 

Travis, TX 

Williamson, TX 

0680 .................. Bakersfield, CA ............................................................................................................................................................... 1.0036 

Kern, CA 

0720 .................. Baltimore, MD ................................................................................................................................................................. 0.9908 

Anne Arundel, MD 

Baltimore, MD 

Baltimore City, MD 

Carroll, MD 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62141

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Harford, MD 

Howard, MD 

Queen Annes, MD 

0733 .................. Bangor, ME ..................................................................................................................................................................... 0.9955 

Penobscot, ME 

0743 .................. Barnstable-Yarmouth, MA .............................................................................................................................................. 1.2335 

Barnstable, MA 

0760 .................. Baton Rouge, LA ............................................................................................................................................................ 0.8354 

Ascension, LA 

East Baton Rouge 

Livingston, LA 

West Baton Rouge, LA 

0840 .................. Beaumont-Port Arthur, TX .............................................................................................................................................. 0.8616 

Hardin, TX 

Jefferson, TX 

Orange, TX 

0860 .................. Bellingham, WA .............................................................................................................................................................. 1.1643 

Whatcom, WA 

0870 .................. Benton Harbor, MI .......................................................................................................................................................... 0.8847 

Berrien, MI 

0875 .................. Bergen-Passaic, NJ ........................................................................................................................................................ 1.1967 

Bergen, NJ 

Passaic, NJ 

0880 .................. Billings, MT ..................................................................................................................................................................... 0.8961 

Yellowstone, MT 

0920 .................. Biloxi-Gulfport-Pascagoula, MS ...................................................................................................................................... 0.8649 

Hancock, MS 

Harrison, MS 

Jackson, MS 

0960 .................. Binghamton, NY ............................................................................................................................................................. 0.8447 

Broome, NY 

Tioga, NY 

1000 .................. Birmingham, AL .............................................................................................................................................................. 0.9199 

Blount, AL 

Jefferson, AL 

St. Clair, AL 

Shelby, AL 

1010 .................. Bismarck, ND .................................................................................................................................................................. 0.7505 

Burleigh, ND 

Morton, ND 

1020 .................. Bloomington, IN .............................................................................................................................................................. 0.8588 

Monroe, IN 

1040 .................. Bloomington-Normal, IL .................................................................................................................................................. 0.9111 

McLean, IL 

1080 .................. Boise City, ID .................................................................................................................................................................. 0.9352 

Ada, ID 

Canyon, ID 

1123 .................. Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH ................................................................................................. 1.1291 

Bristol, MA 

Essex, MA 

Middlesex, MA 

Norfolk, MA 

Plymouth, MA 

Suffolk, MA 

Worcester, MA 

Hillsborough, NH 

Merrimack, NH 

Rockingham, NH 

Strafford, NH 

1125 .................. Boulder-Longmont, CO ................................................................................................................................................... 1.0046 

Boulder, CO 

1145 .................. Brazoria, TX .................................................................................................................................................................... 0.8525 

Brazoria, TX 

1150 .................. Bremerton, WA ............................................................................................................................................................... 1.0614 

Kitsap, WA 

1240 .................. Brownsville-Harlingen-San Benito, TX ........................................................................................................................... 1.0125 

Cameron, TX 

1260 .................. Bryan-College Station, TX .............................................................................................................................................. 0.9219 

Brazos, TX 

1280 .................. Buffalo-Niagara Falls, NY ............................................................................................................................................... 0.9339 

62142 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Erie, NY 

Niagara, NY 

1303 .................. Burlington, VT ................................................................................................................................................................. 0.9322 

Chittenden, VT 

Franklin, VT 

Grand Isle, VT 

1310 .................. Caguas, PR .................................................................................................................................................................... 0.4061 

Caguas, PR 

Cayey, PR 

Cidra, PR 

Gurabo, PR 

San Lorenzo, PR 

1320 .................. Canton-Massillon, OH .................................................................................................................................................... 0.8895 

Carroll, OH 

Stark, OH 

1350 .................. Casper, WY .................................................................................................................................................................... 0.9244 

Natrona, WY 

1360 .................. Cedar Rapids, IA ............................................................................................................................................................ 0.8975 

Linn, IA 

1400 .................. Champaign-Urbana, IL ................................................................................................................................................... 0.9527 

Champaign, IL 

1440 .................. Charleston-North Charleston, SC ................................................................................................................................... 0.9420 

Berkeley, SC 

Charleston, SC 

Dorchester, SC 

1480 .................. Charleston, WV .............................................................................................................................................................. 0.8876 

Kanawha, WV 

Putnam, WV 

1520 .................. Charlotte-Gastonia-Rock Hill, NC-SC ............................................................................................................................ 0.9712 

Cabarrus, NC 

Gaston, NC 

Lincoln, NC 

Mecklenburg, NC 

Rowan, NC 

Union, NC 

York, SC 

1540 .................. Charlottesville, VA .......................................................................................................................................................... 1.0295 

Albemarle, VA 

Charlottesville City, VA 

Fluvanna, VA 

Greene, VA 

1560 .................. Chattanooga, TN-GA ...................................................................................................................................................... 0.9207 

Catoosa, GA 

Dade, GA 

Walker, GA 

Hamilton, TN 

Marion, TN 

1580 .................. Cheyenne, WY ............................................................................................................................................................... 0.8980 

Laramie, WY 

1600 .................. Chicago, IL ..................................................................................................................................................................... 1.0852 

Cook, IL 

De Kalb, IL 

Du Page, IL 

Grundy, IL 

Kane, IL 

Kendall, IL 

Lake, IL 

McHenry, IL 

Will, IL 

1620 .................. Chico-Paradise, CA ........................................................................................................................................................ 1.0543 

Butte, CA 

1640 .................. Cincinnati, OH-KY-IN ...................................................................................................................................................... 0.9595 

Dearborn, IN 

Ohio, IN 

Boone, KY 

Campbell, KY 

Gallatin, KY 

Grant, KY 

Kenton, KY 

Pendleton, KY 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62143

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Brown, OH 

Clermont, OH 

Hamilton, OH 

Warren, OH 

1660 .................. Clarksville-Hopkinsville, TN-KY ...................................................................................................................................... 0.8022 

Christian, KY 

Montgomery, TN 

1680 .................. Cleveland-Lorain-Elyria, OH ........................................................................................................................................... 0.9626 

Ashtabula, OH 

Geauga, OH 

Cuyahoga, OH 

Lake, OH 

Lorain, OH 

Medina, OH 

1720 .................. Colorado Springs, CO .................................................................................................................................................... 0.9793 

El Paso, CO 

1740 .................. Columbia MO .................................................................................................................................................................. 0.8396 

Boone, MO 

1760 .................. Columbia, SC ................................................................................................................................................................. 0.9450 

Lexington, SC 

Richland, SC 

1800 .................. Columbus, GA-AL ........................................................................................................................................................... 0.8690 

Russell,AL 

Chattanoochee, GA 

Harris, GA 

Muscogee, GA 

1840 .................. Columbus, OH ................................................................................................................................................................ 0.9753 

Delaware, OH 

Fairfield, OH 

Franklin, OH 

Licking, OH 

Madison, OH 

Pickaway, OH 

1880 .................. Corpus Christi, TX .......................................................................................................................................................... 0.8647 

Nueces, TX 

San Patricio, TX 

1890 .................. Corvallis, OR .................................................................................................................................................................. 1.0545 

Benton, OR 

1900 .................. Cumberland, MD-WV ..................................................................................................................................................... 0.8662 

Allegany MD 

Mineral WV 

1920 .................. Dallas, TX ....................................................................................................................................................................... 1.0049 

Collin, TX 

Dallas, TX 

Denton, TX 

Ellis, TX 

Henderson, TX 

Hunt, TX 

Kaufman, TX 

Rockwall, TX 

1950 .................. Danville, VA .................................................................................................................................................................... 0.8643 

Danville City, VA 

Pittsylvania, VA 

1960 .................. Davenport-Moline-Rock Island, IA-IL ............................................................................................................................. 0.8774 

Scott, IA 

Henry, IL 

Rock Island, IL 

2000 .................. Dayton-Springfield, OH ................................................................................................................................................... 0.9232 

Clark, OH 

Greene, OH 

Miami, OH 

Montgomery, OH 

2020 .................. Daytona Beach, FL ......................................................................................................................................................... 0.8900 

Flagler, FL 

Volusia, FL 

2030 .................. Decatur, AL ..................................................................................................................................................................... 0.8894 

Lawrence, AL 

Morgan, AL 

2040 .................. Decatur, IL ...................................................................................................................................................................... 0.8122 

Macon, IL 

62144 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

2080 .................. Denver, CO ..................................................................................................................................................................... 1.0905 

Adams, CO 

Arapahoe, CO 

Broomfield, CO 

Denver, CO 

Douglas, CO 

Jefferson, CO 

2120 .................. Des Moines, IA ............................................................................................................................................................... 0.9267 

Dallas, IA 

Polk, IA 

Warren, IA 

2160 .................. Detroit, MI ....................................................................................................................................................................... 1.0227 

Lapeer, MI 

Macomb, MI 

Monroe, MI 

Oakland, MI 

St. Clair, MI 

Wayne, MI 

2180 .................. Dothan, AL ...................................................................................................................................................................... 0.7597 

Dale, AL 

Houston, AL 

2190 .................. Dover, DE ....................................................................................................................................................................... 0.9825 

Kent, DE 

2200 .................. Dubuque, IA .................................................................................................................................................................... 0.8748 

