65884 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 414 and 484 

[CMS–1304–F] 

RIN 0938–AN76 

Medicare Program; Home Health 

Prospective Payment System Rate 

Update for Calendar Year 2007 and 

Deficit Reduction Act of 2005 Changes 

to Medicare Payment for Oxygen 

Equipment and Capped Rental Durable 

Medical Equipment; Final Rule 

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 

services. In addition, this final rule sets 

forth policy changes related to Medicare 

payment for certain durable medical 

equipment for the purpose of 

implementing sections 1834(a)(5) and 

1834(a)(7) of the Social Security Act, as 

amended by section 5101 of the Deficit 

Reduction Act of 2005. This final rule 

also responds to public comments on 

the August 3, 2006, proposed rule that 

pertain to a number of issues including 

the requirement that home health 

payments are based on the reporting of 

specific quality data by home health 

agencies. 

DATES: Effective Date: These regulations 

are effective on January 1, 2007. 

FOR FURTHER INFORMATION CONTACT: 

Randy Throndset, (410) 786–0131, or 

Sharon Ventura, (410) 786–1985 (for 

issues related to the home health 

prospective payment system). Doug 

Brown, (410) 786–0028 (for issues 

related to reporting home health quality 

data). Alexis Meholic, (410) 786–2300 

(for issues related to payments for 

oxygen equipment and capped rental 

durable medical equipment). 

SUPPLEMENTARY INFORMATION: 

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. 

On February 8, 2006, the Congress 

enacted the Deficit Reduction Act (DRA) 

of 2005 (Pub. L. 109–171). This 

legislation made additional changes to 

the HH PPS. 

Section 5201 of the DRA changed the 

CY 2006 update from the applicable 

home health market basket percentage 

increase minus 0.8 percentage points to 

a 0 percent update. 

Section 5201 of the DRA amended 

section 421(a) of the MMA. The 

amended section 421(a) of the 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 and visits beginning 

on or after January 1, 2006 and before 

January 1, 2007, that the Secretary 

increase by 5 percent the payment 

amount otherwise made under section 

1895 of the Act. The statute waives 

budget neutrality for purposes of this 

increase as it specifically requires that 

the Secretary 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. 

The 0 percent update to the payment 

rates and the rural add-on provisions of 

the DRA were implemented through 

Pub. 100–20, One Time Notification, 

Transmittal 211 issued February 10, 

2006. 

In addition, section 5201(c) of the 

DRA amends the statute to add section 

1895(b)(3)(B)(v) to the Act, requiring 

HHAs to submit data for purposes of 

measuring health care quality. This 

requirement is applicable for 2007 and 

each subsequent year. For 2007 and 

each subsequent year, in the case of a 

HHA that does not submit quality data, 

the home health market basket 

percentage increase would be reduced 

by 2 percentage points. 

B. Updates 

1. 2000 Final Rule 

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 a 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 home 


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health services, 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. 

2. 2005 Final Rule 

On November 9, 2005, we published 

a final rule (70 FR 68132), which set 

forth an update to the 60-day national 

episode rates and the national per-visit 

amounts under the Medicare 

prospective payment system for home 

health services for CY 2006. As part of 

that final rule, we adopted revised area 

labor market Metropolitan Statistical 

Area designations for CY 2006. In 

implementing the new area labor market 

designations, we allowed for a 1-year 

transition period. This transition 

consists of a blend of 50 percent of the 

new area labor market designations’

wage index and 50 percent of the 

previous area labor market designations’

wage index. In addition, we revised the 

fixed dollar loss ratio, which is used in 

the calculation of outlier payments. 

C. System for Payment of Home Health 

Services 

Generally, Medicare makes payment 

under the HH PPS on the basis of a 

national standardized 60-day episode 

payment, adjusted for case mix and 

wage index. For episodes with four or 

fewer visits, Medicare pays on the basis 

of a national per-visit amount by 

discipline, referred to as a low 

utilization payment adjustment (LUPA). 

Medicare also adjusts the 60-day 

episode payment for certain intervening 

events that give rise to a partial episode 

payment adjustment (PEP adjustment) 

or a significant change in condition 

adjustment (SCIC). For certain cases that 

exceed a specific cost threshold, an 

outlier adjustment may also be 

available. For a complete and full 

description of the HH PPS as required 

by the BBA and as amended by 

OCESAA and BBRA, see the July 3, 

2000 HH PPS final rule (65 FR 41128). 

D. Changes in Payment for Oxygen and 

Oxygen Equipment and Other Durable 

Medical Equipment (Capped Rental 

Items) 

The Medicare payment rules for 

durable medical equipment (DME) are 

set forth in section 1834(a) of the Act 

and 42 CFR part 414, subpart D of our 

regulations. General payment rules for 

DME are set forth in section 1834(a)(1) 

of the Act and § 414.210 of our 

regulations, and § 414.210 also contains 

paragraphs relating to maintenance and 

servicing of items and replacement of 

items. Specific rules for oxygen and 

oxygen equipment are set forth in 

section 1834(a)(5) of the Act and 

§ 414.226 of our regulations, and 

specific rules for capped rental items are 

set forth in section 1834(a)(7) of the Act 

and § 414.229 of our regulations. Rules 

for determining a period of continuous 

use for the rental of DME are set forth 

in § 414.230 of our regulations. The 

Medicare payment basis for DME is 

equal to 80 percent of either the lower 

of the actual charge or the fee schedule 

amount for the item. The beneficiary 

coinsurance is equal to 20 percent of 

either the lower of the actual charge or 

the fee schedule amount for the item. 

In accordance with the rules set forth 

in section 1834(a)(5) of the Act and 

§ 414.226 of our regulations, since 1989, 

suppliers have been paid monthly for 

furnishing oxygen and oxygen 

equipment to Medicare beneficiaries. 

Suppliers have also been paid an addon fee for furnishing portable oxygen 

equipment to patients when medically 

necessary. Before the enactment of the 

DRA, these monthly payments 

continued for the duration of use of the 

equipment, provided that Medicare Part 

B coverage and eligibility criteria were 

met. Medicare covers three types of 

oxygen delivery systems: (1) Stationary 

or portable oxygen concentrators, which 

concentrate oxygen in room air; (2) 

stationary or portable liquid oxygen 

systems, which use oxygen stored as a 

very cold liquid in cylinders and tanks; 

and (3) stationary or portable gaseous 

oxygen systems, which administer 

compressed oxygen directly from 

cylinders. Both liquid and gaseous 

oxygen systems require delivery of 

oxygen contents. 

Medicare payment for furnishing 

oxygen and oxygen equipment is made 

on a monthly basis and the fee schedule 

amounts vary by State. Payment for 

oxygen contents for both stationary and 

portable equipment is included in the 

fee schedule allowances for stationary 

equipment. Medicare fee schedules for 

home oxygen equipment are modality 

neutral; meaning that in a given State, 

there is one fee schedule amount that 

applies to all stationary systems and one 

fee schedule amount that applies to all 

portable systems. 

Effective January 1, 2006, section 

5101(b) of the DRA amended the Act at 

section 1834(a)(5) of the Act, limiting to 

36 months the total number of 

continuous months for which Medicare 

will pay for oxygen equipment on a 

rental basis. At the end of the 36-month 

period, this section mandates that the 

supplier transfer title to the stationary 

and portable oxygen equipment to the 

beneficiary. Section 5101(b) of the DRA 

does not, however, limit the number of 

months for which Medicare will pay for 

oxygen contents for beneficiary-owned 

stationary or portable gaseous or liquid 

systems, and payment will continue to 

be made as long as the oxygen remains 

medically necessary. Section 5101(b) of 

the DRA also provides that payment for 

reasonable and necessary maintenance 

and servicing of beneficiary-owned 

oxygen equipment will be made for 

parts and labor not covered by a 

supplier’s or manufacturer’s warranty. 

In the case of beneficiaries using oxygen 

equipment on December 31, 2005, the 

36-month rental period prescribed by 

the DRA begins on January 1, 2006. 

In accordance with the rules set forth 

in section 1834(a)(7) of the Act and 

§ 414.229 of our regulations, before the 

enactment of the DRA, suppliers of 

capped rental items (that is, other DME 

not described in paragraphs (2) through 

(6) of section 1834(a) of the Act) were 

paid on a rental or purchase option 

basis. Payment for most items in the 

capped rental category was made on a 

monthly rental basis, with rental 

payments being capped at 15 months or 

13 months, depending on whether the 

beneficiary chose to continue renting 

the item or to take over ownership of the 

item through the ‘‘purchase option.’’ For 

all capped rental items, the supplier was 

required to inform the beneficiary of his 

or her purchase option, during the 10th 

rental month, to enter into a purchase 

agreement under which the supplier 

would transfer title to the item to the 

beneficiary on the first day after the 

13th continuous month during which 

payment was made for the rental of the 

item. Therefore, if the beneficiary chose 

the purchase option, rental payments to 

the supplier would continue through 

the 13th month of continuous use of the 

equipment, after which time title to the 

equipment would transfer from the 

supplier to the beneficiary. Medicare 

would also make payment for any 

reasonable and necessary repair or 

maintenance and servicing of the 

equipment following the transfer of title. 

If the beneficiary did not choose the 

purchase option, rental payments would 

continue through the 15th month of 

continuous use. In these cases, suppliers 

would maintain title to the equipment 

but would have to continue furnishing 

the item to the beneficiary as long as 

medical necessity continued. Beginning 

6 months after the 15th month of 

continuous use in which payment was 

made, Medicare would also make semiannual maintenance and servicing 

payments to suppliers. These payments 

were approximately equal to 10 percent 


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of the purchase price for the equipment 

as determined by the statute. Total 

Medicare payments made through the 

13th and 15th months of rental equal 

105 and 120 percent, respectively, of the 

purchase price for the equipment. 

In the case of power-driven 

wheelchairs, since 1989 payment has 

also been made on a lump-sum 

purchase basis at the time that the item 

is initially furnished to the beneficiary 

if the beneficiary chooses to obtain the 

item in this manner. Most beneficiaries 

choose to obtain power-driven 

wheelchairs via this lump-sum purchase 

option. 

Effective for items for which the first 

rental month occurs on or after January 

1, 2006, section 5101(a) of the DRA of 

2005 amended section 1834(a)(7) of the 

Act, limiting to 13 months the total 

number of continuous months for which 

Medicare will pay for DME in this 

category. After a 13-month period of 

continuous use during which rental 

payments are made, the statute requires 

that the supplier transfer title to the 

equipment to the beneficiary. 

Beneficiaries may still elect to obtain 

power-driven wheelchairs on a lumpsum purchase agreement basis. In all 

cases, payment for reasonable and 

necessary maintenance and servicing of 

beneficiary-owned equipment will be 

made for parts and labor not covered by 

the supplier’s or manufacturer’s 

warranty. 

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 the August 3, 2006 proposed 

rule. 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 

We published a proposed rule in the 

Federal Register on August 3, 2006 (71 

FR 44081) that set forth a proposed 

update to the 60-day national episode 

rates and the national per-visit amounts 

under the Medicare prospective 

payment system for home health 

services. In addition, that proposed rule 

set forth proposed policy changes 

related to Medicare payment for certain 

durable medical equipment for the 

purpose of implementing sections 

1834(a)(5) and 1834(a)(7) of the Social 

Security Act, as amended by section 

5101 of the Deficit Reduction Act of 

2005. That proposed rule also invited 

comments on a number of issues 

including payments based on reporting 

quality data, the adoption of health 

information technology, as well as how 

to improve data transparency for 

consumers. 

A. National Standardized 60-Day 

Episode Rate 

The 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 the 

Medicare HH PPS is a national 

standardized 60-day episode rate. As set 

forth in § 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 

2007 HH PPS rates used the same casemix 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. In the 

October 22, 2004 final rule, we rebased 

and revised the home health market 

basket, resulting in a labor-related share 

of 76.775 percent and a non-labor 

portion of 23.225 percent (69 FR 62126). 

We multiply the national 60-day 

episode rate by the patient’s applicable 

case-mix weight. We divide the casemix adjusted amount into a labor and 

non-labor portion. We multiply the 

labor portion by the applicable wage 

index based on the site of service of the 

beneficiary. 

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

of the Act, we have updated the HH PPS 

rates annually in a separate Federal 

Register document. Section 484.225 sets 

forth the specific annual percentage 

update. To reflect section 

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

section 5201 of the DRA, we proposed 

to revise § 484.225, paragraph (g) 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 unless the HHA 

has not submitted quality data in which case 

the unadjusted national rate is equal to the 

rate for the previous calendar year increased 

by the applicable home health market basket 

index amount minus 2 percentage points. 

For CY 2007, 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 2007, 

we will base the wage index adjustment 

to the labor portion of the PPS rates on 

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

discussed in section II.F of the August 

3, 2006 proposed rule (not including 

any reclassifications under section 

1886(d)(8)(B) of the Act). 

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 will adjust the 

labor portion of the updated national 

per-visit amounts by discipline used to 

calculate the LUPA by the most recent 

pre-floor and pre-reclassified hospital 

wage index, as discussed in section II.F 

of the August 3, 2006 proposed rule. 

Medicare pays the 60-day case-mix 

and wage-adjusted episode payment on 

a split percentage payment approach. 

The split percentage payment approach 

includes an initial percentage payment 

and a final percentage payment as set 

forth in § 484.205(b)(1) and 

§ 484.205(b)(2). We may base the initial 

percentage payment on the submission 

of a request for anticipated payment 

(RAP) 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 which calendar year rates 

Medicare would use to pay the claim. 

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: 


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• 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. 

B. CY 2007 Update to the Home Health 

Market Basket Index 

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

amended by section 5201 of the DRA, 

requires for CY 2007 that the standard 

prospective payment amounts be 

increased by a factor equal to the 

applicable home health market basket 

update. The proposed rule contained a 

home health market basket update of 3.1 

percent. Since publication of the 

proposed rule, we have estimated a new 

home health market basket update of 3.3 

percent for CY 2007. 

CY 2007 Adjustments 

In calculating the annual update for 

the CY 2007 60-day episode rates, we 

first look at the CY 2006 rates as a 

starting point. The CY 2006 national 

60-day episode rate, as modified by 

section 5201(a)(4) of the DRA (and 

implemented through Pub. 100–20, One 

Time Notification, Transmittal 211 

issued February 10, 2006) is $2,264.28. 

In order to calculate the CY 2007 

national 60-day episode rate, we 

multiply the CY 2006 national 60-day 

episode rate ($2,264.28) by the 

estimated home health market basket 

update of 3.3 percent for CY 2007. The 

estimated home health market basket 

percentage increase reflects changes 

over time in the prices of an appropriate 

mix of goods and services included in 

covered home health services. The 

estimated home health market basket 

percentage increase is generally used to 

update the HH PPS rates on an annual 

basis. 

We increase the CY 2006 60-day 

episode payment rate by the estimated 

home health market basket update (3.3 

percent) ($2,264.28 × 1.033) to yield the 

updated CY 2007 national 60-day 

episode rate ($2,339.00) (see Table 1 

below). The CY 2007 HH PPS rates 

apply to episodes ending on or after 

January 1, 2007, and before January 1, 

2008. 

TABLE 1.—NATIONAL 60-DAY EPISODE AMOUNTS UPDATED BY THE ESTIMATED HOME HEALTH MARKET BASKET UPDATE

FOR CY 2007, BEFORE CASE-MIX ADJUSTMENT

Total CY 2006 Prospective Payment Amount 

Per 60-day Episode 

Multiply by the Estimated Home Health Market 

Basket Update (3.3 Percent)1

CY 2007 Updated National 60-Day Episode 

Rate 

$2,264.28 × 1.033 $2,339.00 

1The estimated home health market basket update of 3.3 percent for CY 2007 is based on Global Insight, Inc, 3rd Qtr, 2006 forecast with historical data through 2nd Qtr, 2006. 

National Per-Visit Amounts Used To 

Pay LUPAs and Compute Imputed Costs 

Used in Outlier Calculations 

As discussed previously in the August 

3, 2006 proposed rule, the policies 

governing the LUPAs and outlier 

calculations set forth in the July 3, 2000 

HH PPS final rule will continue during 

CY 2007. In calculating the annual 

update for the CY 2007 national pervisit amounts we use to pay LUPAs and 

to compute the imputed costs in outlier 

calculations, we look again at the CY 

2006 rates as a starting point. We then 

multiply those amounts by the 

estimated home health market basket 

update for CY 2007 (3.3 percent) to 

yield the updated per-visit amounts for 

each home health discipline for CY 

2007 (episodes ending on or after 

January 1, 2007, and before January 1, 

2008) (see Table 2 below). 

TABLE 2.—NATIONAL PER-VISIT AMOUNTS FOR LUPAS AND OUTLIER CALCULATIONS UPDATED BY THE ESTIMATED HOME

HEALTH MARKET BASKET UPDATE FOR CY 2007 

Home health discipline type 

Final CY 2006 

per-visit amounts 

per 60-day episode for LUPAs 

Multiply by the estimated home 

health market basket (3.3 percent) 1

CY 2007 per-visit 

payment amount 

per discipline for 

LUPAs 

Home Health Aide ..................................................................................................... $44.76 × 1.033 $46.24 

Medical Social Services ............................................................................................. 158.45 × 1.033 163.68 

Occupational Therapy ................................................................................................ 108.81 × 1.033 112.40 

Physical Therapy ....................................................................................................... 108.08 × 1.033 111.65 

Skilled Nursing ........................................................................................................... 98.85 × 1.033 102.11 

Speech-Language Pathology .................................................................................... 117.44 × 1.033 121.32 

1The estimated home health market basket update of 3.3 percent for CY 2007 is based on Global Insight, Inc, 3rd Qtr, 2006 forecast with historical data through 2nd Qtr, 2006. 

C. Rural Add-On 

As stated above, section 5201(b) of the 

DRA 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 and visits beginning 

on or after January 1, 2006 and before 

January 1, 2007, that the Secretary 

increase by 5 percent the payment 

amount otherwise made under section 

1895 of the Act. The statute waives 

budget neutrality related to this 

provision as it specifically states that 

the Secretary shall 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. 

While the rural add-on primarily 

affects those episodes paid based on CY 

2006 rates, it also affects a number of CY 

2007 episodes. For example, an episode 

that begins on December 20, 2006 and 

ends on February 17, 2007 for services 

furnished in a rural area, will be paid 

based on CY 2007 rates because the 

episode ends on or after January 1, 2007 

and before January 1, 2008; and the 


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episode will also receive the rural addon because the episode begins on or 

after January 1, 2006 and before January 

1, 2007. 

The applicable case-mix and wage 

index adjustment is subsequently 

applied to the 60-day episode amount 

for the provision of home health 

services where the site of service for the 

beneficiary is a non-Metropolitan 

Statistical Area (MSA). Similarly, the 

applicable wage index adjustment is 

subsequently applied to the LUPA pervisit amounts adjusted for the provision 

of home health services where the site 

of service for the beneficiary is a nonMSA area. We implemented this 

provision for CY 2006 on February 13, 

2006 through Pub. 100–20, One Time 

Notification, Transmittal 211 issued 

February 10, 2006. The 5 percent rural 

add-on is noted in tables 3 and 4 below. 

TABLE 3.—PAYMENT AMOUNTS FOR 60-DAY EPISODES BEGINNING IN CY 2006 AND ENDING IN CY 2007 UPDATED BY

THE ESTIMATED HOME HEALTH MARKET BASKET UPDATE FOR CY 2007 WITH RURAL ADD-ON, BEFORE CASE-MIX

ADJUSTMENT

CY 2007 Total prospective payment amount 

per 60-day episode 5 Percent rural add-on 

CY 2007 Payment amount per 60-day episode 

beginning in CY 2006 and before January 1, 

2007 and ending in CY 2007 for a beneficiary 

who resides in a non-MSA area 

$2,339 × 1.05 $2,455.95 

TABLE 4.—PER-VISIT AMOUNTS FOR EPISODES BEGINNING IN CY 2006 AND ENDING IN CY 2007 UPDATED BY THE

ESTIMATED HOME HEALTH MARKET BASKET UPDATE FOR CY 2007 WITH RURAL ADD-ON

Home health discipline type CY 2007 Per-visit 

amounts 

Multiply by the 5 

percent rural addon 

CY 2007 per-visit 

payment amount 

per discipline for 

60-day episodes 

beginning on or 

after January 1, in 

CY 2006 and ending in CY 2007 for 

a beneficiary who 

resides in a nonMSA area 

Home Health Aide ..................................................................................................... $46.24 × 1.05 $48.55 

Medical Social Services ............................................................................................. 163.68 × 1.05 171.86 

Occupational Therapy ................................................................................................ 112.40 × 1.05 118.02 

Physical Therapy ....................................................................................................... 111.65 × 1.05 117.23 

Skilled Nursing ........................................................................................................... 102.11 × 1.05 107.22 

Speech-Language Pathology .................................................................................... 121.32 × 1.05 127.39 

D. Home Health Care Quality 

Improvement 

Section 5201(c)(2) of the DRA added 

section 1895(b)(3)(B)(v)(II) to the Act, 

requiring that ‘‘each home health agency 

shall submit to the Secretary such data 

that the Secretary determines are 

appropriate for the measurement of 

health care quality. Such data shall be 

submitted in a form and manner, and at 

a time, specified by the Secretary for 

purposes of this clause.’’ In addition, 

section 1895(b)(3)(B)(v)(I) of the Act, as 

also added by section 5201(c)(2) of the 

DRA, dictates that ‘‘for 2007 and each 

subsequent year, in the case of a home 

health agency that does not submit data 

to the Secretary in accordance with 

subclause (II) with respect to such a 

year, the home health market basket 

percentage increase applicable under 

such clause for such year shall be 

reduced by 2 percentage points.’’

The Omnibus Budget Reconciliation 

Act of 1987 (OBRA 87) required the use 

of a standardized assessment instrument 

for quality oversight of HHAs. A 

standardized assessment instrument 

provides an HHA with a uniform 

mechanism to assess the needs of their 

patients and provide CMS with a 

uniform mechanism to assess the HHA’s 

ability to adequately address those 

needs. To fulfill the OBRA 87 mandate, 

CMS required that, as part of their 

comprehensive assessment process, 

HHAs collect and report Outcome and 

Assessment Information Set (OASIS) 

data and later mandated the submission 

of this data as a Medicare Condition of 

Participation for home health agencies 

at 42 CFR 484.20 and 484.55. 

The OASIS data provide consumers 

and HHAs with ten publicly-reported 

home health quality measures which 

have been endorsed by the National 

Quality Forum (NQF). Reporting this 

quality data has also required the 

development of several supporting 

mechanisms such as the HAVEN 

software used to encode and transmit 

data using a CMS standard electronic 

record layout, edit specifications, and 

data dictionary. Use of the HAVEN 

software, which includes the OASIS, 

has become a standard practice within 

HHA operations. These early 

investments in data infrastructure and 

supporting software that CMS and 

HHAs have made over the past several 

years in order to create this quality 

reporting structure, have made quality 

reporting and measurement an 

important component of the HHA 

industry. The 10 measures are: 

(1) Improvement in ambulation/ 

locomotion 

(2) Improvement in bathing 

(3) Improvement in transferring 

(4) Improvement in management of oral 

medications 

(5) Improvement in pain interfering 

with activity 

(6) Acute care hospitalization 

(7) Emergent care 

(8) Improvement in dyspnea 

(9) Improvement in urinary 

incontinence 

(10) Discharge to community 

We proposed to use OASIS data and 

the 10 quality measures based on those 

data as the appropriate measure of home 

health quality for CY 2007. Continuing 

to use the OASIS instrument minimizes 


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the burden to providers and ensures that 

costs associated with the development 

and testing of a new reporting 

mechanism are not incurred. We believe 

that the noted 10 quality measures are 

the most appropriate measure of home 

health quality. Accordingly, for CY 

2007, we proposed to require that the 

OASIS data, specifically the 10 quality 

measures, be submitted by HHAs, to 

meet the requirement that each HHA 

submit data appropriate for the 

measurement of health care quality, as 

determined by the Secretary. 

Additionally, section 

1895(b)(3)(B)(v)(II) of the Act provides 

the Secretary with the discretion to 

require the submission of the required 

data in a form, manner, and time 

specified by him. For CY 2007, we 

proposed to consider OASIS data 

submitted by HHAs to CMS for episodes 

beginning on or after July 1, 2005 and 

before July 1, 2006 as meeting the 

reporting requirement. This proposed 

reporting time period would allow a full 

12 months of data and provides CMS 

the time necessary to analyze and make 

any necessary payment adjustments to 

the CY 2007 payment rates for HHAs 

that fail to meet the reporting 

requirement. HHAs that met the 

reporting requirement would be eligible 

for the full home health market basket 

percentage increase. Using historical 

data to determine a prospective update 

is also used for hospital pay for 

reporting. 

As discussed in the August 3, 2006 

proposed rule, during the next few 

years, we noted that we would be 

pursuing the development of patient 

level process measures for home health 

agencies. We also proposed to continue 

to refine the current OASIS tool in 

response to recommendations from a 

Technical Expert Panel conducted to 

review the data elements that make up 

the OASIS tool. These process measures 

would refer to specific care practices 

that are, or are not, followed by the 

home health agency for each patient. An 

example of this type of measure may be: 

the percentage of patients at risk of falls 

for whom prevention of falls was 

addressed in the care plan. We expect 

to introduce these additional measures 

over CY 2008 and CY 2009 so as to 

complement the existing OASIS 

outcome measures. During the years 

leading to CY 2010 payments, we will 

test and refine these measures to 

determine if they can more accurately 

reflect the level of quality care being 

provided at HHAs without being overly 

burdensome with the data collection 

instrument. Some process measures are 

in the very early stages of development. 

To the extent that evidence-based data 

are available on which to determine the 

appropriate measure specifications, and 

adequate risk-adjustments are made, we 

anticipate collecting and reporting these 

measures as part of each agency’s home 

health quality plan. We believe that 

future modifications to the current 

OASIS tool including reducing the 

number of questions on the tool, 

refining possible responses, as well as 

adding new process measures will be 

made. In all cases, we anticipate that 

any future quality measures should be 

evidence-based, clearly linked to 

improved outcomes, and able to be 

reliably captured with the least burden 

to the provider. We are also beginning 

work in order to measure patient 

experience of care (in the form of a 

patient satisfaction survey) in the home 

health setting. 

We recognize, however, that the 

conditions of participation (42 CFR part 

484) that require OASIS submission also 

provide for exclusions from this 

requirement. Generally, agencies are not 

subject to the OASIS submission 

requirement, and thus do not receive 

Medicare payments, for patients that are 

not Medicare beneficiaries or for 

patients that are not receiving Medicarecovered home health services. Under 

the conditions of participation, agencies 

are excluded from the OASIS reporting 

requirement on individual patients if: 

• Those patients are receiving only 

non-skilled services, 

• Neither Medicare nor Medicaid is 

paying for home health care (patients 

receiving care under a Medicare or 

Medicaid Managed Care Plan are not 

excluded from the OASIS reporting 

requirement), 

• Those patients are receiving pre- or 

post-partum services, 

• Those patients are under 18 years of 

age. 

We believe that the rationale behind 

our proposal to exclude these agencies 

from submitting OASIS data on patients 

excluded from OASIS submission as a 

condition of participation is equally 

applicable to HHAs for purposes of 

meeting the DRA quality data reporting 

requirement. If an agency is not 

submitting OASIS for patients excluded 

from OASIS submission as a condition 

of participation, we believe that the 

submission of OASIS data for quality 

measures for Medicare payment 

purposes is also not necessary. 

Accordingly, we proposed that HHAs 

would not need to submit quality 

measures for DRA reporting purposes 

for those patients who are excluded 

from OASIS submission as a condition 

of participation. 

Additionally, we proposed that 

agencies that are newly certified (on or 

after May 31, 2006 for payments to be 

made in CY 2007) would be excluded 

from the DRA reporting requirement as 

data submission and analysis would not 

be possible for an agency certified this 

late in the reporting time period. In 

future years, agencies that certify on or 

after May 31 of the preceding year 

involved would be excluded from any 

payment penalty under the DRA for the 

following calendar year. For example, 

for purposes of determining compliance 

with the quality data reporting 

requirement for CY 2007, if HHA ‘‘X’’

were to enroll in the Medicare Program 

on or before May 30, 2006, CMS would 

expect HHA ‘‘X’’ to submit the required 

quality data (unless covered by another 

exclusion protocol) on or before June 30, 

2006 (the end of the reporting period for 

payments effectuated in CY 2007). 

However, if HHA ‘‘Y’’ was to enroll in 

the Medicare Program on or after May 

31, 2006, CMS would automatically 

exclude HHA ‘‘Y’’ from the DRA quality 

data reporting requirements and the 

agency would be entitled to the full 

market basket increase for CY 2007. We 

note that these proposed exclusions 

would only affect reporting 

requirements under the DRA and would 

not otherwise affect the agency’s OASIS 

reporting responsibilities under the 

conditions of participation. 

We proposed to require that all HHAs, 

unless covered by these specific 

exclusions, meet the reporting 

requirement, or be subject to a 2 percent 

reduction in the home health market 

basket percentage increase in 

accordance with section 

1895(b)(3)(B)(v)(I) of the Act. The 2 

percent reduction would apply to all 

episodes ending on or before December 

31, 2007. We provide the reduced 

payment rates in tables 5, 6, 7, and 8 

below. 


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TABLE 5.—FOR HHAS THAT DO NOT SUBMIT THE REQUIRED QUALITY DATA— NATIONAL 60-DAY EPISODE AMOUNT UPDATED BY THE ESTIMATED HOME HEALTH MARKET BASKET UPDATE FOR CY 2007, MINUS 2 PERCENTAGE POINTS, 

BEFORE CASE-MIX ADJUSTMENT

Total CY 2006 prospective payment amount 

per 60-day episode 

Multiply by the estimated home health market 

basket update (3.3 Percent 1 minus 2 percent) 

CY 2007 updated national 60-day episode rate 

for HHAs that do not submit required quality 

data 

$2,264.28 × 1.013 $2,293.72 

1The estimated home health market basket update of 3.3 percent for CY 2007 is based on Global Insight, Inc, 3rd Qtr, 2006 forecast with historical data through 2nd Qtr, 2006. 

TABLE 6—FOR HHAS THAT DO NOT SUBMIT THE REQUIRED QUALITY DATA—NATIONAL PER-VISIT AMOUNTS UPDATED

BY THE ESTIMATED HOME HEALTH MARKET BASKET UPDATE FOR CY 2007, MINUS 2 PERCENTAGE POINTS

Home health discipline type 

Final CY 2006 

per-visit amounts 

per 60-day episode 

Multiply by the estimated home 

health market basket update (3.3 

percent 1 minus 2 

percent) 

CY 2007 per-visit 

payment amount 

per discipline for 

HHAs that do not 

submit required 

quality data 

Home Health Aide ..................................................................................................... $44.76 × 1.013 $45.34 

Medical Social Services ............................................................................................. 158.45 × 1.013 160.51 

Occupational Therapy ................................................................................................ 108.81 × 1.013 110.22 

Physical Therapy ....................................................................................................... 108.08 × 1.013 109.49 

Skilled Nursing ........................................................................................................... 98.85 × 1.013 100.14 

Speech-Language Pathology .................................................................................... 117.44 × 1.013 118.97 

1The estimated home health market basket update of 3.3 percent for CY 2007 is based on Global Insight, Inc, 3rd Qtr, 2006 forecast with historical data through 2nd Qtr, 2006. 

TABLE 7.—FOR HHAS THAT DO NOT SUBMIT THE REQUIRED QUALITY DATA— PAYMENT AMOUNT FOR 60-DAY EPISODES

BEGINNING IN CY 2006 AND ENDING IN CY 2007 UPDATED BY THE ESTIMATED HOME HEALTH MARKET BASKET FOR

CY 2007, MINUS 2 PERCENTAGE POINTS, WITH RURAL ADD-ON, BEFORE CASE-MIX ADJUSTMENT

CY 2007 Updated national 60-day episode 

rate for HHAs that do not submit required 

quality data 

5 Percent rural add-on 

CY 2007 Payment amount per 60-day episode 

beginning in CY 2006 and ending in CY 2007 

for a beneficiary who resides in a non-MSA 

area for HHAs that do not submit required 

quality data 

$2,293.72 × 1.05 $2,408.41 

TABLE 8—FOR HHAS THAT DO NOT SUBMIT THE REQUIRED QUALITY DATA— PER-VISIT PAYMENT AMOUNTS FOR EPISODES BEGINNING IN CY 2006 AND ENDING IN CY 2007 UPDATED BY THE ESTIMATED HOME HEALTH MARKET BASKET FOR CY 2007, MINUS 2 PERCENTAGE POINTS, WITH RURAL ADD-ON

Home health discipline type 

CY 2007 Per-visit 

amounts for HHAs 

that do not submit 

required quality 

data 

5 Percent rural 

add-on 

CY 2007 Per-visit 

payment amounts 

for episodes beginning in CY 

2006 and ending 

in CY 2007 for a 

beneficiary who 

resides in a nonMSA area for 

HHAs that do not 

submit required 

quality data 

Home Health Aide ..................................................................................................... $45.34 × 1.05 $47.61 

Medical Social Services ............................................................................................. 160.51 × 1.05 168.54 

Occupational Therapy ................................................................................................ 110.22 × 1.05 115.73 

Physical Therapy ....................................................................................................... 109.49 × 1.05 114.96 

Skilled Nursing ........................................................................................................... 100.14 × 1.05 105.55 

Speech-Language Pathology .................................................................................... 118.97 × 1.05 124.92 

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

further requires that the ‘‘Secretary shall 

establish procedures for making data 

submitted under subclause (II) available 

to the public.’’ Additionally, the statute 

requires that ‘‘such procedures shall 

ensure that a home health agency has 

the opportunity to review the data that 

is to be made public with respect to the 

agency prior to such data being made 

public.’’ To meet the requirement for 

making such data public, we proposed 


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to continue to use the CMS Home 

Health Compare Web site whereby 

HHAs are listed geographically. 

Currently the 10 proposed quality 

measures are posted on the CMS Home 

Health Compare Web site. Consumers 

can search for all Medicare-approved 

home health providers that serve their 

city or zip code and then find the 

agencies offering the types of services 

they need as well as the required quality 

measures. See http:// 

www.medicare.gov/HHCompare. HHAs 

would continue to have access (through 

the Home Health Compare contractor) 

to its own quality data (updated 

periodically) and we would establish a 

process by which agencies would 

receive a report before reporting the data 

publicly. 

Currently, the CMS Home Health 

Compare Web site does not publicly 

report data when agencies have fewer 

than 20 episodes of care within a 

reporting period. In light of the DRA 

requirements, we recognize the need to 

provide the required data to the public 

and would make these statistics 

available through expansion of the CMS 

Home Health Compare Web site. 

In the July 27, 2005 Medicare 

Payment Advisory Commission 

(MedPAC) testimony before the U.S. 

Senate Committee on Finance, MedPAC 

expressed support for the concept of 

differential payments for Medicare 

providers, which could create 

incentives to improve quality. To 

support this initiative, MedPAC stated 

that ‘‘outcome measures from CMS’

Outcome-based Quality Indicators’’

(currently collected through the OASIS 

instrument) ‘‘could form the starter set.’’