Dubuque, IA 

2240 .................. Duluth-Superior, MN-WI ................................................................................................................................................. 1.0356 

St. Louis, MN 

Douglas, WI 

2281 .................. Dutchess County, NY ..................................................................................................................................................... 1.1658 

Dutchess, NY 

2290 .................. Eau Claire, WI ................................................................................................................................................................ 0.9139 

Chippewa, WI 

Eau Claire, WI 

2320 .................. El Paso, TX .................................................................................................................................................................... 0.9065 

El Paso, TX 

2330 .................. Elkhart-Goshen, IN ......................................................................................................................................................... 0.9279 

Elkhart, IN 

2335 .................. Elmira, NY ...................................................................................................................................................................... 0.8445 

Chemung, NY 

2340 .................. Enid, OK ......................................................................................................................................................................... 0.9001 

Garfield, OK 

2360 .................. Erie, PA .......................................................................................................................................................................... 0.8699 

Erie, PA 

2400 .................. Eugene-Springfield, OR .................................................................................................................................................. 1.0940 

Lane, OR 

2440 .................. Evansville-Henderson, IN-KY ......................................................................................................................................... 0.8395 

Posey, IN 

Vanderburgh, IN 

Warrick, IN 

Henderson, KY 

2520 .................. Fargo-Moorhead, ND-MN ............................................................................................................................................... 0.9115 

Clay, MN 

Cass, ND 

2560 .................. Fayetteville, NC .............................................................................................................................................................. 0.9363 

Cumberland, NC 

2580 .................. Fayetteville-Springdale-Rogers, AR ............................................................................................................................... 0.8637 

Benton, AR 

Washington, AR 

2620 .................. Flagstaff, AZ-UT ............................................................................................................................................................. 1.0611 

Coconino, AZ 

Kane, UT 

2640 .................. Flint, MI ........................................................................................................................................................................... 1.1178 

Genesee, MI 

2650 .................. Florence, AL ................................................................................................................................................................... 0.7883 

Colbert, AL 

Lauderdale, AL 

2655 .................. Florence, SC ................................................................................................................................................................... 0.8961 

Florence, SC 

2670 .................. Fort Collins-Loveland, CO .............................................................................................................................................. 1.0219 

Larimer, CO 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62145

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

2680 .................. Ft. Lauderdale, FL .......................................................................................................................................................... 1.0165 

Broward, FL 

2700 .................. Fort Myers-Cape Coral, FL ............................................................................................................................................ 0.9372 

Lee, FL 

2710 .................. Fort Pierce-Port St. Lucie, FL ........................................................................................................................................ 1.0046 

Martin, FL 

St. Lucie, FL 

2720 .................. Fort Smith, AR-OK ......................................................................................................................................................... 0.8303 

Crawford, AR 

Sebastian, AR 

Sequoyah, OK 

2750 .................. Fort Walton Beach, FL ................................................................................................................................................... 0.8786 

Okaloosa, FL 

2760 .................. Fort Wayne, IN ............................................................................................................................................................... 0.9737 

Adams, IN 

Allen, IN 

De Kalb, IN 

Huntington, IN 

Wells, IN 

Whitley, IN 

2800 .................. Forth Worth-Arlington, TX .............................................................................................................................................. 0.9538 

Hood, TX 

Johnson, TX 

Parker, TX 

Tarrant, TX 

2840 .................. Fresno, CA ..................................................................................................................................................................... 1.0408 

Fresno, CA 

Madera, CA 

2880 .................. Gadsden, AL ................................................................................................................................................................... 0.8049 

Etowah, AL 

2900 .................. Gainesville, FL ................................................................................................................................................................ 0.9459 

Alachua, FL 

2920 .................. Galveston-Texas City, TX .............................................................................................................................................. 0.9403 

Galveston, TX 

2960 .................. Gary, IN .......................................................................................................................................................................... 0.9343 

Lake, IN 

Porter, IN 

2975 .................. Glens Falls, NY .............................................................................................................................................................. 0.8467 

Warren, NY 

Washington, NY 

2980 .................. Goldsboro, NC ................................................................................................................................................................ 0.8779 

Wayne, NC 

2985 .................. Grand Forks, ND-MN ..................................................................................................................................................... 0.9092 

Polk, MN 

Grand Forks, ND 

2995 .................. Grand Junction, CO ........................................................................................................................................................ 0.9900 

Mesa, CO 

3000 .................. Grand Rapids-Muskegon-Holland, MI ............................................................................................................................ 0.9520 

Allegan, MI 

Kent, MI 

Muskegon, MI 

Ottawa, MI 

3040 .................. Great Falls, MT ............................................................................................................................................................... 0.8810 

Cascade, MT 

3060 .................. Greeley, CO .................................................................................................................................................................... 0.9444 

Weld, CO 

3080 .................. Green Bay, WI ................................................................................................................................................................ 0.9586 

Brown, WI 

3120 .................. Greensboro-Winston-Salem-High Point, NC .................................................................................................................. 0.9312 

Alamance, NC 

Davidson, NC 

Davie, NC 

Forsyth, NC 

Guilford, NC 

Randolph, NC 

Stokes, NC 

Yadkin, NC 

3150 .................. Greenville, NC ................................................................................................................................................................ 0.9183 

Pitt, NC 

3160 .................. Greenville-Spartanburg-Anderson, SC ........................................................................................................................... 0.9400 

62146 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Anderson, SC 

Cherokee, SC 

Greenville, SC 

Pickens, SC 

Spartanburg, SC 

3180 .................. Hagerstown, MD ............................................................................................................................................................. 0.9940 

Washington, MD 

3200 .................. Hamilton-Middletown, OH ............................................................................................................................................... 0.9066 

Butler, OH 

3240 .................. Harrisburg-Lebanon-Carlisle, PA .................................................................................................................................... 0.9286 

Cumberland, PA 

Dauphin, PA 

Lebanon, PA 

Perry, PA 

3283 .................. Hartford, CT .................................................................................................................................................................... 1.1055 

Hartford, CT 

Litchfield, CT 

Middlesex, CT 

Tolland, CT 

3285 .................. Hattiesburg, MS .............................................................................................................................................................. 0.7362 

Forrest, MS 

Lamar, MS 

3290 .................. Hickory-Morganton-Lenoir, NC ....................................................................................................................................... 0.9502 

Alexander, NC 

Burke, NC 

Caldwell, NC 

Catawba, NC 

3320 .................. Honolulu, HI .................................................................................................................................................................... 1.1014 

Honolulu, HI 

3350 .................. Houma, LA ...................................................................................................................................................................... 0.7721 

Lafourche, LA 

Terrebonne, LA 

3360 .................. Houston, TX .................................................................................................................................................................... 1.0117 

Chambers, TX 

Fort Bend, TX 

Harris, TX 

Liberty, TX 

Montgomery, TX 

Waller, TX 

3400 .................. Huntington-Ashland, WV-KY-OH .................................................................................................................................... 0.9565 

Boyd, KY 

Carter, KY 

Greenup, KY 

Lawrence, OH 

Cabell, WV 

Wayne, WV 

3440 .................. Huntsville, AL .................................................................................................................................................................. 0.8851 

Limestone, AL 

Madison, AL 

3480 .................. Indianapolis, IN ............................................................................................................................................................... 1.0039 

Boone, IN 

Hamilton, IN 

Hancock, IN 

Hendricks, IN 

Johnson, IN 

Madison, IN 

Marion, IN 

Morgan, IN 

Shelby, IN 

3500 .................. Iowa City, IA ................................................................................................................................................................... 0.9655 

Johnson, IA 

3520 .................. Jackson, MI .................................................................................................................................................................... 0.9146 

Jackson, MI 

3560 .................. Jackson, MS ................................................................................................................................................................... 0.8406 

Hinds, MS 

Madison, MS 

Rankin, MS 

3580 .................. Jackson, TN .................................................................................................................................................................... 0.8900 

Chester, TN 

Madison, TN 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62147

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

3600 .................. Jacksonville, FL .............................................................................................................................................................. 0.9548 

Clay, FL 

Duval, FL 

Nassau, FL 

St. Johns, FL 

3605 .................. Jacksonville, NC ............................................................................................................................................................. 0.8402 

Onslow, NC 

3610 .................. Jamestown, NY .............................................................................................................................................................. 0.7589 

Chautaqua, NY 

3620 .................. Janesville-Beloit, WI ....................................................................................................................................................... 0.9583 

Rock, WI 

3640 .................. Jersey City, NJ ............................................................................................................................................................... 1.0923 

Hudson, NJ 

3660 .................. Johnson City-Kingsport-Bristol, TN-VA .......................................................................................................................... 0.8203 

Carter, TN 

Hawkins, TN 

Sullivan, TN 

Unicoi, TN 

Washington, TN 

Bristol City, VA 

Scott, VA 

Washington, VA 

3680 .................. Johnstown, PA ................................................................................................................................................................ 0.7981 

Cambria, PA 

Somerset, PA 

3700 .................. Jonesboro, AR ................................................................................................................................................................ 0.7934 

Craighead, AR 

3710 .................. Joplin, MO ...................................................................................................................................................................... 0.8721 

Jasper, MO 

Newton, MO 

3720 .................. Kalamazoo-Battlecreek, MI ............................................................................................................................................ 1.0350 

Calhoun, MI 

Kalamazoo, MI 

Van Buren, MI 

3740 .................. Kankakee, IL ................................................................................................................................................................... 1.0603 

Kankakee, IL 

3760 .................. Kansas City, KS-MO ...................................................................................................................................................... 0.9642 

Johnson, KS 

Leavenworth, KS 

Miami, KS 

Wyandotte, KS 

Cass, MO 

Clay, MO 

Clinton, MO 

Jackson, MO 

Lafayette, MO 

Platte, MO 

Ray, MO 

3800 .................. Kenosha, WI ................................................................................................................................................................... 0.9772 

Kenosha, WI 

3810 .................. Killeen-Temple, TX ......................................................................................................................................................... 0.9242 

Bell, TX 

Coryell, TX 

3840 .................. Knoxville, TN .................................................................................................................................................................. 0.8509 

Anderson, TN 

Blount, TN 

Knox, TN 

Loudon, TN 

Sevier, TN 

Union, TN 

3850 .................. Kokomo, IN ..................................................................................................................................................................... 0.8986 

Howard, IN 

Tipton, IN 

3870 .................. La Crosse, WI-MN .......................................................................................................................................................... 0.9290 

Houston, MN 

La Crosse, WI 

3880 .................. Lafayette, LA .................................................................................................................................................................. 0.8105 

Acadia, LA 

Lafayette, LA 

St. Landry, LA 

62148 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

St. Martin, LA 

3920 .................. Lafayette, IN ................................................................................................................................................................... 0.9068 

Clinton, IN 

Tippecanoe, IN 

3960 .................. Lake Charles, LA ............................................................................................................................................................ 0.7959 

Calcasieu, LA 

3980 .................. Lakeland-Winter Haven, FL ............................................................................................................................................ 0.8931 

Polk, FL 

4000 .................. Lancaster, PA ................................................................................................................................................................. 0.9883 

Lancaster, PA 

4040 .................. Lansing-East Lansing, MI ............................................................................................................................................... 0.9659 

Clinton, MI 

Eaton, MI 

Ingham, MI 

4080 .................. Laredo, TX ...................................................................................................................................................................... 0.8747 

Webb, TX 

4100 .................. Las Cruces, NM .............................................................................................................................................................. 0.8784 

Dona Ana, NM 

4120 .................. Las Vegas, NV-AZ .......................................................................................................................................................... 1.1121 

Mohave, AZ 

Clark, NV 

Nye, NV 

4150 .................. Lawrence, KS ................................................................................................................................................................. 0.8644 

Douglas, KS 

4200 .................. Lawton, OK ..................................................................................................................................................................... 0.8212 

Comanche, OK 

4243 .................. Lewiston-Auburn, ME ..................................................................................................................................................... 0.9562 

Androscoggin, ME 

4280 .................. Lexington, KY ................................................................................................................................................................. 0.8053 

Bourbon, KY 

Clark, KY 

Fayette, KY 

Jessamine, KY 

Madison, KY 

Scott, KY 

Woodford, KY 

4320 .................. Lima, OH ........................................................................................................................................................................ 0.9258 

Allen, OH 

Auglaize, OH 

4360 .................. Lincoln, NE ..................................................................................................................................................................... 1.0208 

Lancaster, NE 

4400 .................. Little Rock-North Little, AR ............................................................................................................................................. 0.8827 

Faulkner, AR 

Lonoke, AR 

Pulaski, AR 

Saline, AR 

4420 .................. Longview-Marshall, TX ................................................................................................................................................... 0.8739 

Gregg, TX 

Harrison, TX 

Upshur, TX 

4480 .................. Los Angeles-Long Beach, CA ........................................................................................................................................ 1.1732 

Los Angeles, CA 

4520 .................. Louisville, KY-IN ............................................................................................................................................................. 0.9163 

Clark, IN 

Floyd, IN 

Harrison, IN 

Scott, IN 

Bullitt, KY 

Jefferson, KY 

Oldham, KY 

4600 .................. Lubbock, TX ................................................................................................................................................................... 0.8777 

Lubbock, TX 

4640 .................. Lynchburg, VA ................................................................................................................................................................ 0.9018 

Amherst, VA 

Bedford City, VA 

Bedford, VA 

Campbell, VA 

Lynchburg City, VA 

4680 .................. Macon, GA ...................................................................................................................................................................... 0.9596 

Bibb, GA 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62149

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Houston, GA 

Jones, GA 

Peach, GA 

Twiggs, GA 

4720 .................. Madison, WI .................................................................................................................................................................... 1.0395 

Dane, WI 

4800 .................. Mansfield, OH ................................................................................................................................................................. 0.9105 

Crawford, OH 

Richland, OH 

4840 .................. Mayaguez, PR ................................................................................................................................................................ 0.4769 

Anasco, PR 

Cabo Rojo, PR 

Hormigueros, PR 

Mayaguez, PR 

Sabana Grande, PR 

San German, PR 

4880 .................. McAllen-Edinburg-Mission, TX ....................................................................................................................................... 0.8602 

Hidalgo, TX 

4890 .................. Medford-Ashland, OR ..................................................................................................................................................... 1.0534 

Jackson, OR 

4900 .................. Melbourne-Titusville-Palm Bay, FL ................................................................................................................................ 0.9633 

Brevard, FL 

4920 .................. Memphis, TN-AR-MS ..................................................................................................................................................... 0.9234 

Crittenden, AR 

De Soto, MS 

Fayette, TN 

Shelby, TN 

Tipton, TN 

4940 .................. Merced, CA ..................................................................................................................................................................... 1.0576 

Merced, CA 

5000 .................. Miami, FL ........................................................................................................................................................................ 1.0026 

Dade, FL 

5015 .................. Middlesex-Somerset-Hunterdon, NJ .............................................................................................................................. 1.1360 

Hunterdon, NJ 

Middlesex, NJ 

Somerset, NJ 

5080 .................. Milwaukee-Waukesha, WI .............................................................................................................................................. 1.0076 

Milwaukee, WI 

Ozaukee, WI 

Washington, WI 

Waukesha, WI 

5120 .................. Minneapolis-St. Paul, MN-WI ......................................................................................................................................... 1.1067 

Anoka, MN 

Carver, MN 

Chisago, MN 

Dakota, MN 

Hennepin, MN 

Isanti, MN 

Ramsey, MN 

Scott, MN 

Sherburne, MN 

Washington, MN 

Wright, MN 

Pierce, WI 

St. Croix, WI 

5140 .................. Missoula, MT .................................................................................................................................................................. 0.9618 

Missoula, MT 

5160 .................. Mobile, AL ....................................................................................................................................................................... 0.7933 

Baldwin, AL 

Mobile, AL 

5170 .................. Modesto, CA ................................................................................................................................................................... 1.1966 

Stanislaus, CA 

5190 .................. Monmouth-Ocean, NJ .................................................................................................................................................... 1.0889 

Monmouth, NJ 

Ocean, NJ 

5200 .................. Monroe, LA ..................................................................................................................................................................... 0.7913 

Ouachita, LA 

5240 .................. Montgomery, AL ............................................................................................................................................................. 0.8300 

Autauga, AL 

Elmore, AL 

62150 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Montgomery, AL 

5280 .................. Muncie, IN ...................................................................................................................................................................... 0.8580 

Delaware, IN 

5330 .................. Myrtle Beach, SC ........................................................................................................................................................... 0.9022 

Horry, SC 

5345 .................. Naples, FL ...................................................................................................................................................................... 1.0596 

Collier, FL 

5360 .................. Nashville, TN .................................................................................................................................................................. 1.0108 

Cheatham, TN 

Davidson, TN 

Dickson, TN 

Robertson, TN 

Rutherford, TN 

Sumner, TN 

Williamson, TN 

Wilson, TN 

5380 .................. Nassau-Suffolk, NY ........................................................................................................................................................ 1.2921 

Nassau, NY 

Suffolk, NY 

5483 .................. New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT ............................................................................................ 1.2254 

Fairfield, CT 

New Haven, CT 

5523 .................. New London-Norwich, CT .............................................................................................................................................. 1.1596 

New London, CT 

5560 .................. New Orleans, LA ............................................................................................................................................................ 0.9103 

Jefferson, LA 

Orleans, LA 

Plaquemines, LA 

St. Bernard, LA 

St. Charles, LA 

St. James, LA 

St. John The Baptist, LA 

St. Tammany, LA 

5600 .................. New York, NY ................................................................................................................................................................. 1.3588 

Bronx, NY 

Kings, NY 

New York, NY 

Putnam, NY 

Queens, NY 

Richmond, NY 

Rockland, NY 

Westchester, NY 

5640 .................. Newark, NJ ..................................................................................................................................................................... 1.1625 

Essex, NJ 

Morris, NJ 

Sussex, NJ 

Union, NJ 

Warren, NJ 

5660 .................. Newburgh, NY-PA .......................................................................................................................................................... 1.1171 

Orange, NY 

Pike, PA 

5720 .................. Norfolk-Virginia Beach-Newport News, VA-NC .............................................................................................................. 0.8895 

Currituck, NC 

Chesapeake City, VA 

Gloucester, VA 

Hampton City, VA 

Isle of Wight, VA 

James City, VA 

Mathews, VA 

Newport News City, VA 

Norfolk City, VA 

Poquoson City,VA 

Portsmouth City, VA 

Suffolk City, VA 

Virginia Beach City, VA 

Williamsburg City, VA 

York, VA 

5775 .................. Oakland, CA ................................................................................................................................................................... 1.5221 

Alameda, CA 

Contra Costa, CA 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62151

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

5790 .................. Ocala, FL ........................................................................................................................................................................ 0.9153 