MedPAC further states ‘‘* * * the 

Agency for Healthcare Research and 

Quality concur(s) that a set of these 

measures is reliable and adequately risk 

adjusted.’’

The MedPAC testimony recognizes 

that while the goal of care for many 

home health patients is improving 

health and functioning, for some 

patients the goal of the HHA is to 

simply stabilize their conditions and 

prevent further decline. Additionally, 

the MedPAC testimony reflects that 

measures of structure and process could 

also be considered. 

Various home health outcome 

measures are now in common use and 

have been studied for some time. A 

number of these measures have been 

endorsed by the National Quality Forum 

(NQF) and are evidence-based, well 

accepted, and not unduly burdensome. 

When determining outcome measures 

that will be most appropriate, it is 

important to measure aspects of care 

that providers can control and are 

adequately risk-adjusted. Home-based 

care presents particular difficulties for 

provider control because patient 

conditions are compounded by a variety 

of home environment and support 

system issues. 

We are currently pursuing the 

development of patient-level process 

measures for HHAs, as well as refining 

the current OASIS tool in response to 

recommendations from a Technical 

Expert Panel conducted to review the 

data elements that make up the OASIS 

tool. These additional measures would 

complement the existing OASIS 

outcome measures and would assist us 

in identifying processes of care that lead 

to improvements for certain populations 

of patients. These process measures are 

currently in the very early stages of 

development. As we stated previously, 

to the extent that evidence-based data 

are available on which to determine the 

appropriate measure specifications, and 

adequate risk-adjustments are made, we 

anticipate collecting and reporting these 

measures as part of our home health 

quality plan. Possible modifications to 

the current OASIS tool include reducing 

the number of questions on the tool, 

refining possible responses, as well as 

adding new process measures. 

We solicited comments on how to 

make the outcome measures more 

useful. We also solicited comments on 

measures of home health care processes 

for which there is evidence of improved 

care to beneficiaries. In all cases, we 

noted that measures should be 

evidence-based, clearly linked to 

improved outcomes, and able to be 

reliably captured with the least burden 

to the provider. We also considered 

measures of patient experience of care 

in the home health setting, as well as 

efficiency measures, and solicited 

comment on the use of these measures 

and their importance in the home health 

setting. In the proposed rule, we noted 

that we would address any changes to 

the HH PPS quality data submission 

requirement in future rulemaking. 

We also stated our intent to provide 

guidance on the specifications, 

definitions, and reporting requirements 

of any additional measures through the 

standard protocol for measure 

development. 

We proposed to revise the regulations 

at § 484.225 to reflect these proposed 

payment requirements which would 

require submission of quality data. For 

CY 2007, we will finalize the 

requirement to use the 10 OASIS 

measures as meeting the DRA quality 

data reporting requirement as discussed 

in section II.D. of the August 3, 2006 

proposed rule and the regulations at 

§ 484.225. 

E. Outliers and 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 for which the 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 

(FDL) amount 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 FDL 

ratio, which is a proportion expressed in 

terms of the national standardized 

episode payment amount. The outlier 

payment is defined to be a proportion of 

the wage-adjusted estimated costs 

beyond the wage-adjusted threshold. 

The proportion of additional costs paid 

as outlier payments is referred to as the 

loss-sharing ratio. 

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

that estimated total outlier payments are 

no more than 5 percent of total 

estimated HH PPS payments. In 

response to the concerns about potential 

financial losses that might result from 

unusually expensive cases expressed in 

comments to the October 28, 1999 

proposed rule (64 FR 58133), the July 

2000 final rule set the target for 

estimated outlier payments at the 5 

percent level. The FDL 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 FDL ratio and the losssharing ratio. A high FDL 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 

FDL 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 do the former. 


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In the July 2000 final rule, we chose 

a value of 0.80 for the loss-sharing ratio, 

which preserves incentives for agencies 

to attempt to provide care efficiently for 

outlier cases. A loss-sharing ratio of 0.80 

was also consistent with the losssharing ratios used in other Medicare 

PPS outlier policies. Furthermore, we 

estimated the value of the FDL ratio that 

would yield estimated total outlier 

payments that were 5 percent of total 

home health PPS payments. The 

resulting value for the FDL ratio for the 

July 2000 final rule was 1.13. 

Our CY 2005 update to the HH PPS 

rates (69 FR 62124) changed the FDL 

ratio from the original 1.13 to 0.70 to 

allow more home health episodes to 

qualify for outlier payments and to 

better meet the 5 percent target of 

outlier payments to total HH PPS 

payments. We stated in that CY 2005 

update that we planned to continue to 

monitor the outlier expenditures on a 

yearly basis and to make adjustments as 

necessary (69 FR 62129). To do so, we 

planned on using the best Medicare data 

available at the time of publication. For 

the CY 2005 update, we used CY 2003 

home health claims data. 

Our CY 2006 update to the HH PPS 

rates (70 FR 68132) changed the FDL 

ratio from 0.70 to 0.65 to allow even 

more home health episodes to qualify 

for outlier payments and to better meet 

the 5 percent target of outlier payments 

to total HH PPS payments. For the CY 

2006 update, we used CY 2004 home 

health claims data. 

At the time of publication of the 

August 3, 2006 proposed rule, we did 

not have more recent data, but we noted 

that we may update the FDL ratio for CY 

2007 depending on the availability of 

more recent data. We further noted that 

if we updated the FDL ratio for the CY 

2007 update, we would use the same 

methodology performed in updating the 

current FDL ratio described in the 

October 22, 2004 final rule. Subsequent 

to the publication of the August 3, 2006 

proposed rule, we have now obtained 

more recent data, that is, CY 2005 home 

health claims data. 

Accordingly for this final rule, we 

have used the same methodology and 

performed an analysis on the CY 2005 

HH PPS analytic data to update the FDL 

ratio for CY 2007. The results of this 

analysis indicate that an FDL ratio of 

0.67 is consistent with the existing losssharing ratio of 0.80 and a projected 

target percentage of estimated outlier 

payments of 5 percent. Therefore, we 

are updating the FDL ratio from the 

current 0.65 to 0.67 for CY 2007. 

Expressed in terms of a fixed dollar 

loss amount, an FDL ratio of 0.67 

indicates that providers would absorb 

approximately $1,567 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 $1,567 is computed by 

multiplying the standard 60-day episode 

payment amount (2,339.00) by the FDL 

ratio (0.67). In contrast, using the 

current FDL ratio (0.65), the fixed dollar 

loss amount would be approximately 

$1,520 ($2,339.00 × 0.65) 

F. Hospital Wage Index—Revised OMB 

Definitions for Geographical Statistical 

Areas 

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 the 

HH PPS to account for area wage 

differences. We apply the appropriate 

wage index value to the labor portion 

(76.775 percent; see 60 FR 62126) of the 

HH PPS rates based on the geographic 

area in which the beneficiary received 

home health services as discussed in 

section II.A of the August 3, 2006 

proposed rule. Generally, we determine 

each HHA’s labor market area based on 

definitions of Metropolitan Statistical 

Areas (MSAs) issued by the Office of 

Management and Budget (OMB). 

We acknowledged in our October 22, 

2004 final rule that on June 6, 2003, the 

OMB issued an OMB Bulletin (No. 03–

04) announcing revised definitions for 

MSAs, new definitions for Micropolitan 

Statistical Areas and Combined 

Statistical Areas, and guidance on using 

the statistical definitions. A copy of the 

Bulletin may be obtained at the 

following Internet address: http:// 

www.whitehouse.gov/omb/bulletins/ 

b03–04.html. At that time, we did not 

propose to apply these new definitions 

known as Core-Based Statistical Areas 

(CBSAs). In the November 9, 2005 final 

rule, we adopted the OMB-revised 

definitions and implemented a one-year 

transition policy consisting of a 50/50 

blend of the MSA-based and the new 

CBSA-based wage indexes. 

As discussed previously and set forth 

in the July 3, 2000 final rule, the statute 

provides that the wage adjustment 

factors may be the factors used by the 

Secretary for purposes of section 

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

wage adjustment factors. Again, as 

discussed in the July 3, 2000 final rule, 

we proposed to use the pre-floor and 

pre-reclassified hospital wage index 

data 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 prereclassified hospital wage index data 

results in the appropriate adjustment to 

the labor portion of the costs as required 

by statute. For the CY 2007 update to 

the home health payment rates, we 

proposed to continue using the most 

recent pre-floor and pre-reclassified 

hospital wage index available at the 

time of publication. See Addenda A and 

B of this final rule, respectively, for the 

rural and urban hospital wage indexes 

using the CBSA designations. For the 

HH PPS rates addressed in the August 

3, 2006 proposed rule, we used 

preliminary 2007 pre-floor and prereclassified hospital wage index data. 

We incorporated updated hospital wage 

index data for the 2007 pre-floor and 

pre-reclassified hospital wage index to 

be used in this final rule (not including 

any reclassifications under section 

1886(d)(8)(B) of the Act). 

As implemented under the HH PPS in 

the July 3, 2000 HH PPS final rule, each 

HHA’s labor market is determined based 

on definitions of MSAs issued by OMB. 

In general, an urban area is defined as 

an MSA or New England County 

Metropolitan Area (NECMA) as defined 

by OMB. Under § 412.62(f)(1)(iii), a 

rural area is defined as any area outside 

of an urban area. The urban and rural 

area geographic classifications are 

defined in § 412.62(f)(1)(ii) and 

§ 412.62(f)(1)(iii), respectively, and have 

been used under the HH PPS since it 

was implemented. 

Under the HH PPS, the wage index 

value is based upon the site of service 

for the beneficiary (defined by section 

1861(m) of the Act as the beneficiary’s 

place of residence). As has been our 

longstanding practice, any area not 

included in an MSA (urban area) is 

considered to be nonurban 

(§ 412.64(b)(1)(ii)(C)) and receives the 

statewide rural wage index value (see, 

for example, 65 FR 41173). 

For CY 2007, we proposed using 100 

percent of the CBSA-based wage area 

designations for purposes of 

determining the HH PPS wage index 

adjustment. 

In adopting the CBSA designations, 

we identified some geographic areas 

where there were no hospitals, and thus 

no hospital wage data on which to base 

the calculation of the CY 2007 home 

health wage index. For CY 2006, we 

adopted a policy in the HH PPS final 

rule (70 FR 68132) of using the CY 2005 

pre-floor, pre-reclassified hospital wage 

index value for rural areas when no 

rural hospital wage data are available. 

We also adopted a policy that for urban 

labor markets without an urban hospital 


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from which a hospital wage index can 

be derived, all of the CBSAs within the 

State would be used to calculate a 

statewide urban average wage index to 

use as a reasonable proxy for these 

areas. We have not received any 

concerns from the industry regarding 

our policy to calculate an urban wage 

index, using an average of all of the 

urban CBSAs wage index values within 

the State, for urban labor markets 

without an urban hospital from which a 

hospital wage index can be derived. 

Consequently, in the August 3, 2006 

proposed rule, we proposed to continue 

to apply the average wage index from all 

urban areas in the state to any urban 

areas lacking hospital wage data in that 

state. Currently, the only CBSA that 

would be affected by this is CBSA 25980 

Hinesville, Georgia. 

In the August 3, 2006 proposed rule, 

we again proposed to apply the CY 2005 

pre-floor/pre-reclassified hospital wage 

index to rural areas where no hospital 

wage data is available. Currently, the 

only rural areas that would be affected 

by this are Massachusetts and Puerto 

Rico. Since publication of the CY 2006 

HH PPS final rule, representatives of the 

home health industry have expressed 

concerns with this policy, specifically 

as it applies to Massachusetts. In 

response to these concerns and in 

recognition that, in the future, there may 

be additional rural areas impacted by a 

lack of hospital wage data from which 

to derive a wage index, we considered 

alternative methodologies for imputing 

a rural wage index for areas where no 

hospital wage data are available. 

We specifically considered imputing a 

rural wage index by computing a simple 

average of all of the statewide (rural) 

wage indexes at the Census Division 

level. Census Divisions are defined by 

the U.S. Census Bureau and may be 

found at www.census.gov/geo/www/ 

us_regdiv.pdf. Massachusetts is located 

in Census Division I, along with 

Connecticut, Maine, New Hampshire, 

Vermont and Rhode Island. The Census 

Bureau states, ‘‘Puerto Rico and the 

Island Areas are not part of any census 

region or census division.’’ Therefore, 

we could not compute a rural wage 

index for Puerto Rico using this 

alternative methodology. 

In the August 3, 2006 proposed rule, 

we solicited comments on the current 

methodology and alternative 

methodologies for determining a wage 

index for areas without the necessary 

hospital wage data. Since publication of 

the August 3, 2006 proposed rule, we 

have received numerous comments 

regarding our policy for determining a 

wage index for rural areas without the 

necessary hospital wage data. In direct 

response to these comments, we have 

decided to revise the methodology for 

imputing a rural wage index. We 

discuss the change to the methodology 

for imputing a rural wage index in 

section III of this final rule. 

G. Payment for Oxygen, Oxygen 

Equipment and Capped Rental DME 

Items 

As discussed in the August 3, 2006 

proposed rule, we would amend our 

regulations at § 414.226 by revising the 

payment rules for oxygen and oxygen 

equipment in paragraph (a), adding a 

new paragraph (f) that provides that the 

beneficiary assumes ownership of 

oxygen equipment on the first day that 

begins after the 36th continuous month 

in which rental payments are made, and 

adding a new paragraph (g) that 

contains new supplier requirements that 

we believe are necessary in light of the 

amendments made to section 1834(a)(5) 

of the Act by section 5101(b) of the 

DRA. As discussed in the August 3, 

2006 proposed rule, we would amend 

our regulations at § 414.226 by adding a 

new paragraph (c) that establishes new 

classes and national payment amounts 

for oxygen and oxygen equipment based 

on our authority in section 1834(a)(9)(D) 

of the Act. We also proposed to revise 

paragraph (b) of this section to 

incorporate the special payment rules 

for oxygen equipment mandated by 

section 1834(a)(21) of the Act. The 

provisions of section 1834(a)(21), which 

we believe are self-implementing, 

resulted in adjustments to Medicare 

payment amounts for oxygen contents 

and stationary oxygen equipment as 

well as portable oxygen equipment in 

2005, which were implemented through 

program instructions. We are now 

seeking to codify these changes to make 

our regulations consistent with the 

payment methodology for these items in 

2005 and 2006, and because the 

payment reductions mandated by 

section 1834(a)(21) are incorporated into 

our proposal, as more fully discussed in 

section I of the August 3, 2006 proposed 

rule, to create new payment classes for 

oxygen and oxygen equipment. The 

August 3, 2006 proposed rule indicated 

that we would redesignate old 

paragraph (c) of this section as 

paragraph (d) and would amend this 

paragraph to indicate under what 

situations payments would be made for 

the items and services described in new 

paragraph (c). Finally, the August 3, 

2006 proposed rule indicated that we 

would redesignate old paragraph (d) of 

this section as paragraph (e) and would 

make technical changes to this 

paragraph so that the cross-references 

are accurate in light of the other changes 

we proposed to make to § 414.226. 

The August 3, 2006 proposed rule 

would also amend our regulations at 

§ 414.229 by revising the payment rules 

for capped rental durable medical 

equipment (DME) items (also called 

capped rental items) in paragraph (a), 

revising paragraph (f) to provide for new 

payment rules for capped rental items 

furnished beginning on or after January 

1, 2006, revising paragraph (g) to 

provide for supplier requirements that 

we believe are necessary in light of the 

amendments made to section 

1834(a)(7)(A) of the Act by section 

5101(a) of the DRA, and adding a new 

paragraph (h) to address the lump-sum 

purchase option for power-driven 

wheelchairs furnished on or after 

January 1, 2006. The language in current 

paragraphs (f) and (g) of this section is 

obsolete, and therefore, we proposed to 

delete this language. 

The August 3, 2006 proposed rule 

indicated that we would amend our 

regulations at § 414.210 by revising the 

maintenance and servicing rules in 

paragraph (e) and the replacement of 

equipment rules in paragraph (f) to 

further implement the new supplier 

requirements that we proposed below. 

Finally, we proposed to revise 

§ 414.230(b) to incorporate section 

5101(b)(2)(B) of the DRA, which 

provides that for all beneficiaries 

receiving oxygen equipment paid for 

under section 1834(a) on December 31, 

2005, the period of continuous use 

begins on January 1, 2006. We also 

proposed to revise § 414.230(f), which 

governs when a new period of 

continuous use begins if a beneficiary 

receives new equipment, to account for 

the fact that oxygen equipment is paid 

on a modality neutral basis. 

Section 5101(a) of the DRA changes 

the Medicare payment methodology for 

capped rental equipment to beneficiary 

ownership after 13 months of 

continuous use, for those beneficiaries 

who need the equipment for more than 

13 months. This section also makes the 

transfer of title for the capped rental 

items a requirement rather than a 

beneficiary option after 13 months of 

continuous use. The changes made by 

this section of the DRA apply to capped 

rental items, including rented powerdriven wheelchairs, for which the first 

rental month occurs on or after January 

1, 2006. We proposed to update 

§ 414.229 of our regulations to reflect 

these new statutory requirements. 

However, for capped rental items and 

rented power-driven wheelchairs for 

which the first rental month occurred 

before January 1, 2006, the existing rules 

in § 414.229 would continue to apply. In 


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addition, as was the case before 

enactment of the DRA, beneficiaries 

may elect to obtain power-driven 

wheelchairs furnished on or after 

January 1, 2006, on a lump-sum 

purchase basis. 

Section 5101(b) of the DRA changes 

the Medicare payment methodology for 

oxygen equipment from continuous 

rental to beneficiary ownership after 36 

months of continuous use, for those 

beneficiaries who medically need the 

oxygen equipment for more than 36 

months. For beneficiaries who were 

receiving oxygen equipment on 

December 31, 2005 for which payment 

was made under section 1834(a) of the 

Act, the 36-month rental period began 

on January 1, 2006. For beneficiaries 

who begin to rent oxygen equipment on 

or after January 1, 2006, the 36-month 

rental period commences at the time 

they begin to rent the equipment. We 

proposed to update § 414.226 of our 

regulations to incorporate these new 

requirements. 

In light of the changes made by 

sections 5101(a) and (b) of the DRA, we 

believe it was necessary to propose 

additional supplier requirements in 

order to maintain beneficiary 

protections and access to oxygen, 

oxygen equipment, and capped rental 

DME items under section 1834(a) of the 

Act. For both capped rental DME items 

and oxygen equipment, the DRA 

amendments make the transfer of title 

from the supplier to the beneficiary a 

requirement rather than an option after 

the statutorily-prescribed rental period 

ends for each category of items. 

Therefore, suppliers and beneficiaries 

should be aware that title to these items 

will automatically transfer to the 

beneficiary if the medical need for the 

equipment continues for a period of 

continuous use that is longer than 36 

months for oxygen equipment and 13 

months for capped rental items. We are 

concerned that there may be incentives 

for suppliers to avoid having to transfer 

title to equipment to beneficiaries as 

required by the DRA. For example, we 

are aware of cases where a supplier has 

informed beneficiaries that it would 

decline to accept assignment for capped 

rental items and would charge 

beneficiaries who elected the purchase 

option the full retail price for the item 

during the 13th rental month (which 

was right before the supplier would be 

required to transfer title under the 

purchase option). In these cases, the 

beneficiary would become financially 

liable for the total retail price for the 

equipment in the 13th month if they 

elected the purchase option. In our 

August 3, 2006 proposed rule, we made 

several proposals relating to the 

furnishing of oxygen equipment and 

capped rental items which we believe 

protect beneficiaries from these types of 

abusive practices and which we believe 

are reasonable for a supplier to comply 

with. Our authority to promulgate these 

requirements stems from our authority 

to administer the payment rules at 

section 1834(a)(5) of the Act for oxygen 

equipment and section 1834(a)(7) of the 

Act for capped rental items, as well as 

the general authority provided in 

section 1871 of the Act for prescribing 

regulations necessary for administering 

the Medicare program. Other than the 

length of the rental periods, which the 

DRA made effective beginning on 

January 1, 2006 for all oxygen 

equipment and for capped rental items 

for which the first rental period began 

on or after that date, we proposed that 

the requirements presented in this 

section of the regulations would be 

effective on January 1, 2007, and would 

apply to suppliers that furnish oxygen 

equipment or capped rental items on a 

rental basis. 

We believe that a supplier of an item 

that is subject to these new payment 

rules that furnishes the item in the first 

month for which a rental payment is 

made has an obligation to continue 

furnishing the item to the beneficiary for 

the entire period of medical need in 

which payments are made, up to and 

including the time when title to the 

equipment transfers to the beneficiary. 

We believe it is reasonable for the 

beneficiary to have an expectation that 

he or she will not be forced to change 

equipment or suppliers during the 

period of medical need unless he or she 

wants to. Therefore, we proposed that 

unless an exception applies, the 

supplier that furnishes oxygen 

equipment or a capped rental item for 

the first month of the statutorily 

prescribed rental period must continue 

to furnish the oxygen equipment or the 

capped rental item for as long as the 

equipment remains medically 

necessary, up to and including the last 

month for which a rental payment is 

made by Medicare. We believe that this 

proposal was necessary to ensure 

beneficiary access to equipment during 

a period of medical need, which we 

believe could be jeopardized if suppliers 

have the option to take back the rented 

equipment just before the rental period 

expires in order to retain title to that 

equipment. We proposed that this 

requirement would be subject to the 

following exceptions: (1) Cases where 

the item becomes subject to a 

competitive acquisition program 

implemented in accordance with 

section 1847(a) of the Act; (2) cases 

where a beneficiary relocates on either 

a temporary or permanent basis to an 

area that is outside the normal service 

area of the initial supplier; (3) cases 

where the beneficiary chooses to obtain 

equipment from a different supplier; 

and (4) other cases where CMS or the 

carrier determine that an exception is 

warranted. We have proposed rules in 

connection with the first exception in 

our Notice of Proposed Rulemaking for 

Competitive Acquisition for Certain 

Durable Medical Equipment, 

Prosthetics, Orthotics, and Supplies 

(DMEPOS) and Other Issues. These 

proposed rules are addressed beginning 

on page 25662 of the May 1, 2006 

proposed rule (71 FR 25654). If the 

second exception applies, we proposed 

that the supplier or beneficiary would 

need to arrange for another supplier in 

the new area to furnish the item on 

either a temporary or permanent basis. 

This proposed exception is consistent 

with what currently happens when 

beneficiaries move outside a supplier’s 

service area on either a temporary or 

permanent basis. The third exception is 

intended to protect a beneficiary’s right 

to obtain the equipment from the 

supplier of his or her choice. Finally, we 

proposed to allow other exceptions to 

this proposed requirement on a case-bycase basis at the discretion of CMS or 

the Medicare contractor. CMS will be 

monitoring the case-by-case 

determinations made by the Medicare 

contractor. 

We are concerned that there might be 

potential incentives for a supplier to 

replace more valuable or newer 

equipment used by the beneficiary with 

less valuable or older equipment from 

its inventory at some point before the 

36th rental month for oxygen equipment 

or 13th rental month for capped rental 

DME expires in order to avoid losing 

title to the more valuable equipment. In 

order to avoid such potential situations, 

we proposed that the supplier may not 

provide different equipment from that 

which was initially furnished to the 

beneficiary at any time during the 36- 

month period for oxygen equipment or 

13th rental month for capped rental 

DME unless one of the following 

exceptions applies: (1) The equipment is 

lost, stolen, or irreparably damaged; (2) 

the equipment is being repaired while 

loaner equipment is in use; (3) there is 

a change in the beneficiary’s medical 

condition such that the equipment 

initially furnished is no longer 

appropriate or medically necessary; or 

(4) the carrier determines that a change 

in equipment is warranted. However, 

we proposed that a change from one 

oxygen equipment modality to another 


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without physician documentation that 

such a change is medically necessary for 

the individual would not be considered 

a change in equipment that is warranted 

under the fourth exception stated above 

since there is no medical basis for the 

change. In those cases where the 

equipment is replaced, we proposed 

that the replacement item must be 

equipment that is, at minimum, in the 

same condition as the equipment being 

replaced. That proposal was intended to 

safeguard beneficiary access to quality 

oxygen equipment and capped rental 

items throughout the duration of the 

rental period. 

Under Medicare, suppliers who 

furnish items of DME can accept 

assignment on all claims for Medicare 

services or on a claim-by-claim basis. 

Assignment is an agreement between 

the supplier and the beneficiary under 

which the supplier agrees to request 

direct payment from Medicare for the 

item, to accept 80 percent of the 

Medicare allowed payment amount for 

the item from the carrier, and to charge 

the beneficiary not more than the 

remaining 20 percent of the Medicare 

approved payment amount, plus any 

unmet deductible. If a supplier elects 

not to accept assignment, Medicare pays 

the beneficiary 80 percent of the 

Medicare allowed payment amount, 

after subtracting any unmet deductible, 

and there is no limit under Title XVIII 

of the Act on the amount the supplier 

can charge the beneficiary for rental of 

the DME item. The beneficiary, in these 

situations, is financially responsible for 

the difference between 80 percent of the 

Medicare allowed payment amount and 

the amount the supplier charges for the 

rental of the DME item. 

Section 1842(h) allows suppliers to 

sign a participation agreement where 

the supplier agrees voluntarily, before a 

calendar year, to accept assignment for 

all Medicare items and services 

furnished to a beneficiary for the 

following calendar year. Current 

supplier participation agreements are 

renewable annually. However, the 

agreements do not apply for a full 

period of medical need for specific 

beneficiaries in cases where such need 

extends for more than a calendar year. 

Nor do current participation agreements 

apply to periods of medical need where 

such a period overlaps calendar years. 

In the latter case, while a supplier may 

renew its participation agreement 

annually, a beneficiary would not know 

before choosing a supplier whether the 

supplier would be willing to accept 

assignment of all claims during the 

13-month or 36-month rental period. 

In order for the beneficiary to make an 

informed choice, we proposed that 

before furnishing the oxygen equipment 

or a capped rental item, the supplier 

must disclose to the beneficiary its 

intentions regarding whether it will 

accept assignment of all monthly rental 

claims for the equipment during the 

period of medical necessity, up to and 

including the 36th month of continuous 

use for oxygen equipment or the 13th 

rental month of continuous use for 

capped rental DME in which rental 

payments could potentially be made. 

We believe that it is reasonable for the 

supplier to disclose to each beneficiary 

its intentions regarding assignment of 

claims for all months during a rental 

period as this decision has a direct 

financial effect on the beneficiary. A 

supplier’s intentions could be expressed 

in the form of a written agreement 

between the supplier and a beneficiary. 

This proposal would require suppliers 

to give beneficiaries advance notice of 

the possible extent of their financial 

liability during the period of medical 

need in which monthly rental payments 

are made for the equipment, so that they 

can use this information to help select 

a supplier. Additionally, to promote 

informed beneficiary choices, we plan 

to post information on a CMS and/or 

CMS contractor Web site(s) indicating 

supplier specific information on oxygen 

equipment and capped rental items 

such as (1) the percentage of 

beneficiaries for whom each supplier 

accepted assignment during a prior 

period of time (for example, a quarter), 

and/or (2) the percentage of cases in 

which the supplier accepted assignment 

during the beneficiary’s entire rental 

period. We believe that those proposals 

create reasonable rules for suppliers that 

furnish oxygen equipment and capped 

rental items and ensure that 

beneficiaries have information 

necessary to make informed choices that 

could have significant financial 

consequences for them. 

H. Payment for Oxygen Contents for 

Beneficiary-Owned Oxygen Equipment 

Section 1834(a)(5) of the Act, as 

amended by section 5101(b)(1) of the 

DRA, requires that Medicare continue to 

make monthly payments for the delivery 

and refilling of oxygen contents for the 

period of medical need after 

beneficiaries own their own gaseous or 

liquid oxygen stationary or portable 

equipment. Before the enactment of the 

DRA, Medicare made monthly payments 

for the delivery and refilling of oxygen 

contents for beneficiaries who own their 

own stationary and/or portable 

equipment (equipment they obtained on 

a purchase basis before June 1, 1989, 

out-of-pocket, or before they enrolled in 

Medicare Part B). In accordance with 

the DRA, we proposed that after the 

supplier transfers title to the stationary 

and/or portable oxygen equipment to 

the beneficiary, Medicare would 

continue to make separate monthly 

payments for gaseous or liquid oxygen 

contents until medical necessity ends. 

We also proposed that if the beneficiaryowned equipment is replaced, and 

Medicare pays for the replacement in 

accordance with proposed revised 

§ 414.210(f) (see section K of this final 

rule for a more complete discussion of 

our proposed oxygen equipment 

replacement policies), a new 36-month 

rental period start and the payment for 

oxygen contents would be included in 

the monthly rental payments. We 

proposed that all oxygen content 

payment amounts would be based on 

new rates developed in accordance with 

our proposal to establish new payment 

classes, as discussed in section I below. 

In transferring title to gaseous or 

liquid oxygen equipment used during 

the 36-month rental period, we 

proposed that suppliers must transfer 

title for all equipment that will meet the 

beneficiary’s continued medical need, 

including those oxygen cylinders or 

vessels that are refilled at the supplier’s 

place of business. Customary practice by 

suppliers for refilling oxygen contents is 

to deliver to the beneficiary cylinders 

filled with contents and take back the 

empty cylinders to the supplier’s place 

of business to refill the oxygen contents. 

Under our proposal, title would transfer 

for both sets of cylinders, meaning the 

ones that are being used by the 

beneficiary for the month and the ones 

that the supplier refills in its business 

location and delivers for use during the 

next subsequent month. This policy 

would apply to both gaseous and liquid 

oxygen stationary equipment and 

portable systems. Similarly, in those 

cases where the beneficiary uses an 

oxygen equipment system which 

includes a compressor which fills 

portable gaseous cylinders in the 

beneficiary’s home, we proposed that 

suppliers must transfer title for this 

equipment to the beneficiary. 

Concerns have been raised regarding 

beneficiary access to, and safety issues 

associated with, the delivery of oxygen 

contents for beneficiary-owned 

stationary and portable gaseous or 

liquid equipment. We believe that these 

concerns are based on the 

misconception that beneficiaries 

become responsible for filling their own 

cylinders. To the contrary, there are 

numerous State and Federal regulations 

governing the safe handling, filling, and 

transport of oxygen and those 

regulations are unaffected by the DRA 

oxygen provisions. We expect that 


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suppliers will continue to furnish 

replacement contents for beneficiaryowned gaseous and liquid systems in 

the same way that they have furnished 

replacement contents for beneficiaryowned equipment in the past. For 

example, suppliers that deliver a 1 

month supply of gaseous cylinders to a 

beneficiary’s home at the same time that 

they are picking up empty cylinders that 

the beneficiary used during the previous 

month could continue this practice 

under section 5101(b) of the DRA. 

I. Classes of Oxygen and Oxygen 

Equipment 

Based on information from paid 

Medicare claims with dates of service in 

calendar year 2004, distribution of usage 

among the four general categories of 

oxygen systems was: (a) 69 percent of 

beneficiaries used both a stationary 

concentrator (which does not require 

delivery of oxygen contents) and a 

portable system that requires delivery of 

gaseous or liquid oxygen, (b) 5 percent 

of beneficiaries used a stationary system 

that requires delivery of gaseous or 

liquid oxygen and a portable system that 

requires delivery of gaseous or liquid 

oxygen, (c) 24 percent of beneficiaries 

used a stationary concentrator system 

only, and (d) 2 percent of beneficiaries 

used only a stationary system that 

requires delivery of liquid or gaseous 

oxygen. The prevalent use of stationary 

concentrator systems is due, in part, to 

the fact that this system is the most costeffective and dependable of the 

stationary oxygen modalities. The main 

reason that the concentrator system is 

the most cost-effective system is that the 

oxygen is concentrated from room air, 

and therefore, the high cost of delivering 

contents to the beneficiary’s residence is 

removed when this system is used. 

Medicare’s current payment structure 

results in two separate payments for 

beneficiaries using both stationary and 

portable systems, both of which are 

modality neutral, meaning that the 

payment amount does not differ 

depending on the type of oxygen 

delivery system (gaseous, liquid, or 

concentrator) that is furnished. One 

payment, hereinto referred to as the 

‘‘stationary payment,’’ includes 

payment for the rental of stationary 

equipment, delivery of stationary 

oxygen contents (for gaseous or liquid 

systems), and delivery of portable 

oxygen contents (for gaseous or liquid 

systems). A separate add-on payment, 

hereinto referred to as the ‘‘portable 

add-on,’’ is also made in cases where 

the beneficiary is renting portable 

oxygen equipment. As a result of this 

payment methodology which has been 

in place since 1989, suppliers have a 

financial incentive to furnish low cost 

concentrator systems as opposed to 

more expensive gaseous or liquid 

systems because the monthly payment 

is the same regardless of which system 

is used. Finally, in implementing 

section 1834(a)(5) and (9) of the Act, 

monthly payment amounts were 

established through regulations at 

§ 414.226 for (1) stationary and portable 

oxygen contents (for beneficiaries who 

use stationary and, if applicable, 

portable equipment), and (2) portable 

oxygen contents only (for beneficiaries 

who only use portable oxygen 

equipment). The current average 

statewide monthly payment amounts 

are: 

Equipment & Contents Oxygen Contents Only 

Stationary Pmt ............................................................................... $199 Stationary & Portable ................................................................... $156 

Portable Add-on ............................................................................. 32 Portable Only ............................................................................... 21 

Based on our data, 36 percent of 

Medicare beneficiaries continue using 

oxygen equipment for more than 3 

years, that is, beyond the 36th month 

after which title for the equipment 

would transfer to the beneficiary in 

accordance with the DRA. 

We have heard concerns about the 

appropriateness of the current payment 

structure for oxygen and oxygen 

equipment in light of changes in the 

technologies for oxygen delivery 

systems that have occurred since 1989, 

and these concerns have been amplified 

in light of the recent changes made by 

the DRA. The specific concerns pertain 

to beneficiary access to (1) portable 

oxygen contents after title to the 

equipment transfers to the beneficiary, 

(2) devices that allow a beneficiary to 

fill portable tanks at home (otherwise 

referred to in the oxygen equipment 

industry as transfilling systems), and (3) 

portable oxygen concentrators. As we 

implement the DRA provisions for 

oxygen equipment and promulgate 

additional supplier requirements, we 

want to ensure that the Medicare 

payment methodology results in 

payments for oxygen and oxygen 

equipment that are accurate, do not 

impede beneficiary access to 

innovations in technology, and do not 

create inappropriate incentives for 

suppliers. 

Some believe that Medicare’s 

stationary payment for equipment and 

contents (average of $199) is ‘‘too high’’

and that Medicare’s payment for 

portable oxygen contents only for 

beneficiary-owned portable equipment 

(average of $21) is ‘‘too low’’. While 

some contend that the overall payment 

(stationary payment plus portable addon) for oxygen and oxygen equipment is 

adequate as long as the beneficiary 

continues to rent the equipment, they 

are concerned about the adequacy of 

Medicare’s $21 monthly payment for 

furnishing oxygen contents for 

beneficiary-owned portable equipment. 

Some believe that Medicare’s current 

average monthly payment of $156 for 

oxygen contents, which includes 

payment for both stationary and 

portable systems, is high enough to 

create an incentive for suppliers to 

furnish stationary oxygen systems that 

require the ongoing delivery of oxygen 

contents, rather than stationary 

concentrator systems that do not require 

delivery of oxygen contents. 