Marion, FL 

5800 .................. Odessa-Midland, TX ....................................................................................................................................................... 0.9632 

Ector, TX 

Midland, TX 

5880 .................. Oklahoma City, OK ......................................................................................................................................................... 0.8966 

Canadian, OK 

Cleveland, OK 

Logan, OK 

McClain, OK 

Oklahoma, OK 

Pottawatomie, OK 

5910 .................. Olympia, WA ................................................................................................................................................................... 1.1007 

Thurston, WA 

5920 .................. Omaha, NE-IA ................................................................................................................................................................ 0.9754 

Pottawattamie, IA 

Cass, NE 

Douglas, NE 

Sarpy, NE 

Washington, NE 

5945 .................. Orange County, CA ........................................................................................................................................................ 1.1612 

Orange, CA 

5960 .................. Orlando, FL ..................................................................................................................................................................... 0.9742 

Lake, FL 

Orange, FL 

Osceola, FL 

Seminole, FL 

5990 .................. Owensboro, KY .............................................................................................................................................................. 0.8434 

Daviess, KY 

6015 .................. Panama City, FL ............................................................................................................................................................. 0.8124 

Bay, FL 

6020 .................. Parkersburg-Marietta, WV-OH ....................................................................................................................................... 0.8288 

Washington, OH 

Wood, WV 

6080 .................. Pensacola, FL ................................................................................................................................................................. 0.8306 

Escambia, FL 

Santa Rosa, FL 

6120 .................. Peoria-Pekin, IL .............................................................................................................................................................. 0.8886 

Peoria, IL 

Tazewell, IL 

Woodford, IL 

6160 .................. Philadelphia, PA-NJ ........................................................................................................................................................ 1.0824 

Burlington, NJ 

Camden, NJ 

Gloucester, NJ 

Salem, NJ 

Bucks, PA 

Chester, PA 

Delaware, PA 

Montgomery, PA 

Philadelphia, PA 

6200 .................. Phoenix-Mesa, AZ .......................................................................................................................................................... 0.9982 

Maricopa, AZ 

Pinal, AZ 

6240 .................. Pine Bluff, AR ................................................................................................................................................................. 0.8673 

Jefferson, AR 

6280 .................. Pittsburgh, PA ................................................................................................................................................................. 0.8756 

Allegheny, PA 

Beaver, PA 

Butler, PA 

Fayette, PA 

Washington, PA 

Westmoreland, PA 

6323 .................. Pittsfield, MA ................................................................................................................................................................... 1.0439 

Berkshire, MA 

6340 .................. Pocatello, ID ................................................................................................................................................................... 0.9602 

Bannock, ID 

6360 .................. Ponce, PR ...................................................................................................................................................................... 0.4954 

Guayanilla, PR 

Juana Diaz, PR 

62152 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Penuelas, PR 

Ponce, PR 

Villalba, PR 

Yauco, PR 

6403 .................. Portland, ME ................................................................................................................................................................... 1.0112 

Cumberland, ME 

Sagadahoc, ME 

York, ME 

6440 .................. Portland-Vancouver, OR-WA ......................................................................................................................................... 1.1403 

Clackamas, OR 

Columbia, OR 

Multnomah, OR 

Washington, OR 

Yamhill, OR 

Clark, WA 

6483 .................. Providence-Warwick-Pawtucket, RI ............................................................................................................................... 1.1062 

Bristol, RI 

Kent, RI 

Newport, RI 

Providence, RI 

Washington, RI 

6520 .................. Provo-Orem, UT ............................................................................................................................................................. 0.9613 

Utah, UT 

6560 .................. Pueblo, CO ..................................................................................................................................................................... 0.8752 

Pueblo, CO 

6580 .................. Punta Gorda, FL ............................................................................................................................................................. 0.9441 

Charlotte, FL 

6600 .................. Racine, WI ...................................................................................................................................................................... 0.9045 

Racine, WI 

6640 .................. Raleigh-Durham-Chapel Hill, NC ................................................................................................................................... 1.0258 

Chatham, NC 

Durham, NC 

Franklin, NC 

Johnston, NC 

Orange, NC 

Wake, NC 

6660 .................. Rapid City, SD ................................................................................................................................................................ 0.8912 

Pennington, SD 

6680 .................. Reading, PA ................................................................................................................................................................... 0.9216 

Berks, PA 

6690 .................. Redding, CA ................................................................................................................................................................... 1.1835 

Shasta, CA 

6720 .................. Reno, NV ........................................................................................................................................................................ 1.0456 

Washoe, NV 

6740 .................. Richland-Kennewick-Pasco, WA .................................................................................................................................... 1.0520 

Benton, WA 

Franklin, WA 

6760 .................. Richmond-Petersburg, VA .............................................................................................................................................. 0.9398 

Charles City County, VA 

Chesterfield, VA 

Colonial Heights City, VA 

Dinwiddie, VA 

Goochland, VA 

Hanover, VA 

Henrico, VA 

Hopewell City, VA 

New Kent, VA 

Petersburg City, VA 

Powhatan, VA 

Prince George, VA 

Richmond City, VA 

6780 .................. Riverside-San Bernardino, CA ....................................................................................................................................... 1.0975 

Riverside, CA 

San Bernardino, CA 

6800 .................. Roanoke, VA .................................................................................................................................................................. 0.8429 

Botetourt, VA 

Roanoke, VA 

Roanoke City, VA 

Salem City, VA 

6820 .................. Rochester, MN ................................................................................................................................................................ 1.1504 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62153

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Olmsted, MN 

6840 .................. Rochester, NY ................................................................................................................................................................ 0.9196 

Genesee, NY 

Livingston, NY 

Monroe, NY 

Ontario, NY 

Orleans, NY 

Wayne, NY 

6880 .................. Rockford, IL .................................................................................................................................................................... 0.9626 

Boone, IL 

Ogle, IL 

Winnebago, IL 

6895 .................. Rocky Mount, NC ........................................................................................................................................................... 0.8998 

Edgecombe, NC 

Nash, NC 

6920 .................. Sacramento, CA ............................................................................................................................................................. 1.1849 

El Dorado, CA 

Placer, CA 

Sacramento, CA 

6960 .................. Saginaw-Bay City-Midland, MI ....................................................................................................................................... 0.9696 

Bay, MI 

Midland, MI 

Saginaw, MI 

6980 .................. St. Cloud, MN ................................................................................................................................................................. 1.0215 

Benton, MN 

Stearns, MN 

7000 .................. St. Joseph, MO ............................................................................................................................................................... 1.0013 

Andrews, MO 

Buchanan, MO 

7040 .................. St. Louis, MO-IL ............................................................................................................................................................. 0.9081 

Clinton, IL 

Jersey, IL 

Madison, IL 

Monroe, IL 

St. Clair, IL 

Franklin, MO 

Jefferson, MO 

Lincoln, MO 

St. Charles, MO 

St. Louis, MO 

St. Louis City, MO 

Warren, MO 

Sullivan City, MO 

7080 .................. Salem, OR ...................................................................................................................................................................... 1.0557 

Marion, OR 

Polk, OR 

7120 .................. Salinas, CA ..................................................................................................................................................................... 1.3823 

Monterey, CA 

7160 .................. Salt Lake City-Ogden, UT .............................................................................................................................................. 0.9487 

Davis, UT 

Salt Lake, UT 

Weber, UT 

7200 .................. San Angelo, TX .............................................................................................................................................................. 0.8168 

Tom Green, TX 

7240 .................. San Antonio, TX ............................................................................................................................................................. 0.9023 

Bexar, TX 

Comal, TX 

Guadalupe, TX 

Wilson, TX 

7320 .................. San Diego, CA ................................................................................................................................................................ 1.1267 

San Diego, CA 

7360 .................. San Francisco, CA ......................................................................................................................................................... 1.4712 

Marin, CA 

San Francisco, CA 

San Mateo, CA 

7400 .................. San Jose, CA ................................................................................................................................................................. 1.4744 

Santa Clara, CA 

7440 .................. San Juan-Bayamon, PR ................................................................................................................................................. 0.4802 

Aguas Buenas, PR 

Barceloneta, PR 

62154 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Bayamon, PR 

Canovanas, PR 

Carolina, PR 

Catano, PR 

Ceiba, PR 

Comerio, PR 

Corozal, PR 

Dorado, PR 

Fajardo, PR 

Florida, PR 

Guaynabo, PR 

Humacao, PR 

Juncos, PR 

Los Piedras, PR 

Loiza, PR 

Luguillo, PR 

Manati, PR 

Morovis, PR 

Naguabo, PR 

Naranjito, PR 

Rio Grande, PR 

San Juan, PR 

Toa Alta, PR 

Toa Baja, PR 

Trujillo Alto, PR 

Vega Alta, PR 

Vega Baja, PR 

Yabucoa, PR 

7460 .................. San Luis Obispo-Atascadero-Paso Robles, CA ............................................................................................................. 1.1118 

San Luis Obispo, CA 

7480 .................. Santa Barbara-Santa Maria-Lompoc, CA ...................................................................................................................... 1.0771 

Santa Barbara, CA 

7485 .................. Santa Cruz-Watsonville, CA ........................................................................................................................................... 1.4780 

Santa Cruz, CA 

7490 .................. Santa Fe, NM ................................................................................................................................................................. 1.0590 

Los Alamos, NM 

Santa Fe, NM 

7500 .................. Santa Rosa, CA .............................................................................................................................................................. 1.2962 