Some technologies provide an 

attachment to a stationary oxygen 

concentrator that allows beneficiaries to 

fill their own portable tanks at home. 

Delivery of portable oxygen contents to 

the beneficiary’s home is, therefore, not 

necessary since this equipment refills 

the beneficiary’s rented or owned 

portable oxygen tanks. This transfilling 

technology eliminates the need for 

frequent and costly trips by a supplier 

to a beneficiary’s home to refill portable 

oxygen tanks and would save the 

Medicare program and beneficiaries 

who use portable equipment the 

expense of paying for delivery of 

portable oxygen contents. We note that 

we are not aware that a similar 

‘‘transfilling’’ technology has been 

developed that would be capable of 

filling stationary tanks in the 

beneficiary’s home. Therefore, there 

remains a need for ongoing delivery of 

gaseous or liquid oxygen contents for 

stationary equipment. In accordance 

with the DRA, after 36 months of 

continuous use, title for the transfilling 

equipment and accompanying portable 

oxygen tanks would transfer to the 

beneficiary who would then own a 

portable equipment system that selfgenerates oxygen in their home. 

However, some are concerned that 

current Medicare payment rules that 


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allow payment for oxygen contents for 

stationary equipment creates an 

incentive for suppliers to furnish 

stationary oxygen equipment that 

require liquid or gaseous oxygen 

deliveries, rather than concentrators and 

transfilling equipment that self-generate 

oxygen in the beneficiary’s home. In 

addition, portable oxygen concentrators 

are now available that meet both the 

beneficiary’s stationary and portable 

oxygen needs. Some have raised 

concern about whether the combination 

of the Medicare stationary payment and 

portable add-on payment 

(approximately $231 per month), which 

is what is currently paid for portable 

oxygen concentrators, is sufficient to 

facilitate use of this new technology 

which, like a transfilling system, 

eliminates the need for delivery of 

oxygen contents, but is more expensive 

than a ‘‘standard’’ or ‘‘non-portable’’

concentrator. 

In light of these concerns, we 

proposed regulatory changes to address 

the Medicare payment rates for oxygen 

and oxygen equipment. We proposed to 

address these issues by using our 

authority under section 1834(a)(9)(D) of 

the Act to establish separate classes and 

monthly payment rates for items of 

oxygen and oxygen equipment. 

Specifically, there are two changes we 

proposed for oxygen and oxygen 

equipment: 

1. We proposed to establish a new 

class and monthly payment amount for 

oxygen generating portable oxygen 

equipment (for example, portable 

concentrators and transfilling systems). 

2. We proposed to establish separate 

classes and monthly payment amounts 

for gaseous and liquid oxygen contents 

that must be delivered for beneficiaryowned stationary and portable oxygen 

equipment. 

The first change involves creating a 

new separate class for portable oxygen 

systems that generate their own oxygen 

and therefore eliminate the need for 

delivery of oxygen contents (for 

example, portable concentrator systems 

or transfilling systems). A higher 

monthly payment amount would be 

allowed, as described below, for these 

systems to account for the increased, 

up-front costs to the supplier of 

furnishing these more expensive 

concentrator or transfilling systems, 

which would be partially offset by the 

reduced payments that the supplier 

would receive from the Medicare 

program and beneficiaries due to the 

fact that these systems do not require 

the delivery of oxygen contents. 

The second change involves creating 

two separate classes (stationary contents 

only and portable contents only) and 

monthly payment rates for furnishing 

oxygen contents for beneficiary-owned 

stationary and portable systems. 

Currently, the combined average 

monthly payment amount of $156 for 

furnishing oxygen contents for 

beneficiary-owned stationary and 

portable systems includes payment for 

both stationary contents and portable 

contents. The current fee schedule 

amounts for oxygen contents are based 

on calendar year data from 1986 for the 

combined average Medicare monthly 

payment for both stationary and 

portable contents divided by number of 

rental months for stationary liquid and 

gaseous oxygen equipment. As a result, 

the current combined stationary/ 

portable contents payment results in 

Medicare payments for portable 

contents even in those cases where the 

beneficiary does not use portable 

oxygen equipment. Under our proposal 

to create one payment class for oxygen 

contents used for stationary equipment, 

and a separate class for oxygen contents 

used for portable equipment, new 

national monthly payment amounts for 

stationary contents delivery and 

portable contents delivery would be 

established by splitting the combined 

payment of $156 into two new 

payments as explained below. This 

change would increase the monthly 

payment for furnishing portable oxygen 

contents and would address the 

concerns that the monthly payment rate 

of $21 is too low for the delivery and 

filling of portable tanks after the 

beneficiary assumes ownership of the 

equipment in accordance with the DRA. 

In order to achieve budget neutrality 

for the new classes of oxygen and 

increase payment amounts for 

furnishing portable contents, we would 

need to reduce other Medicare oxygen 

payment rates. Budget neutrality would 

require that Medicare’s total spending 

for all modalities of stationary and 

portable systems, including contents, be 

the same under the proposed change as 

they would be without the change. 

We proposed to achieve budget 

neutrality by reducing the current 

monthly payment amounts (the 

stationary payment) for stationary 

oxygen equipment and oxygen contents 

(for stationary or portable equipment) 

made during the rental period. This 

reduction in payment is necessary to 

offset increased payments for the 

changes identified above and to meet 

the requirement in section 

1834(a)(9)(D)(ii) that the classes and 

payments be established in a budget 

neutral fashion. In most cases, suppliers 

furnish Medicare beneficiaries with 

stationary oxygen concentrators. These 

devices can be purchased for $1,000 or 

less and the current, average Medicare 

payment of $199 pays suppliers $1,990 

over 10 months. We believe that these 

facts indicate that making a reduction 

(from $199 on average to $177) in 

Medicare payment for this relatively 

inexpensive oxygen equipment in order 

to pay oxygen suppliers adequately for 

furnishing portable oxygen contents and 

more expensive portable oxygen 

equipment technologies is warranted. 

With this approach, the proposed new 

classes, as well as proposed new 

national monthly payment rates, would 

be as follows: 

1. Stationary Payment: $177. 

2. Portable Add-On: $32. 

3. Oxygen Generating Portable 

Equipment Add-On (portable 

concentrators or transfilling systems): 

$64. 

4. Stationary Contents Delivery: $101. 

5. Portable Contents Delivery: $55. 

We provide a detailed discussion of 

the payment rate calculations/ 

adjustments in the paragraphs that 

follow. Under the proposed new oxygen 

and oxygen equipment class structure 

described above, in those cases where 

the beneficiary needs both stationary 

and portable oxygen, monthly payments 

of $241 or $209 (proposed revised 

stationary payment of $177 plus one of 

two proposed portable equipment 

payments, $32 or $64) would be made 

during rental months 1 through 36. The 

stationary payment (which includes 

payment for stationary equipment, as 

well as oxygen contents for stationary 

and portable systems) of $177 would be 

made during rental months 1 through 36 

for beneficiaries who only need 

stationary oxygen and oxygen 

equipment. Monthly payments of $101 

for stationary oxygen contents and/or 

$55 for portable oxygen contents would 

be made in cases where beneficiaries 

own their stationary and/or portable 

oxygen equipment. As explained in 

more detail in the paragraphs that 

follow, the $101 payment is for 

stationary oxygen contents only and is 

derived from the current payment of 

$156, which is made for both stationary 

and portable oxygen contents. The $55 

payment for portable oxygen contents 

only is also derived from the current 

payment of $156 that is made for both 

stationary and portable oxygen contents 

and would replace the current statewide 

portable oxygen contents fees (average 

of $21), which was based on a relatively 

small number of claims and allowed 

services compared to the number of 

claims and allowed services that were 

used in computing the statewide fees 

(average of $156) for a combination of 

stationary and portable oxygen contents. 


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As noted above, the proposed national 

payment rates for delivery of oxygen 

contents for beneficiary-owned gaseous/ 

liquid equipment were derived from the 

current average payment for a combined 

oxygen contents delivery of $156. We 

proposed to establish $101, or 65 

percent of $156, as the monthly 

payment rate for delivery of larger, 

heavier, beneficiary-owned stationary 

gaseous oxygen cylinders or liquid 

oxygen vessels and $55, or 35 percent of 

$156, as the monthly payment rate for 

delivery of smaller, lighter, beneficiaryowned portable gaseous oxygen 

cylinders or liquid oxygen vessels. The 

65/35 split is based on our 

understanding that there are higher 

costs associated with delivering 

stationary tanks (cylinders of gaseous 

oxygen and vessels of liquid oxygen) 

which are approximately twice as large 

as the portable tanks. Such costs include 

supplier overhead costs, including the 

costs to purchase, maintain, and 

dispatch trucks, obtain insurance, and 

purchase fuel. The 65/35 split is 

intended to account for the difference in 

costs associated with the size of the 

tanks. Larger tanks take up more space 

on the trucks, take longer to fill, are 

harder to move, and result in increased 

fuel costs. 

We estimate that the increase from 

$21 to $55 in the monthly payment rate 

for delivery of oxygen contents for 

beneficiary-owned portable equipment 

will result in increased expenditures of 

approximately $22 million over a 24 

month period, or $11 million annually. 

This figure is based on current data on 

utilization of portable oxygen by 

Medicare beneficiaries. 

The add-on payment amount of $64 

for the oxygen generating portable 

equipment class was calculated based 

on data indicating long term savings 

generated from use of equipment that 

eliminated the need for payment of $55 

per month for portable oxygen contents. 

The first step in calculating the 

proposed $64 payment for oxygen 

generating portable equipment involves 

the computation of a national, 

enhanced, modality neutral monthly 

payment amount of $241 for new 

technology systems (stationary 

concentrators and transfilling systems, 

as well as portable concentrators), 

which was derived from the sum of the 

current average stationary payment 

($199), the current average portable addon payment ($32), and an additional $10 

to pay suppliers for furnishing more 

expensive equipment that eliminates the 

need for delivery of portable oxygen 

contents. Specifically, we calculated the 

modality neutral increased payment 

(that is, $10 above the current 

combination of the stationary payment 

and portable add-on payment) by 

estimating potential savings that the 

Medicare program would realize as a 

result of not having to pay for delivery 

of oxygen contents for beneficiaryowned portable oxygen systems in the 

fourth and fifth years of use. We 

calculated the increased payment to be 

equal to potential savings from not 

delivering oxygen contents. In 

calculating this increased payment, we 

were only factoring in savings from the 

fourth and fifth years of use since we 

assume that most beneficiaries will elect 

to obtain replacement equipment after 

the 5-year reasonable useful lifetime for 

their equipment has expired. Since our 

data indicate that 35.8 percent of 

beneficiaries will use oxygen equipment 

for more than 3 years, and that 

approximately 74 percent of these 

beneficiaries use portable equipment, 

the $10 amount is calculated based on 

the following formula, and is rounded to 

the nearest dollar: 

((. $ ) . 358 55 24 74

36

×× × months)

 months

We estimate that the additional $10 

payment per month for oxygen 

generating portable equipment 

(transfilling units and portable 

concentrators) will result in increased 

expenditures of approximately $15 

million over a 36 month period, or $5 

million annually. This figure is based on 

current data on utilization of stationary 

and portable oxygen by Medicare 

beneficiaries over 36 months. 

The second step in calculating the 

proposed $64 add-on payment for the 

proposed new class of oxygen 

generating portable equipment involves 

subtracting the proposed new stationary 

payment. Therefore, the national 

monthly payment of $241 computed in 

the first step above would be reduced by 

$177, the proposed new adjusted 

stationary payment amount, to arrive at 

the proposed add-on payment of $64 for 

just the oxygen generating portable 

equipment. In addition, to offset the 

increased annual payments of 

approximately $16 million that will 

result from increased payments for 

portable oxygen contents ($11 million) 

and newer technology oxygen 

generating portable equipment ($5 

million), we proposed to decrease the 

current stationary payment by $22 

($199–$177). We estimated that this 

offset would result in annual Medicare 

savings of approximately $16 million, 

and would therefore offset the increased 

payments for new technology oxygen 

generating portable equipment and 

delivery of oxygen contents for other 

beneficiary-owned portable equipment. 

We proposed that these fees be 

established on a nationwide basis due to 

the fact that the variation in the current 

statewide fee schedule amounts for 

oxygen and oxygen equipment, as well 

as the portable equipment add-on 

payment, are currently only 3 percent 

and 5 percent, respectively. 

We proposed that the $64 add-on 

payment would be made for oxygen 

generating portable equipment only if 

the equipment eliminates the need for 

delivery or portable oxygen contents. 

However, if transfilling equipment is 

used in connection with a stationary 

oxygen concentrator (whether as an 

integrated system component or as a 

separate part) to both deliver stationary 

oxygen and fill portable oxygen tanks, 

Medicare would make both a $177 

stationary payment for the stationary 

oxygen concentrator and stationary 

oxygen contents, and a separate $64 

oxygen generating portable equipment 

payment for the portable oxygen 

transfilling equipment. 

There are also portable oxygen 

transfilling products that are not part of 

or used in conjunction with a stationary 

oxygen concentrator. These products are 

only used to fill portable oxygen tanks 

in the beneficiary’s home. If the 

beneficiary is using one of these 

products, Medicare would make a $64 

oxygen generating portable equipment 

payment. If the patient is also renting 

any type of stationary oxygen 

equipment (gaseous, liquid, or 

concentrator), Medicare would make a 

separate, additional $177 stationary 

equipment payment for that equipment. 

If a portable oxygen concentrator is 

furnished, Medicare would make the 

$64 oxygen generating portable 

equipment add-on payment if the 

portable oxygen concentrator is used as 

both the beneficiary’s stationary oxygen 

equipment and portable oxygen 

equipment. In this case, the portable 

oxygen concentrator equipment would 

fall under both the stationary oxygen 

equipment class and the oxygen 

generating portable equipment class. 

Therefore, the $177 stationary payment 

would also be made in this situation, 

since the equipment being furnished 

meets the beneficiary’s needs for both 

stationary and portable oxygen 

equipment. In this case, it would be 

necessary for the supplier to use two 

HCPCS codes to bill for this device 

since it is being used as both the 

stationary and portable oxygen 

equipment for the beneficiary. If the 

beneficiary owns any type of stationary 

equipment (concentrator, liquid, or 

gaseous), and is also furnished with a 

portable oxygen concentrator, only the 


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oxygen generating payment of $64 

would be made (that is, the supplier 

would not also receive the $177 

payment) and the portable oxygen 

concentrator equipment would fall 

under the oxygen generating portable 

equipment class because it is only being 

used to meet the beneficiary’s need for 

portable oxygen equipment. Finally, if, 

the beneficiary is renting any type of 

stationary equipment (concentrator, 

liquid, or gaseous), and is also furnished 

with a portable oxygen concentrator, the 

oxygen generating add-on payment of 

$64 would be paid for the portable 

oxygen concentrator and the stationary 

payment of $177 would be paid 

separately for the stationary oxygen 

equipment and contents. 

In summary, we proposed new 

payment classes for oxygen contents for 

beneficiary-owned stationary 

equipment, oxygen contents for 

beneficiary-owned portable equipment, 

and oxygen generating portable 

equipment. Payments for oxygen 

contents for beneficiary-owned portable 

equipment and oxygen generating 

portable equipment would exceed what 

is currently paid for these items to 

ensure access to portable oxygen 

regardless of the type of equipment 

used. These increased payments would 

be offset by a reduction in the stationary 

payment. The six broad categories of 

oxygen equipment used by beneficiaries 

are as follows: 

A. Concentrator and liquid or gaseous 

portable equipment. 

B. Concentrator and/or oxygen 

generating portable equipment. 

C. Liquid or gaseous stationary 

equipment and liquid or gaseous 

portable equipment. 

D. Liquid or gaseous stationary 

equipment and oxygen generating 

portable equipment. 

E. Concentrator only. 

F. Liquid or gaseous stationary 

equipment only. 

Based on our proposed new payment 

classes, Medicare payment under these 

six categories would be as follows: 

Category Equipment rental 

and contents 

Contents for beneficiaryowned equipment 

A ................................................................................................................................ $209 ($177 + $32) $55 

B ................................................................................................................................ $241 ($177 + $64) $0 

C ................................................................................................................................ $209 ($177 + $32) $156 ($101 + $55) 

D ................................................................................................................................ $241 ($177 + $64) $101 

E ................................................................................................................................ $177 $0 

F ................................................................................................................................ $177 $101 

We proposed to revise our regulations 

in order to implement these new 

payment classes and payment amounts, 

effective for claims with dates of service 

on or after January 1, 2007. 

J. Payment for Maintenance and 

Servicing of Oxygen and Oxygen 

Equipment and Capped Rental Items 

Immediately following passage of the 

DRA, concerns were raised regarding 

the ability of a beneficiary to obtain 

maintenance and servicing of his or her 

DME once he or she has taken title to 

it. We believe that these concerns are 

largely based on misconceptions that 

the beneficiary will ‘‘be on his or her 

own’’ in terms of maintenance and 

servicing of equipment and submission 

of claims for payment for these services. 

We believe that these concerns are 

unfounded because Medicare payment 

has traditionally been made for 

reasonable and necessary repair and 

maintenance of beneficiary-owned 

DME. In addition, section 

1834(a)(5)(F)(ii)(II)(bb) of the Act, as 

amended by section 5101(b)(1)(B) of the 

DRA, and Section 1834(a)(7)(A)(iv) of 

the Act, as amended by Section 

5101(A)(1) of the DRA, require that 

Medicare continue to pay for reasonable 

and necessary maintenance and 

servicing for parts and labor not covered 

under a manufacturer’s or supplier’s 

warranty in amounts determined to be 

appropriate by the Secretary. 

Medicare has also traditionally paid 

for loaner equipment used while the 

beneficiary’s equipment is being 

repaired, or in some cases, when the 

beneficiary does not have access to the 

equipment (for example, in cases when 

a natural disaster such as a hurricane 

forces the beneficiary to be evacuated 

from his or her home). We proposed to 

continue Medicare payment for such 

loaner equipment. 

We are not aware of instances where 

beneficiaries have encountered 

problems in finding suppliers to provide 

maintenance and servicing of 

beneficiary-owned DME. Section 

414.210(e) of our regulations currently 

provides that reasonable and necessary 

charges for maintenance and servicing 

of DME are those charges made for parts 

and labor not otherwise covered under 

a manufacturer’s or supplier’s warranty. 

This definition has been applied in 

paying claims for maintenance and 

servicing of beneficiary-owned DME for 

several years, and the wording of this 

regulatory definition is parallel to that 

used in amended sections 

1834(a)(7)(A)(iv) and (a)(5)(F)(ii)(II)(bb) 

of the Act in describing the 

‘‘maintenance and servicing’’ payments 

that are permitted for capped rental 

DME and oxygen equipment after title 

has transferred to the beneficiary. We 

proposed to continue use of this existing 

regulatory definition to define 

‘‘maintenance and servicing’’ in section 

5101 of the DRA. We, however, also 

proposed to apply our existing policy of 

not covering certain routine 

maintenance or periodic servicing of 

purchased equipment, such as testing, 

cleaning, regulating, changing filters, 

and general inspection of beneficiaryowned DME that can be done by the 

beneficiary or caregiver, to beneficiaryowned oxygen equipment and to 

continue that policy for beneficiaryowned capped rental equipment. As 

specified in current program 

instructions at section 110.2.B of 

chapter 15 of the Medicare Benefit 

Policy Manual (Pub 100–02), ‘‘the 

owner [of the equipment] is expected to 

perform such routine maintenance 

rather than a retailer or some other 

person who charges the beneficiary.’’

We expect that the supplier, when 

transferring title to the equipment to the 

beneficiary, would also provide to the 

beneficiary any operating manuals 

published by the manufacturer which 

describe the servicing an owner may 

perform to properly maintain the 

equipment. We also believe that these 

owner manuals are commonly available 

at the various manufacturer Web sites. 

In addition, the Durable Medical 

Equipment, Prosthetics, Orthotics and 

Supplies (DMEPOS) supplier standards 

at § 424.57(c)(12) require suppliers to 

provide the beneficiary with necessary 

information and instructions on how to 

use DME items safely and effectively. 

We believe that after receiving this 

information, and after becoming familiar 

with the equipment during the 13 or 36 

month rental period, the beneficiary 

and/or caregiver should be very 

knowledgeable regarding the routine 


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maintenance required for the item. All 

non-routine maintenance of beneficiaryowned oxygen equipment and capped 

rental items which would need to be 

performed by authorized technicians 

would be covered as reasonable and 

necessary maintenance and servicing. 

Examples of the types of maintenance 

that would be covered are currently 

listed in program instructions at section 

110.2.B of chapter 15 of the Medicare 

Benefit Policy Manual (Pub 100–02) and 

include ‘‘breaking down sealed 

components and performing tests which 

require specialized testing equipment 

not available to the beneficiary.’’

We proposed that maintenance and 

servicing of beneficiary-owned oxygen 

equipment and capped rental items 

would be reasonable and necessary if it 

is non-routine maintenance and 

servicing necessary to make the 

equipment serviceable. Payment is 

currently made under the Medicare 

program for parts and labor associated 

with repairing beneficiary-owned DME. 

Medicare allowed payment amounts for 

replacement parts are currently paid 

based on the carrier’s individual 

consideration of the item. With regard to 

replacement parts for beneficiary-owned 

oxygen equipment or capped rental 

equipment, we proposed that the carrier 

pay for the parts in a lump sum amount 

based on its consideration of the cost of 

the item, as is consistent with what our 

carriers currently do when evaluating 

maintenance and servicing claims for 

other beneficiary-owned DME. 

Currently, payment for labor is based on 

15-minute increments in amounts that 

are established by the carriers and 

updated on an annual basis by the same 

factor specified in section 1834(a)(14) of 

the Act, which is used to update fee 

schedule amounts for DME. We 

proposed that the carriers use the same 

fee for labor that is currently used in 

paying for labor associated with 

repairing, maintaining, and servicing 

other beneficiary-owned DME, as we are 

not aware of any past problems 

associated with access to these services 

paid at these rates. We believe that the 

current methods and fees used by 

carriers in paying for maintenance and 

servicing of beneficiary-owned DME are 

reasonable given that we are not aware 

of any past problems associated with 

access to these services paid at these 

rates. In most cases, neither the 

Medicare program nor the beneficiary 

actually pays the full amount for 

repairing or maintaining an item since 

manufacturer warranties that cover all 

or part of these costs are widespread. 

For example, some manufacturers of 

commonly used oxygen concentrators 

offer full warranties that cover all parts 

and labor for 5 years. Rules in 

§ 414.210(f) regarding replacement of 

DME that has been in continuous use for 

the equipment’s reasonable useful 

lifetime provide that the beneficiary can 

elect to obtain replacement equipment 

after the reasonable useful lifetime for 

the equipment has expired. Therefore, 

we believe that the beneficiary should 

incur little, if any, expense for repair or 

maintenance of necessary equipment in 

cases where manufacturer warranties 

exist that cover parts and labor 

necessary to repair a new item during a 

5-year period. 

K. Payment for Replacement of 

Beneficiary-Owned Oxygen Equipment, 

Capped Rental Items, and Associated 

Supplies and Accessories 

Medicare has traditionally paid for 

replacement beneficiary-owned DME 

after the expiration of the equipment’s 

useful lifetime (see § 414.210(f) and 

§ 414.229(g) of our regulations), and for 

replacement supplies and accessories 

used in conjunction with beneficiaryowned DME when these supplies and 

accessories are necessary for the 

effective use of the DME (see § 110.3 of 

Chapter 15 of the Medicare Benefit 

Policy Manual (pub. 100–02)). Examples 

of supplies include drugs and 

administration sets used with infusion 

pumps. Examples of accessories include 

masks and tubing used with respiratory 

equipment. We proposed to apply these 

policies to beneficiary-owned oxygen 

equipment, as well as the supplies and 

accessories used in conjunction with 

this equipment, and to continue to 

apply these policies to beneficiaryowned capped rental items, as well as 

the supplies and accessories used in 

conjunction with these items. 

Specifically, we proposed to update 

§ 414.210(f) and § 414.229(g) of our 

regulations to reflect that payment may 

be made for the replacement of 

beneficiary-owned oxygen equipment 

and capped rental DME in cases where 

the item is lost, stolen, or irreparably 

damaged, or in cases where the item has 

been in continuous use for its 

reasonable useful lifetime. We proposed 

that payment for the replacement be 

made on a rental basis in accordance 

with the payment rules in § 414.226 for 

oxygen equipment and § 414.229 for 

capped rental items. We also proposed 

to revise § 414.229 to reflect that these 

proposed changes to the replacement 

policy for beneficiary-owned capped 

rental items only apply to those items 

for which the first rental month occurs 

on or after January 1, 2007 since the 

DRA does not apply to capped rental 

items for which the first rental month 

occurs before January 1, 2006. The 

current rules will remain in place for 

capped rental items to which the DRA 

does not apply. 

We are aware that some manufacturer 

warranties may cover replacement of 

oxygen or capped rental equipment 

within a certain time period after the 

item is furnished. As was our policy 

before the enactment of DRA (see 

§ 110.2.C of Chapter 15 of the Medicare 

Benefit Policy Manual (pub. 100–02)), 

we proposed that Medicare not pay for 

the replacement of beneficiary-owned 

oxygen equipment or capped rental 

items covered by a manufacturer’s or 

supplier’s warranty. In cases where 

equipment replacement is not covered 

by a manufacturer’s or supplier’s 

warranty, we proposed that the supplier 

must still replace beneficiary-owned 

oxygen equipment or beneficiary-owned 

capped rental items at no cost to the 

beneficiary or to the Medicare program 

if: (1) The total accumulated costs, as 

illustrated in the example below, to 

repair the item after transfer of title to 

the beneficiary exceed 60 percent of the 

replacement cost; and (2) the item has 

been in continuous use for less than its 

reasonable useful lifetime, as 

established in accordance with the 

procedures set forth in proposed revised 

§ 414.210(f). For example, a capped 

rental item that can be replaced for 

$1,000 (total of fee schedule payments 

after 13 rental months) and for which 

title has transferred to the beneficiary in 

accordance with section 

1834(a)(7)(A)(ii) of the Act can be used 

to illustrate what we mean when we use 

the term ‘‘accumulated costs’’ above. In 

this example, if Medicare has paid a 

total of $500 for 3 repairs necessary to 

make the item functional, and a fourth 

repair costing $200 is needed in order 

to make the item functional, the 

accumulated costs for repair in this case 

will equal $700, which exceeds $600 or 

60 percent of the $1,000 cost to replace 

the item. In this case, the supplier 

would be required to furnish a 

replacement item. The greater than 60 

percent of cost threshold for 

replacement is consistent with the 

threshold repair costs that can result in 

the replacement of prosthetics (artificial 

limbs) in accordance with section 

1834(h)(1)(G) of the Act. We believe this 

threshold should apply to oxygen 

equipment and capped rental items as 

well, because artificial limbs, like these 

items, are built to withstand repeated 

use. 

We proposed that the supplier be 

responsible for the cost of the 

replacement equipment because we 

believe that the item in this case did not 

last for the entire reasonable useful 


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lifetime. After the beneficiary acquires 

title to the item, the supplier that 

transferred title would be responsible 

for furnishing the replacement item. We 

proposed this provision to safeguard the 

beneficiary from receiving, and the 

Medicare program from paying for, 

substandard equipment, and to avoid 

creating an incentive for suppliers to 

increase the number of claims submitted 

for repairs in an effort to recover 

revenue lost as a result of DRA section 

5101. We believe that this requirement 

is not unreasonable since suppliers 

should be furnishing items in good 

working order and are otherwise bound 

by regulations at § 424.57(c)(15) to 

accept returns from beneficiaries of 

substandard items. Exceptions to this 

rule may be granted by CMS or the 

carrier as appropriate (for example, the 

supplier would not be responsible for 

replacing an item in need of repair due 

to beneficiary neglect or abuse). 

L. Periods of Continuous Use 

Rules that apply in determining a 

period of continuous use for rental of 

DME are found at § 414.230 of our 

regulations. We proposed that these 

rules would continue to apply in 

implementing section 5101 of the DRA, 

with one exception. The rules in 

§ 414.230(f) provide that a new period of 

continuous use begins for new or 

additional equipment prescribed by a 

physician and found to be medically 

necessary, even if the new or additional 

equipment is similar to the old 

equipment. 

Medicare payments for stationary and 

portable oxygen and oxygen equipment 

are currently modality neutral, which 

means that the same payment amounts 

apply to the different types of oxygen 

equipment furnished to Medicare 

beneficiaries. Since there is no 

distinction made between oxygen 

equipment modalities for payment 

purposes under the Medicare program, 

we do not believe that it is necessary or 

appropriate to begin a new period of 

continuous use when the beneficiary 

changes from one oxygen equipment 

modality to another. We proposed to 

revise § 414.230(f) of our regulations to 

designate the existing language in this 

section as paragraph (f)(1) and to add a 

new paragraph (f)(2) to reflect this 

exception, effective for oxygen 

equipment furnished on or after January 

1, 2007. We also proposed to revise 

§ 414.230(b) to incorporate section 

5101(b)(2)(B) of the DRA, which 

provides that for all beneficiaries 

receiving oxygen equipment paid for 

under section 1834(a) on December 31, 

2005, the period of continuous use 

begins on January 1, 2006. 

M. Other Issues: Health Care 

Information Transparency, Health 

Information Technology, and Medicare 

Payment Structures 

Both Medicare’s payment structures 

and the actual delivery of post acute 

care have evolved significantly over the 

past decade. Before the BBA, HHAs and 

other post-acute settings such as 

inpatient rehabilitation facilities (IRFs) 

and skilled nursing facilities (SNFs) 

were paid on the basis of cost. Since 

that time, we have implemented various 

legislative mandates that established 

prospective payment systems in these 

settings. The PPS methodologies used in 

these settings rely on patient-level 

clinical information to provide pricing, 

support the provision of high quality 

services, and encourage the efficient 

delivery of care. CMS is exploring 

refinements to the existing provideroriented ‘‘silos’’ to create a more 

seamless system for payment and 

delivery of post-acute care (PAC) under 

Medicare. This new model could feature 

more consistent payments for the same 

type of care across different sites of 

service, value based purchasing 

incentives, and the collection of 

uniform clinical assessment information 

to support quality and discharge 

planning functions. 

CMS is considering a demonstration 

to determine whether incentive 

payments to HHAs impact 

improvements in the quality of care of 

Medicare beneficiaries. 

Section 5008 of the Deficit Reduction 

Act of 2005 (DRA) provides for a 

demonstration on uniform assessment 

and data collection across different sites 

of service. This 3-year demonstration 

project is to be established by January 1, 

2008. We are in the early stages of 

developing a standard, comprehensive 

assessment instrument to be completed 

at hospital discharge and ultimately 

integrated with PAC assessments. The 

demonstration will enable us to test the 

usefulness of this instrument, and 

analyze cost and outcomes across 

different PAC sites. The lessons learned 

from this demonstration will inform 

efforts to improve the post-acute 

payment systems. 

We have evaluated the existing 

assessment instruments that managed 

care and other insurers use. These 

instruments will form the basis of our 

efforts to create a discharge assessment 

tool that can serve to facilitate posthospital placement decisions; enhance 

the safety and quality of care during 

patient transfers through transmission of 

core information to a receiving provider; 

and provide baseline information for 

longitudinal follow-up of health and 

function. 

In the April 25, 2006 Inpatient 

Prospective Payment System proposed 

rule (71 FR 23996), we discussed in 

detail the Health Care Information 

Transparency Initiative and our efforts 

to promote effective use of Health 

Information Technology (HIT) as a 

means to help improve health care 

quality and improve efficiency. 

Specifically, with regard to the 

transparency initiative, we discussed 

several potential options for making 

pricing and quality information 

available to the public (71 FR 24120 

through 24121). We solicited comments 

on ways the Department can encourage 

transparency in health care quality and 

pricing whether through its leadership 

on voluntary initiatives or through 

regulatory requirements. We also sought 

comments on the Department’s statutory 

authority to impose such requirements. 

In addition, we discussed the potential 

for HIT to facilitate improvements in the 

quality and efficiency of health care 

services (71 FR 24100 through 24101). 

We solicited comments on our statutory 

authority to encourage the adoption and 

use of HIT. The 2007 Budget states that 

‘‘the Administration supports the 

adoption of Health Information 

Technology (HIT) as a normal cost of 

doing business to ensure patients 

receive high quality care.’’ We also 

sought comments on the appropriate 

role of HIT in potential value-based 

purchasing programs, beyond the 

intrinsic incentives of a PPS to provide 

efficient care, encourage the avoidance 

of unnecessary costs, and increase 

quality of care. In addition, we sought 

comments on promotion of the use of 

effective HIT and how CMS can 

encourage its use in HHAs. 

We intend to consider both the health 

care information transparency initiative 

and the use of HIT as we refine and 

update all Medicare payment systems. 

Therefore, we sought comments on 

these initiatives as applied to the HH 

PPS in the August 3, 2006 proposed 

rule, including the Department’s 

statutory authority to impose any such 

requirements. We stated that we may 

address these initiatives in the final HH 

PPS rule. For example, a HIT proposal 

could include adding a requirement that 

HHAs use HIT that is compliant with 

and certified by the Certification 

Commission for Health Information 

Technology (CCHIT) in the areas in 

which the technology is available. As 

noted previously, the CMS Home Health 

Compare Web site contains home health 

quality information. We note that we are 

in the process of seeking input on these 

initiatives in various proposed Medicare 


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payment rules being issued this year. In 

particular, we intend to consider both 

the health care information initiative 

and the use of HIT as we refine and 

update all Medicare payment systems. 

III. Analysis of and Responses to Public 

Comments 

We received approximately 106 

comments on the August 3, 2006 

proposed rule. 

General 

Comment: Several commenters raised 

concerns about combining several 

unrelated matters into a single public 

notice. The commenters believed the 

style to be confusing and counter to 

CMS’ initiatives for better public 

communication. 

Response: We recognize the 

commenters concern and note that we 

make every attempt to provide sufficient 

information in the Federal Register 

document to clearly and specifically 

state the contents of the Federal 

Register document. We note that we 

targeted a similarly situated audience in 

that suppliers of oxygen equipment, 

DME suppliers, and HHAs all provide 

services in the post-acute care setting. 

Comment: Several commenters 

requested that telehealth services be 

directly funded. These commenters 

believe that utilization of telehealth 

services would save Medicare money by 

reducing hospitalization and decreasing 

the use of multiple medical services. 

Response: Telehealth services are not 

a recognized visit or service under the 

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. 

Comment: A commenter stated that 

CMS should indefinitely retain the 5 

percent rural add-on. Other commenters 

recognized that it would take 

congressional action to extend the 5 

percent rural add-on for rural providers. 

Nonetheless, these commenters 

supported an extension of the rural addon period. In addition, commenters 

recommended that CMS examine the 

differences between the cost of 

providing home health services in a 

rural setting and those costs of 

providing home health services in an 

urban area. 

Response: The rural add-on was a 

temporary add-on established by the 

DRA. Specifically, section 5201 of the 

DRA required, for home health services 

furnished in a rural area with respect to 

episodes and visits beginning on or after 

January 1, 2006 and before January 1, 

2007, that we increase by 5 percent the 

payment amount that otherwise would 

be made for the services. The statute 

does not provide for a continuation of 

the rural add-on. We will continue to 

monitor the HH PPS to help ensure that 

home health providers continue to 

receive appropriate reimbursement for 

the services they provide. 

Market Basket 

Comment: Several commenters 

believe that the proposed market basket 

update falls short of increased costs in 

the delivery of home health services. 

Specifically, they state that labor costs 

have risen significantly with the 

continuing shortage of nursing and 

therapy staff, transportation costs 

skyrocketed in 2005–2006 at a rate far 

greater than the estimated 2.2 percent 

that was set out in the 2006 rate setting 

rule, technology costs, and costs 

associated with regulatory compliance 

have grown. Some of these commenters 

believe the problem with the estimated 

market basket increase appears to stem 

from two weaknesses in the calculation 

formula: The use of FY 2000 cost reports 

and the accuracy of the projection. 

These commenters believe the FY 2000 

cost reports are inaccurate because they 

only contained a portion of the 

operational changes that have occurred 

since the onset of the prospective 

payment system. 

Response: The home health market 

basket is a fixed-weight Laspeyres-type 

price index, which measures the average 

change in the price of goods and 

services purchased by HHAs in 

providing an efficient level of home 

health care services. Furthermore, the 

projected estimated HH market basket 

has been fairly consistent with the 

actual market basket determination. 

Since the inception of the PPS in FY 

2001 including years through CY 2005, 

the forecasted average annual increase 

of the home health market basket has 

been 3.3 percent while the actual 

average annual increase of the home 

health market basket has been 3.2 

percent. 

With respect to the use of the FY 2000 

cost reports, they represent the most 

recent and complete cost reports 

available at the time of the most recent 

rebasing of the home health market 

basket presented in the CY 2005 

proposed rule. Our recent analysis of 

Medicare cost report data for 2001 

through 2003 shows very similar cost 

weights, including those associated with 

compensation, to the FY 2000 based 

market basket. Therefore, we believe the 

use of the FY 2000 cost reports continue 

to accurately reflect a proxy of home 

health weights. 

We further note that for the final rule, 

we are using the 2006 3rd quarter 

forecast with historical data through 

2006, 2nd quarter, which results in a 

forecast for the home health market 

basket for CY 2007 of 3.3 percent. This 

projection includes a higher forecast for 

the CPI for private transportation (2.2 

percent) and higher forecast for the 

price of compensation (3.5 percent) 

compared to the forecast in the 

proposed rule of 0.3 percent and 3.4 

percent, respectively. 

Comment: One commenter suggested 

that CMS move away from using the CPI 

for private transportation to proxy price 

changes associated with transportation 

costs and substitute it with a more 

accurate reflection of home health care 

transportation experience. 

Response: We believe the CPI for 

private transportation is an accurate 

proxy for the price changes associated 

with home health care agencies’

transportation costs. This CPI measures 

the price changes of new and used 

motor vehicles, motor fuels, motor 

vehicle parts and equipment, 

maintenance and repair, and insurance 

costs. We believe that home health 

agencies incur all of these transportation 

costs. 

Comment: One commenter suggested 

that the market basket weights assigned 

to each input should be re-examined 

every 2 years using cost report data that 

are less than 2 years old. The 

commenter also suggests that the 

validity of the weights should be 

periodically tested using audited cost 

report data. 

Response: We rebase the home health 

market basket on a periodic basis. When 

we rebase a market basket, we examine 

the costs for each year since the most 

recent rebasing. In general, cost weights 

remain stable from year to year and 

become less so over a longer time 

period, such as 5 or more years. 

Additionally, we always use the most 

recent and complete cost report data at 

the time of rebasing. For the CY 2005 

proposed rule, the most recent and 

complete cost report data available was 

for the year 2000. We are also confident 

in the validity of the Medicare cost 

report data received by the industry. 

Thus, we believe a formal audit is not 

required. However, as part of the 

standard rebasing methodology in 

calculating the cost report weights, we 

trim the data to remove the impact of 

outliers. 

Comment: One commenter 

recommended that the shortfalls in 

annual cost increase projections be 

added to succeeding year inflation 

updates. The commenter stated, for 

example, the under-projection in 


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transportation cost increases in 2006 

should be reflected in 2007 and 2008. 

Response: We believe that the 

accuracy of the market basket updates 

has been reasonable, as evidenced by 

the last several years which contained 

average forecasted updates of 3.3 

percent while actual average annual 

increase of the home health market 

basket has been 3.2 percent. 

Comment: One commenter suggested 

that projections should be thoroughly 

evaluated and validated. The 

commenter is aware that CMS uses a 

proprietary system, Global Insights, Inc. 

(GII), in determining its projections and 

believes this system should be 

examined by a CMS Technical Expert 

Panel in the immediate future. 

Response: GII is an independent firm 

that forecasts price proxies and other 

economic indicators. We believe that 

the projections we use are unbiased and 

consistent across all GII customers, both 

private and government. Moreover, we 

continue to work closely with GII to 

continually monitor the reasonableness 

of its projections. 

Comment: Other commenters 

expressed support for a market basket 

update of 3.1 percent and a 15 percent 

adjustment to the standardized rates for 

dually eligible beneficiaries. 

Response: We appreciate the support 

for the proposed market basket increase. 

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

the unadjusted national rate for CY 2007 

to be increased by the applicable home 

health market basket index amount. The 

home health market basket for CY 2007 

is forecasted to be 3.3 percent. We do 

not, however, have the statutory 

authority to establish a 15 percent 

adjustment to the standardized rates for 

dually eligible beneficiaries. 

Comment: One commenter stated that 

home care providers should receive 

their full Medicare market basket update 

for 2007 and each subsequent year. 

Response: HHAs will receive 

payments based on a full market basket 

update for services provided to 

Medicare beneficiaries for CY 2007 and 

subsequent years as provided at section 

1895(b)(3)(B)(v) of the Act, subject to 

submitting the required quality 

measures and other possible legislative 

mandates. 

Quality/Pay for Reporting 

Comment: A commenter 

recommended that CMS make the 

penalty for not submitting the required 

quality data budget neutral and thus 

increase the national standardized 

episode amount. This would provide a 

small reward for the majority of 

agencies that already comply with the 

data submission requirement. 

Response: Section 1895(b)(3)(B)(V)(I) 

of the Act, added by section 5201(c)(2) 

of the DRA, stipulates that the market 

basket percentage increase be reduced 

by 2 percentage points for HHAs who 

fail to submit required data. The statute 

does not provide that the reduction in 

the market basket percentage increase be 

budget neutral. 

Comment: Several commenters 

supported CMS’ proposed and 

continued use of the OASIS instrument 

and reporting infrastructure in response 

to the DRA requirements. 

Response: We appreciate the 

commenters’ support for this decision. 

One of our goals is to allow HHAs to 

fulfill the DRA’s quality data reporting 

requirements in the most efficient and 

least burdensome way possible. 

Comment: Several commenters 

believe that CMS needs to continue to 

refine and enhance the OASIS 

assessment instrument and associated 

quality measures. 

Response: As we stated previously, 

we intend to refine the current OASIS 

instrument and associated quality 

measures. We will also continue 

improving the assessment instrument’s 

accuracy in reflecting both the health 

status and improvements in condition of 

our beneficiaries. 

Comment: Several commenters 

confused the various HH Conditions of 

Participation requirements, that is, the 

completion, completeness, and accuracy 

of the OASIS assessment, with the 

reporting requirements established by 

the DRA. 

Response: The proposed rule dealt 

solely with the requirements of section 

5201(c)(2) of the DRA to specify the 

health quality data needed for quality 

measurements under the HH PPS. To 

meet the requirements established in the 

DRA, we proposed to rely on the data 

submitted by home health providers 

through the OASIS instrument. The 

regulations surrounding completion, 

completeness, timeliness or other rules 

associated with the OASIS were not 

affected by the HH PPS proposed rule. 

Comment: A few commenters were 

concerned that the reporting timeframe 

established in the proposed rule is over 

before publication of the final rule. The 

commenters noted that prior 

notification of payment penalties 

associated with the DRA quality 

measures requirement could not be 

known before the reporting period 

commenced. 

Response: We acknowledge the 

commenters’ concern, but we believe 

our proposed approach adequately 

addresses these issues. Section 

5201(c)(2) of the DRA amends the Act 

to such that ‘‘each home health agency 

shall submit to the Secretary such data 

that the Secretary determines are 

appropriate for the measurement of 

health care quality. Such data shall be 

submitted in a form and manner, and at 

a time, specified by the Secretary.’’ In 

considering how to best implement this 

provision while still obtaining the 

needed quality measures, our approach 

was to use processes and mechanisms 

that were already in place and 

functioning, as the most efficient and 

appropriate way to meet the statutory 

requirements. Using historical data to 

determine the prospective update is 

similar to the methodology used for 

hospital pay for reporting. In this 

manner, by utilizing an existing system, 

we were able to provide the least 

burdensome measures on the providers, 

and would penalize only those 

providers who were not otherwise 

meeting the OASIS submission 

requirement under the home health 

Conditions of Participation. 

Comment: One commenter supported 

CMS’ initiative to refine the home 

health quality measures and to 

complement those measures with health 

information technology. This 

commenter stated that the proper use of 

new quality measures in certain areas 

coupled with the appropriate use of 

health information technology will help 

to promote quality care, efficiency, save 

Federal dollars, and satisfy the needs of 

our beneficiaries. 

Response: We appreciate the 

commenter’s support and will continue 

to pursue using health information 

technology to further the goals of 

providing appropriate payments for 

quality services under the HH PPS. 

Outlier Payments and Fixed Dollar Loss 

Ratio 

Comment: A commenter expressed 

concerns with CMS’ proposal to update 

the fixed dollar loss ratio in the final 

rule if current data become available. 

The commenter believes that CMS has 

an obligation to modify PPS outlier 

criteria each year until the 5 percent set 

aside is realized. Commenters urged 

CMS to ensure that data is available 

before the final rule is published. The 

commenter recommended that CMS 

provide an opportunity for review and 

comment before implementation of any 

change that reduces the likely number 

of episodes qualifying for outlier 

payments. Another commenter urged 

CMS to retain or increase the current 

outlier payment structure. 

Response: Section 1895(b)(5) of the 

Act states that the ‘‘Secretary may 

provide for an addition or adjustment to 

the payment amount otherwise made in 

the case of outliers * * * [t]he total 


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amount * * * may not exceed 5 percent 

of the total payments projected or 

estimated to be made based on the’’ HH 

PPS. The statute makes clear that to the 

extent the Secretary chooses to provide 

for an outlier adjustment in HH PPS, 

such adjustment may not be more than 

5 percent of the projected or estimated 

HH PPS payments. The statute does not 

provide for an outlier adjustment of 5 

percent. 

At the time of publication of the 

August 3, 2006 proposed rule, we did 

not have more recent data, but noted 

that we may update the FDL ratio for CY 

2007 depending on the availability of 

more recent data. We stated that 

depending on the availability of more 

recent data at the time of publication of 

the HH PPS final rule for CY 2007, we 

may, if necessary, implement an update 

to the FDL ratio for the CY 2007 update 

to the HH PPS rates. Subsequent to the 

publication of the August 3, 2006 

proposed rule, we have now obtained 

more recent data, that is, CY 2005 home 

health claims data. Accordingly, for this 

final rule, we have used the same 

methodology and performed analysis 

using the CY 2005 data to update the 

FDL ratio for CY 2007. For CY 2007, we 

are not only retaining the current outlier 

payment structure but also increasing 

the FDL ratio to allow more episodes to 

qualify for outlier payments. This new 

FDL ratio is 0.67. 

Home Health Wage Index 

Comment: Several commenters 

expressed serious concerns about the 

use of the pre-floor, pre-reclassified 

hospital wage index for adjusting for 

geographic variation in wages. These 

commenters believe that CMS has the 

regulatory authority to take immediate 

steps to implement a wage index that 

secures a reasonable level of parity with 

hospitals in the geographic areas served 

by HHAs. Specific recommendations 

include applying the State-specific rural 

floor to all urban areas and 

implementing a reclassification value 

proxy for HHAs operating in areas 

where hospitals have been reclassified. 

Commenters also made 

recommendations that CMS consider a 

wholesale revision and reform of the 

home health wage index. 

Response: These commenters are 

referring to the rural floor and 

geographic reclassification applicable to 

hospital payments. The rural floor 

provision is provided at section 4410 of 

Public Law 105–33 and is specific to 

hospitals. The reclassification provision 

provided at section 1886(d)(10) of the 

Act is also specific to hospitals. Because 

these floors and reclassifications apply 

only to hospitals, and not to HHAs, we 

believe the use of the most recent 

available pre-floor and pre-reclassified 

hospital wage index data results in the 

appropriate adjustment to the labor 

portion of home health costs as required 

at 1895(b)(4)(C). As to the revision and 

reform of the home health wage index, 

we further note that CMS has, along 

with the industry, explored the 

feasibility of developing a home health 

specific wage index. Because of the 

volatility of the home health wage data 

and the significant amount of resources 

that would be required to improve the 

quality of those data, we do not expect 

to propose a home health specific wage 

index until we can demonstrate that a 

home health specific wage index would 

be more reflective of the wages and 

salaries paid in a specific area, that it 

would significantly improve our ability 

to determine payment for HHAs, and 

that we can justify the resources 

required to collect the data, as well as 

the increased burden on providers. 

Comment: One commenter was 

concerned about the wage index for 

CBSA 12940 ‘‘East Baton Rouge, 

Ascension, Livingston, West Baton 

Rouge, Louisiana.’’ The commenter 

stated that the proposed ‘‘wage index 

reflects a decrease from .8593 in CY 

2006 to .8099 in CY 2007, a decrease of 

nearly 6%.’’ The commenter believes 

this must be the result of an error and 

that this wage index should be reviewed 

for accuracy. 

Response: First, the wage index that is 

applied to payments for services 

furnished to home health patients in CY 

2006 in CBSA 12940 is not 0.8593. In 

CY 2006, we apply a transition wage 

index of either 0.7967 or 0.8618 

(depending on the State and county 

code where the beneficiary resides) to 

payments for home health services 

provided in CBSA 12940. This is clearly 

noted in Addendum A of the CY 2006 

HH PPS final rule (70 FR 68161). The 

wage index value of 0.8593 would have 

been applied to payments for home 

health services rendered in CBSA 12940 

had we not implemented a transition 

policy for CY 2006. As noted in the CY 

2006 final rule (70 FR 68138), we 

implemented a transition policy based 

on the concern about the potential 

negative financial impact of moving to 

a CBSA-based wage index. The final 

wage index value for CBSA 12940 will 

be 0.8084 for CY 2007. 

Second, the change in the wage index 

value for CBSA 12940 is also due in part 

to the inclusion of wage data from the 

following counties: East and West 

Feliciana Counties, Iberville County, 

Pointe Coupee County, and St. Helena 

County. These five counties were 

previously classified as rural. However, 

under the CBSA designations, which we 

implemented beginning in CY 2006, 

they are now part of CBSA 12940. 

We further note that we employ 

processes to review the accuracy of the 

wage index. The home health wage 

index is derived from the pre-floor, prereclassified hospital wage index which 

is calculated based on cost report data 

from hospitals paid under the hospital 

inpatient prospective payment system 

(IPPS). All IPPS hospitals must 

complete the wage index survey 

(Worksheet S–3, Parts II and III) as part 

of their Medicare cost reports. Cost 

reports will be rejected if Worksheet S–

3 is not completed. Additionally, 

intermediaries perform desk reviews on 

all hospitals’ Worksheet S–3 wage data, 

and we run edits on the wage data to 

further ensure the accuracy and validity 

of the wage data. In addition, HHAs 

have the opportunity to submit 

comments on the hospital wage index 

data during the annual IPPS rulemaking 

period. Therefore, we believe our review 

processes result in an accurate reflection 

of the applicable wages for the areas 

given. 

Comment: A commenter expressed 

concern because implementation of a 

CBSA-based wage index places Lake 

County, Illinois in the same CBSA as 

Racine, Wisconsin rather than in the 

CBSA-based wage index that includes 

Chicago. The commenter states that 

Lake County, Illinois draws from the 

same employment pool as does the 

Chicago metro area. The commenter 

further states that this situation requires 

dual licensure in order for HHAs in 

Illinois to hire nurses from Wisconsin. 

Response: Lake County, Illinois is not 

included in the same CBSA with 

Racine, Wisconsin. Racine County is in 

CBSA 39540 and has a CY 2007 wage 

index of 0.9356. Lake County, Illinois is 

included with Kenosha County, 

Wisconsin in CBSA 29404. Lake County 

and Kenosha County are adjacent 

counties in the States of Illinois and 

Wisconsin, respectively. The CY 2007 

wage index for CBSA 29404 is 1.0570. 

OMB considers Lake County and 

Kenosha County to be part of the same 

Metropolitan Division. OMB defines a 

‘‘metropolitan division’’ as ‘‘a county or 

group of counties within a core-based 

statistical area that contains a core with 

a population of at least 2.5 million. A 

metropolitan division consists of one or 

more main counties that represent an 

employment center or centers, plus 

adjacent counties associated with the 

main county or counties through 

commuting ties.’’ This information is 

available at the following Web address: 

http://www.whitehouse.gov/omb/ 

bulletins/b03–04.html. We believe that 


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the OMB geographic designations 

generally reflect the general labor 

market. 

State participation in the Nurse 

Licensure Compact alleviates the need 

for nurses to be licensed in multiple 

states. The state of Wisconsin 

participates in the Nurse Licensure 

Compact but Illinois does not. Illinois’

participation in the Nurse Licensure 

Compact would alleviate the need for 

nurses to be licensed in both states. 

Comment: Other commenters had 

issues with the decreases in wage index 

that they will experience in the move to 

a full CBSA-based wage index in CY 

2007. 

Response: We appreciate the detailed 

concerns sent by the commenters 

regarding the impact of the wage index 

update for their specific areas. We note 

that there will always be some areas that 

experience an increase in wage index 

values while others experience a 

decrease in wage index values. 

Variability in wage index values occurs 

each year as wage index values fluctuate 

from year to year based on the changes 

to the hospital wage data. As a result, 

wage index values within the system 

increase or decrease. We are aware of 

the changes to wage index values may 

be due in part to the adoption of the 

revised OMB designations, and in light 

of these concerns, we provided a oneyear transition period for CY 2006. As 

to the appropriateness of what CBSA a 

particular area has been designated into, 

CBSA designations are determined by 

the Office of Management and Budget 

(OMB). We continue to believe that 

OMB’s CBSA designations reflect the 

most recent available geographic 

classifications and are a reasonable and 

appropriate way to define geographic 

areas for purposes of determining wage 

index values. 

Comment: One commenter 

recommended that CMS apply a 

transition policy that would phase in 

large and unexpected wage index 

reductions over a two-year period, 

similar to the transition CMS applied for 

the IPPS conversion to CBSAs. 

Response: As noted previously, we 

implemented a one-year transition 

policy as a means to gradually introduce 

the changes and impact of a CBSAbased wage index to the HH PPS. We 

believe that the transitional one-year 

period was appropriate and do not agree 

that a longer transition period is 

necessary or appropriate. We again note 

that fluctuations in each wage index 

would be expected even if we did not 

adopt the revised OMB designations. 

Comment: Commenters raised 

concerns with CMS’ proposal to 

continue to use the CY 2005 rural wage 

index for areas where there is no rural 

hospital data to compute a wage index. 

Commenters also raised concerns 

with the alternative methodology that 

we discussed, that is, basing the 

imputed rural wage index on data from 

the state’s Census Division. Commenters 

believe that this type of situation 

highlights the need to move away from 

using pre-floor, pre-reclassified hospital 

wage data for the home health wage 

index. Commenters recommended a 

number of alternative methodologies for 

imputing a wage index value for areas 

where there are no rural hospital data to 

compute a wage index value. The 

commenters all believe that an imputed 

proxy should be reflective of the most 

local data available. Almost all of these 

comments specifically refer to the wage 

index for rural Massachusetts. 

Response: As noted above, several 

commenters recommended alternative 

methodologies for imputing a rural wage 

index. One recommended alternative 

was to use CAH data to impute a wage 

index for rural Massachusetts. However, 

CAHs are not required to submit the 

cost reporting worksheets that we use to 

compute the hospital wage index. 

Requiring CAHs to do so would impose 

an additional data collection burden on 

them. Additionally, those data would 

then need to be collected and audited. 

Therefore, we believe this option would 

be unduly burdensome and inefficient. 

Another alternative that was 

recommended was to use the rural wage 

index from the single state closest to the 

Massachusetts rural area. Rhode Island 

is the closest State to the Massachusetts 

rural area, but Rhode Island has no rural 

areas. The commenter acknowledged 

this and proposed using the wage index 

for Connecticut. We do not believe that 

using the rural wage index from the 

closest State is appropriate because this 

methodology is not easy to apply to 

other states where this situation could 

arise. 

Another alternative that was 

recommended was to use the same 

methodology that we use to calculate an 

‘‘imputed rural floor’’ for PPS hospitals 

with no rural areas (69 FR 49111). This 

methodology compares the three States 

that lack rural hospital wage data 

(Rhode Island, New Jersey, and 

Massachusetts) to those three States as 

a class. As the commenter recognized, 

this approach does not match the 

criterion for using rural data. The 

commenter also recognized that since it 

uses data from hospitals in New Jersey, 

it does not meet the criterion of using 

the most local data available. We agree 

with the commenter that this is not the 

optimum alternative for imputing a 

rural wage index for the HH PPS. 

A fourth alternative that was 

recommended was to use the average 

wage index from contiguous CBSAs as 

an acceptable proxy for a rural wage 

index. 

A fifth alternative that was suggested 

was to use BLS wage data to derive a 

ratio of rural wages to wages in an urban 

MSA within the State. That ratio could 

then be multiplied by the wage index 

from the urban MSA to derive an 

estimated wage index for the rural area. 

We do not believe that using the BLS 

data to impute a rural wage index is the 

best alternative as it does not meet our 

criterion of using pre-floor, prereclassified hospital data. Also, using 

the BLS wage data would require a 

determination as to which health sector 

occupations to consider. This 

alternative methodology would also not 

weight the occupations appropriately. In 

contrast, the pre-floor, pre-reclassified 

hospital wage data encompasses wages 

and hours, that is, actual utilization per 

occupation. 

Using OMB’s geographic classification 

system, the entire rural Massachusetts 

area, consists of Dukes and Nantucket 

Counties. Both of these counties are 

islands. This creates a unique set of 

circumstances to consider. 

As we stated in the August 3, 2006 

proposed rule, we also believe that an 

imputed proxy should (1) use pre-floor, 

pre-reclassified hospital data, (2) use 

rural wage data, (3) be easy to evaluate, 

and (4) be easily updatable from year-toyear. After a thorough review of the 

comments received and a further review 

of the needs and concerns inherent in 

this situation, we agree with the 

commenters that an additional criterion 

should be added, that is, that the most 

‘‘local’’ data available should be used to 

impute a rural wage index. We have reevaluated our proposed method of 

imputing a rural wage index, (that is, 

using the CY 2005 wage index) and have 

decided that a more appropriate proxy 

is needed. Although our proposed 

methodology uses local, rural pre-floor, 

pre-reclassified hospital wage data, this 

method is not updateable from year-toyear. In addition, we now believe that 

the alternative methodology noted in 

the August 3, 2006 proposed rule (that 

is, using an average of the wage indexes 

in the Census Division) is not optimal 

because although it uses pre-floor, prereclassified hospital wage data from 

rural areas, it does not use the most 

local data available. 

We believe that the alternative 

methodology of using the wage index 

from contiguous CBSAs best meets our 

criteria for imputing a rural wage index 

and represents an appropriate wage 

index proxy for rural areas without 


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hospital wage data. While it does not 

use rural data, it does use pre-floor, prereclassified hospital wage data, it is easy 

to evaluate, it is updateable from year to 

year, and it uses the most local data 

available. Therefore, we are revising our 

methodology for imputing a wage index 

for rural areas without hospital wage 

data. We will use the average wage 

index from all CBSAs that are 

contiguous to that rural area if the rural 

area does not have rural hospital wage 

data. 

In determining an imputed rural wage 

index, we interpret ‘‘contiguous’’ as 

sharing a border. In the case of 

Massachusetts, the entire rural area 

consists of Dukes and Nantucket 

Counties. We determined that the 

borders of Dukes and Nantucket 

Counties are ‘‘contiguous’’ with 

Barnstable and Bristol Counties. The 

wage indexes for Barnstable (1.2539) 

and Bristol (1.0783) are averaged 

resulting in an imputed rural wage 

index of 1.1661 for rural Massachusetts 

for CY 2007. While we believe that this 

policy could be readily applied to other 

rural areas that lack hospital wage data 

(possibly due to hospitals converting to 

a different provider type (such as a 

CAH) that does not submit the 

appropriate wage data), should a similar 

situation arise in the future, we may reexamine this policy. 

However, we do not believe that this 

final policy is appropriate for Puerto 

Rico. As noted in the August 3, 2006 

proposed rule, there are sufficient 

economic differences between the 

hospitals in the United States and those 

in Puerto Rico, including the fact that 

hospitals in Puerto Rico are paid on 

blended Federal/Commonwealthspecific rates that a separate distinct 

policy for Puerto Rico is necessary. 

Consequently, any alternative 

methodology for imputing a wage index 

for rural Puerto Rico would need to take 

into account those differences. Our 

policy of imputing a rural wage index 

based on the wage index(es) of CBSAs 

contiguous to that rural area does not 

recognize the unique circumstances of 

Puerto Rico. We received neither 

comments on our proposed approach to 

impute a wage index for rural areas in 

Puerto Rico nor any alternative 

suggestions. While we have not yet 

identified an alternative methodology 

for imputing a wage index for rural 

Puerto Rico, we will continue to 

evaluate the feasibility of using existing 

hospital wage data and, possibly, wage 

data from other sources. 

Accordingly, we will continue to use 

the most recent wage index previously 

available for Puerto Rico, that is, the 

wage index from 2004, which is 0.4047. 

Health Care Information Transparency 

and Health Information Technology 

Comment: One commenter addressed 

our discussion of health care 

information transparency and health 

information technology. The commenter 

disagreed with our implication that 

public comment was previously 

solicited from the home health 

community via the 2006 IPPS proposed 

rule published on August 25, 2006. 

However, the commenter is pleased that 

CMS has initiated a public dialogue in 

this area. The commenter suggests that 

CMS conduct a technology inventory in 

home health services to determine 

utilization and perceived roadblocks to 

expanded utilization. The commenter 

also believes that any such mandate 

must be accompanied by adjustments in 

payments. Additional commenters 

raised concerns about the potential 

impact of health information 

technology. Commenters do not believe 

that CMS has sufficiently supported the 

significant investments agencies have 

had to make in the past several years to 

establish and maintain HIT capabilities. 

Commenter concerns focused on the 

potential financial impact on providers 

who have invested significantly in HIT. 

Commenters believe that HIT requires a 

shared investment between providers 

and purchasers of care, to include CMS. 

Response: As explained in the 

proposed rule, we intend to consider 

both the health care information 

transparency initiative and the use of 

HIT as we refine and update all 

Medicare payment systems. As 

previously stated, the 2007 Budget 

states that ‘‘the Administration supports 

the adoption of health information 

technology (HIT) as a normal cost of 

doing business to ensure patients 

receive high quality care.’’ We are not 

including specific recommendations in 

this final rule. However, we appreciate 

the input and recommendations 

provided in the use of HIT and welcome 

further comments on this important 

topic from HHAs. 

Comment: One commenter stated that 

the public does not understand how 

Medicare’s HH PPS works. The 

commenter believes that a prospective 

system is a ‘‘soft’’ reimbursement 

methodology, as payment rates have 

little relationship to home health 

pricing noting that in some instances 

the HH PPS payment far exceeds 

charges and in other instances the 

payment falls short of charges. 

Response: We are actively pursuing 

the goal of price and quality 

transparency generally in the health 

care system. We have already released 

payment information on inpatient 

services and ambulatory surgical centers 

and are considering how to do so in 

other care settings. We agree that any 

pricing information released publicly 

should be clearly understood by the 

public, both consumers and patients. 

We recognize that Medicare payment for 

home health services captures a wide 

variety of costs and that payment rates 

may not always exactly match the costs 

for specific patients. However, as a 

prospective payment system, HH PPS 

payments estimate the average cost of 

providing services and are designed to 

recognize the higher costs associated 

with care for more severely ill patients. 

As such, the information could be of 

great interest to individual patients and 

the general public when they consider 

treatment options. It may also be 

important for patients and their families 

to understand what services the 

payment covers, to assist in planning for 

their health care needs. 

The price of home health care is also 

an important component of price 

information in broader episodes of care. 

For example, a patient hospitalized with 

congestive heart failure may have a 

variety of post-acute care options, 

including being discharged home 

without home health services. The 

ability to identify the cost of different 

services, including home health, in a 

total episode of care allows patients, 

providers, and the Medicare program to 

be better educated about the value of 

different mixes of services. This type of 

analysis, including knowing the price of 

home health services, could provide 

valuable data such as re-admission 

information and indicating the value of 

specific care sites to patients. 

We are not including specific 

recommendations in this final rule. 

However, we will continue to identify 

price and quality information that could 

be publicly released to help inform 

patient and consumer health care 

decisions and encourage higher value 

health care. We welcome further 

comments on this important topic from 

HHAs. 

Consolidated Billing and Supply Issues 

Comment: One commenter requested 

that CMS exclude HCPCS Code A7043 

(vacuum drainage bottle and tubing for 

use with implanted catheter) from the 

HH PPS. The commenter believes that 

the regulations authorize CMS to 

exclude prosthetic devices and items 

related to prosthetic devices that are 

covered under Part B from the HH PPS. 

The commenter stated that the Pleurx 

pleural catheter and vacuum drainage 

bottle meet the definition of a prosthetic 

device because they replace the 

malfunctioning pleura by artificially 


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draining the pleura. Additionally, the 

commenter believes that the HH PPS 

rates do not adequately compensate 

HHAs when they care for beneficiaries 

requiring the Pleurx pleural catheter 

and vacuum drainage bottle. 

Response: We addressed consolidated 

billing requirements in the Final Rule 

for the HH PPS published on July 3, 

2000 (65 FR 41139). Medical supplies 

are a covered home health service and 

are bundled into the payment rate under 

the HH PPS. Section 1861(m)(5) 

specifically includes catheters and 

catheter supplies as a covered home 

health service. Therefore, vacuum 

drainage bottles and tubing for use with 

an implanted catheter are bundled 

medical supplies while the patient is 

under a home health episode of care. 

Moreover, as we have consistently 

noted in responding to comments, the 

statute does not provide for an 

exception or carve-out of medical 

supplies from the PPS rate for patients 

under a plan of care under the HH PPS. 

The costs of all such supplies are 

included in the HH PPS rate (see 65 FR 

41139). 

We disagree with the commenter that 

the HH PPS rates do not adequately 

compensate HHAs when they care for 

beneficiaries requiring vacuum drainage 

bottles and tubing for use with the 

implanted catheter because this medical 

supply was included within the original 

list of 199 non-routine medical codes 

subject to home health consolidated 

billing effective October 1, 2000. While 

the HCPCS code for vacuum drainage 

bottles has changed, the cost of vacuum 

drainage bottles was included in the 

original case-mix weights used to 

determine the HH PPS rates (65 FR 

41138). 

Comment: Several commenters raised 

concerns about being unable to obtain 

the same brand of single-use urinary 

catheter from their HHA that they 

received directly from a DMEPOS 

supplier prior to receiving home health. 

These commenters believed that 

excluding HCPCS code A4353, which 

includes single-use catheters, would 

allow them to receive their catheters 

directly from the DMEPOS supplier. A 

number of commenters also request that 

HHAs be allowed to omit a patient’s 

chronic urinary condition from the 

patient’s specific home health plan of 

care which they say will allow the 

patient to continue to obtain the same 

name brand of single-use catheter they 

were using prior to receiving home 

health. 

Response: As noted above, medical 

supplies are bundled into the HH PPS 

payment rate and cannot be excluded 

from that rate. As to this specific item 

under HCPCS code A4353, that item is 

considered to be a medical supply and 

accordingly bundled into the HH PPS 

payment rate. 

We remind the commenters that if 

they believe that a product is not 

adequately described in the existing 

HCPCS Level II code set, they may 

submit an application to CMS to revise 

the code set, using the format and 

guidance provided on CMS’ HCPCS 

Web site at www.cms.hhs.gov/ 

medhcpcsgeninfo. 

We note that under consolidated 

billing, the billing for those medical 

supplies is the responsibility of the 

HHA. If the patient’s physician 

determines that a particular feature of a 

given supply is medically necessary for 

the patient, the physician may specify 

the designated feature in the physician’s 

order for the supply and in the plan of 

care. If the HHA determines that there 

exists an appropriate substitute for the 

supply ordered by the physician, it may 

provide that patient with the 

appropriate substitute supply. If the 

home health patient does not agree with 

the HHA that the substitute supply is 

appropriate, the patient should contact 

us through the Medicare Hotline at 1–

800–MEDICARE (1–800–633–4227). 

This toll-free helpline is available 24 

hours a day, 7 days a week to answer 

questions. Beneficiaries can speak to a 

customer service representative in 

English or Spanish. TTY users should 

call 1–877–486–2048. 

We disagree with the request that a 

HHA omit a medical condition from a 

plan of care in order to allow the patient 

to obtain desired medical supplies 

outside of the plan of care. The 

regulations at 42 CFR 484.18 require 

that the plan of care covers all pertinent 

diagnoses, including types of services 

and equipment required. In addition to 

calling 1–800-MEDICARE, if the home 

health patient believes that she is not 

receiving the necessary Medicare 

covered supplies, she may call the 

Regional Home Health Intermediary 

(RHHI) or CMS regional office. Under 

the Contacts section of our Web site at 

http://www.cms.hhs.gov/center/hha.asp 

we provide information on how to 

contact the RHHIs and CMS regional 

offices. 

HH PPS Refinements 

Comment: One commenter urged 

CMS to undertake a review of the HH 

PPS and make appropriate adjustments 

to the case-mix weights before 2008. 

Another commenter requested that there 

be a review of LUPA rates, and to 

subsequently increase the LUPA rates to 

ensure that they cover the costs of 

providing care to those patients. One 

commenter recommended that an ‘‘addon’’ to the HH PPS payment be made for 

dually eligible beneficiaries in order to 

recognize the added costs incurred by 

such patients. The same commenter also 

believes that the costs associated with 

wound care are not adequately paid for 

in the current case-mix system. 

Response: Our ongoing research 

agenda on the HH PPS refinements 

encompasses review of case-mix 

adjustment and other payment 

adjustment provisions under the HH 

PPS. Our continuing work also includes 

review of overall system performance to 

the extent data permit analysis of this 

topic. We intend to address certain 

aspects of the HH PPS, which could 

include LUPA rates, when we initiate a 

refinement regulation. We also note 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 up to 

a year from the time a service is 

rendered to when the claim is submitted 

and processed into a standard analytical 

file. 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. Assuming that the 

necessary data files will become 

complete, we believe that the end point 

of the adaptation period will allow us to 

pursue a refinement rule in the near 

future. 

Comment: A commenter 

recommended that CMS establish a 

home health technical advisory group to 

regularly review and update the 

multitude of component parts of the HH 

PPS reimbursement methodology. 