Sonoma, CA 

7510 .................. Sarasota-Bradenton, FL ................................................................................................................................................. 0.9630 

Manatee, FL 

Sarasota, FL 

7520 .................. Savannah, GA ................................................................................................................................................................ 0.9460 

Bryan, GA 

Chatham, GA 

Effingham, GA 

7560 .................. Scranton--Wilkes-Barre--Hazleton, PA ........................................................................................................................... 0.8523 

Columbia, PA 

Lackawanna, PA 

Luzerne, PA 

Wyoming, PA 

7600 .................. Seattle-Bellevue-Everett, WA ......................................................................................................................................... 1.1479 

Island, WA 

King, WA 

Snohomish, WA 

7610 .................. Sharon, PA ..................................................................................................................................................................... 0.7881 

Mercer, PA 

7620 .................. Sheboygan, WI ............................................................................................................................................................... 0.8949 

Sheboygan, WI 

7640 .................. Sherman-Denison, TX .................................................................................................................................................... 0.9617 

Grayson, TX 

7680 .................. Shreveport-Bossier City, LA ........................................................................................................................................... 0.9112 

Bossier, LA 

Caddo, LA 

Webster, LA 

7720 .................. Sioux City, IA-NE ............................................................................................................................................................ 0.9094 

Woodbury, IA 

Dakota, NE 

7760 .................. Sioux Falls, SD ............................................................................................................................................................... 0.9441 

Lincoln, SD 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62155

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

Minnehaha, SD 

7800 .................. South Bend, IN ............................................................................................................................................................... 0.9447 

St. Joseph, IN 

7840 .................. Spokane, WA .................................................................................................................................................................. 1.0661 

Spokane, WA 

7880 .................. Springfield, IL .................................................................................................................................................................. 0.8738 

Menard, IL 

Sangamon, IL 

7920 .................. Springfield, MO ............................................................................................................................................................... 0.8597 

Christian, MO 

Greene, MO 

Webster, MO 

8003 .................. Springfield, MA ............................................................................................................................................................... 1.0174 

Hampden, MA 

Hampshire, MA 

8050 .................. State College, PA ........................................................................................................................................................... 0.8462 

Centre, PA 

8080 .................. Steubenville-Weirton, OH-WV ........................................................................................................................................ 0.8281 

Jefferson, OH 

Brooke, WV 

Hancock, WV 

8120 .................. Stockton-Lodi, CA ........................................................................................................................................................... 1.0564 

San Joaquin, CA 

8140 .................. Sumter, SC ..................................................................................................................................................................... 0.8520 

Sumter, SC 

8160 .................. Syracuse, NY .................................................................................................................................................................. 0.9394 

Cayuga, NY 

Madison, NY 

Onondaga, NY 

Oswego, NY 

8200 .................. Tacoma, WA ................................................................................................................................................................... 1.1078 

Pierce, WA 

8240 .................. Tallahassee, FL .............................................................................................................................................................. 0.8656 

Gadsden, FL 

Leon, FL 

8280 .................. Tampa-St. Petersburg-Clearwater, FL ........................................................................................................................... 0.9024 

Hernando, FL 

Hillsborough, FL 

Pasco, FL 

Pinellas, FL 

8320 .................. Terre Haute, IN ............................................................................................................................................................... 0.8582 

Clay, IN 

Vermillion, IN 

Vigo, IN 

8360 .................. Texarkana, AR-Texarkana, TX ....................................................................................................................................... 0.8414 

Miller, AR 

Bowie, TX 

8400 .................. Toledo, OH ..................................................................................................................................................................... 0.9525 

Fulton, OH 

Lucas, OH 

Wood, OH 

8440 .................. Topeka, KS ..................................................................................................................................................................... 0.8904 

Shawnee, KS 

8480 .................. Trenton, NJ ..................................................................................................................................................................... 1.0276 

Mercer, NJ 

8520 .................. Tucson, AZ ..................................................................................................................................................................... 0.8926 

Pima, AZ 

8560 .................. Tulsa, OK ........................................................................................................................................................................ 0.8729 

Creek, OK 

Osage, OK 

Rogers, OK 

Tulsa, OK 

Wagoner, OK 

8600 .................. Tuscaloosa, AL ............................................................................................................................................................... 0.8440 

Tuscaloosa, AL 

8640 .................. Tyler, TX ......................................................................................................................................................................... 0.9502 

Smith, TX 

8680 .................. Utica-Rome, NY .............................................................................................................................................................. 0.8295 

Herkimer, NY 

Oneida, NY 

62156 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

8720 .................. Vallejo-Fairfield-Napa, CA .............................................................................................................................................. 1.3517 

Napa, CA 

Solano, CA 

8735 .................. Ventura, CA .................................................................................................................................................................... 1.1105 

Ventura, CA 

8750 .................. Victoria, TX ..................................................................................................................................................................... 0.8469 

Victoria, TX 

8760 .................. Vineland-Millville-Bridgeton, NJ ...................................................................................................................................... 1.0573 

Cumberland, NJ 

8780 .................. Visalia-Tulare-Porterville, CA ......................................................................................................................................... 0.9964 

Tulare, CA 

8800 .................. Waco, TX ........................................................................................................................................................................ 0.8146 

McLennan, TX 

8840 .................. Washington, DC-MD-VA-WV .......................................................................................................................................... 1.0971 

District of Columbia, DC 

Calvert, MD 

Charles, MD 

Frederick, MD 

Montgomery, MD 

Prince Georges, MD 

Alexandria City, VA 

Arlington, VA 

Clarke, VA 

Culpepper, VA 

Fairfax, VA 

Fairfax City, VA 

Falls Church City, VA 

Fauquier, VA 

Fredericksburg City, VA 

King George, VA 

Loudoun, VA 

Manassas City, VA 

Manassas Park City, VA 

Prince William, VA 

Spotsylvania, VA 

Stafford, VA 

Warren, VA 

Berkeley, WV 

Jefferson, WV 

8920 .................. Waterloo-Cedar Falls, IA ................................................................................................................................................ 0.8633 

Black Hawk, IA 

8940 .................. Wausau, WI .................................................................................................................................................................... 0.9570 

Marathon, WI 

8960 .................. West Palm Beach-Boca Raton, FL ................................................................................................................................ 1.0059 

Palm Beach, FL 

9000 .................. Wheeling, OH-WV .......................................................................................................................................................... 0.7449 

Belmont, OH 

Marshall, WV 

Ohio, WV 

9040 .................. Wichita, KS ..................................................................................................................................................................... 0.9473 

Butler, KS 

Harvey, KS 

Sedgwick, KS 

9080 .................. Wichita Falls, TX ............................................................................................................................................................ 0.8395 

Archer, TX 

Wichita, TX 

9140 .................. Williamsport, PA ............................................................................................................................................................. 0.8486 

Lycoming, PA 

9160 .................. Wilmington-Newark, DE-MD ........................................................................................................................................... 1.1121 

New Castle, DE 

Cecil, MD 

9200 .................. Wilmington, NC ............................................................................................................................................................... 0.9237 

New Hanover, NC 

Brunswick, NC 

9260 .................. Yakima, WA .................................................................................................................................................................... 1.0323 

Yakima, WA 

9270 .................. Yolo, CA ......................................................................................................................................................................... 0.9378 

Yolo, CA 

9280 .................. York, PA ......................................................................................................................................................................... 0.9150 

York, PA 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62157

ADDENDUM B.—CY 2005 WAGE INDEX FOR URBAN AREAS PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued

MSA Urban area (constituent counties or county equivalents) Wage 

index 

9320 .................. Youngstown-Warren, OH ............................................................................................................................................... 0.9518 

Columbiana, OH 

Mahoning, OH 

Trumbull, OH 

9340 .................. Yuba City, CA ................................................................................................................................................................. 1.0364 

Sutter, CA 

Yuba, CA 

9360 .................. Yuma, AZ ........................................................................................................................................................................ 0.8871 

Yuma, AZ 

ADDENDUM C.—COMPARISON OF PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE INDEX FOR FY 2003 AND CY 

2005 

Rural area FY 2003 Wage 

index 

CY 2005 Wage 

index 

Percent change, 

FY 2003–CY 2005 

ALABAMA .................................................................................................................. 0.7660 0.7637 ¥0.30 

ALASKA ..................................................................................................................... 1.2293 1.1637 ¥5.34 

ARIZONA ................................................................................................................... 0.8493 0.9140 7.62 

ARKANSAS ............................................................................................................... 0.7666 0.7704 0.50 

CALIFORNIA ............................................................................................................. 0.9840 1.0297 4.64 

COLORADO .............................................................................................................. 0.9015 0.9368 3.92 

CONNECTICUT ......................................................................................................... 1.2394 1.1917 ¥3.85 

DELAWARE ............................................................................................................... 0.9128 0.9504 4.12 

FLORIDA ................................................................................................................... 0.8814 0.8789 ¥0.28 

GEORGIA .................................................................................................................. 0.8230 0.8247 0.21 

GUAM ........................................................................................................................ 0.9611 0.9611 0.00 

HAWAII ...................................................................................................................... 1.0255 1.0522 2.60 

IDAHO ........................................................................................................................ 0.8747 0.8826 0.90 

ILLINOIS .................................................................................................................... 0.8204 0.8341 1.67 

INDIANA .................................................................................................................... 0.8755 0.8736 ¥0.22 

IOWA ......................................................................................................................... 0.8315 0.8550 2.83 

KANSAS .................................................................................................................... 0.7923 0.8088 2.08 

KENTUCKY ............................................................................................................... 0.8079 0.7844 ¥2.91 

LOUISIANA ................................................................................................................ 0.7567 0.7291 ¥3.65 

MAINE ........................................................................................................................ 0.8874 0.9039 1.86 

MARYLAND ............................................................................................................... 0.8946 0.9179 2.60 

MASSACHUSETTS ................................................................................................... 1.1288 1.0217 ¥9.49 

MICHIGAN ................................................................................................................. 0.9000 0.8741 ¥2.88 

MINNESOTA .............................................................................................................. 0.9151 0.9339 2.05 

MISSISSIPPI .............................................................................................................. 0.7680 0.7583 ¥1.26 

MISSOURI ................................................................................................................. 0.8021 0.7829 ¥2.39 

MONTANA ................................................................................................................. 0.8481 0.8701 2.59 

NEBRASKA ............................................................................................................... 0.8204 0.9035 10.13 

NEVADA .................................................................................................................... 0.9577 0.9833 2.67 

NEW HAMPSHIRE .................................................................................................... 0.9796 0.9940 1.47 

New Jersey ................................................................................................................ .............................. .............................. ..............................