Response: We appreciate the 

comment; however, we do not believe 

such a group is necessary at this time. 

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. Additionally, for the 

past few years, we have conducted 

‘‘open-door’’ forums to provide the 

public with an opportunity to provide 

input and comment on the HH PPS and 

related issues. Finally, as part of 

ongoing refinement research, a technical 

expert panel (TEP) addressed the 

various aspects of the HH PPS for 

possible refinements to the system. We 

strongly believe that specific 

refinements to the HH PPS, if 

appropriate, should be addressed in a 

single refinement regulation. In doing 

so, the causes and effects that any 

particular refinement would have on the 

rest of the system could be taken into 

effect, eliminating the risk of 


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implementing any one refinement in a 

vacuum and resulting in a complete and 

responsible refinement to the system. 

Classes of Oxygen and Oxygen 

Equipment 

Statutory Authority 

Comment: One commenter asserted 

that the statute does not give authority 

for CMS to create new classes for these 

items and that payments must be made 

at the rate set by statute. 

Response: We disagree. Section 

1834(a)(9)(D) of the Act provides 

authority to create separate classes and 

payment amounts for any item of 

oxygen and oxygen equipment as long 

as they are budget neutral, that is, the 

separate classes and payment amounts 

do not result in expenditures for any 

year to be more or less than 

expenditures that would otherwise have 

been made if the classes had not been 

established. 

New Oxygen Generating Portable 

Equipment Technology 

Comment: One commenter 

commended CMS for recognizing the 

many benefits that oxygen generating 

portable equipment (OGPE) can provide. 

Some commenters urged that the 

proposed payment rate for OGPE be 

increased to provide adequate 

compensation for suppliers and to 

encourage suppliers to invest in the new 

technologies. Two commenters asked 

CMS to reconsider the proposed 

payment rates for OGPE to accurately 

reflect the cost of the equipment; which 

is claimed to range from $2,500 to 

$3,500. Some commenters 

recommended that CMS should not 

implement the proposed payment rates 

changes at this time and that setting 

new payment rates should be delayed 

until sufficient data is gathered to 

identify the costs of oxygen services. 

Response: We appreciate the support 

for our proposal to create a new 

payment category for OGPE. We do not 

agree with the commenters who 

suggested delaying the new categories 

because we are concerned that 

maintaining the current system could 

create incentives for suppliers to utilize 

older technology rather than newer 

technology that may be more 

appropriate for certain beneficiaries. We 

believe that it is appropriate and 

necessary to implement a new payment 

class for OGPE in order to ensure access 

to these items; therefore, we will 

finalize a new payment category for 

OGPE. 

In the proposed rule, we explained 

that there are currently two different 

types of OGPE: transfilling units that 

work independently or in conjunction 

with standard, stationary oxygen 

concentrators to fill portable oxygen 

canisters in the home; or portable 

oxygen concentrators that meet both the 

patient’s stationary and portable oxygen 

needs. In both cases, the supplier can 

bill for both the monthly payment for 

oxygen and oxygen equipment 

(currently averaging $199.84) and the 

portable equipment add-on (currently 

averaging $31.79). In establishing the 

new payment rate for OGPE, we 

proposed to consider the savings that 

would be generated from use of these 

new technologies. The savings would 

come from not having to make payments 

for portable oxygen contents for 

beneficiary owned portable systems that 

generate their own oxygen. The new, 

enhanced monthly payment for OGPE 

would be paid in conjunction with the 

monthly payment for stationary 

equipment. The combined monthly 

payments for stationary oxygen 

equipment and OGPE would provide 

extra payments to suppliers of the 

newer technology portable oxygen 

equipment, with the extra payments 

being directly linked to the savings 

generated for the program by 

eliminating the need to make future 

payments for portable oxygen contents. 

The proposed add-on for OGPE of $64 

was derived using a multiple step 

process described in section I of the 

provisions of the proposed regulation. 

As explained above, this process would 

involve determining savings generated 

from not having to pay proposed 

monthly payments of $55 for portable 

oxygen contents during the beneficiary 

ownership period and applying the 

savings evenly over the 36-month OGPE 

rental period. A total payment of $241 

was proposed for stationary equipment 

($177) plus the OGPE add-on payment 

($64). The final process for calculating 

the OGPE add-on payment, like the 

proposed process, involved determining 

savings generated from not having to 

pay final monthly payments of $77.45 

for portable oxygen contents during the 

beneficiary ownership period and 

applying the savings evenly over the 36- 

month OGPE rental period. To 

determine these savings we multiplied 

$77.45 by 24 months (number of months 

in the equipment ownership period) to 

get $1,858.80. We divided $1,858.80 by 

the 36 months of the rental period to get 

the OGPE add-on of $51.63 per month. 

However, as explained above in the 

discussion of the final methodology 

necessary to assure annual budget 

neutrality of the new classes of oxygen 

and oxygen equipment, distribution of 

use of items in the various classes over 

five years is factored into the calculation 

used to determine the budget neutrality 

adjustment factor. Therefore, the final 

payment rates for the new classes are 

based on current utilization and an 

assumption of the number of 

beneficiaries that will be using OGPE in 

the future. The total payment for 

stationary equipment and OGPE for 

2007 is $250.03 ($198.40 for stationary 

+ $51.63 for OGPE). The total payment 

for stationary equipment and OGPE is 

estimated to be $250.03 in 2008, 

$244.84 in 2009, and $241.02 in 2010; 

this compares to the total payment in 

the proposed rule of $241. 

We also note that in response to 

comments on the budget neutrality of 

our proposal, the final national limited 

monthly payment rates for each oxygen 

class were computed using weighted 

average fee schedule amounts instead of 

straight average fee schedule amounts. 

As a result, we have used slightly 

different numbers in our responses to 

comments than we used in the proposed 

rule. Our revised budget neutrality 

analysis is discussed in full below. 

Comment: One commenter stated that 

CMS needs to provide assurance that 

payment rates will not decrease, except 

in the case of competitive bidding, and 

that each year the rates will be increased 

by the percentage change in the 

Consumer Price Index for Urban 

Consumers (CPI–U), the covered item 

update factor that is generally 

established as the annual update for 

DME, unless otherwise indicated. 

Response: We cannot provide 

assurance that oxygen payment rates 

will never be decreased in the future or 

that rates will always be increased by 

the CPI–U update. CMS is required to 

implement provisions of law passed by 

Congress, including the covered item 

updates to the fee schedule amounts for 

oxygen and oxygen equipment. Further, 

in order to maintain annual budget 

neutrality for the oxygen payment 

classes as required by Section 

1834(a)(9)(D)(ii) of the Act, CMS may 

need to adjust the payment amounts as 

appropriate. 

Definition of Modality 

Comment: Many commenters asked 

us to clarify the definition of 

‘‘modality.’’ The commenters stated that 

the definition should be based on 

clinical characteristics of the beneficiary 

rather than physical characteristics of 

the device such that: a stationary oxygen 

class of patients who are moribund, bed 

bound with limited need to leave the 

home; a portable oxygen class of 

patients who require oxygen at night 

only and have limited mobility; and an 

ambulatory oxygen class of patients 


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whose oxygen needs include support for 

frequent ambulation. The commenters 

state that the HCPCS code should be 

modified to ensure that each respective 

clinical class can be identified. 

Response: Medicare currently pays for 

two classes of oxygen equipment, 

stationary and portable. For the 

stationary class, there are three 

modalities that Medicare pays the same 

‘‘modality neutral’’ payment rate for: 

concentrators, liquid cylinders and 

gaseous tanks. For the portable class, 

Medicare makes a modality neutral 

payment for all types of portable 

equipment. For the final rule, we are 

adding a new payment class for OGPE 

and new separate payment classes for 

delivery of stationary and portable 

oxygen contents. As has always been the 

case, a physician may order a specific 

oxygen equipment modality based on 

the clinical needs of the patient, and the 

supplier is bound by that order. 

However, there is currently no Medicare 

national coverage determination (NCD) 

that establishes medical necessity 

criteria for different oxygen modalities. 

Therefore, at this time, we do not 

believe it is necessary or appropriate to 

separate oxygen and oxygen equipment 

into different classes based on the 

clinical characteristics of different 

beneficiary populations. 

Comment: A few commenters asked 

us to clarify the medical policy that 

defines the criteria allowing patients to 

switch from one modality of oxygen 

equipment to another modality. The 

commenters also asked CMS to create a 

payment policy to pay suppliers for this 

type of equipment change. Some 

commenters recommended that CMS 

instruct its DME program safeguard 

contractor (PSC) to incorporate specific 

medical necessity coverage 

requirements in a local coverage 

determination (LCD) that specifies 

under what circumstances or diagnoses 

a beneficiary could change from one 

modality of equipment to another, how 

suppliers will be paid for furnishing a 

new equipment modality to a 

beneficiary, and specific documentation 

requirements for both the supplier and 

physician for a change in modality. 

Response: A physician prescription 

for home oxygen is required for 

coverage for home oxygen equipment. 

Generally, the physician prescribes the 

units of oxygen the patient needs and 

the beneficiary works with the supplier 

in deciding the modality of the oxygen 

equipment. In the final rule, we are 

allowing beneficiaries the option to 

change modalities during their rental 

period (this policy modification is 

discussed below); however, as we 

proposed in section L of the proposed 

rule, a new 36-month rental period 

would not begin in order to comply 

with the modality neutral payment rules 

for oxygen and oxygen equipment that 

we developed in accordance with 

sections 1834(a)(5) and (9) of the Act. 

Even if Medicare coverage rules and 

medical necessity criteria for different 

modalities of oxygen equipment were 

established in an NCD or LCD, there 

would be no effect on Medicare 

payments for specific types of items 

furnished under each payment class. It 

is important to note, however, that 

Medicare coverage and medical 

necessity for oxygen and oxygen 

equipment is outside the scope of this 

rulemaking effort. 

Stationary and Portable Oxygen 

Contents 

Comment: One commenter asked for 

justification of the 65 percent and 35 

percent apportionment of the payment 

for oxygen contents. We also received 

comments recommending the same 

payment rate for all types of oxygen 

contents because oxygen contents are 

the same regardless of the weight of the 

container. One commenter 

recommended we keep the reduction of 

approximately $22 to stationary 

equipment (from $199 to $177) and 

reallocate the excess savings to (a) 

portable gaseous oxygen contents and/or 

equipment, increasing the rates to $75 to 

$80 and applying the increased rate to 

portable gaseous oxygen equipment 

furnished during the equipment rental 

period and portable gaseous oxygen 

contents furnished after the equipment 

rental period and (b) portable liquid 

oxygen contents and/or equipment, 

increasing the rates to $90 to $95 and 

applying the increased rate to portable 

liquid oxygen equipment furnished 

during the equipment rental period and 

portable liquid oxygen contents 

furnished after the equipment rental 

period. 

Response: In the proposed rule, we 

proposed to apportion the current 

oxygen contents rate of $156 per month 

by 65 percent and 35 percent based on 

the weight of the containers and other 

factors that might make delivery of 

stationary oxygen contents more 

expensive than delivery of portable 

oxygen contents. Stationary oxygen 

containers are larger and heavier than 

the portable oxygen containers; 

therefore, we proposed to apportion a 

greater amount of the payment to 

delivery of stationary oxygen contents. 

We received comments indicating that 

the average monthly costs of furnishing 

both types of oxygen contents are the 

same despite the fact that stationary 

oxygen contents are bulkier than 

portable oxygen contents. This is 

because stationary oxygen contents are 

delivered and refilled at a lower 

frequency than portable oxygen 

contents. Therefore, we are modifying 

the proposed payment rates for the two 

types of oxygen contents based on an 

even (that is, 50–50 percent) split in the 

current $154.90 weighted average 

payment amount for both stationary and 

portable oxygen contents. As a result, 

we will be paying the same monthly rate 

of $77.45 for delivery of each of 

stationary oxygen contents and portable 

oxygen contents. We will therefore 

continue to pay $154.90 in cases where 

both stationary and portable oxygen 

contents are medically necessary and 

are delivered. A payment of $77.45 per 

month rather than $55 per month for 

delivery of portable oxygen contents 

will further ensure that beneficiaries 

will receive necessary contents for their 

portable oxygen systems and is 

consistent with a suggestion from one 

commenter that payment for delivery of 

portable gaseous oxygen contents 

should be from $75 to $80. Most 

patients currently use gaseous portable 

oxygen systems as opposed to liquid 

portable gaseous systems or portable 

concentrators. A very small number of 

beneficiaries use stationary liquid or 

gaseous systems, and, in most cases, the 

supplier that delivers stationary oxygen 

contents for beneficiaries who use both 

stationary and portable liquid or 

gaseous systems would also be the 

supplier of the portable oxygen contents 

as well. Therefore, we believe that 

reducing the proposed payment for 

stationary oxygen contents from $101 to 

$77.45 is appropriate in light of the 

increased payment for portable oxygen 

contents. 

Comment: One commenter suggested 

that CMS establish a delivery fee for 

each time a supplier delivers oxygen. 

Response: The longstanding Medicare 

policy for payment for delivery of DME 

and other supplier expenses is that 

payment for these costs are included in 

the single payment made for furnishing 

the equipment. This policy is based on 

section 1834(a)(5) of the Act, which 

provides that a monthly payment 

amount recognized under section 

1834(a)(9) be paid for oxygen and 

oxygen equipment, and section 

1834(a)(9), which mandates that 

monthly payment (or fee schedule) 

amounts be calculated based on 

payments made in 1986 under the 

reasonable charge payment 

methodology. The reasonable charges 

that were used to calculate the fee 

schedule payment amounts included 

delivery costs and all other costs for 

furnishing the equipment. Therefore, 


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the cost associated with the delivery of 

oxygen contents is included in the fee 

schedule payment amounts for 

stationary and portable oxygen contents. 

Furthermore, section 1834(a)(9)(D)(i) of 

the Act requires that monthly payment 

rates are to be established for each class 

of oxygen and oxygen equipment. Since 

total Medicare expenditures under the 

new classes and payment amounts will 

be the same as they would have been 

under the old classes and fee schedule 

amounts, we believe that the new 

payment rates incorporate the delivery 

costs that made up part of the old fee 

schedule amounts. 

Comment: One commenter was 

concerned that the payment rate for 

delivery of oxygen contents for 

beneficiary-owned portable oxygen 

equipment would not be enough to 

cover the number of tanks or cylinders 

needed for each beneficiary. The 

commenter indicated that under the 

previous payment methodology where 

monthly payments for oxygen and 

oxygen equipment were made as long as 

medical necessity continued, suppliers 

were able to offset costs associated with 

delivering portable oxygen contents 

with the payment made for the 

stationary oxygen and oxygen 

equipment. The commenter expressed 

concern that the proposed $55 monthly 

payment for delivery of portable oxygen 

contents will not cover the costs of 

delivering more than 11 portable tanks 

per month. In addition, the commenter 

stated that this figure does not include 

the cost of delivery. Another commenter 

noted that the current fee schedule 

amount of approximately $21 per month 

would not cover the costs of one 

delivery per month of portable oxygen 

contents, and that this will force 

suppliers to adopt a policy whereby the 

beneficiary must pick up tanks from the 

supplier’s store. 

Response: We agree with the 

commenters that the payment rate for 

portable oxygen contents of $21 is 

insufficient as a monthly payment for 

the delivery of portable oxygen 

contents, and therefore; we are 

finalizing our proposal to increase it in 

this final rule. We are dividing $154.90, 

the current weighted average payment 

amount for both stationary and portable 

oxygen contents evenly so that the 

payment rate for portable oxygen 

contents will be increased from the 

current weighted average payment 

amount of $20.77 to $77.45 per month. 

The revised payment rate for stationary 

oxygen contents will also be $77.45 per 

month. These monthly payment rates 

include delivery of tanks and cylinders, 

a service that the supplier is required to 

perform in order to be in compliance 

with standards set forth at 

§ 424.57(c)(12). Based on comments 

received on this issue, we believe that 

the finalized payment rate of $77.45 will 

adequately pay suppliers for delivery of 

stationary or portable oxygen contents. 

We are therefore confident that the 

payment rate adequately covers the 

supplier’s costs of delivering oxygen 

contents. 

Comment: One commenter asked for 

clarification on payment if there is a 

change in equipment due to medical 

necessity. For example, the commenter 

asked whether a new 36-month rental 

period starts when there is an increase 

in the patient’s oxygen volume that 

would require delivery of more portable 

oxygen tanks. 

Response: As we discuss more fully 

below, suppliers can furnish another 

capped rental item or type of oxygen 

equipment with a physician 

prescription or if the beneficiary would 

like newer technology or an upgraded 

item. However, unless the change in 

equipment is based on medical 

necessity, a new rental period will not 

start. In addition, because there is no 

distinction made between oxygen 

equipment modalities for payment 

purposes under the Medicare program, 

we would not consider a change from 

one modality to another to be a change 

in the type of equipment furnished to a 

beneficiary. Accordingly, a new period 

of continuous use would not start in 

those circumstances. 

Budget Neutrality 

Comment: Several commenters 

claimed that the proposed rates were 

not budget neutral. They claimed that 

the calculation of decreased 

expenditures that would result from a 

$22 reduction in payment for stationary 

equipment is underestimated and that 

such payment reduction translates to 

savings ranging from $239 million to 

$260 million. One commenter stated 

that the proposed rule was not budget 

neutral for each year as required by 

statute. Another commenter pointed out 

that the 2004 data did not have specific 

utilization rates for portable 

concentrators or transfilling systems 

since separate HCPCS codes did not 

exist for these services at that time. 

Response: We have revised the offset/ 

budget neutrality calculations that we 

proposed based on comments received 

and have modified the payment rates for 

the classes of oxygen accordingly. 

First, in response to the commenter 

that expressed concern with our use of 

2004 data, we have updated our analysis 

by using the latest available data from 

the SADMERC on the number of 

beneficiaries for which claims were 

received from July 1, 2006 through 

September 30, 2006, for HCPCS codes 

E0424, E0431, E0434, E0439, E1390, 

E1391, and E1392 to determine the 

distribution of beneficiaries among the 

categories of stationary and portable 

oxygen equipment. This data is used to 

count the number of beneficiaries using 

items in each equipment class. The 

number and percent distribution of 

beneficiaries using the different 

categories of equipment are shown in 

table 10. These latest data show 0.3 

percent of beneficiaries using portable 

concentrators. While using these later 

claims gives us data on users of portable 

concentrators, we do not have data on 

beneficiaries using transfilling systems 

since the code for such equipment 

began on October 1, 2006. Thus, for 

purposes of calculating rates, we had to 

make an assumption about the percent 

of beneficiaries who will use OGPE 

equipment (which include both portable 

concentrators and transfilling systems) 

after the new classes and payment rates 

go into effect. From comments received, 

we assumed a shift of 5 percent of 

beneficiaries towards OGPE for our 

budget neutrality calculations. We will 

revisit this assumption on an annual 

basis and make adjustments through 

program instructions to rates applicable 

to years after 2007 if actual utilization 

of oxygen equipment by beneficiaries is 

different from our assumptions. 

TABLE 10.—CATEGORIES OF OXYGEN USERS

Equipment/Modality Number of 

beneficiaries 

Percent of 

users 

(percent) 

Stationary Equipment Only .................................................................................................................................. 327,863 31.3 

Liquid/Gas Stationary AND Portable Equipment ................................................................................................. 57,950 5.5 

Concentrator AND Portable Equipment .............................................................................................................. 657,948 62.8 


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TABLE 10.—CATEGORIES OF OXYGEN USERS—Continued 

Equipment/Modality Number of 

beneficiaries 

Percent of 

users 

(percent) 

Stationary AND Oxygen Generating Portable Equipment .................................................................................. 3,248 0.3 

Total Number of Beneficiaries ...................................................................................................................... 1,047,009 100.0 

As in the proposed rule, we used a 

five year period for determining the rate 

changes because the reasonable useful 

lifetime policy for DME equipment 

allows beneficiaries to elect to obtain a 

new item after five years of use. 

Therefore, we assumed that Medicare 

would make three years of rental 

payments and two years of payment for 

oxygen contents. 

To calculate budget neutral rates, as 

in the proposed rule, we compared 

estimates of Medicare spending for 

oxygen equipment and contents based 

on current classes of items and payment 

rates with estimates of the spending that 

Medicare would make based on the new 

classes and payment rates outlined in 

this final rule. In order to further 

address the concerns of commenters 

that the payment rates for the new 

classes be budget neutral, we compared 

the payment rates for the new classes to 

the current, weighted average monthly 

payment amounts for oxygen and 

oxygen equipment (for example, 

$199.84 for stationary equipment), as 

opposed to comparing them to the 

straight average monthly payment 

amounts rounded to the nearest dollar 

(for example, $199 for stationary 

equipment). Based on the concerns 

expressed by commenters regarding the 

importance of assuring the budget 

neutrality of the new classes of oxygen 

and oxygen equipment, we are using the 

average of the current monthly 

payments per State weighted by actual 

utilization by State to establish a more 

precise average Medicare payment for 

each class of oxygen and oxygen 

equipment. To estimate total 

expenditures for oxygen and oxygen 

equipment for a given year, we 

multiplied the monthly payment rate for 

each category of equipment by the total 

number of users of each such category, 

then by the percent of users at the 

midpoint of each of three equipment 

rental years, then by 12 for the number 

of months in a year. Then, we 

multiplied the monthly payment rate for 

each category of oxygen contents by the 

total number of users of each such 

category, then by the percent of users at 

the midpoint of each of two beneficiary 

ownership years, then by 12 for the 

number of months in a year. We added 

the estimated spending for equipment 

and contents to obtain the five year total 

of payments for equipment and 

contents. We used data from the 

September 2006 OIG report, entitled 

‘‘Medicare Home Oxygen Equipment: 

Cost and Servicing’’ (OEI–09–04–

00420), on the distribution of the 

number of beneficiaries using stationary 

concentrators by the number of months 

rented that showed the following 

percentages of oxygen users at the 

midpoint of each year: 61 percent for 

the first year, 36 percent for the second 

year, 26 percent for the third year, 19 

percent for the fourth year, and 14 

percent for the fifth year. We then used 

this same methodology to estimate 

Medicare spending incorporating the 

payment rate changes in this final rule. 

Since spending is greater under the 

payment rate changes in this final rule, 

we applied a budget neutrality 

adjustment to the monthly payment 

amount for stationary equipment in 

order to achieve the same expenditures 

that would be spent under payment 

rates without the changes in the final 

rule. 

In response to comments received 

about our proposed methodology not 

being budget neutral annually, we 

calculated budget-neutral rates for a 

five-year period from 2006 to 2010, 

applying the methodology described 

above. The complete, detailed budget 

neutrality analysis, data, and payment 

rate calculations are available at the 

following internet website: http:// 

www.cms.hhs.gov/DMEPOSFeeSched/. 

This results in smaller budget-neutrality 

adjustments in the early years and larger 

ones in the later years because the 

increased expenditures in the first three 

years results primarily from the OGPE 

add-on payment. The full effect of the 

higher payments for portable oxygen 

contents will not be realized until 2010, 

which will be the second year of the 

equipment ownership for beneficiaries 

who have been renting oxygen 

equipment on a continuous basis since 

2006. 

Table 11 shows the 2007 budget 

neutral monthly payment rates and our 

estimates of the budget neutral monthly 

payment rates for 2008 through 2010 for 

the five classes of oxygen and oxygen 

equipment, in addition to the combined 

rates for stationary and portable oxygen 

contents. The rates for stationary 

equipment decrease by year to offset the 

new OGPE class and the increase in the 

portable contents rate. Table 12 shows 

the 2007 monthly payment rates and our 

estimates of the monthly payment rates 

for 2008 through 2010 for four of the 

most common combinations of oxygen 

equipment. 

TABLE 11.—CURRENT WEIGHTED AVERAGE MONTHLY PAYMENT AMOUNTS COMPARED TO PROPOSED AND FINAL

MONTHLY PAYMENT RATES FOR CLASSES OF OXYGEN AND OXYGEN EQUIPMENT

Oxygen class Current Proposed Final 2007 2008* 2009* 2010* 

During Equipment Rental Period (36 Months) 

Stationary Equipment (offset needed) ......................................... $199.84 $177.00 

(¥22.84) 

$198.40 

(¥1.44) 

$198.40 

(¥1.44) 

$193.21 

(¥6.63) 

$189.39 

(¥10.45) 

Portable Add-on ........................................................................... 31.79 32.00 31.79 31.79 31.79 31.79 

OGPE Add-on .............................................................................. N/A 64.00 51.63 51.63 51.63 51.63 


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Oxygen class Current Proposed Final 2007 2008 2009 2010 

Contents Payments After Equipment Ownership 

Stationary & Portable Contents ................................................... 154.90 156.00 154.90 154.90 154.90 154.90 

Portable Contents Only ................................................................ 20.77 55.00 77.45 77.45 77.45 77.45 

Stationary Contents Only ............................................................. N/A $101.00 $77.45 $77.45 $77.45 $77.45 

*Rates for 2008 and beyond are budget-neutral based on assumed OGPE utilization of 5 percent. Actual OGPE utilization will be reviewed on 

an annual basis and rates will be adjusted, if necessary, through program instructions to ensure annual budget neutrality. 

TABLE 12.—PAYMENTS FOR VARIOUS COMBINATIONS OF OXYGEN EQUIPMENT

[Estimated for calendar years 2008 thru 2010] 

Categories of equipment During rental period Contents after ownership 

Concentrator only: 

2007/2008 ........................................................................................ $198.40 $0 

2009 ................................................................................................. 193.21 0 

2010 ................................................................................................. 189.39 0 

Concentrator + gaseous portable: 

2007/2008 ........................................................................................ 230.19 (198.40 + 31.79) 77.45 

2009 ................................................................................................. 225.00 (193.21 + 31.79) 77.45 

2010 ................................................................................................. 221.18 (189.39 + 31.79) 77.45 

Concentrator + OGPE: 

2007/2008 ........................................................................................ 250.03 (198.40 + 51.63) 0 

2009 ................................................................................................. 244.84 (193.21 + 51.63) 0 

2010 ................................................................................................. 241.02 (189.39 + 51.63) 0 

Liquid stationary & portable: 

2007/2008 ........................................................................................ 230.19 (198.40 + 31.79) 154.90 (77.45 × 2) 

2009 ................................................................................................. 225.00 (193.21 + 31.79) 154.90 (77.45 × 2) 

2010 ................................................................................................. 221.18 (189.39 + 31.79) 154.90 (77.45 × 2) 

These estimates assume that 5 percent 

of oxygen users will use OGPE 

equipment in all years. However, we 

will monitor actual use and, as part of 

our annual budget-neutrality 

determination, we will revise rates 

through program instructions under the 

methodology specified in this final rule 

if actual OGPE usage is different from 

our assumption. We also plan to revise 

the payment rates in the future based on 

updated data on the distribution of 

beneficiaries using oxygen equipment 

and the number of months they use the 

equipment. These rates apply to all 

beneficiaries who use oxygen 

equipment on or after January 1, 2007, 

including both new and existing users. 

Comment: Some expressed concern 

that the proposed payment amounts for 

portable oxygen equipment and portable 

oxygen contents are not sufficient to 

offset the cost of providing these 

systems. The commenters recommend 

reallocating the savings that comes from 

the proposed reduction of the stationary 

class to upwardly adjust the monthly 

payment for portable equipment and 

contents. Some commenters strongly 

urged CMS to offset any future cuts in 

home oxygen concentrator payments 

with appropriate increases in other 

classes of oxygen specifically portable 

and ambulatory classes. 

Response: We have changed the 

payment amounts based on comments 

received and have increased portable 

contents payment amount from 

approximately $20.77 to $77.45 per 

month and have increased the add-on 

rate for OGPE from approximately 

$31.79 (the current portable add-on rate 

during the rental period) to $51.63 per 

month. We have also recalculated the 

offsets for budget neutrality and in order 

to maintain budget neutrality, and will 

not be reducing stationary payments 

from approximately $199.84 to $177 as 

proposed. The stationary equipment 

payment will be $198.40 in 2007, and is 

projected to be $198.40 in 2008, $193.21 

in 2009, and $189.39 in 2010, based on 

current calculations discussed above. 

The fees for 2008 and later would be 

adjusted on an annual basis, if 

necessary, to ensure the annual budget 

neutrality of the change in payment 

classes and rates. We will annually 

reevaluate the actual distribution of 

oxygen equipment and make any 

adjustment in the payment amounts 

through program instructions that are 

necessary to maintain annual budget 

neutrality as required by section 

1834(a)(9)(D)(ii) of the Act. 

Data 

Comment: A few commenters were 

concerned about the lack of data 

provided that established the budget 

neutrality proposal and asked CMS to 

release the data and assumptions. A few 

commenters stated that the proposed 

rule did not conform to the 

requirements of the Data Quality Act 

(DQA) that require Agencies to provide 

information on sources of the 

disseminated information as well as 

supporting data and models in a 

scientific, financial, or statistical context 

so the public may question the 

objectivity of the data and source. 

Response: The DQA requires agencies 

to, among other things, issue guidelines 

to ensure and maximize the quality, 

objectivity, utility, and integrity of 

information disseminated by the agency. 

While the DQA applies to a wide variety 

of information dissemination activities 

and all types of media, it has not been 

established that the DQA applies to 

rulemaking. Nevertheless, we are 

providing extensive details in this final 

rule about the data and methodology 

used to calculate budget neutrality. 

Consistent with our guidelines for 

information quality assurance, the 

information upon which we relied is 

from a reliable source that uses accepted 

methods for data collection and 

analysis, and we reviewed the quality of 

the information before using it. Where 

CMS is responsible for disseminating 

influential information (that is, 

information that will have a substantial 

impact on important public policies or 

important private sector decisions), we 

ensure that there is a high degree of 

transparency about the data and 

methods to facilitate its reproducibility 

by qualified third parties. To the extent 


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the data upon which we rely is not 

confidential, our guidelines call for 

identification and documentation of 

data sets in producing estimates and 

projections, and for clear descriptions of 

the methods used. 

Transition 

Comment: Some commenters asked 

CMS to allow for a grace period during 

which suppliers could transfer patients, 

with their consent, to other modalities. 

Many commenters urged CMS to allow 

for a grandfathering process so that 

those who began renting oxygen on 

January 1, 2006 would be under former 

payment rates and policies. These 

commenters argued that the final rule 

should only apply prospectively. 

Response: The final rule, including 

the new oxygen payment classes and 

rates, will be effective on January 1, 

2007. However, as explained above and 

illustrated in table 11, the new payment 

rates will be annually adjusted if 

necessary to ensure budget neutrality. 

We disagree with the comment that we 

allow for a grandfathering provision 

whereby beneficiaries who began 

renting equipment on January 1, 2006 be 

allowed to continue under the former 

payment rates and policies. Such an 

approach would deny such beneficiaries 

the opportunity to obtain access to the 

new technology equipment. We will 

periodically reevaluate actual 

distribution and make any adjustment 

in payment amounts through program 

instructions that are necessary to 

maintain annual budget neutrality as 

required by statute. Adjustments in 

payment amounts will be determined 

based on the model we are using to 

ensure annual budget neutrality as 

explained above. As we discuss below, 

we will allow for changes in modalities 

during the rental period if the 

beneficiary requests an upgrade or if the 

physician provides a new order for the 

equipment modality. 

Comment: One commenter strongly 

urged CMS to adopt a blended rate 

during a three-year transition policy. 

Traditionally CMS has established 

blended rates by taking 75 percent of the 

original rate and 25 percent of the new 

rate during the first year; 50 percent and 

50 percent in the second year; and 25 

percent and 75 percent in the third year. 

Response: As explained above, we 

have revised the calculation of the 

budget-neutral oxygen equipment 

payment amounts in response to 

comments. Our revised approach 

calculates the budget-neutral rates that 

will apply for the first five years based 

on our estimates of the number of 

beneficiaries that will use specific types 

of equipment during each of these years. 

We have also determined that we may 

need to adjust the rates on an annual 

basis after the fifth year to ensure that 

budget neutrality is maintained. Based 

on our calculations, we do not believe 

that the blended percentages 

recommended by the commenter would 

result in budget neutral payment 

amounts. 

Deficit Reduction Act Requirements 

Rental Cap 

Comment: Numerous commenters 

were concerned that the 36-month 

rental period for oxygen equipment will 

not help beneficiaries and will create 

undue hardship for them because they 

will lose services that they have valued 

for years. Moreover, they stated that 

current Medicare benefit guidelines, as 

well as guidelines issued by all major 

national insurance companies, State 

Medicaid programs and all home care 

industry accreditation organizations, 

have always classified oxygen 

equipment as ‘‘high maintenance 

equipment needing frequent 

maintenance service which is not 

recommended or advisable for patients 

to own.’’ Other commenters predicted 

that hospital admissions will likely be 

increased as a result of the cap. These 

commenters argued that capping home 

oxygen services would direct patients 

toward the most expensive part of our 

health care system, which is 

hospitalization. Another commenter felt 

it was inappropriate to transfer title to 

this equipment to a patient because 

medical oxygen is a prescribed drug. 

The commenter believes that allowing 

beneficiaries to assume ownership is 

akin to giving them the source of a 

controlled substance. 

Response: The Congress mandated in 

section 1834(a)(5)(F)(ii)(I) of the Act 

(added by section 5101(b)(1) of the 

DRA) that on the first day that begins 

after the 36th continuous month during 

which payment is made for rented 

oxygen equipment, title to the oxygen 

equipment must transfer to the 

beneficiary. Section 1834(a)(5)(F)(ii)(II) 

provides that the Secretary must make 

reasonable and necessary maintenance 

and servicing payments for the 

equipment after the beneficiary assumes 

ownership of it and we are planning to 

do so, as detailed in the provisions of 

this final rule and in response to 

comments received regarding 

maintenance and servicing of 

beneficiary-owned equipment. 

Suppliers will be paid on a monthly 

basis for the delivery of oxygen contents 

in tanks and cylinders in accordance 

with the requirements of section 

1834(a)(5)(F)(ii)(II) of the Act. As part of 

this ongoing service, we expect 

suppliers to deliver tanks and cylinders 

in proper working condition. As a 

result, we believe that beneficiaryowned equipment will be properly 

maintained and that beneficiaries will 

not suffer undue hardship as a result of 

the title transfer provisions. We also do 

not see how the title transfer provisions 

will affect how much oxygen 

beneficiaries use, since oxygen must be 

prescribed by a physician and delivered 

by a supplier in accordance with that 

prescription. 

Comment: Several commenters 

remarked that, as beneficiaries, they 

cannot afford to take care of their 

oxygen equipment once title to the 

equipment has transferred to them and 

request that we reconsider the rule. One 

commenter noted that his/her portable 

equipment must be replaced at least a 

couple of times a year due to 

malfunctions. 

Response: Although section 

1834(a)(5)(F) of the Act requires 

beneficiary ownership of oxygen 

equipment after 36 continuous rental 

payments are made, this subparagraph 

also mandates that payment be made for 

reasonable and necessary maintenance 

and servicing of the beneficiary-owned 

equipment. The provisions of this final 

rule describe the changes we are making 

in the regulations to ensure that the 

beneficiary will continue to have access 

to equipment that will function for the 

entire reasonable useful lifetime 

established for the equipment. In 

accordance with existing regulations, if 

the equipment has been in continuous 

use for the equipment’s useful lifetime, 

the beneficiary may elect to obtain new 

equipment. However, we note that a 

beneficiary would not be required to 

obtain new oxygen equipment as long as 

the equipment continued to function 

properly. In addition, as we discuss 

below, we are finalizing a provision 

under which a supplier may be required 

to replace the item at no charge to the 

beneficiary if the equipment does not 

function for the entire useful lifetime. In 

addition to meeting the annual Part B 

deductible, for assigned claims, the 

beneficiary is only responsible for 

paying 20 percent of the allowed charge 

for reasonable and necessary 

maintenance and servicing of 

beneficiary-owned equipment. We 

believe that these policies will help 

limit beneficiary costs once title to 

oxygen equipment has transferred. 

Comment: One commenter expressed 

concern about the 13-month rental 

period for capped rental DME and 

recommended that CMS reconsider the 

assignment of certain products to the 

capped rental category, particularly 


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those that sell for under $250.00 or rent 

for under $25.00 per month. The 

commenter argued that the expense of 

submitting and processing claims for 13 

months exceeds any savings from shortterm rentals. 

Response: The statute only allows for 

purchase of DME that is: inexpensive or 

routinely purchased (section 

1834(a)(2)(A) of the Act); a powerdriven wheelchair (section 

1834(a)(7)(A)(iii) of the Act); or 

customized (section 1834(a)(4) of the 

Act). In accordance with the statute, 

inexpensive DME includes equipment 

having a purchase price of $150 or less 

and routinely purchased DME is 

equipment that is acquired at least 75 

percent of the time by purchase. In 

accordance with section 1834(a)(7) of 

the Act, capped rental DME is DME not 

described in any of the other payment 

categories in paragraphs (2) through (6) 

of section 1834(a) of the Act. We do not 

have authority to redefine these 

categories because they are statutorily 

based. 

Transfer of Title 

Comment: A commenter noted that 

the loss of title to the oxygen equipment 

will serve as a disincentive for suppliers 

to invest in advancing oxygen 

equipment technology. As a result, 

manufacturers will shift their research 

and development efforts away from the 

development of smaller, longer-lasting 

portable systems and instead, focus on 

the development of cheaper devices. 

Response: We are obligated to 

implement section 1834(a)(5)(F)(ii)(I) of 

the Act, which requires that on the first 

day that begins after the 36th 

continuous month in which rental 

payments are made for oxygen 

equipment, the supplier transfer title to 

the equipment to the beneficiary. 

However, we disagree with the 

commenter that this rule will act to 

stymie advancements in oxygen 

equipment technology and are finalizing 

policies in this rule that we believe will 

properly incentivize suppliers to invest 

in new oxygen technology. In the case 

of portable oxygen equipment, the 

purpose of establishing an additional 

payment class for OGPE is to increase 

payments for the newer, more efficient, 

but more expensive OGPE technologies. 

In addition, as discussed below, we are 

clarifying in this final rule that 

beneficiaries may select newer 

technology items or upgraded items 

during the equipment rental period by 

agreeing to sign an Advanced 

Beneficiary Notification (ABN). 

Comment: Several commenters were 

concerned about the development of a 

secondary market for oxygen equipment 

resulting from individuals interested in 

selling their used equipment. They 

stated that the sale of these medical 

devices would not be monitored to 

ensure the condition of the device being 

sold, patient safety or clinical 

effectiveness. Several commenters 

requested that we work with the FDA to 

develop standardized guidelines that 

apply specifically to the public’s resale 

of used medical devices. 

Response: We are aware that there 

may be safety issues associated with the 

resale of used oxygen equipment, and 

our regulations would not supersede 

any other Federal or State laws that 

govern these transactions. However, 

section 1834(a)(5)(F)(ii)(I) specifically 

mandates beneficiary ownership of both 

stationary and portable oxygen 

equipment after 36 months of 

continuous use. It has long been 

common practice for suppliers to pick 

up beneficiary-owned DME after 

medical necessity ends, in cases where 

the beneficiary or relatives of the 

beneficiary make such a request. In 

order to minimize the possibility that 

beneficiaries will incorrectly dispose of 

oxygen equipment that is no longer 

medically necessary, we will encourage 

suppliers to advise beneficiaries that 

they can pick-up and store the 

beneficiary’s oxygen equipment if the 

beneficiary no longer needs it. Suppliers 

would be paid for picking up and 

storing oxygen tanks and cylinders that 

are no longer medically necessary (see 

below for a full discussion of this 

modification to our maintenance and 

servicing proposal). We will also note in 

the final regulations that in cases where 

suppliers have picked up beneficiaryowned oxygen equipment under these 

circumstances and the beneficiary’s 

medical necessity for the equipment 

subsequently resumes, the supplier 

must return to the beneficiary similar 

equipment of equal or greater value to 

the beneficiary-owned equipment that 

was picked up, unless the beneficiary 

elects to obtain new equipment because 

the reasonable useful lifetime for the 

previous equipment has expired, or 

unless a different oxygen modality is 

prescribed and the beneficiary signs an 

advanced beneficiary notice (ABN) (see 

below for a full discussion of this policy 

modification). 

Comment: Several commenters urged 

that CMS and the Food and Drug 

Administration (FDA) discuss the 

ability of suppliers of oxygen contents 

for beneficiary-owned equipment to 

comply with 21 CFR 210 and 211. 

Further, the commenters stated that 

CMS must outline the process for 

reimbursing suppliers for any in-home 

services they would need to perform in 

the event of an FDA recall after the 

beneficiary takes title to the device. 

Another commenter noted that once the 

beneficiary takes ownership, many 

devices will no longer be trackable for 

recall purposes. Several commenters 

recommended that CMS develop safety 

standards that can be applied to 

beneficiary owned equipment. 

Standards would help ensure that 

beneficiaries/caregivers comply with 

Department of Transportation (DOT), 

FDA and the Compressed Gas 

Association oxygen guidelines as well 

as ensure that they do not 

inappropriately handle or dispose of 

cylinders. One commenter observed that 

the proposed rule provided no 

clarification on how many cylinders 

Medicare expects to be transferred in 

ownership to the patient. There are 

several factors that can influence the 

number of cylinders a patient receives, 

such as oxygen liter flow, activity level 

of the patient, and distance from the 

patient’s residence to the supplier’s 

warehouse. Given these variables, the 

commenter noted that a patient could 

receive from 2–6 cylinders at the time 

of set-up. Additionally, beneficiaries 

may receive more cylinders temporarily 

to accommodate travels outside of the 

supplier’s service area. One commenter 

questioned how CMS will address 

instances where beneficiaries require 

more or less portable cylinders post title 

transfer. Another commenter requested 

that Medicare not require suppliers to 

transfer title to oxygen tanks to 

beneficiaries since it would be 

burdensome and unmanageable for 

suppliers to keep track of virtually 

identical tanks. Under the current 

regulatory framework for oxygen as a 

medical gas, one commenter noted that 

suppliers are not permitted to label 

oxygen containers with the beneficiary’s 

name which makes it difficult to 

develop tracking systems to ensure that 

each patient’s cylinders can be 

identified. One commenter estimated 

that beneficiaries use anywhere from 2 

to 10 or more tanks of oxygen per week. 

Another commenter recommended that 

we not require transfer of title for both 

sets of cylinder vessels, but rather only 

those that are in use in the home and 

not the ones that the supplier refills in 

its business location. One commenter 

recommended that we retain the 

current, efficient approach where the 

supplier owns all the cylinders because 

this allows the supplier to use different 

cylinders with the same patient. Several 

commenters noted that our proposal to 

transfer title to both the oxygen cylinder 

that is being filled and the one in the 

beneficiary’s home is unworkable given 


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its impact on supplier’s operations and 

the regulatory framework for oxygen as 

a medical gas. The FDA guidance 

defines the custody, control and 

management of filling liquid container 

to be in compliance when the filling 

company owns the liquid containers. 

When the patient owns the liquid 

containers after 36 months, the 

company would no longer be able to fill 

the container without extensive testing 

prior to filling because the containers 

would be considered by FDA to be out 

of the filler’s control. In addition, the 

filling company would no longer be 

assured that the container was 

maintained in accordance with the 

manufacturer’s specification. The DOT 

requires that the filling company have 

access to service and maintenance 

records in order to determine which 

inspections and tests to perform and at 

what frequency. If this information is 

not available to the filler, then the FDA 

mandates additional testing which 

requires more sophisticated testing 

equipment than the typical supplier of 

home medical oxygen has available. 

Similarly, in accordance with DOT 

regulations, a cylinder filled with a 

hazardous material may not be offered 

for transportation unless it was filled by 

the owner of the cylinder or with the 

owner’s consent. This requires that the 

manufacturer of the medical oxygen, 

that is, the company that fills the 

oxygen container under FDA 

regulations, to have the equipment 

owner’s permission prior to refilling the 

container. After the patient owns the 

oxygen equipment, compliance with 

this regulation will be very difficult for 

the supplier, especially if the 

transfilling is done by a third-party. The 

new supplier has no knowledge of how 

the compressed gas cylinders have been 

stored and maintained and how or when 

federally-mandated hydrostatic testing 

has been performed. The commenter 

predicted that it is likely that the new 

supplier will decline to service the 

cylinders for fear of employee injury 

and subsequent liability. Several 

commenters urged us to confer with the 

FDA about the application of FDA 

regulations to patient owned cylinders. 

Response: We are aware that oxygen 

tanks and cylinders must be handled in 

accordance with Federal statutes and 

regulations and expect that suppliers’

equipment will meet the requirements 

set forth in these statutes and 

regulations before they transfer title to 

the equipment to the beneficiaries. Once 

title transfers, the supplier will still be 

required to deliver refilled oxygen 

contents in tanks and cylinders. We are 

also aware that beneficiaries might not 

know about other Federal laws that 

govern the disposal and resale of oxygen 

equipment. Although CMS doesn’t 

administer or enforce these laws, we 

believe it is appropriate to take steps to 

ensure that beneficiaries are made aware 

of them. Therefore, we are adding a 

provision to the final rule that would 

require suppliers to educate 

beneficiaries at the time of title transfer 

about safety issues associated with 

disposing of oxygen equipment that is 

no longer medically necessary, and to 

advise beneficiaries that they must 

comply with any applicable Federal, 

State, and local laws that govern the 

disposal or resale of oxygen equipment. 

In addition, as we stated above, we 

would encourage suppliers to advise 

beneficiaries that they can pick-up and 

store the tanks once they are no longer 

medically necessary, and Medicare 

would pay for this service (discussed 

below). Further, suppliers could offer to 

buy the tanks back from the beneficiary. 

In the proposed rule, we proposed 

that the title to two sets of cylinders or 

tanks would be transferred to the 

beneficiary after 36 months of 

continuous rental. That is, title would 

transfer for one set of cylinders or tanks 

that the beneficiary would use at home, 

and title would transfer for a second set 

that would be refilled at the supplier’s 

location. The number of tanks or 

cylinders is dependent on how many 

tanks or cylinders a beneficiary uses and 

how many tank or cylinder deliveries a 

supplier makes during a given month. 

After considering the comments, we 

have concluded that it is unrealistic and 

inappropriate to require suppliers to 

comply with a policy where 

beneficiaries own specific tanks that 

must be refilled by suppliers for specific 

beneficiaries. Therefore, we are 

changing this policy in this final rule. 

Even though the beneficiary owns the 

equipment, the supplier may switch out 

the tanks or cylinders with their tank 

and cylinder supply, similar to how 

propane tanks are refilled in the market 

today. Just as owners of propane tanks 

receive different tanks each time they 

need replacement contents, we are 

clarifying in this final rule that this 

propane tank model will be the practice 

under Medicare with delivery and 

refilling of oxygen contents for 

beneficiary-owned oxygen tanks and 

cylinders. Because this policy 

modification will enable suppliers to 

continue swapping tanks and cylinders 

for beneficiaries, as they currently do, 

we believe that suppliers should also be 

able to handle recall situations as they 

currently do. In the case of other 

beneficiary-owned oxygen equipment 

such as concentrators, we expect 

suppliers to handle recalls in the same 

way manner that they currently handle 

recalls of other beneficiary-owned DME, 

such as power-driven wheelchairs. The 

decision regarding whether such 

services would be considered 

reasonable and necessary maintenance 

and servicing would be made by the 

Medicare contractor. For example, if 

suppliers currently bill and are paid by 

Medicare contractors for labor and parts 

when performing in-home services 

needed in the event of an FDA recall 

after the beneficiary takes title to a DME 

device such as a power wheelchair, then 

they should continue this practice. If the 

supplier has never furnished DME paid 

on a purchase basis by Medicare or 

capped rental items, they should 

consult with the Medicare contractor to 

determine if these services would be 

considered reasonable and necessary 

maintenance and servicing. 

Comment: One commenter stated that 

the OIG study on oxygen entitled 

‘‘Medicare Home Oxygen Equipment: 

Cost and Servicing,’’ is flawed and 

presents an inaccurate representation of 

Medicare ‘‘equipment and servicing.’’

Response: The commenter provides 

no factual information to support their 

claim that the findings of this study are 

flawed. Although none of the policies of 

this final rule are based solely on the 

findings in this report, we do believe 

that the information in the report is 

credible and provides useful 

information regarding the maintenance 

and servicing of and costs of oxygen 

concentrators as reported by suppliers. 

Since we did not author the OIG study 

on oxygen, any concerns or comments 

about the contents of this report should 

be addressed to the Department of 

Health and Human Services, Office of 

the Inspector General. 

Comment: A commenter requested 

access to the Medicare Common 

Working File (CWF), the system that 

houses beneficiary specific information 

regarding Medicare eligibility and past 

claims history, in order to obtain 

beneficiary specific information such as 

whether the beneficiary has received the 

‘‘same or similar’’ equipment from 

another supplier in the past. The 

commenter stated that suppliers must 

also be able to access historical usage 

data so that they may understand 

whether they will be paid for the 

equipment and services they are being 

asked to provide within 2 to 4 hours of 

the typical referral. Another commenter 

suggested that if access to information 

in the CWF was not possible, CMS must 

establish criteria for using ABNs to 

notify the beneficiaries of their financial 


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responsibility if there is ‘‘same or 

similar’’ medical equipment. 

Response: The request for access to 

the CWF is outside the scope of this 

rulemaking process. We note that 

general criteria for use of the ABN can 

be found in Chapter 30 of the Medicare 

Claims Processing Manual, located at 

http://www.cms.hhs.gov/Manuals/IOM/ 

list.asp. 

Comment: Several commenters 

questioned whether Medicare would 

require suppliers to transfer title to 

capped rental items and oxygen 

equipment to beneficiaries who have 

not paid their coinsurance or 

deductibles under Part B. One 

commenter recommended that we 

provide an exception to the title transfer 

requirement if a beneficiary has failed to 

pay his or her coinsurance for a 

significant period (such as more than 6 

months) across the course of the 36- 

month rental period. The commenter 

also suggested that we could take 

responsibility, once the title transfers, 

for attempting to collect the amount of 

missed coinsurance payments from the 

beneficiary or pay the supplier’s bad 

debt for unpaid deductibles and 

coinsurance. Several commenters urged 

that we clarify this provision in the final 

rule and recommended that title to the 

equipment should not transfer to the 

patient until payment is made in full for 

all services rendered through the 36th 

month. (Medicare typically pays the 

36th month’s rate approximately 30 

days later). 

Response: Section 5101 of the DRA is 

clear that the title to equipment 

transfers from the supplier to the 

beneficiary on the first day that begins 

after the 13th continuous month in 

which payment is made for capped 

rental items and on the first day that 

begins after the 36th continuous month 

in which payment is made for oxygen 

equipment. The statute mandates that 

ownership transfer after the 13th and 

36th continuous month for capped 

rental items and oxygen equipment, and 

does not make transfer of ownership 

contingent on payment of beneficiary 

coinsurance. We believe that suppliers 

have a sufficient period of time to 

collect any outstanding beneficiary 

coinsurance during the rental period 

before title is required to be transferred. 

In addition, our rules would not 

preclude a supplier from seeking unpaid 

coinsurance or deductible amounts from 

a beneficiary after title has transferred. 

CMS or the carrier will have the 

discretion to review cases that allow 

suppliers to stop furnishing an item to 

a beneficiary, if warranted. 

Comment: Some commenters are 

concerned that the proposed rule does 

not provide sufficient clarity and 

specificity for stakeholders and 

Medicare beneficiaries alike to fully 

recognize the impact the final rule will 

have on beneficiaries when it becomes 

effective. The commenters predicted 

that the complexity of oxygen 

equipment, as well as the fact that each 

different type of equipment carries with 

it different safety and routine 

maintenance requirements, will be 

overwhelming for the average Medicare 

beneficiary. 

Response: We recognize that 

equipment maintenance may be 

overwhelming for some beneficiaries 

and, as we explain in more detail below, 

we are revising the final rule to allow 

for payment every six months for 

general maintenance and servicing of 

certain beneficiary-owned oxygen 

equipment. These payments would be 

made in addition to payment for any 

reasonable and necessary replacement 

parts and repairs that are non-routine 

and not covered by the manufacturer’s 

warranty. We intend to monitor the 

implementation of these provisions to 

ensure beneficiary safety. 

Back Up Equipment 

Comment: Some suppliers furnish 

backup oxygen equipment for use by 

beneficiaries in the event of power 

failures or malfunction of primary 

oxygen equipment. Several commenters 

requested that the final rule state that 

since Medicare has not made any rental 

payments for backup oxygen equipment, 

title to this equipment should not 

transfer to the beneficiary. The 

commenters believe that title to backup 

equipment does not transfer under the 

coverage rules established under 

Medicare contractor local coverage 

determinations (LCDs) for oxygen 

equipment. 

Response: We agree with the 

commenters that the title for backup 

oxygen equipment would not transfer to 

the beneficiary after 36 months because 

Medicare does not make rental 

payments for this equipment. In 

addition, the LCDs referred to by the 

commenters correctly reflect Medicare’s 

policy that equipment is not medically 

necessary if it is identical or similar to 

equipment already in use by the 

beneficiary and is used to meet the same 

set of medical needs. That is, backup 

equipment is a second piece of 

equipment used for precautionary 

reasons to deal with an emergency in 

case the primary piece of equipment 

malfunctions rather than to meet a 

different set of medical needs. 

Therefore, the beneficiary-ownership 

provision would not apply to backup 

oxygen equipment. 

Payment for Oxygen, Oxygen 

Equipment and Capped Rental DME 

Comment: Several commenters 

requested that a new rental period begin 

whenever a change in supplier takes 

place, regardless of the reason. One 

commenter indicated that now that 

payments for oxygen equipment will be 

limited to 36 months of continuous use, 

the administrative burden on suppliers, 

such as ascertaining how many 

Medicare rental payments have already 

been made for specific items used by 

specific beneficiaries, will increase. The 

new suppliers will need additional 

resources to complete a thorough 

screening of all new patients to 

determine the amount of Medicare 

payments that may be made for specific 

items. 

Response: Longstanding policy found 

in § 414.230(g) regarding a change in 

suppliers during a period of continuous 

use of rented DME indicates that a 

change in supplier will not result in a 

new rental episode. In accordance with 

the amendments made by section 5101 

of the DRA to section 1834(a)(7)(A) of 

the Act, and section 1834(a)(5) of the 

Act, payment may not extend over a 

period of continuous use of longer than 

13 or 36 months, respectively, for 

capped rental items and oxygen 

equipment. For the reasons indicated 

below, we are applying the policy in 

§ 414.230(g) to all beneficiary-owned 

capped rental items and oxygen 

equipment. 

Comment: One commenter requested 

that we acknowledge those situations in 

which the title is not held by a supplier 

that rents oxygen equipment or 

cylinders to beneficiaries. The 

commenter indicated that it is common 

practice for a supplier to rent equipment 

from a manufacturer and never hold 

title to the equipment, but stated that 

the 36-month rental cap for oxygen 

equipment fails to address this common 

problem. 

Response: We understand that in 

some instances, suppliers furnish 

oxygen equipment to beneficiaries that 

they themselves have rented from 

manufacturers or leasing companies. 

However, under section 

1834(a)(5)(F)(ii)(I) of the Act (added by 

section 5101(b)(1)(B) of the DRA), 

suppliers are required to transfer title of 

oxygen equipment to beneficiaries on 

the first day that begins after the 36th 

month during which payment is made 

for the equipment. In addition, under 

section 1834(a)(7)(A)(ii) of the Act 

(added by section 5101(a)(1) of the 

DRA), suppliers are required to transfer 

title of capped rental equipment to 

beneficiaries on the first day that begins 


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after the 13th month during which 

payment is made for the equipment. 

Therefore, regardless of what 

arrangements a supplier might make 

with a manufacturer or leasing 

company, the supplier must be in a 

position to transfer title to the 

equipment in accordance with these 

statutory provisions. 

Payment for Maintenance and Servicing 

Comment: One commenter requested 

that during the period of continuous 

use, suppliers be permitted to continue 

the current practice of replacing 

equipment in need of service or repair 

with equipment of the same type that is 

in good working order. The commenter 

further requested that the rule build in 

the added costs of administration and 

delivery if the original piece of 

equipment must be delivered to the 

patient. 

Response: We recognize that under 

current practice, suppliers sometimes 

choose to replace oxygen or capped 

rental equipment, rather than repair it, 

during the rental period, and as we 

discuss below, we have decided to 

allow this practice to continue. 

However, as discussed in detail in the 

proposed rule, we continue to be 

concerned that beneficiaries be 

protected from situations where 

equipment may be replaced with 

equipment of lesser value prior to the 

transfer of title to the equipment. 

Therefore, we would require that the 

replacement equipment must be in the 

same or better condition as the 

equipment being replaced. Delivery of 

the equipment is included in the 

monthly rental payment amount. 

Comment: Several commenters stated 

that the proposed rule does not address 

the service components that are 

currently provided to beneficiaries 

which may require trained and qualified 

personnel to administer. These services 

include: Verifying oxygen purity, 

oxygen dose verification, verification of 

alarm system functions, cleaning and 

replacement of filters, disposable 

oxygen accessories, 24-hour, 7-day per 

week on-call and emergency support, 

patient training, and clinical 

professional support. The proposed rule 

also does not address that some 

manufacturers require equipment 

maintenance, which requires 

disassembly of the device, to be 

performed every 5,000 hours and this 

must be performed at the supplier’s 

facility. This additional equipment 

maintenance requires suppliers to incur 

the additional costs of picking up the 

equipment and providing loaner 

equipment. One commenter stated that 

regular maintenance takes place in the 

patient’s home, on average, every 90 

days. Another commenter provided a 

statistic from the June 2006 Morrison 

Informatics Inc. study, which 

demonstrated that non-equipment costs 

comprise 72 percent of suppliers’ total 

costs. Commenters also noted that the 

new quality standards confirm that the 

non-equipment professional and 

administrative services cost categories 

reported in the Morrison study are 

legitimate costs that should be 

recognized in the Medicare payment for 

home oxygen. Further, the rule does not 

address reimbursement for licensed 

respiratory therapists who conduct inhome clinical patient assessments 

according to written or verbal physician 

orders for beneficiaries who own oxygen 

equipment. The commenters urged CMS 

to allow patients to continue receiving 

these assessments, but note that this 

activity will only be sustainable if CMS 

establishes a new HCPCS code and 

appropriate reimbursement rate. The 

commenter noted that suppliers cannot 

provide these assessments without fair 

reimbursement rates because it could 

constitute an illegal inducement and 

raise other fraud and abuse concerns. 

Commenters stated that we need to 

establish regular and ongoing payment 

after ownership transfers to support 

beneficiary access to necessary clinical, 

support, and other services. 

Response: Section 1834(a)(5)(F)(ii)(II) 

of the Act requires CMS to pay 

separately for any reasonable and 

necessary maintenance and servicing 

after the beneficiary assumes ownership 

of oxygen equipment, and section 

1834(a)(7)(A)(iv) of the Act requires the 

same in the case of capped rental DME 

items. We proposed to use the standard 

in § 414.210(e) of our regulations to 

define the ‘‘maintenance and servicing’’

for which Medicare would make 

payment under section 5101 of the DRA. 

We also proposed to apply our existing 

policy of not covering certain routine or 

periodic servicing of purchased 

equipment, such as testing, cleaning, 

regulating, changing filters, and general 

inspection, that could be done by the 

beneficiary or caregiver, and referred to 

chapter 15, section 110.2B of the 

Medicare Benefit Policy Manual for 

further guidance on what types of 

routine maintenance would not be 

covered. After considering comments 

that raise concerns regarding a 

beneficiary’s ability to properly 

maintain his or her oxygen equipment, 

as well as safety issues that could arise 

if the equipment is not properly 

maintained, we have decided to revise 

our policy in the final rule under which, 

beginning 6 months after title to oxygen 

equipment transfers to the beneficiary, 

the supplier may bill for general 

maintenance and servicing of certain 

beneficiary-owned oxygen equipment 

once every 6 months. We believe that 

allowing payment every 6 months is 

reasonable based on findings by the 

Department of Health and Human 

Services, Office of the Inspector 

General, in a September 2006 report 

entitled ‘‘Medicare Home Oxygen 

Equipment: Cost and Servicing,’’ that 

the current frequency of suppliers in 

checking concentrators (every four 

months, on average) exceeds the 

guidelines of the two major 

manufacturers that accounted for twothirds of the concentrators rented by 

beneficiaries sampled for purposes of 

the report. In addition, according to 

guidelines from two major concentrator 

manufacturers, comprehensive 

preventative maintenance need only 

performed annually or after several 

thousand hours of use. Under this 

policy, suppliers could bill for general 

maintenance and servicing of all oxygen 

equipment except liquid or gaseous 

equipment (stationary and portable) 

because these types of systems consist 

primarily of tanks or cylinders, as well 

as replacement supplies and accessories 

(for example, masks and tubing) which 

we proposed to pay for separately, and 

we would expect that as a part of the 

tank and cylinder filling process, 

suppliers would check to ensure that 

the tanks and cylinders were 

functioning properly. However, we will 

make payment for the pick-up and 

storage or disposal of tanks and 

cylinders that are no longer medically 

needed by the beneficiary. We are also 

specifying that the general maintenance 

and servicing payments for oxygen 

equipment other than liquid and 

gaseous equipment would not begin 

until at least 6 months after the date that 

title to the equipment transfers because 

suppliers should only be transferring 

title to equipment that is in good 

working order and that has been 

routinely maintained. Payment for 

general maintenance and servicing 

would be limited to 30 minutes of labor, 

which we believe will adequately 

compensate suppliers based on findings 

by the OIG in the same September 2006 

report that many routine maintenance 

activities performed by suppliers on 

concentrators could be performed in 

less than 5 minutes. Finally, as we 

explained above, these payments for 

general maintenance and servicing 

would be made in addition to payment 

for reasonable and necessary repairs of 

beneficiary-owned oxygen equipment. 

Suppliers would be able to bill for such 


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non-routine maintenance, to the extent 

that the parts and labor are not covered 

by the manufacturer’s warranty, 

beginning immediately after the 

beneficiary assumes ownership of the 

equipment, and as we proposed, 

payment would be made for the parts in 

a lump sum amount based on the 

carrier’s consideration of the cost for the 

item because this is consistent with how 

we currently pay for replacement parts 

for other beneficiary-owned DME. We 

would also make an additional labor 

payment if such non-routine 

maintenance is performed at the same 

time as general maintenance, as long as 

the non-routine repair takes longer than 

30 minutes. In addition, we are 

finalizing our proposal to pay on a 

purchase basis for all supplies and 

accessories (e.g., tubing, masks, 

cannulas, etc.) necessary for the 

effective use of beneficiary-owned 

oxygen equipment. 

In addition, to further limit the 

possibility raised by commenters that 

beneficiaries will incorrectly dispose of 

tanks and cylinders, we are modifying 

our proposal to allow suppliers to 

submit a bill for picking up beneficiaryowned oxygen tanks and cylinders that 

are no longer medically necessary 

should a beneficiary request such a 

pick-up. The supplier could submit this 

bill any time after the beneficiary has 

acquired ownership to the tanks or 

cylinders. This pick-up allowance 

would not apply to other types of 

oxygen equipment, such as 

concentrators, because beneficiary 

storage of such equipment does not raise 

safety concerns. 

In-home clinical patient assessments 

by licensed respiratory therapists fall 

outside the scope of the Medicare Part 

B benefit for DME. 

Comment: Several commenters 

requested that Medicare develop 

standard protocols for routine 

maintenance of oxygen equipment and 

reimburse suppliers for providing this 

service. Several commenters requested 

that the non-routine maintenance 

include: inspection of internal 

components for dust, debris, wear; 

internal filter changes; oxygen purity 

testing that requires an oxygen analyzer 

device; coil cleaning and any 

maintenance that requires breaking 

internal seals. Several commenters 

requested that ‘‘routine maintenance’’

and ‘‘non-routine maintenance’’ be 

clearly defined in the final rule, 

specifically for oxygen and capped 

rental DME. Several commenters 

proposed that routine maintenance be 

defined as follows: wiping down 

outside surfaces of oxygen devices, 

changing the external cabinet filter, 

changing oxygen tubing and cleaning 

and replacing oxygen humidifier bottles. 

Response: As we explained above, we 

are modifying our maintenance and 

servicing proposal for oxygen 

equipment to allow for general 

maintenance and servicing of oxygen 

equipment other than liquid or gaseous 

oxygen equipment. Medicare will pay 

for up to 30 minutes of labor spent 

performing general, routine 

maintenance during each of these 

maintenance calls. Medicare will also 

pay separately for any replacement parts 

that are necessary to properly service 

the equipment during these calls, and 

for labor associated with any nonroutine maintenance required as part of 

the visit if it takes longer than the 30 

minutes we are already paying for under 

the general maintenance and servicing 

policy. However, to the extent that a 

supplier services beneficiary-owned 

oxygen equipment more often than 

every six months, or services 

beneficiary-owned capped rental items 

at any time, Medicare will only make 

payments for non-routine maintenance 

and servicing. In the proposed rule, we 

stated that examples of the types of 

maintenance and servicing that would 

be covered as non-routine maintenance 

of oxygen equipment and capped rental 

DME can be found in section 110.2.B of 

Chapter 15 of the Medicare Benefit 

Policy Manual (Pub. 100–02). This 

policy has been in the manual for many 

years and we have never experienced 

any major problems associated with 

interpretation of these guidelines on 

what constitutes reasonable and 

necessary maintenance and servicing. 

We also believe that the examples 

provided in the manual represent good, 

general guidance that will enable 

beneficiaries and suppliers to discern 

what types of maintenance and 

servicing would be covered. We 

therefore do not believe that it is 

necessary to provide a listing of every 

service that constitutes routine and nonroutine maintenance. 

Comment: Several commenters 

recommended that we develop a 

methodology to provide for emergency 

services for beneficiary-owned 

equipment. Commenters also requested 

that this emergency mechanism, 

including after-hours care, in-home 

assessments, patient education and 

adherence monitoring, take into account 

the value of the therapists’ time, mileage 

reimbursement expense and related 

costs. One commenter noted that 

patients rely on the 24-hour, 7-day-aweek on-call service to answer major 

and minor questions related to their 

equipment. A large percentage of these 

calls result in an in-home visit after 

hours and on the weekend. 

Response: Payment will be made for 

any reasonable and necessary 

maintenance and servicing of 

beneficiary-owned DME, including 

emergency situations. In addition, 

consistent with current Medicare 

policies, payment for rental of loaner 

equipment would be made while repairs 

of beneficiary-owned equipment are 

provided. In-home clinical patient 

assessments by licensed respiratory 

therapists fall outside the scope of the 

Medicare Part B benefit for DME. 

Comment: One commenter predicts 

that a number of beneficiaries may hire 

a third party to perform routine 

maintenance tasks that the beneficiary 

would otherwise be responsible for 

performing once he or she takes title to 

oxygen equipment to ensure that there 

is no chance for error. As a result, these 

beneficiaries may likely pay more for 

home oxygen therapy than they are 

paying under the current provisions. 

Response: As we discussed above, we 

are allowing payment for general 

maintenance and servicing of 

beneficiary-owned oxygen equipment 

other than liquid or gaseous oxygen 

equipment. In addition, a liquid or 

gaseous system consists of only tanks or 

cylinders, which we would expect a 

supplier to maintain as part of the filling 

process, and supplies, which we will 

pay for separately. As a result, we 

expect that a beneficiary’s maintenance 

costs will not be significantly higher 

under this rule than it was under the 

previous rules. 

Comment: One commenter 

recommended that we conduct a study 

in a clearly-defined marketplace to 

ascertain the level of hospitalizations, 

emergency room visits, physician office 

visits, or other Part A/B expenses 

incurred by beneficiaries as a result of 

their being unable to access a qualified 

supplier after they assume ownership of 

the medical equipment under the new 

rules. 

Response: We disagree that such a 

study is necessary. As described in 

detail above, we have provided for 

appropriate payments for maintenance, 

servicing, and repairs of beneficiaryowned equipment. Therefore, we 

believe that beneficiaries will have 

sufficient access to qualified suppliers 

after assuming ownership of equipment. 

Comment: A few commenters noted 

that the proposed rule does not provide 

any guidelines or timetable as to how 

often Medicare will pay to replace the 

disposable supplies associated with 

home oxygen therapy, such as cannulas, 

oxygen tubing, humidification bottles, 

adaptors, and filters. These components 


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require frequent replacement and are 

currently included in the monthly 

Medicare rental fee. As the proposed 

rule is currently drafted, suppliers 

would be required to provide 

replacements of necessary supplies for 

free and commenters believe that this 

will lead to a reduction in the number 

of suppliers that furnish oxygen. 

Response: Medicare has traditionally 

paid for supplies and accessories that 

are necessary to use in conjunction with 

the beneficiary-owned DME item. This 

policy can be found in section 110.3 of 

Chapter 15 of the Medicare Benefit 

Policy Manual (Pub. 100–02). We 

proposed to apply this policy to 

supplies and accessories used in 

conjunction with beneficiary-owned 

oxygen equipment and capped rental 

items and did not receive comments 

opposing this proposal. Therefore, we 

are finalizing our proposal to pay 

separately for these supplies and 

accessories as often as is reasonable and 

necessary. 

Comment: Several commenters are 

concerned that serious health problems 

could affect a Medicare beneficiary’s 

ability to understand and take 

responsibility for routine maintenance 

and servicing of his or her oxygen 

equipment. Commenters noted that 

some beneficiaries are physically and 

mentally unable to perform the 

necessary routine maintenance on 

equipment, and it is simply unsafe to 

impose the responsibility for 

maintaining this equipment on 

beneficiaries. Another commenter noted 

that even the OIG’s September 2006 

Oxygen Report, entitled ‘‘Medicare 

Home Oxygen Equipment: Cost and 

Servicing’’ (OEI–09–04–00420), 

reinforced the point that a certain 

percentage of patients will not be able 

to perform routine maintenance by 

stating that ‘‘50 percent of the service 

visits conducted through the surveyed 

patients included what has been 

describes routine maintenance.’’ Other 

commenters noted that transferring the 

burden of maintenance and repair of 

sophisticated oxygen technologies to the 

beneficiary and, therefore, the total 

management of their home oxygen 

therapy regimen, presents serious risk to 

patient safety and care. Commenters 

also indicated that oxygen and oxygen 

equipment are more technically 

complex than other types of DME and 

can cause serious injury if improperly 

maintained and serviced. 