NEW MEXICO ........................................................................................................... 0.8872 0.8529 ¥3.87 

NEW YORK ............................................................................................................... 0.8542 0.8403 ¥1.63 

NORTH CAROLINA ................................................................................................... 0.8666 0.8501 ¥1.90 

NORTH DAKOTA ...................................................................................................... 0.7788 0.7743 ¥0.58 

OHIO .......................................................................................................................... 0.8613 0.8760 1.71 

OKLAHOMA ............................................................................................................... 0.7590 0.7537 ¥0.70 

OREGON ................................................................................................................... 1.0303 1.0050 ¥2.46 

PENNSYLVANIA ....................................................................................................... 0.8462 0.8348 ¥1.35 

PUERTO RICO .......................................................................................................... 0.4356 0.4047 ¥7.09 

RHODE ISLAND ........................................................................................................ .............................. .............................. ..............................

SOUTH CAROLINA ................................................................................................... 0.8607 0.8640 0.38 

SOUTH DAKOTA ...................................................................................................... 0.7815 0.8393 7.40 

TENNESSEE ............................................................................................................. 0.7877 0.7876 ¥0.01 

TEXAS ....................................................................................................................... 0.7821 0.7910 1.14 

UTAH ......................................................................................................................... 0.9312 0.8843 ¥5.04 

VERMONT ................................................................................................................. 0.9345 0.9375 0.32 

VIRGINIA ................................................................................................................... 0.8504 0.8480 ¥0.28 

VIRGIN ISLANDS ...................................................................................................... 0.7845 0.7457 ¥4.95 

WASHINGTON .......................................................................................................... 1.0179 1.0072 ¥1.05 

WEST VIRGINIA ........................................................................................................ 0.7975 0.8084 1.37 

WISCONSIN .............................................................................................................. 0.9162 0.9498 3.67 

WYOMING ................................................................................................................. 0.9007 0.9182 1.94 

62158 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

Urban MSA FY 2003 wage 

index 

CY 2005 wage 

index 

Percent change, 

FY 2003–CY 2005 

0040 ........................................................................................................................... 0.7792 0.8009 2.78 

0060 ........................................................................................................................... 0.4587 0.4294 ¥6.39 

0080 ........................................................................................................................... 0.9600 0.9055 ¥5.68 

0120 ........................................................................................................................... 1.0594 1.1266 6.34 

0160 ........................................................................................................................... 0.8384 0.8570 2.22 

0200 ........................................................................................................................... 0.9315 1.0485 12.56 

0220 ........................................................................................................................... 0.7859 0.8171 3.97 

0240 ........................................................................................................................... 0.9735 0.9536 ¥2.04 

0280 ........................................................................................................................... 0.9225 0.8462 ¥8.27 

0320 ........................................................................................................................... 0.9034 0.9178 1.59 

0380 ........................................................................................................................... 1.2358 1.2109 ¥2.01 

0440 ........................................................................................................................... 1.1103 1.0817 ¥2.58 

0450 ........................................................................................................................... 0.8044 0.7881 ¥2.03 

0460 ........................................................................................................................... 0.8997 0.9115 1.31 

0470 ........................................................................................................................... 0.4337 0.3757 ¥13.37 

0480 ........................................................................................................................... 0.9876 0.9502 ¥3.79 

0500 ........................................................................................................................... 1.0211 1.0203 ¥0.08 

0520 ........................................................................................................................... 0.9991 0.9971 ¥0.20 

0560 ........................................................................................................................... 1.1017 1.0907 ¥1.00 

0580 ........................................................................................................................... 0.8325 0.8215 ¥1.32 

0600 ........................................................................................................................... 1.0264 0.9208 ¥10.29 

0640 ........................................................................................................................... 0.9637 0.9596 ¥0.43 

0680 ........................................................................................................................... 0.9899 1.0036 1.38 

0720 ........................................................................................................................... 0.9929 0.9908 ¥0.21 

0733 ........................................................................................................................... 0.9664 0.9955 3.01 

0743 ........................................................................................................................... 1.3202 1.2335 ¥6.57 

0760 ........................................................................................................................... 0.8294 0.8354 0.72 

0840 ........................................................................................................................... 0.8324 0.8616 3.51 

0860 ........................................................................................................................... 1.2282 1.1643 ¥5.20 

0870 ........................................................................................................................... 0.9042 0.8847 ¥2.16 

0875 ........................................................................................................................... 1.2150 1.1967 ¥1.51 

0880 ........................................................................................................................... 0.9022 0.8961 ¥0.68 

0920 ........................................................................................................................... 0.8757 0.8649 ¥1.23 

0960 ........................................................................................................................... 0.8341 0.8447 1.27 

1000 ........................................................................................................................... 0.9222 0.9199 ¥0.25 

1010 ........................................................................................................................... 0.7972 0.7505 ¥5.86 

1020 ........................................................................................................................... 0.8907 0.8588 ¥3.58 

1040 ........................................................................................................................... 0.9109 0.9111 0.02 

1080 ........................................................................................................................... 0.9310 0.9352 0.45 

1123 ........................................................................................................................... 1.1235 1.1291 0.50 

1125 ........................................................................................................................... 0.9689 1.0046 3.68 

1145 ........................................................................................................................... 0.8535 0.8525 ¥0.12 

1150 ........................................................................................................................... 1.0944 1.0614 ¥3.02 

1240 ........................................................................................................................... 0.8880 1.0125 14.02 

1260 ........................................................................................................................... 0.8821 0.9219 4.51 

1280 ........................................................................................................................... 0.9365 0.9339 ¥0.28 

1303 ........................................................................................................................... 1.0052 0.9322 ¥7.26 

1310 ........................................................................................................................... 0.4371 0.4061 ¥7.09 

1320 ........................................................................................................................... 0.8932 0.8895 ¥0.41 

1350 ........................................................................................................................... 0.9690 0.9244 ¥4.60 

1360 ........................................................................................................................... 0.9056 0.8975 ¥0.89 

1400 ........................................................................................................................... 1.0635 0.9527 ¥10.42 

1440 ........................................................................................................................... 0.9235 0.9420 2.00 

1480 ........................................................................................................................... 0.8898 0.8876 ¥0.25 

1520 ........................................................................................................................... 0.9850 0.9712 ¥1.40 

1540 ........................................................................................................................... 1.0438 1.0295 ¥1.37 

1560 ........................................................................................................................... 0.8976 0.9207 2.57 

1580 ........................................................................................................................... 0.8628 0.8980 4.08 

1600 ........................................................................................................................... 1.1044 1.0852 ¥1.74 

1620 ........................................................................................................................... 0.9745 1.0543 8.19 

1640 ........................................................................................................................... 0.9381 0.9595 2.28 

1660 ........................................................................................................................... 0.8406 0.8022 ¥4.57 

1680 ........................................................................................................................... 0.9670 0.9626 ¥0.46 

1720 ........................................................................................................................... 0.9916 0.9793 ¥1.24 

1740 ........................................................................................................................... 0.8496 0.8396 ¥1.18 

1760 ........................................................................................................................... 0.9307 0.9450 1.54 

1800 ........................................................................................................................... 0.8374 0.8690 3.77 

1840 ........................................................................................................................... 0.9751 0.9753 0.02 

1880 ........................................................................................................................... 0.8729 0.8647 ¥0.94 

1890 ........................................................................................................................... 1.1453 1.0545 ¥7.93 

1900 ........................................................................................................................... 0.7847 0.8662 10.39 

1920 ........................................................................................................................... 0.9998 1.0049 0.51 

1950 ........................................................................................................................... 0.8859 0.8643 ¥2.44 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62159

Urban MSA FY 2003 wage 

index 

CY 2005 wage 

index 

Percent change, 

FY 2003–CY 2005 

1960 ........................................................................................................................... 0.8835 0.8774 ¥0.69 

2000 ........................................................................................................................... 0.9282 0.9232 ¥0.54 

2020 ........................................................................................................................... 0.9062 0.8900 ¥1.79 

2030 ........................................................................................................................... 0.8973 0.8894 ¥0.88 

2040 ........................................................................................................................... 0.8055 0.8122 0.83 

2080 ........................................................................................................................... 1.0601 1.0905 2.87 

2120 ........................................................................................................................... 0.8791 0.9267 5.41 

2160 ........................................................................................................................... 1.0448 1.0227 ¥2.12 