Response: Although we believe that 

the one commenter misquoted the OIG 

report and took their data out of context, 

we agree with the commenters’ general 

concerns regarding the ability of 

beneficiaries to properly maintain their 

oxygen equipment once they acquire 

title to it and are revising the rule to 

permit payments for general 

maintenance and servicing of certain 

beneficiary-owned equipment as 

explained above. 

Comment: Several commenters 

suggested that we establish HCPCS 

codes to adequately describe the parts 

and repair services that will be covered 

and reimbursed for beneficiary-owned 

oxygen equipment. Another commenter 

requested that we implement a national 

policy and fee schedule for repair parts 

and labor that is eligible for either a 

Consumer Price Index (CPI) or Medicare 

Economic Index (MEI) adjustment 

annually. The fee schedule should 

reflect the fully-loaded costs of 

providing repair, not just repair parts 

and labor. A standardized approach will 

address those instances where a 

supplier goes out of business and is 

unable to assist in maintaining 

equipment. Another commenter 

indicated that services that are currently 

included as part of the monthly bundled 

rate for oxygen and equipment would 

no longer be provided after the 36th 

month unless a HCPCS code and 

allowable is developed. 

Response: We have generally given 

the carrier discretion to determine rates 

for labor and parts with respect to the 

non-routine repair of beneficiary-owned 

equipment based on reasonable charges 

and believe that this methodology 

results in adequate reimbursement to 

suppliers. However, should these 

commenters wish to make specific 

requests or recommendations for 

addition of specific codes for 

replacement parts, we would encourage 

them to participate in the HCPCS 

editorial process, which is described 

online at: http://www.cms.hhs.gov/ 

MedHCPCSGenInfo/. 

Comment: Several commenters 

request that we provide guidance on the 

type of documentation that CMS expects 

suppliers to obtain to support repair 

claims. They stated that DME MACs and 

CMS must have clear policies outlining 

when Medicare will pay for repairs and 

the documentation it will require to 

support those claims. 

Response: In accordance with the 

rules at § 414.210(e), Medicare carriers 

have long had discretion to require any 

documentation from suppliers that is 

necessary to enable them to make 

determinations regarding whether 

maintenance and servicing of 

beneficiary-owned DME is reasonable 

and necessary. The carriers provide 

guidance to suppliers regarding the 

specific documentation that is needed 

for these purposes. 

Comment: Several commenters 

requested that ‘‘labor’’ be redefined to 

start when the technician leaves the 

facility and ends when he or she returns 

to the shop. The labor time charge 

should not be just for technician time in 

the home or shop. The commenters 

noted that the current parts and labor 

fees do not take into consideration any 

travel time or time to evaluate the 

equipment. 

Response: Medicare payment for labor 

is based on 15-minute increments for 

time when the technician is working on 

the equipment. Separate payment is not 

allowed for delivery and service charges 

for DME such as travel time to and from 

the beneficiary’s home. Such payment is 

included in the payment for the item or 

service. This policy has been in place 

for many years and we have not 

encountered serious problems with 

access to repair of beneficiary-owned 

DME. However, this policy does allow 

for additional payment for extraordinary 

expenses in rare or unusual 

circumstances as specified in current 

program instructions. This policy can be 

found in section 60 of Chapter 20 of the 

Medicare Claims Processing Manual 

(Pub. 100–04). This payment 

determination for travel is at the 

discretion of the carrier. 

Payment for Replacement of Equipment 

Comment: Many commenters 

expressed concern about our equipment 

replacement proposal. Numerous 

commenters believed that this provision 

places an unreasonable economic 

burden on suppliers. Commenters 

indicated that we should specify that, 

once ownership shifts to the patient, it 

becomes the patient’s responsibility to 

maintain and repair the equipment. 

Some commenters believe that, given 

the 5-year useful life of the equipment, 

the circumstances that would require 

equipment to be replaced may be so far 

removed from the date that title 

transferred that there would be no 

plausible connection between the 

supplier’s actions and a conclusion that 

the supplier delivered substandard 

equipment. Commenters noted that the 

proposed rule does not allow for the 

supplier to receive a new continuous 

rental period for replacement equipment 

which is not yet patient-owned, so it is 

inequitable to require a supplier to 

replace free of charge the patient-owned 

equipment that prematurely fails 

because the patient did not maintain it 

in accordance with the manufacturer’s 

guidelines. This situation should be 

remedied by providing for a new 

continuous rental should the 

beneficiary’s action during the 

ownership useful lifetime period result 


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in the premature failure of the 

equipment. Commenters also 

complained that routine maintenance 

often must be performed by the user and 

that the supplier has no means to ensure 

when or if this was done or done 

correctly. Several commenters indicated 

that manufacturer warranties for oxygen 

equipment are void if the title is 

transferred. Therefore, requiring that the 

supplier that furnished the oxygen 

equipment replace at no cost items that, 

under Medicare rules, did not last for 

the entire reasonable useful lifetime 

would subject suppliers to undue 

financial burden. 

Response: We expect that equipment 

furnished by the supplier will function 

for the entire period established under 

Medicare regulations and program 

instructions as the equipment’s 

reasonable useful lifetime. If this is not 

the case, then the supplier has not 

furnished a quality item of durable 

medical equipment for which they have 

been paid. If suppliers have information 

or data that proves that specific types of 

DME do not routinely last for 5 years, 

they can furnish this information to 

CMS for consideration in possibly 

establishing a new reasonable useful 

lifetime for equipment. 

Comment: A commenter stated that 

suppliers are financially unable to 

furnish additional equipment in the 

event it needs to be replaced after the 

title is transferred. Another commenter 

noted that once the title is transferred, 

patients may find it difficult to locate an 

oxygen supplier that is willing or able 

to provide them with a loaner unit on 

short notice. 

Response: We expect that oxygen 

equipment and capped rental items 

furnished by the supplier will function 

for the entire period established under 

Medicare regulations and program 

instructions as the reasonable useful 

lifetime. As long as suppliers are 

furnishing items that meet this standard, 

they should not generally need to 

replace beneficiary-owned items and 

should not suffer the kind of financial 

hardship envisioned by the commenter. 

In addition, we believe that the 

modifications to our maintenance and 

servicing policy will limit the 

possibility that oxygen equipment will 

not be properly maintained after the 

beneficiary acquires title to it. 

Accordingly, we are finalizing our 

proposal to require that suppliers 

replace malfunctioning oxygen 

equipment that does not last for its 

reasonable useful lifetime, however, as 

explained more fully below, we are 

modifying it to allow carriers greater 

discretion in determining when a 

supplier must replace the item at no 

charge to the beneficiary or the 

Medicare program. We are also 

finalizing the same proposal with 

respect to capped rental DME. The 

replacement item must be equipment of 

equal or greater value to the equipment 

being replaced. We have never 

encountered major problems associated 

with beneficiaries obtaining servicing of 

equipment. Due to the current 

abundance of oxygen suppliers, we 

believe that this will also be the case 

with regard to servicing of beneficiaryowned oxygen equipment. 

Comment: A commenter noted that 

our current definition of ‘‘useful life’’

exceeds the warranty that manufacturers 

typically provide on most of the current 

oxygen technologies, and expressed 

concern that forcing a supplier to be 

financially responsible for a device 

beyond the manufacturer’s warranty 

period would impose a significant 

financial burden on suppliers. The 

commenter stated that Medicare should 

modify its definition of ‘‘useful life’’ and 

develop technology or equipmentspecific definitions. Another commenter 

noted that it is unclear in the rule if we 

are basing ‘‘lifetime’’ on manufacturer 

warranty or some other basis. The 

commenter stated that basing our 

definition of ‘‘lifetime’’ on the 

manufacturer warranty could be 

problematic since an equipment’s 

‘‘lifetime’’ varies widely by 

manufacturer and type of equipment. 

Response: Under § 414.220(f) of our 

regulations, the reasonable useful 

lifetime of durable medical equipment 

is either the period established through 

program instructions or, in the absence 

of program instructions, the period 

determined by our carriers (at least five 

years). These periods are not based on 

manufacturer warranties. If suppliers 

have information or data that proves 

that specific types of durable medical 

equipment do not routinely last for five 

years, they can furnish this information 

to CMS for consideration in possibly 

establishing a new reasonable useful 

lifetime for equipment. In addition, 

consistent with how we currently 

measure the reasonable useful lifetime 

for capped rental items, we would 

measure the reasonable useful lifetime 

for oxygen equipment beginning on the 

date that the equipment is furnished to 

the beneficiary. 

Comment: Several commenters 

requested that we not adopt the 

proposal that a supplier be required to 

replace equipment once accumulated 

repair costs exceed 60 percent of the 

cost to replace the equipment. Although 

the commenters acknowledged that the 

60 percent threshold was based on a 

similar replacement provision for 

artificial limbs, the commenters do not 

believe that the proposal is appropriate 

since unlike oxygen, artificial limbs do 

not require regular maintenance or 

additional supplies that must be 

regularly replaced in order to function 

properly. The commenters also noted 

that the proposed rule does not define 

‘‘replacement cost’’ and how such cost 

would be calculated in determining the 

60 percent threshold. According to the 

commenters, the proposal is not clear 

regarding whether the ‘‘replacement 

cost’’ is the original cost to Medicare of 

the equipment being replaced, the 

Medicare fee schedule amount, or the 

fair market value of the item. Several 

commenters requested that we eliminate 

the 60 percent analysis and reimburse at 

the cost of each incident of repair rather 

than the accumulation of repairs. 

Several commenters noted that given 

the 5-year useful lifetime of the 

equipment, the circumstances that 

would require equipment to be replaced 

may be so far removed from the date 

that title transferred that there would be 

no plausible connection between the 

supplier’s actions and a conclusion that 

the supplier delivered substandard 

equipment. Several commenters 

requested that responsibility for the 

equipment shift to the patient once the 

title transfers because the supplier will 

not have any record of routine 

maintenance in years four and five, 

placing the supplier in the position of 

having to replace equipment that may 

not have been properly maintained. One 

commenter suggested that we could 

establish a supplier responsibility 

period of 30 days following transfer of 

title that would require replacement if 

the repair costs were 60 percent of the 

replacement cost. Some commenters 

indicated that we appear to be trying to 

balance appropriate coverage for needed 

non-warranty repairs with beneficiary 

protection from receiving poor quality 

equipment via the proposed rule that 

covers repairs until they accumulate to 

60 percent of the replacement cost. 

Some commenters indicated that some 

equipment, such as semi-electric 

hospital beds and power wheelchairs, 

have component parts that can be quite 

expensive to repair/replace and that 

these costs could easily exceed the 60 

percent trigger but still be in the 

equipment’s useful lifetime. Repairs of 

such equipment are often a function of 

active use, not poor quality of defective 

equipment. 

One commenter remarked that there 

are areas of the proposed rule that 

present legal concerns because Medicare 

does not have statutory authority to 

implement these requirements. The 


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commenter is unaware of any statutory 

requirement for the repair or 

replacement of patient-owned 

equipment or for the use of a 60 percent 

threshold. Moreover, CMS has not 

conducted any independent laboratory 

studies or manufacturer surveys of DME 

or oxygen equipment to determine if the 

5-year ‘‘average useful life’’ is accurate 

or current before making it subject to 

such a provision. 

Response: We agree with the 

commenters that the proposed 60 

percent threshold may not be pertinent 

in all cases and have revised the final 

rule to reflect a more general policy. 

Equipment furnished must function for 

the entire period established under 

Medicare regulations and program 

instructions as the reasonable useful 

lifetime. We are modifying our proposal 

to permit our contractors to use the 60 

percent repair threshold at their 

discretion when making case-by-case 

determinations on whether a supplier 

must replace equipment that does not 

function during the reasonable useful 

lifetime. However, we continue to 

believe that the 60 percent threshold is 

a useful factor for our carriers to 

consider because it is probative of 

whether the beneficiary has been 

furnished with, and the Medicare 

program has paid for, a substandard 

item. 

The replacement item must be 

equipment of equal or greater value to 

the equipment being replaced. Under 

§ 414.210(f) of our regulations, the 

reasonable useful lifetime for DME is 

five years, unless we determine 

otherwise. For a capped rental DME 

item, § 414.229(b) of our regulations 

specifies that the monthly fee schedule 

amount for rental of the item equals ten 

percent of the purchase price for the 

item; therefore, the replacement cost of 

the item is equal to the rental fee 

schedule amount multiplied by ten. For 

oxygen equipment, there is no 

established purchase price for Medicare 

purposes, so the replacement cost of an 

item will be established by the carrier 

on an individual, case-by-case basis 

using information such as invoices to 

determine the replacement cost of the 

item. With respect to beneficiary-owned 

oxygen equipment, ‘‘repair’’ costs will 

not include the costs of labor associated 

with general maintenance and servicing 

of the equipment. 

Comment: One commenter requested 

that we provide information about how 

equipment failures due to beneficiary 

neglect or abuse will be determined. 

Another commenter questioned who is 

responsible for providing the 

replacement equipment in the event that 

there is more than one supplier 

involved, for example, if the beneficiary 

moves. 

Response: We are finalizing a policy 

that would allow CMS or the carrier to 

make determinations if replacement 

equipment is warranted. We will be 

monitoring the number of replacement 

equipment provided to a beneficiary. In 

the case that a beneficiary is abusing or 

neglecting the equipment, CMS or the 

carrier may determine that the supplier 

is not responsible for furnishing 

replacement equipment. 

Comment: One commenter suggested 

that in lieu of prohibiting the 

replacement of equipment during the 

period of continuous use, CMS can 

require that the beneficiary receive title 

to equipment that is of comparable 

quality to the equipment delivered at 

the beginning of the period of 

continuous use. 

Response: As we explained above, we 

have decided to modify our proposal 

and allow suppliers to furnish different 

equipment during the rental period as 

long as the equipment is of equal or 

greater value as the equipment being 

replaced. 

Comment: Several commenters 

questioned that under the proposed 

regulations, a new period of continuous 

use would begin only when beneficiaryowned equipment is lost, stolen or 

irreparably damaged. The commenter 

requested that a new period of 

continuous use begin when a supplier 

furnishes replacement equipment 

during the period of continuous use. 

Otherwise, suppliers replacing lost 

equipment will be forced to transfer title 

to two devices, but receive payment 

only for one. Alternatively, commenters 

suggested allowing the carriers to make 

the determination whether to initiate a 

new period of continuous use on a caseby-case basis. Two commenters stated 

that while they agree with the proposed 

provision that a new period of 

continuous use would begin when 

beneficiary-owned equipment is lost, 

stolen, or irreparably damaged, they 

questioned our decision to apply this 

exception only to beneficiary-owned 

equipment. The commenters noted that 

when equipment is lost, stolen, or 

irreparably damaged during the period 

of continuous use and a supplier 

furnishes replacement equipment, a 

new period of continuous use should 

begin; otherwise, the regulation would 

impose a patently unfair result when 

rented equipment is lost or damaged 

through no fault of the supplier. The 

commenters suggested if this is the case, 

CMS should allow carriers to make the 

determination whether to initiate a new 

period of continuous use on a case-bycase basis to ensure a more balanced 

application of the requirement to 

transfer equipment ownership to 

beneficiaries. 

Response: Current rules regarding 

replacement of capped rental items 

located at § 414.229(g) allow for 

replacement of rented items if the 

carrier determines that the item is lost 

or irreparably damaged. In the proposed 

rule, we inadvertently deleted this text 

when we proposed to revise 

§ 414.229(g), although we never 

intended to change this longstanding 

policy, which reflects our belief that 

suppliers should be compensated for 

furnishing a new rental item if the item 

is needed as a result of circumstances 

beyond the supplier’s control. 

Therefore, as part of this final rule, we 

will reincorporate this policy in our 

regulations but will move it to 

§ 414.210(f), the general section on 

replacement of equipment, so that the 

policy applies to all rented items. To be 

consistent with what we proposed in 

the context of beneficiary-owned items, 

we will also specify that this policy 

would also apply if an item is stolen. 

However, we continue to believe that 

a new period of continuous use should 

not automatically begin whenever the 

beneficiary changes equipment (that is, 

from equipment falling under one 

HCPCS code to different but similar 

equipment described by another HCPCS 

code). This is consistent with 

longstanding policy relating to payment 

for DME. This policy can be found in 

section 30.5.4 of Chapter 20 of the 

Medicare Claims Processing Manual 

(Pub. 100–04). In no case can a new 

rental period begin for a change in 

equipment from one product within a 

HCPCS code to another product within 

the same HCPCS code or from one 

oxygen modality within a payment class 

to another oxygen modality within a 

payment class. Items falling within the 

same HCPCS code and paid based on 

the same payment rules and fee 

schedule amounts are considered the 

same item or service for Medicare 

purposes. Likewise, oxygen modalities 

falling under the same payment class 

and paid based on the same payment 

rules and fee schedule amounts are 

considered the same item or service for 

Medicare purposes. Oxygen modality 

changes are generally done for the 

convenience of the beneficiary, and not 

because they are medically necessary. 

The Medicare NCD and contractor LCDs 

establish medical necessity criteria for 

oxygen and oxygen equipment, but do 

not establish separate medical necessity 

criteria for different types or modalities 

of stationary or portable oxygen 

equipment. We also note that 

beneficiaries who wish to exchange 


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equipment or oxygen modalities during 

the rental period for reasons other than 

medical necessity can be required to 

sign an ABN. 

Periods of Continuous Use 

Comment: Several commenters 

requested that we clarify how a ‘‘break 

in service’’ applies to short-term or 

intermittent usage of home oxygen 

therapy. They stated that patients that 

fall within the Group II oxygen coverage 

guidelines may not be sufficiently 

hypoxemic to require ongoing oxygen 

therapy and their short-term use should 

not be included in the 36-month 

continuous rental period. They also 

stated that other ‘‘breaks in service’’ that 

should not count towards the period 

include skilled nursing facility stays or 

acute care admissions any longer than a 

month. The commenters noted that 

current rules at § 414.230(c) state that an 

interruption in the use of the equipment 

of not longer than 60 consecutive days 

plus the days remaining in the rental 

month in which use ceases is 

temporary, regardless of the reason for 

the interruption. Current Medicare 

program instructions indicate that a new 

rental period begins in cases where the 

interruption is greater than 60 days plus 

the days remaining in the rental month 

in which use ceases if it is supported by 

new medical necessity documentation. 

The commenters believe that there is no 

basis for CMS to apply different breakin-service rules to oxygen. 

One commenter stated that 

beneficiary enrollment/disenrollment in 

Medicare managed care plans further 

complicates our proposals on switching 

equipment and consistent assignment 

during the rental period. The 

commenter indicated that a single 

beneficiary may be in traditional 

Medicare, enroll in one HMO, disenroll 

and go back on transitional Medicare, 

then enroll in a different HMO all in one 

rental period. The commenter 

questioned how these scenarios can 

possibly be addressed in a reasonable 

manner under the proposed rule. 

Response: The rules for defining a 

period of continuous use for which we 

make payments for DME were first 

adopted in an October 9, 1991 interim 

final rule with comment (56 FR 50821). 

In that rule, we stated that we believed 

certain language in the House 

Committee Report accompanying 

section 4062(b)(1) of the Omnibus 

Reconciliation Act of 1987 (Pub. L. 100–

203) (which authorized the 

implementation of the DME fee 

schedules) indicated that Congress did 

not intend for a period of continuous 

use to automatically terminate each time 

there was a break in service. Therefore, 

we stated that an interruption in the 

rental period of not longer than 60 days 

plus the days remaining in the rental 

month in which the use ceases would be 

considered a temporary suspension of 

the period of continuous use pending 

resumption of medical need. This 

precedent, which we finalized in a 

December 3, 1992 final rule (57 FR 

57109), has now become longstanding 

Medicare policy, has worked well 

throughout the years and has addressed 

all of the situations highlighted by the 

commenters (e.g., short term use of 

DME, breaks-in-service, etc.). Therefore, 

we believe that these rules should 

continue to apply. In accordance with 

§ 414.230(c) and current program 

instructions found in section 30.5.4 of 

Chapter 20 of the Medicare Claims 

Processing Manual (Pub. 100–04), if the 

interruption is less than 60 consecutive 

days plus the days remaining in the 

rental month in which use ceases, 

contractors will not begin a new rental 

period. Also, when an interruption 

continues beyond the end of the rental 

month in which the use ceases, 

contractors will not make payment for 

additional rental until use of the item 

resumes. Contractors will establish a 

new date of service when use resumes. 

Unpaid months of interruption do not 

count toward the 15-month limit. These 

policies will apply to beneficiary-owned 

oxygen equipment and capped rental 

DME. In addition, because Medicare 

makes payment for a rental item on the 

date of delivery of the item, and 

payment for each subsequent rental 

month on the same day, or ‘‘anniversary 

date’’ for that month, if the break in 

service is short, the supplier would still 

be paid for that rental month. 

Comment: Several commenters were 

concerned about the impact and 

interaction of the proposed DRA policy 

and payment changes and the 

competitive bidding provisions. One 

commenter noted that certain DRA 

provisions and planned competitive 

bidding provisions overlap and conflict. 

The commenters requested that we 

clarify the conflicts in both final rules. 

The commenter stated that, for example, 

a rule conflict exists when a contract 

supplier is forced to accept an oxygen 

patient with only 6 months rental left in 

the 36-month rental period. To address 

this conflict, the commenter suggested 

that we allow the 36-month period to 

start over again whenever a patient 

switches suppliers if less than 36 

months of continuous use have 

transpired. 

Response: We will address issues that 

pertain to the Medicare DMEPOS 

Competitive Bidding Program in the 

final rule for that program. 

Comment: Several commenters 

requested that we clarify which 

supplier’s equipment transfers to the 

beneficiary if the beneficiary has two 

residences in different areas and uses a 

local supplier in each area. They stated 

that ‘‘snow birds’’ may face hurdles in 

maintaining access to equipment unless 

a new period of continuous use begins 

when they change suppliers. The 

commenters suggested that extended 

travel outside of the supplier’s service 

area should not be counted toward the 

period of continuous use to the extent 

the supplier is not paid for furnishing 

the oxygen equipment during that 

period. Another commenter noted that 

the proposed rule does not address how 

suppliers that coordinate services for 

patients who travel after they have 

purchased the equipment will be 

reimbursed. Another commenter 

indicated that the proposed rule was 

unclear on the methodology for those 

who have two homes during different 

times of the year. The supplier in the 

new area will not have the full 36 

months to collect reimbursement. 

Response: We expect that travel 

arrangements for beneficiaries with 

oxygen equipment would be handled by 

suppliers in the same manner that such 

instances are currently arranged for 

beneficiaries with capped rental items. 

Capped rental items have been paid 

under these circumstances and 

addressed through program instructions 

since 1989. The capped rental policies 

that apply when a beneficiary changes 

suppliers are listed in section 30.5.4 of 

chapter 20 of the Medicare Claims 

Processing Manual (Pub. 100–04) and 

indicate that if a beneficiary changes 

suppliers during or after the rental 

period, this does not result in new 

rental episode. The equipment 

furnished to the beneficiary at the time 

that transfer of title is required by the 

statute and this final rule is the 

equipment for which the beneficiary 

would receive title to. 

Beneficiary Safeguards 

Comment: One commenter stated that 

we should add an additional safeguard 

to protect beneficiaries if their initial 

supplier decides to discontinue service 

once title of the oxygen equipment 

transfers to the beneficiary. The 

commenter recommended that we add a 

new paragraph in § 414.226(g) requiring 

the supplier that furnishes the oxygen 

equipment throughout the rental period 

to notify the beneficiary no later than 3 

months before the end of the rental 

period that the supplier will no longer 

continue to provide services once the 

transfer of title takes place. The 

commenter believes this will give the 


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beneficiary adequate notice and time to 

find another comparable supplier and 

will not leave a gap in their service once 

ownership takes place. The commenter 

noted that current DME Quality 

Standards establish certain ‘‘consumer 

services,’’ but they do not address this 

issue. 

Response: We agree with this 

comment but believe that 2 months is a 

more reasonable period of time in terms 

of how much advance notice should be 

given to beneficiaries in these 

situations. We have revised § 414.226(g) 

to require the supplier to notify the 

beneficiary no later than 2 months 

before the end of the rental period if the 

supplier will no longer continue to 

maintain and service the equipment, 

and/or deliver oxygen contents, once 

the transfer of title takes place. 

Likewise, in order to be consistent with 

our policies, we are revising 

§ 414.229(g) to require the supplier of a 

capped rental item to disclose no later 

than two months before title transfers 

whether it will continue to maintain 

and service the item. Because we 

recognize that there may be isolated 

cases where a supplier cannot satisfy 

this requirement (such as if the supplier 

goes out of business), we (or our 

carriers) will also allow for exceptions 

on a case-by-case basis. 

Comment: One commenter stated that 

we should require suppliers to re-train 

beneficiaries (and/or their caregivers) on 

the services they will need to perform 

on oxygen equipment at the time the 

suppliers transfer ownership and to 

verify in writing that the beneficiary/ 

caregiver has actually performed the 

tasks for which they will be responsible 

to ensure that they are capable of doing 

so. The commenter recommended that 

we add an additional safeguard in 

§ 414.226(g) that would require the 

supplier at the time of transfer to retrain the beneficiary and/or caregiver 

with respect to information regarding 

preparation of formulas, features, 

routine use, troubleshooting, cleaning, 

maintenance, safety conditions, and 

infection control. The commenter stated 

that although these requirements are 

currently contained in the DME Quality 

Standards, their supplier is only 

required to verify that the beneficiary 

received the instructions and 

information at the time of setup, not that 

he or she understood them or could 

perform them. The commenter believes 

that re-training and verification in 

writing by the supplier that the 

beneficiary and/or caregiver can 

actually carry out the tasks could 

prevent serious injuries and lifethreatening situations in the future. 

Response: We do not believe that it is 

necessary to revise § 414.226(g) as 

recommended. The DRA requires CMS 

to pay separately for any reasonable and 

necessary maintenance and servicing of 

capped rental or oxygen equipment after 

title transfers to the beneficiary. We 

proposed to continue our longstanding 

policy of paying for reasonable and 

necessary repairs and non-routine 

maintenance and servicing that a 

beneficiary cannot perform. In response 

to comments, we have also decided to 

add an exception in the final rule under 

which, beginning 6 months after title to 

oxygen equipment transfers to the 

beneficiary, the supplier may bill for 

general maintenance and servicing of 

certain beneficiary-owned oxygen 

equipment once every 6 months. As for 

routine maintenance that may be 

necessary beyond what Medicare will 

pay for, we also note, as we did in the 

proposed rule, that by the time title 

transfers for oxygen equipment and 

capped rental items, beneficiaries and/ 

or their caregivers should be very 

familiar with their equipment and the 

routine maintenance that is required to 

maintain it. In addition, we note that we 

would expect that at the time of title 

transfer, suppliers would provide 

beneficiaries with operating manuals 

describing their equipment and the 

servicing that must be done to maintain 

it. Beneficiaries could also access many 

of these manuals on manufacturer Web 

sites. 

Comment: One commenter was 

concerned that if the beneficiary 

safeguards are imposed at the same time 

as reduced reimbursement, the viability 

of many oxygen suppliers will be 

threatened, thus affecting patient access 

to oxygen equipment and contents. 

Response: We appreciate the 

comment. However, we believe that the 

provisions discussed in the proposed 

rule and in this final rule with respect 

to oxygen equipment, oxygen contents, 

and capped rental DME items are 

necessary to ensure that our 

beneficiaries receive the appropriate 

equipment and service both during the 

rental period and after they assume title 

to the item. In addition, the beneficiary 

safeguards that we are implementing 

with this final rule reflect what we 

believe to be fair business practices, are 

consistent with our DMEPOS Quality 

Standards, and should not impose 

undue burdens on the suppliers. We 

have clarified our proposals in a number 

of places after considering all of the 

comments received in order to reduce 

the burden on suppliers. 

Comment: One commenter 

recommended that in conjunction with 

this rule, we should impose safeguards 

(for instance, limits on the number of 

times a beneficiary can switch 

suppliers) that prevent beneficiaries 

from gaming the system. 

Response: We do not agree that 

having no limits on the number of times 

that a beneficiary can switch suppliers 

will encourage gaming because under 

this rule, changing suppliers does not 

result in a new period of continuous 

use. Although we cannot envision every 

conceivable gaming scenario, we believe 

that we have fully considered the needs 

of beneficiaries in adopting this rule and 

that the protections we are 

implementing will strongly discourage 

gaming by unscrupulous suppliers. 

Comment: One commenter agreed 

with our proposed beneficiary 

safeguards since suppliers should be 

furnishing items in good working order 

and are otherwise bound by regulations 

at § 424.57(c)(15) to accept returns from 

beneficiaries of substandard items. 

Response: We appreciate the support 

of our proposed beneficiary safeguards. 

We believe that these changes in concert 

with the implementation of the 

DMEPOS quality standards will ensure 

that beneficiaries receive quality 

equipment and appropriate services 

throughout the rental period and after 

title transfer. 

Comment: We received numerous 

comments regarding our continuity of 

equipment proposal. Commenters stated 

that our attempt to ensure that suppliers 

do not substitute substandard 

equipment to patients just before the 

required transfer of title is too 

restrictive. Several commenters 

recommended that suppliers be allowed 

to exchange and/or change a 

beneficiary’s equipment during the 

period of medical need, provided this 

exchange/change is documented. 

However, commenters were concerned 

that the proposed rule does not define 

a change in medical condition or 

provide enough detail to understand 

how and when patients will be entitled 

to switch oxygen modalities, or how it 

will be documented so that suppliers 

will be paid appropriately and 

promptly. Commenters also asked for 

additional clarity regarding our 

interpretation of ‘‘modality’’ and asked 

for specific circumstances when 

patients may be changed from one type 

of equipment to another. Commenters 

recommended that we allow suppliers 

to judiciously exchange or change a 

patient’s equipment during the period of 

medical need provided that this 

exchange or change is sufficiently 

documented and that the supplier 

certifies that the new equipment is not 

a lesser-quality device. Commenters also 

recommended that we instruct our DME 


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Program Safeguard Contractor (PSC) 

medical directors to incorporate specific 

medical necessity coverage and 

documentation requirements in the 

revised Oxygen and Oxygen Equipment 

LCD before the proposed January 1, 

2007 implementation date of this 

regulation. Specifically, the revised LCD 

should address: (a) Under what 

circumstances or diagnoses it is 

medically necessary to change from one 

oxygen modality or equipment type to 

another; (b) how suppliers will be 

reimbursed for changing equipment; 

and (c) specific documentation 

requirements for both the supplier and 

the physician to ensure that the 

contractors can make appropriate 

coverage determination. 

Commenters also raised concerns 

about the potential impact the 

continuity of equipment proposals 

could have on beneficiary access to new 

oxygen technology. They stated that 

there are fairly common circumstances 

where a supplier must exchange 

equipment in order to best serve the 

beneficiary. For example, if suppliers 

cannot exchange equipment, they may 

have to perform a complex repair in the 

patient’s home. Suppliers should not be 

placed in a situation where they have to 

choose between not being able to 

provide service to the beneficiary at the 

time of need versus providing a higher 

level of equipment and taking a 

financial loss over the remaining rental 

period if they are unable to switch to the 

prescribed level of equipment. 

Commenters recommended that the 

proposed rule be modified to clarify that 

it is acceptable for a supplier to 

exchange equipment if (a) the exchange 

is for same or similar equipment; or (b) 

the exchange is to equipment that better 

matches a physician’s order. 

Commenters also stated that it is 

unreasonable to mandate a supplier to 

continue to service a beneficiary if the 

beneficiary is non-compliant with the 

supplier’s instruction on the safe and 

appropriate use of the medical 

equipment. They recommended that the 

oxygen supplier be responsible for 

transferring title for the total number of 

liquid oxygen vessels or oxygen 

cylinders that would be present in the 

patient’s home at one time. 

Response: We appreciate the concerns 

presented by the commenters. Medicare 

pays for two classes of equipment, 

stationary and portable. For the 

stationary class, there are three 

modalities that Medicare pays the same 

‘‘modality neutral’’ payment rate for: 

concentrator, liquid cylinders, and 

gaseous tanks. For the portable class, 

Medicare makes a modality neutral 

payment for all types of portable 

equipment. As we explained above, we 

are finalizing our proposal to add a new 

payment class for oxygen-generating 

portable equipment and separate classes 

for delivery of stationary and portable 

oxygen contents. As has always been the 

case, a physician may order a specific 

oxygen equipment modality based on 

the clinical needs of the patient; and the 

supplier is bound by that order. In 

addition, there is currently no Medicare 

national coverage determination (NCD) 

that establishes medical necessity 

criteria for different oxygen modalities. 

The carrier would still maintain the 

ability to determine that a change in 

equipment is warranted for reasons 

other than those described above. 

Instructions for the DME PSC 

contractors are not part of rulemaking, 

and will be handled under local carrier 

coverage policies. 

After considering all of the comments, 

we are finalizing a policy that would 

allow for four general exceptions to the 

rule that a supplier may not exchange 

equipment during the rental period. We 

believe that these exceptions are flexible 

enough to allow beneficiaries and 

suppliers to exchange equipment where 

appropriate, but limited enough to 

protect beneficiaries from a situation 

where their equipment could be 

replaced with less valuable equipment 

just prior to the date when they acquire 

ownership of it. In all cases, the 

replacement item must be equipment of 

equal or greater value to the equipment 

being replaced. 

(1) The supplier replaces an item with 

the same, or equivalent, make and 

model of equipment because the item 

initially furnished was lost, stolen, 

irreparably damaged, is being repaired, 

or no longer functions. 

(2) The physician orders different 

equipment for the beneficiary. If the 

need for different equipment is based on 

medical necessity, then the order must 

indicate why the equipment initially 

furnished is no longer medically 

necessary, and the supplier must retain 

this order in the beneficiary’s medical 

record. 

(3) The beneficiary chooses to obtain 

a newer technology item or upgraded 

item and signs an ABN. 

(4) CMS or its carriers determine that 

a change in equipment is warranted. 

Comment: We received numerous 

comments regarding our proposal to 

require that a supplier that furnishes 

rented oxygen equipment or capped 

rental items to the beneficiary must 

continue to furnish that item throughout 

the whole rental period except in 

certain situations. These comments 

focused on varying scenarios where 

patients move or choose to switch 

suppliers due to dissatisfaction with 

their service. Commenters were 

concerned that patients in these 

situations will experience an access-tocare issue as few suppliers will accept 

such a patient if he/she has only a few 

months left on the rental schedule but 

would be expected to provide oxygen 

equipment, including the back-up and 

other un-reimbursed equipment. This 

will create inequities as a supplier 

might be required to provide a brand 

new piece of equipment to a beneficiary 

for 10 months of the 36 months, as an 

example, and this de facto diminished 

reimbursement could deter suppliers 

from offering services to Medicare 

beneficiaries and diminish beneficiary 

access to oxygen supplies. Commenters 

recommended that we specify that a 

new 36-month period begins in 

conjunction with this provision. 