2180 ........................................................................................................................... 0.8137 0.7597 ¥6.64 

2190 ........................................................................................................................... 0.9356 0.9825 5.01 

2200 ........................................................................................................................... 0.8795 0.8748 ¥0.53 

2240 ........................................................................................................................... 1.0368 1.0356 ¥0.12 

2281 ........................................................................................................................... 1.0684 1.1658 9.12 

2290 ........................................................................................................................... 0.8952 0.9139 2.09 

2320 ........................................................................................................................... 0.9265 0.9065 ¥2.16 

2330 ........................................................................................................................... 0.9722 0.9279 ¥4.56 

2335 ........................................................................................................................... 0.8416 0.8445 0.34 

2340 ........................................................................................................................... 0.8376 0.9001 7.46 

2360 ........................................................................................................................... 0.8925 0.8699 ¥2.53 

2400 ........................................................................................................................... 1.0944 1.0940 ¥0.04 

2440 ........................................................................................................................... 0.8177 0.8395 2.67 

2520 ........................................................................................................................... 0.9684 0.9115 ¥5.88 

2560 ........................................................................................................................... 0.8889 0.9363 5.33 

2580 ........................................................................................................................... 0.8100 0.8637 6.63 

2620 ........................................................................................................................... 1.0682 1.0611 ¥0.66 

2640 ........................................................................................................................... 1.1135 1.1178 0.39 

2650 ........................................................................................................................... 0.7792 0.7883 1.17 

2655 ........................................................................................................................... 0.8780 0.8961 2.06 

2670 ........................................................................................................................... 1.0066 1.0219 1.52 

2680 ........................................................................................................................... 1.0297 1.0165 ¥1.28 

2700 ........................................................................................................................... 0.9680 0.9372 ¥3.18 

2710 ........................................................................................................................... 0.9823 1.0046 2.27 

2720 ........................................................................................................................... 0.7895 0.8303 5.17 

2750 ........................................................................................................................... 0.9693 0.8786 ¥9.36 

2760 ........................................................................................................................... 0.9457 0.9737 2.96 

2800 ........................................................................................................................... 0.9446 0.9538 0.97 

2840 ........................................................................................................................... 1.0216 1.0408 1.88 

2880 ........................................................................................................................... 0.8505 0.8049 ¥5.36 

2900 ........................................................................................................................... 0.9871 0.9459 ¥4.17 

2920 ........................................................................................................................... 0.9465 0.9403 ¥0.66 

2960 ........................................................................................................................... 0.9584 0.9343 ¥2.51 

2975 ........................................................................................................................... 0.8281 0.8467 2.25 

2980 ........................................................................................................................... 0.8892 0.8779 ¥1.27 

2985 ........................................................................................................................... 0.8897 0.9092 2.19 

2995 ........................................................................................................................... 0.9456 0.9900 4.70 

3000 ........................................................................................................................... 0.9525 0.9520 ¥0.05 

3040 ........................................................................................................................... 0.8950 0.8810 ¥1.56 

3060 ........................................................................................................................... 0.9237 0.9444 2.24 

3080 ........................................................................................................................... 0.9502 0.9586 0.88 

3120 ........................................................................................................................... 0.9282 0.9312 0.32 

3150 ........................................................................................................................... 0.9100 0.9183 0.91 

3160 ........................................................................................................................... 0.9122 0.9400 3.05 

3180 ........................................................................................................................... 0.9268 0.9940 7.25 

3200 ........................................................................................................................... 0.9418 0.9066 ¥3.74 

3240 ........................................................................................................................... 0.9223 0.9286 0.68 

3283 ........................................................................................................................... 1.1549 1.1055 ¥4.28 

3285 ........................................................................................................................... 0.7659 0.7362 ¥3.88 

3290 ........................................................................................................................... 0.9028 0.9502 5.25 

3320 ........................................................................................................................... 1.1457 1.1014 ¥3.87 

3350 ........................................................................................................................... 0.8385 0.7721 ¥7.92 

3360 ........................................................................................................................... 0.9892 1.0117 2.27 

3400 ........................................................................................................................... 0.9636 0.9565 ¥0.74 

3440 ........................................................................................................................... 0.8903 0.8851 ¥0.58 

3480 ........................................................................................................................... 0.9717 1.0039 3.31 

3500 ........................................................................................................................... 0.9587 0.9655 0.71 

3520 ........................................................................................................................... 0.9532 0.9146 ¥4.05 

3560 ........................................................................................................................... 0.8607 0.8406 ¥2.34 

3580 ........................................................................................................................... 0.9275 0.8900 ¥4.04 

3600 ........................................................................................................................... 0.9381 0.9548 1.78 

3605 ........................................................................................................................... 0.8239 0.8402 1.98 

3610 ........................................................................................................................... 0.7976 0.7589 ¥4.85 

3620 ........................................................................................................................... 0.9849 0.9583 ¥2.70 

3640 ........................................................................................................................... 1.1190 1.0923 ¥2.39 

62160 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

Urban MSA FY 2003 wage 

index 

CY 2005 wage 

index 

Percent change, 

FY 2003–CY 2005 

3660 ........................................................................................................................... 0.8268 0.8203 ¥0.79 

3680 ........................................................................................................................... 0.8329 0.7981 ¥4.18 

3700 ........................................................................................................................... 0.7749 0.7934 2.39 

3710 ........................................................................................................................... 0.8613 0.8721 1.25 

3720 ........................................................................................................................... 1.0595 1.0350 ¥2.31 

3740 ........................................................................................................................... 1.0790 1.0603 ¥1.73 

3760 ........................................................................................................................... 0.9736 0.9642 ¥0.97 

3800 ........................................................................................................................... 0.9686 0.9772 0.89 

3810 ........................................................................................................................... 1.0399 0.9242 ¥11.13 

3840 ........................................................................................................................... 0.8970 0.8509 ¥5.14 

3850 ........................................................................................................................... 0.8971 0.8986 0.17 

3870 ........................................................................................................................... 0.9400 0.9290 ¥1.17 

3880 ........................................................................................................................... 0.8475 0.8105 ¥4.37 

3920 ........................................................................................................................... 0.9278 0.9068 ¥2.26 

3960 ........................................................................................................................... 0.7965 0.7959 ¥0.08 

3980 ........................................................................................................................... 0.9357 0.8931 ¥4.55 

4000 ........................................................................................................................... 0.9078 0.9883 8.87 

4040 ........................................................................................................................... 0.9726 0.9659 ¥0.69 

4080 ........................................................................................................................... 0.8472 0.8747 3.25 

4100 ........................................................................................................................... 0.8745 0.8784 0.45 

4120 ........................................................................................................................... 1.1521 1.1121 ¥3.47 

4150 ........................................................................................................................... 0.7923 0.8644 9.10 

4200 ........................................................................................................................... 0.8315 0.8212 ¥1.24 

4243 ........................................................................................................................... 0.9179 0.9562 4.17 

4280 ........................................................................................................................... 0.8581 0.8053 ¥6.15 

4320 ........................................................................................................................... 0.9483 0.9258 ¥2.37 

4360 ........................................................................................................................... 0.9892 1.0208 3.19 

4400 ........................................................................................................................... 0.9097 0.8827 ¥2.97 

4420 ........................................................................................................................... 0.8629 0.8739 1.27 

4480 ........................................................................................................................... 1.2001 1.1732 ¥2.24 

4520 ........................................................................................................................... 0.9276 0.9163 ¥1.22 

4600 ........................................................................................................................... 0.9646 0.8777 ¥9.01 

4640 ........................................................................................................................... 0.9219 0.9018 ¥2.18 

4680 ........................................................................................................................... 0.9204 0.9596 4.26 

4720 ........................................................................................................................... 1.0467 1.0395 ¥0.69 

4800 ........................................................................................................................... 0.8900 0.9105 2.30 

4840 ........................................................................................................................... 0.4914 0.4769 ¥2.95 

4880 ........................................................................................................................... 0.8428 0.8602 2.06 

4890 ........................................................................................................................... 1.0498 1.0534 0.34 

4900 ........................................................................................................................... 1.0253 0.9633 ¥6.05 

4920 ........................................................................................................................... 0.8920 0.9234 3.52 

4940 ........................................................................................................................... 0.9837 1.0576 7.51 

5000 ........................................................................................................................... 0.9802 1.0026 2.29 

5015 ........................................................................................................................... 1.1213 1.1360 1.31 

5080 ........................................................................................................................... 0.9893 1.0076 1.85 

5120 ........................................................................................................................... 1.0903 1.1067 1.50 

5140 ........................................................................................................................... 0.9157 0.9618 5.03 

5160 ........................................................................................................................... 0.8108 0.7933 ¥2.16 

5170 ........................................................................................................................... 1.0498 1.1966 13.98 

5190 ........................................................................................................................... 1.0674 1.0889 2.01 

5200 ........................................................................................................................... 0.8137 0.7913 ¥2.75 

5240 ........................................................................................................................... 0.7734 0.8300 7.32 

5280 ........................................................................................................................... 0.9284 0.8580 ¥7.58 

5330 ........................................................................................................................... 0.8976 0.9022 0.51 

5345 ........................................................................................................................... 0.9754 1.0596 8.63 

5360 ........................................................................................................................... 0.9578 1.0108 5.53 

5380 ........................................................................................................................... 1.3357 1.2921 ¥3.26 

5483 ........................................................................................................................... 1.2408 1.2254 ¥1.24 

5523 ........................................................................................................................... 1.1767 1.1596 ¥1.45 

5560 ........................................................................................................................... 0.9046 0.9103 0.63 

5600 ........................................................................................................................... 1.4414 1.3588 ¥5.73 

5640 ........................................................................................................................... 1.1381 1.1625 2.14 

5660 ........................................................................................................................... 1.1387 1.1171 ¥1.90 

5720 ........................................................................................................................... 0.8574 0.8895 3.74 

5775 ........................................................................................................................... 1.5072 1.5221 0.99 

5790 ........................................................................................................................... 0.9402 0.9153 ¥2.65 

5800 ........................................................................................................................... 0.9397 0.9632 2.50 

5880 ........................................................................................................................... 0.8900 0.8966 0.74 

5910 ........................................................................................................................... 1.0960 1.1007 0.43 

5920 ........................................................................................................................... 0.9978 0.9754 ¥2.24 

5945 ........................................................................................................................... 1.1474 1.1612 1.20 

5960 ........................................................................................................................... 0.9640 0.9742 1.06 

5990 ........................................................................................................................... 0.8344 0.8434 1.08 

Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 62161

Urban MSA FY 2003 wage 

index 

CY 2005 wage 

index 

Percent change, 

FY 2003–CY 2005 

6015 ........................................................................................................................... 0.8865 0.8124 ¥8.36 

6020 ........................................................................................................................... 0.8127 0.8288 1.98 

6080 ........................................................................................................................... 0.8645 0.8306 ¥3.92 

6120 ........................................................................................................................... 0.8739 0.8886 1.68 

6160 ........................................................................................................................... 1.0713 1.0824 1.04 

6200 ........................................................................................................................... 0.9820 0.9982 1.65 

6240 ........................................................................................................................... 0.7962 0.8673 8.93 

6280 ........................................................................................................................... 0.9365 0.8756 ¥6.50 

6323 ........................................................................................................................... 1.0235 1.0439 1.99 

6340 ........................................................................................................................... 0.9372 0.9602 2.45 

6360 ........................................................................................................................... 0.5169 0.4954 ¥4.16 

6403 ........................................................................................................................... 0.9794 1.0112 3.25 

6440 ........................................................................................................................... 1.0667 1.1403 6.90 

6483 ........................................................................................................................... 1.0854 1.1062 1.92 

6520 ........................................................................................................................... 0.9984 0.9613 ¥3.72 

6560 ........................................................................................................................... 0.8820 0.8752 ¥0.77 

6580 ........................................................................................................................... 0.9218 0.9441 2.42 

6600 ........................................................................................................................... 0.9334 0.9045 ¥3.10 

6640 ........................................................................................................................... 0.9990 1.0258 2.68 

6660 ........................................................................................................................... 0.8846 0.8912 0.75 

6680 ........................................................................................................................... 0.9295 0.9216 ¥0.85 

6690 ........................................................................................................................... 1.1135 1.1835 6.29 

6720 ........................................................................................................................... 1.0648 1.0456 ¥1.80 

6740 ........................................................................................................................... 1.1491 1.0520 ¥8.45 

6760 ........................................................................................................................... 0.9477 0.9398 ¥0.83 

6780 ........................................................................................................................... 1.1365 1.0975 ¥3.43 

6800 ........................................................................................................................... 0.8614 0.8429 ¥2.15 

6820 ........................................................................................................................... 1.2139 1.1504 ¥5.23 

6840 ........................................................................................................................... 0.9194 0.9196 0.02 

6880 ........................................................................................................................... 0.9625 0.9626 0.01 

6895 ........................................................................................................................... 0.9228 0.8998 ¥2.49 

6920 ........................................................................................................................... 1.1500 1.1849 3.03 

6960 ........................................................................................................................... 0.9650 0.9696 0.48 

6980 ........................................................................................................................... 0.9700 1.0215 5.31 

7000 ........................................................................................................................... 0.8021 1.0013 24.83 

7040 ........................................................................................................................... 0.8855 0.9081 2.55 

7080 ........................................................................................................................... 1.0367 1.0557 1.83 

7120 ........................................................................................................................... 1.4623 1.3823 ¥5.47 

7160 ........................................................................................................................... 0.9945 0.9487 ¥4.61 

7200 ........................................................................................................................... 0.8374 0.8168 ¥2.46 

7240 ........................................................................................................................... 0.8753 0.9023 3.08 

7320 ........................................................................................................................... 1.1131 1.1267 1.22 

7360 ........................................................................................................................... 1.4142 1.4712 4.03 

7400 ........................................................................................................................... 1.4145 1.4744 4.23 

7440 ........................................................................................................................... 0.4741 0.4802 1.29 

7460 ........................................................................................................................... 1.1271 1.1118 ¥1.36 

7480 ........................................................................................................................... 1.0481 1.0771 2.77 

7485 ........................................................................................................................... 1.3646 1.4780 8.31 

7490 ........................................................................................................................... 1.0712 1.0590 ¥1.14 

7500 ........................................................................................................................... 1.3046 1.2962 ¥0.64 

7510 ........................................................................................................................... 0.9425 0.9630 2.18 

7520 ........................................................................................................................... 0.9376 0.9460 0.90 

7560 ........................................................................................................................... 0.8599 0.8523 ¥0.88 

7600 ........................................................................................................................... 1.1474 1.1479 0.04 

7610 ........................................................................................................................... 0.7869 0.7881 0.15 

7620 ........................................................................................................................... 0.8697 0.8949 2.90 

7640 ........................................................................................................................... 0.9255 0.9617 3.91 

7680 ........................................................................................................................... 0.8987 0.9112 1.39 

7720 ........................................................................................................................... 0.9046 0.9094 0.53 

7760 ........................................................................................................................... 0.9257 0.9441 1.99 

7800 ........................................................................................................................... 0.9802 0.9447 ¥3.62 

7840 ........................................................................................................................... 1.0852 1.0661 ¥1.76 

7880 ........................................................................................................................... 0.8659 0.8738 0.91 

7920 ........................................................................................................................... 0.8424 0.8597 2.05 

8003 ........................................................................................................................... 1.0927 1.0174 ¥6.89 

8050 ........................................................................................................................... 0.8941 0.8462 ¥5.36 

8080 ........................................................................................................................... 0.8804 0.8281 ¥5.94 

8120 ........................................................................................................................... 1.0506 1.0564 0.55 

8140 ........................................................................................................................... 0.8273 0.8520 2.99 

8160 ........................................................................................................................... 0.9714 0.9394 ¥3.29 

8200 ........................................................................................................................... 1.0940 1.1078 1.26 

8240 ........................................................................................................................... 0.8504 0.8656 1.79 

8280 ........................................................................................................................... 0.9065 0.9024 ¥0.45 

62162 Federal Register / Vol. 69, No. 204 / Friday, October 22, 2004 / Rules and Regulations 

Urban MSA FY 2003 wage 

index 

CY 2005 wage 

index 

Percent change, 

FY 2003–CY 2005 

8320 ........................................................................................................................... 0.8599 0.8582 ¥0.20 

8360 ........................................................................................................................... 0.8088 0.8414 4.03 

8400 ........................................................................................................................... 0.9810 0.9525 ¥2.91 

8440 ........................................................................................................................... 0.9199 0.8904 ¥3.21 

8480 ........................................................................................................................... 1.0432 1.0276 ¥1.50 

8520 ........................................................................................................................... 0.8911 0.8926 0.17 

8560 ........................................................................................................................... 0.8332 0.8729 4.76 

8600 ........................................................................................................................... 0.8130 0.8440 3.81 

8640 ........................................................................................................................... 0.9521 0.9502 ¥0.20 

8680 ........................................................................................................................... 0.8465 0.8295 ¥2.01 

8720 ........................................................................................................................... 1.3354 1.3517 1.22 

8735 ........................................................................................................................... 1.1096 1.1105 0.08 

8750 ........................................................................................................................... 0.8756 0.8469 ¥3.28 

8760 ........................................................................................................................... 1.0031 1.0573 5.40 

8780 ........................................................................................................................... 0.9429 0.9964 5.67 

8800 ........................................................................................................................... 0.8073 0.8146 0.90 

8840 ........................................................................................................................... 1.0851 1.0971 1.11 

8920 ........................................................................................................................... 0.8069 0.8633 6.99 

8940 ........................................................................................................................... 0.9782 0.9570 ¥2.17 

8960 ........................................................................................................................... 0.9939 1.0059 1.21 

9000 ........................................................................................................................... 0.7670 0.7449 ¥2.88 

9040 ........................................................................................................................... 0.9520 0.9473 ¥0.49 

9080 ........................................................................................................................... 0.8498 0.8395 ¥1.21 

9140 ........................................................................................................................... 0.8544 0.8486 ¥0.68 

9160 ........................................................................................................................... 1.1173 1.1121 ¥0.47 

9200 ........................................................................................................................... 0.9640 0.9237 ¥4.18 

9260 ........................................................................................................................... 1.0569 1.0323 ¥2.33 

9270 ........................................................................................................................... 0.9434 0.9378 ¥0.59 

9280 ........................................................................................................................... 0.9026 0.9150 1.37 

9320 ........................................................................................................................... 0.9358 0.9518 1.71 

9340 ........................................................................................................................... 1.0276 1.0364 0.86 

9360 ........................................................................................................................... 0.8589 0.8871 3.28 

[FR Doc. 04–23440 Filed 10–15–04; 4:00 pm] 

BILLING CODE 4120–01–P