Response: In an October 9, 1991 

interim final rule with comment period 

(56 FR 50821), we first adopted our 

policy that precludes a new period of 

continuous use from beginning when a 

beneficiary changes suppliers. In 

adopting that policy, we looked to the 

House Committee Report that 

accompanied the enactment of the 

Omnibus Budget Reconciliation Act of 

1987 (Pub. L. 100–203), which 

authorized implementation of the fee 

schedules for DME. The House report 

stated that a change in suppliers during 

an otherwise uninterrupted period 

should be considered continuous. 

Therefore, we adopted § 414.230(g), 

which provides that if the beneficiary 

changes suppliers during or after the 

equipment rental period, that change 

would not result in a new rental period. 

Since we first adopted this policy, we 

believe that suppliers have been able to 

adequately accommodate beneficiaries 

who change suppliers, and we see no 

reason to change this policy now. 

After reviewing the comments on this 

issue, we have maintained our proposal 

requiring a supplier who furnishes 

rented oxygen equipment/capped rental 

for the first month for which payment 

is made to continue to furnish that item 

throughout the 36/13-month period of 

continuous use for as long as it is 

medically necessary, except in the 

following cases: 

• The item becomes subject to a 

competitive acquisition program; 

• A beneficiary relocates on either a 

temporary or permanent basis to an area 

that is outside the normal service area 

of the initial supplier; 

• The beneficiary chooses to obtain 

equipment from a different supplier; or 

• Other cases in which CMS or the 

carrier determine that an exception is 

warranted. 


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We continue to believe that these 

policies are necessary to ensure that 

beneficiaries have adequate access to 

oxygen equipment and capped rental 

items because they protect beneficiaries 

from a situation in which an 

unscrupulous supplier could try to take 

back the equipment just before the 

rental period expires in order to retain 

title to it. We note, however, that our 

rules would not require a supplier to 

accept a beneficiary as a customer 

simply because a beneficiary chooses to 

change suppliers. In addition, we note 

that we are considering certain policies 

that would address how contract 

suppliers are reimbursed if they must 

begin furnishing items to beneficiaries 

midway through the rental period under 

a competitive bidding program, and we 

expect to fully address this issue in the 

final rule that implements the Medicare 

DMEPOS Competitive Bidding Program. 

Comment: One commenter noted that 

our literal interpretation of the DRA 

would require suppliers to track 

equipment by serial number in order to 

make sure the beneficiary receives title 

to the equipment that the supplier 

furnished originally. The commenter 

stated that this will be very difficult for 

suppliers to accomplish and suggested 

that during the period of continuous 

use, suppliers be permitted to continue 

the current practice of simply replacing 

equipment in need of service or repair 

with equipment of the same type that is 

in good working order. This practice 

will allow suppliers to streamline their 

operations and serve beneficiaries more 

efficiently equipment that must be 

repaired or serviced at the supplier’s 

facility. The commenter further stated 

that we can address this issue simply by 

requiring that the beneficiary receive 

title to equipment that is of comparable 

quality to the equipment delivered at 

the beginning of the period of 

continuous use. Another commenter 

stated that we should not impede 

service delivery by restricting 

replacement of equipment during the 

capped rental period. The commenter 

indicated the equipment requirement 

would limit the ability of the new 

patient to try new or different 

equipment/enhanced technology. 

Response: Suppliers have access to 

and frequently use current inventory 

tracking technology that allows them to 

easily track specific items they take 

from their inventory and furnish to a 

patient in their home. This is a normal 

part of the supplier’s business. As 

explained above, suppliers of oxygen 

tanks and cylinders do not need to track 

specific tanks and cylinders belonging 

to beneficiaries. In addition, as 

explained above, this final rule allows 

the suppler to replace equipment during 

the rental period in certain situations. 

Comment: One commenter remarked 

that the proposed rule states that the 

current supplier or beneficiary is 

responsible for finding a new supplier if 

a beneficiary needs to relocate from one 

service area to another service area 

during the rental period. The 

commenter indicated that this should be 

limited to the beneficiary since it is the 

choice of the beneficiary to relocate and 

not that of the supplier. 

Response: While the proposal states 

that the supplier or beneficiary would 

need to arrange for another supplier in 

the new area to furnish the item, it does 

not mandate that the supplier, rather 

than the beneficiary, must make these 

arrangements. In cases where the 

supplier elects not to provide this 

service to the beneficiary, the 

beneficiary or caregiver for the 

beneficiary would need to make these 

arrangements. This proposal is 

consistent with current practice and is 

being adopted as part of this final rule. 

Assignment 

Comment: We received numerous 

comments on the Medicare assignment 

proposal. Some commenters requested 

clarification of our notice requirements 

about Medicare assignment to ensure it 

is consistent with the general rule that 

participating suppliers agree to accept 

assignment on an annual basis and can 

modify their status as a participating 

supplier as well. They also requested 

clarification that suppliers disclose to 

beneficiaries their intent to accept 

assignment on all claims for the 

duration of the rental period, and stated 

that the supplier should be able to 

clarify under what circumstances 

assignment would no longer be 

appropriate, such as if the beneficiary is 

no longer eligible for coverage. Some 

commenters noted that we do not have 

the authority to change Medicare 

assignment terms and should not 

require suppliers to disclose their 

intentions regarding assignment for the 

entire duration of the rental periods. 

Commenters indicated that current 

Medicare supplier standards require a 

supplier to inform patients of whether 

or not it will accept assignment for one 

month at a time (per claim) and that it 

is unreasonable for us to expect a 

supplier to commit to accepting 

assignment for the entire rental period 

when policies, payment levels or other 

things could change by the end of the 

first year. Some commenters requested 

that we not adopt our proposal to post 

assignment statistics for each supplier 

on our website, but that if we proceed 

with publication, we should coordinate 

this effort with suppliers to ensure 

correct information is distributed to the 

public. Some commenters observed that 

we do not indicate how often we will 

make web postings and how we will 

verify the accuracy of postings. This 

could result in an inaccurate picture of 

a supplier’s assignment history since 

suppliers could choose not to accept 

assignment for a variety of reasons, 

which a basic percentage will not 

demonstrate. If we intend to post 

assignment information, commenters 

believe that we should give suppliers 30 

days notice, as well as an opportunity 

to review information prior to posting 

and to correct erroneous information or 

identify the risks posed by erroneous 

information. Commenters indicated that 

we cannot require suppliers to enter 

into private contracts for the duration of 

the period of continuous use. Finally, 

commenters stated that we must clarify 

in the final regulation whether a 

supplier may accept assignment for a 

portion of the rental period, since 

allowing this type of assignment 

arrangement would still further the 

stated intent to create a reasonable rule 

for suppliers and ensure that 

beneficiaries have the information 

necessary to make informed choices. 

Response: Under Medicare, DME 

suppliers can accept assignment on a 

claim-by-claim basis. If a supplier 

accepts assignment, the supplier agrees 

to request direct payment from 

Medicare for the item, to accept 80 

percent of the Medicare allowed 

payment amount for the item from the 

carrier, and to charge the beneficiary not 

more than the remaining 20 percent of 

the Medicare approved payment 

amount, plus any unmet deductible. If 

a supplier elects not to accept 

assignment, Medicare pays the 

beneficiary 80 percent of the Medicare 

allowed payment amount, after 

subtracting any unmet deductible, and 

there is no limit under Title XVIII of the 

Act on the amount the supplier can 

charge the beneficiary for rental of the 

DME item. The beneficiary, in these 

situations, is financially responsible for 

the difference between 80 percent of the 

Medicare allowed payment amount and 

the amount the supplier charges for the 

rental of the DME item. 

Suppliers can also sign a participation 

agreement where they agree voluntarily, 

before a calendar year, to accept 

assignment for all Medicare items and 

services furnished to a beneficiary for 

the following calendar year. Current 

supplier participation agreements are 

renewable annually. 

In the proposed rule, we did not 

propose to change the current voluntary 


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participation agreement. Nor did we 

propose to change acceptance of 

assignment on a claim-by-claim basis for 

suppliers who do not sign participation 

agreements. However, we did point out 

that the calendar year participation 

agreements do not coincide with a 

beneficiary’s full period of medical need 

in cases where such need extends for 

more than a calendar year or where such 

a period overlaps calendar years. While 

a supplier may renew its participation 

agreement annually, a beneficiary 

would not know, before choosing a 

supplier, the intentions of the supplier 

regarding acceptance of assignment of 

all claims during the 13-month or 36- 

month rental period. 

We proposed to require suppliers to 

give beneficiaries advance notice of the 

possible extent of their financial 

liability during the period of medical 

need in which monthly rental payments 

are made for the equipment so that they 

can use this information to make an 

informed choice of supplier. We 

proposed that before furnishing the 

oxygen equipment or a capped rental 

item, the supplier must disclose to the 

beneficiary its intentions regarding 

whether it will accept assignment of all 

monthly rental claims for the equipment 

during the period of medical need, up 

to and including the 36th month of 

continuous use for oxygen equipment or 

the 13th rental month of continuous use 

for capped rental DME in which rental 

payments could potentially be made. 

We indicated that we believe it is 

reasonable for the supplier to disclose to 

each beneficiary its intentions regarding 

acceptance of assignment as this 

decision has a direct financial effect on 

the beneficiary. 

While we proposed to require an upfront declaration on assignment 

intentions, a supplier would not be 

bound by such declaration unless the 

supplier chooses to do so. For example, 

a supplier who routinely signs 

participation agreements and intends to 

accept assignment for all months during 

a beneficiary’s period of medical need 

may choose to let such information be 

known to the beneficiary. Such supplier 

might want to use such information as 

a marketing advantage. A supplier’s 

declaration could indicate that the 

supplier intends to accept assignment 

for a portion of the period of medical 

need. A beneficiary could use such 

information from such supplier and 

compare it with the declaration from 

another supplier who intends to accept 

assignment for the entire period of 

medical need and make a selection 

between such two suppliers. 

While we proposed that a supplier’s 

intentions could be expressed in the 

form of a written agreement between the 

supplier and a beneficiary, we did not 

propose to require a binding written 

agreement. A supplier could select the 

form of the declaration. If a supplier 

chose to offer a written agreement, the 

nature of such agreement would be 

between the supplier and the 

beneficiary. We believe that the required 

declaration is consistent with and 

complements the voluntary 

participation agreement because they 

represent different things; the former is 

a beneficiary-specific declaration of 

intentions applicable to the 

beneficiary’s period of medical need but 

is not binding, while the latter is a 

voluntary agreement that applies to 

claims for all beneficiaries served for a 

calendar year and is binding. 

Assignment applies with respect to 

covered-Medicare services. Thus, a 

supplier’s declaration of assignment 

acceptance would only apply to 

covered-Medicare services. 

In the proposed rule, we indicated 

that in order to promote informed 

beneficiary choices, we plan to post 

information on a CMS and/or CMS 

contractor Web site(s) indicating 

supplier specific information on oxygen 

equipment and capped rental items 

such as (1) the percentage of 

beneficiaries for whom each supplier 

accepted assignment during a prior 

period of time (for example, a quarter), 

and/or (2) the percentage of cases in 

which the supplier accepted assignment 

during the beneficiary’s entire rental 

period. We do not agree with the 

commenters who asked that we not post 

information about assignment statistics 

for each supplier. We believe that such 

information is necessary to promote 

informed beneficiary choices of 

suppliers. It would not be possible to 

promote more informed beneficiary 

choices among suppliers if we did not 

publish such information. Publication of 

such information is consistent with the 

Agency’s goal of promoting 

transparency. We expect that the 

supplier-specific assignment 

information that we post would be 

derived from Medicare paid claims data. 

We plan to give suppliers the 

opportunity to review information prior 

to posting the first time we post 

information. After a period of time, we 

believe that the assignment information 

for a supplier is likely to be relatively 

stable. Thus, rather than delaying the 

posting of information on an ongoing 

basis by providing an opportunity to 

review information prior to each 

posting, we would post the information 

and allow a supplier to contact us or the 

carrier if a supplier believes that 

erroneous information was posted. We 

have not decided how often we would 

post assignment statistics. 

Comment: One commenter asked for 

clarification on whether or not in-home 

clinical assessments will be part of 

patient care after they have received 

home oxygen therapy for 36 months. 

The commenter strongly encouraged us 

to allow patients to continue to receive 

these assessments according to 

physician orders. The commenter noted 

that this activity is sustainable only if 

we establish a new code and an 

appropriate reimbursement rate. 

Response: In-home clinical 

assessments are the responsibility of the 

physician, not the supplier and are 

therefore outside the scope of the DME 

benefit. It is the obligation of the 

physician to ensure that beneficiaries 

continue to be evaluated, as medically 

necessary. 

IV. Provisions of the Final Regulations 

In this final rule, we generally adopt 

the provisions of the August 3, 2006 

proposed rule. We have, however, 

changed the methodology we will use to 

impute a wage index for rural areas. We 

will calculate a rural wage index by 

averaging the wage indexes from all 

CBSAs that we believe are contiguous to 

that rural area if that rural area lacks 

rural hospital wage data. In addition, we 

are revising the fixed-dollar loss ratio 

used in the calculation of the outlier 

payment to reflect the most recent 

available data. 

We are finalizing a policy regarding 

change of equipment during a rental 

period to allow for changes under four 

general scenarios: (1) The supplier 

replaces an item with the same, or 

equivalent, make and model of 

equipment because the item initially 

furnished was lost, stolen, irreparably 

damaged, is being repaired, or no longer 

functions; (2) the physician orders 

different equipment for the beneficiary. 

If the need for different equipment is 

based on medical necessity, then the 

order must indicate why the equipment 

initially furnished is no longer 

medically necessary and the supplier 

must retain this order in the beneficiary 

medical record; (3) the beneficiary 

chooses to obtain a newer technology 

item or upgraded item and signs an 

advanced beneficiary notice (ABN); or 

(4) CMS or the carrier determines that 

a change in equipment is warranted. 

The Medicare contractor can also 

determine that a change in equipment is 

warranted for additional reasons. 

We reincorporated a policy that we 

inadvertently deleted from section 

414.229(g) of our current regulations in 

the proposed rule with regard to 

replacement of equipment to allow for 


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replacement of rented capped rental 

items in cases where the item is lost or 

irreparably damaged. We stated that we 

would be continuing that policy, 

applying it to all rented items, and also 

applying it to cases where an item has 

been stolen. We also stated that we 

would move that policy from 

§ 414.229(g) to § 414.210(f) since it 

would now apply to all rented items. 

We have revised the policy that 

requires suppliers to replace 

beneficiary-owned equipment that they 

furnished that fails to function for the 

full period established as the reasonable 

useful lifetime for the equipment. The 

need for the replacement of the 

equipment will not automatically be 

mandated merely because the repair 

costs are greater than 60 percent of the 

cost to replace the item. Rather, the 

determination regarding the need for 

replacement will be made by the 

Medicare contractor on an individual 

case-by-case basis. 

We added a provision to require 

suppliers to provide information to 

beneficiaries at the time of title transfer 

for oxygen equipment on how to safely 

dispose of oxygen equipment that is no 

longer medically necessary and advise 

that beneficiaries must comply with all 

Federal, State, and local laws that apply 

to the disposal, transport, and resale of 

oxygen equipment. 

We have revised the policy for 

maintenance and servicing of 

beneficiary-owned oxygen equipment so 

that beginning 6 months after title to 

oxygen equipment transfers to the 

beneficiary, the supplier may bill for 

general maintenance and servicing of 

beneficiary-owned oxygen equipment 

once every 6 months. Payment for each 

of these general maintenance calls 

would be limited to 30 minutes of labor, 

plus the reasonable cost for any 

replacement parts. Under this policy, 

suppliers could bill for general 

maintenance and servicing of all oxygen 

equipment except liquid or gaseous 

oxygen equipment (stationary and 

portable). We are also specifying that 

these general maintenance and servicing 

payments would not begin until at least 

6 months after the date that title to the 

equipment transfers. Finally, we will 

make these payments for general 

maintenance and servicing in addition 

to payment for any non-routine repairs 

needed for beneficiary-owned oxygen 

equipment. Suppliers would be able to 

bill for such non-routine maintenance 

beginning immediately after the 

beneficiary assumes ownership of the 

equipment. 

We have revised the provisions 

regarding transfer of title for oxygen 

tanks to clarify that, although Medicare 

payments for oxygen equipment are 

limited to 36 months and the statute 

requires transfer of ownership after 36 

months, the arrangement between the 

supplier and beneficiary allows the 

supplier to replace the beneficiaryowned tanks with new or different tanks 

of equal or greater value when the 

supplier picks up empty tanks to be 

refilled with oxygen contents and 

delivers refilled tanks back to the 

beneficiary. We have also revised the 

provisions to allow for a servicing 

payment when suppliers pick up tanks 

that are no longer medically necessary. 

We have also made several clarifying 

changes to the regulation text. 

We have also added a provision that 

would require a supplier to disclose at 

least 2 months before the date that the 

beneficiary will assume ownership of 

oxygen equipment or a capped rental 

item whether the supplier can maintain 

and service the item after the title 

transfers and, in the case of oxygen 

equipment, whether the supplier can 

deliver oxygen contents. We or our 

carriers would have discretion to make 

exceptions to this requirement on a 

case-by-case basis. 

V. Collection of Information 

Requirements 

Under the Paperwork Reduction Act 

of 1995, we are required to provide 30- 

day notice in the Federal Register and 

solicit public comment when a 

collection of information requirement is 

submitted to the Office of Management 

and Budget (OMB) for review and 

approval. In order to fairly evaluate 

whether an information collection 

should be approved by OMB, section 

3506(c)(2)(A) of the Paperwork 

Reduction Act of 1995 requires that we 

solicit comment on the following issues: 

• The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

• The accuracy of our estimate of the 

information collection burden. 

• The quality, utility, and clarity of 

the information to be collected. 

• Recommendations to minimize the 

information collection burden on the 

affected public, including automated 

collection techniques. 

We are soliciting public comment on 

each of these issues for the following 

sections of this document that contain 

information collection requirements: 

Section 414.2267 Oxygen and Oxygen 

Equipment 

This section requires the supplier to 

disclose to the beneficiary, prior to the 

furnishing of oxygen equipment, 

whether or not it will accept assignment 

of all monthly rental claims for the 

duration of the rental period. 

The burden associated with this 

requirement is the time and effort put 

forth by the supplier to educate the 

beneficiary and to disclose information 

regarding its intent to accept 

assignment. While this information 

collection is subject to the PRA, we 

believe this requirement meets the 

requirements of 5 CFR 1320.3(b)(2), and 

as such, the burden associated with this 

requirement is exempt from the PRA. 

This section requires a supplier to 

retain the physician’s order submitted 

for a different type of equipment in the 

patient’s medical record and to disclose 

to the beneficiary its intentions 

regarding whether it will accept 

assignment of all monthly rental claims 

for the duration of the rental period. 

The burden associated with this 

requirement is the time and effort put 

forth by the supplier to retain and 

disclose the required information. While 

this information collection is subject to 

the PRA, we believe this requirement 

meets the requirements of 5 CFR 

1320.3(b)(2), and as such, the burden 

associated with this requirement is 

exempt from the PRA. 

Section 414.229 Other Durable 

Medical Equipment—Capped Rental 

Items 

This section requires a supplier to 

retain the physician’s order submitted 

for a different type of equipment in the 

patient’s medical record and to disclose 

to the beneficiary its intentions 

regarding whether it will accept 

assignment of all monthly rental claims 

for the duration of the rental period. 

The burden associated with this 

requirement is the time and effort put 

forth by the supplier to retain and 

disclose the required information. While 

this information collection is subject to 

the PRA, we believe this requirement 

meets the requirements of 5 CFR 

1320.3(b)(2), and as such, the burden 

associated with this requirement is 

exempt from the PRA. 

If you comment on these information 

collection and recordkeeping 

requirements, please mail copies 

directly to the following: 

Centers for Medicare & Medicaid 

Services, Office of Strategic 

Operations and Regulatory Affairs, 

Division of Regulations Development, 

Attn: Melissa Musotto, [CMS–1304–

F], Room C4–26–05, 7500 Security 

Boulevard, Baltimore, MD 21244–

1850; and 

Office of Information and Regulatory 

Affairs, Office of Management and 

Budget, Room 10235, New Executive 

Office Building, Washington, DC 


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20503, Attn: Carolyn Lovett, CMS 

Desk Officer, CMS–1304–F, 

carolyn_lovett@omb.eop.gov. Fax 

(202) 395–6974. 

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 19, 

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). 

This final rule will be a major rule, as 

defined in Title 5, United States Code, 

section 804(2), because we estimate the 

impact to the Medicare program, and 

the annual effects to the overall 

economy, will be more than $100 

million. The update set forth in this 

final rule will apply to Medicare 

payments under the HH PPS in CY 

2007. Accordingly, the following 

analysis describes the impact in CY 

2007 only. We estimate that there will 

be an additional $440 million in CY 

2007 expenditures attributable to the CY 

2007 estimated home health market 

basket update of 3.3 percent. We 

estimate that the effect of the wage 

index update will bring CY 2007 

expenditures to $410 million. 

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 small 

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 in any 1 year. 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 any 1 year. Individuals 

and States are not included in the 

definition of a small entity. As stated 

above, this final rule will provide an 

update to all HHAs for CY 2007 as 

required by statute. This final rule will 

have a significant positive effect upon 

small entities that are HHAs. 

Based on our analysis of 2003 claims 

data, we also estimate that 

approximately 90 percent of registered 

DME suppliers are considered small 

businesses according to the Small 

Business Administration’s size 

standards. The size standard for NAICS 

code, 532291, Home Health Equipment 

Rental is $6 million. (see http:// 

www.sba.gov/size/sizetable2002.html, 

read May 9, 2005.) This final rule will 

reduce payments for oxygen equipment 

and capped rental items and, therefore, 

will have a significant negative effect 

upon small entities that are DME 

suppliers overall. However, as 

explained in detail below, we believe 

that Medicare payments will still be 

adequate for the items affected by this 

rule and that suppliers whose primary 

line of business involves furnishing 

these items will remain profitable. 

In addition, section 1102(b) of the Act 

requires us to prepare a regulatory 

impact analysis if a rule may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 604 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside of 

a Metropolitan Statistical Area and has 

fewer than 100 beds. We have 

determined that this final rule will 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 (Pub. L. 

104–4) also requires that agencies assess 

anticipated costs and benefits before 

issuing any rule that may result in 

expenditures in any 1 year by State, 

local, or tribal governments, in the 

aggregate, or by the private sector, of 

$120 million. We believe this final rule 

will 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 will not have 

substantial direct effects on the rights, 

roles, and responsibilities of States. 

B. Anticipated Effects 

1. Home Health PPS 

This final rule will update the HH 

PPS rates contained in Pub. 100–20, 

One Time Notification, Transmittal 211, 

published February 10, 2006. We 

updated the rates in the CY 2006 final 

rule (70 FR 68132, November 9, 2005) 

through Transmittal 211 to take account 

of the DRA changes, specifically the 0 

percent update and the rural add-on. 

The impact analysis of this final rule 

presents the projected effects of the 

change from the CY 2006 transition 

wage index (50/50 blend of MSA-based 

and CBSA-based designations) to the CY 

2007 CBSA-based designations in 

determining the wage index used to 

calculate the HH PPS rates for CY 2007. 

We estimate the effects by estimating 

payments while holding all other 

payment variables constant. We use the 

best data available, but we do not 

attempt to predict behavioral responses 

to these changes, and we do not make 

adjustments for future changes in such 

variables as days or case-mix. 

This analysis incorporates the latest 

estimates of growth in service use and 

payments under the Medicare home 

health benefit, based on the latest 

available Medicare claims from 2004. 

We note that certain events may 

combine to limit the scope or accuracy 

of our impact analysis, because such an 

analysis is future-oriented and, thus, 

susceptible to forecasting errors due to 

other changes in the forecasted impact 

time period. Some examples of such 

possible events are newly-legislated 

general Medicare program funding 

changes made by the Congress, or 

changes specifically related to HHAs. In 

addition, changes to the Medicare 

program may continue to be made as a 

result of the BBA, the BBRA, the 

Medicare, Medicaid, and SCHIP 

Benefits Improvement and Protection 

Act of 2000, the MMA, the DRA, or new 

statutory provisions. Although these 

changes may not be specific to the HH 

PPS, the nature of the Medicare program 

is such that the changes may interact, 

and the complexity of the interaction of 

these changes could make it difficult to 

predict accurately the full scope of the 

impact upon HHAs. 

Our discussion for this final rule will 

focus on the impact of changes in the 

wage index, most notably the adoption 

of the full CBSA designations. The 

impacts of the updated wage data are 

shown in Table 13 below. The 

breakdown of the various impacts 

displayed in the table follows. 

The rows display the estimated effect 

of the changes on different categories. 

The first row of figures represents the 


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estimated effects on all facilities. The 

next 2 rows show the effect on urban 

and rural facilities. This is followed, in 

the next 4 rows, by impacts on urban 

and rural facilities based on whether 

they are a hospital-based or freestanding 

facility. The next 20 rows show the 

effect on urban and rural facilities based 

on the census region in which they are 

located. 

The first column shows the 

breakdown of all HHAs by urban or 

rural status, hospital-based or 

freestanding status, and census division. 

The second column in the table shows 

the number of facilities in the impact 

database. A facility is considered urban 

if it is located in a CBSA and, 

conversely, rural if it is not located in 

a CBSA. 

The third column of the table shows 

the effect of the annual update to the 

wage index. This represents the effect of 

using the most recent wage data 

available to determine the estimated 

home health market basket update. The 

total impact of this change is ¥0.2 

percent; however, there are 

distributional effects of the change. 

The fourth column of the table shows 

the effect of all the changes on the CY 

2007 payments. The estimated market 

basket update of 3.3 percentage points is 

constant for all providers and is 

included in this column. Although the 

market basket increase for CY 2007 is 

3.3 percent, fluctuations in the wage 

index impact the projected payments as 

well. The total impact of the wage index 

update is ¥0.2 percent. Therefore, 

including effects of the wage index, we 

project that total aggregate payments 

will increase by 3.1 percent, assuming 

that facilities do not change their care 

delivery and billing practices in 

response. 

As can be seen from this table, the 

combined effects of all of the changes, 

including the updated wage index and 

the market basket increase of 3.3 

percent, will vary by specific types of 

providers and by location. For example, 

HHAs in the rural Pacific show the 

largest estimated increase in payment at 

11.0 percent, while HHAs in the rural 

Mountain census division show the 

smallest increase in payments at 0.5 

percent. Rural HHAs do somewhat 

better than urban HHAs, seeing an 

estimated increase in payments of 3.6 

percent and 3.1 percent respectively. 

Amongst the different type of facility 

categories, freestanding rural HHAs do 

best, with an estimated increase in 

payments of 3.8 percent. Hospital-based 

urban HHAs are next with an estimated 

increase in payments of 3.4 percent, 

followed by hospital-based rural and 

freestanding urban HHAs following 

with estimated increases of 3.2 percent 

and 3.0 percent respectively. 

TABLE 13.—PROJECTED IMPACT OF CY 2007 UPDATE TO THE HH PPS 

Number of 

facilities 

Updated 

wage data 

(percent) 

Total CY 

2007 change 

(percent) 

Total ............................................................................................................................................. 7,370 ¥0.2 3.1 

Urban ........................................................................................................................................... 5,273 ¥0.2 3.1 

Rural ............................................................................................................................................ 2,097 0.3 3.6 

Hospital based urban ................................................................................................................... 1,988 0.1 3.4 

Freestanding urban ...................................................................................................................... 3,285 ¥0.3 3.0 

Hospital based rural ..................................................................................................................... 1,201 ¥0.1 3.2 

Freestanding rural ........................................................................................................................ 896 0.5 3.8 

Urban by Region 

New England ............................................................................................................................... 254 ¥1.2 2.1 

Middle Atlantic ............................................................................................................................. 423 ¥0.2 3.1 

South Atlantic ............................................................................................................................... 913 ¥0.4 2.8 

East North Central ....................................................................................................................... 886 0.4 3.7 

East South Central ...................................................................................................................... 222 ¥0.6 2.7 

West North Central ...................................................................................................................... 304 0.1 3.4 

West South Central ..................................................................................................................... 1,300 ¥0.8 2.5 

Mountain ...................................................................................................................................... 281 1.6 4.9 

Pacific .......................................................................................................................................... 649 0.4 3.7 

Outlying ........................................................................................................................................ 41 ¥4.2 1.0 

Rural by Region 

New England ............................................................................................................................... 43 ¥1.1 2.2 

Middle Atlantic ............................................................................................................................. 82 0.1 3.4 

South Atlantic ............................................................................................................................... 239 ¥0.7 2.6 

East North Central ....................................................................................................................... 284 1.6 5.0 

East South Central ...................................................................................................................... 215 0.1 3.4 

West North Central ...................................................................................................................... 488 0.2 3.5 

West South Central ..................................................................................................................... 475 ¥0.4 2.8 

Mountain ...................................................................................................................................... 173 ¥2.7 0.5 

Pacific .......................................................................................................................................... 88 7.5 11.0 

Outlying ........................................................................................................................................ 10 8.9 12.5 

The impact of the wage index for CY 

2007 is shown in Addendum C to this 

document. Addendum C to this 

document shows a side-by-side 

comparison, by State and county code, 

of the CY 2006 transition wage index, 

which was a 50/50 blend of MSA-based 

and CBSA-based pre-floor, prereclassified hospital wage indexes, and 

pre-floor, pre-reclassified hospital wage 

index for the CY 2007 HH PPS update. 

In the last column of Addendum C to 

this document, we show the percentage 

change in the wage index from CY 2006 

to the wage index for CY 2007. We 

estimate that there will be an additional 

$410 million in CY 2007 expenditures 

attributable to the CY 2007 estimated 


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market basket increase of 3.3 percent 

and the wage index update of ¥0.2 

percent. Thus, the anticipated 

expenditures outlined in this final rule 

will exceed the $100 million annual 

threshold for a major rule as defined in 

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

This final rule will have a positive 

effect on providers of Medicare home 

health services by increasing their 

Medicare payment rates. We anticipate 

that very few HHAs will not submit the 

quality data required by section 

1895(b)(3)(B)(v)(II) of the Act necessary 

to receive the full market basket 

percentage increase. Submission of 

OASIS data is a Medicare condition of 

participation for HHAs. Therefore, we 

expect that very few HHAs would be 

subject to the 2 percent reduction in 

payments in CY 2007. As indicated in 

the rule, most HHAs that do not report 

OASIS provide pediatric, non-Medicare, 

or personal care only. However, CMS is 

aware of instances of non-compliance 

among a very small portion of HHAs 

with regard to OASIS submission. 

For the purposes of the CY 2007 

impact analysis, we anticipate that less 

than 1 percent of HHAs, involving less 

than 1 percent of total Medicare HH 

payments, would fail to submit quality 

data and hence will be subject to the 2 

percent reduction. This is not enough to 

impact the estimated $410 million in 

additional expenditures. Finally, we do 

not believe there is a differential impact 

due to the aggregate nature of the 

update. We do not anticipate specific 

effects on other providers. 

2. Oxygen and Oxygen Equipment 

Provisions 

As mandated by the DRA of 2005, this 

final rule limits to 36 months the total 

number of continuous months for which 

Medicare will pay for oxygen 

equipment, after which the title to the 

oxygen equipment will be transferred 

from the supplier to the beneficiary. 

Since Medicare currently pays for 

oxygen equipment on a monthly basis 

for as long as it is medically necessary, 

this change will result in savings to 

Medicare. In addition, the DRA 

mandates that Medicare continue to 

make monthly payments for furnishing 

contents for beneficiary-owned oxygen 

equipment, as well as payments for 

reasonable and necessary maintenance 

and servicing of beneficiary-owned 

oxygen equipment. 

Approximately one million 

beneficiaries now receive oxygen 

therapy. Although monthly rental 

payments already have been reduced by 

30 percent by section 4552 of the 

Balanced Budget Act of 1997 and 

approximately 10 percent by section 

302(c)(2) of the Medicare Prescription 

Drug, Improvement, and Modernization 

Act of 2003, Medicare allowed charges 

rose to $2.72 billion by 2005, a 68 

percent increase since 1998 that reflects 

the growing use. Before the amendments 

to section 1834(a)(5) of the Act made by 

the DRA, Medicare continued to make 

rental payments for as long as medical 

necessity continued, even when the 

total payments greatly exceeded the cost 

of purchasing the equipment and the 

supplier retained title to the equipment. 

We believe the DRA amendments to the 

Act will result in a loss of revenue to 

suppliers that will no longer receive 

payments for oxygen equipment after 

the 36th month of continuous use. 

Based on data for items furnished in 

calendar year 2005, oxygen 

concentrators accounted for 

approximately 94 percent of Medicare 

utilization for stationary oxygen 

systems, in terms of both allowed 

charges and allowed services. Since 

oxygen concentrators can typically be 

purchased for $1,000 or less, we believe 

that 36 months of payment at 

approximately $200 per month will 

ensure the supplier is reimbursed for its 

cost for furnishing the equipment. The 

$200 allowed payment amount may be 

re-adjusted in the future to assure that 

payments are adequate, but not 

excessive. This could be accomplished 

though the competitive acquisition 

programs mandated by section 1847 of 

the Act or in accordance with our 

authority for adjusting fee schedule 

amounts at section 1842(b)(8) and (9) of 

the Act. Based on data gathered by the 

OIG in the course of developing their 

September 2006 report (OEI–09–04–

00420), approximately 22 percent of 

Medicare beneficiaries rented oxygen 

equipment for 36 months or longer and 

approximately 16 percent of Medicare 

beneficiaries rented oxygen equipment 

for 48 months or longer. In section IV, 

‘‘Provisions of the Final Regulation’’

section of this preamble, we are 

allowing beneficiaries to obtain 

replacement oxygen equipment in cases 

where their equipment has been in 

continuous use for the reasonable useful 

lifetime of the equipment. Unless CMS 

or its carriers establish a specific 

reasonable useful lifetime for oxygen 

equipment, the default lifetime for DME 

of 5 years will apply. The main effect of 

this rule on suppliers is that they will 

not be able to receive payment for the 

equipment beyond 36 months for 

approximately 22 percent of Medicare 

patients. They will also not be able to 

receive payment for furnishing the same 

item to subsequent patients in these 

cases since they lose title to the 

equipment. In the case of oxygen 

concentrator systems and portable 

oxygen transfilling systems, delivery of 

oxygen contents is not necessary, and 

therefore, payment will not be made for 

the furnishing of contents for these 

types of beneficiary owned equipment. 

Under the old payment rules, payment 

for oxygen concentrators used for 

stationary equipment purposes would 

have continued at approximately $200 

per month for the entire period of 

medical need. Section 5101(b) of the 

DRA mandates that payment for oxygen 

equipment end and that title to the 

equipment transfer after 36 months of 

continuous use. 

In the case of liquid and gaseous 

oxygen systems, suppliers will continue 

to be paid for furnishing oxygen 

contents for beneficiary-owned systems. 

The current statewide monthly payment 

amounts for oxygen and oxygen 

equipment that would be paid during 

the 36-month period of continuous use 

for beneficiaries who only use stationary 

equipment range from $194.48 to 

$200.41, with the weighted average 

statewide fee being $199.84. The current 

statewide monthly payment amount for 

furnishing oxygen contents for 

beneficiary owned equipment range 

from $137.54 to $198.12, with the 

weighted average statewide fee being 

$154.90. The average decrease in 

Medicare fee schedule amounts that 

may result from the DRA changes for 

liquid and gaseous systems after the 36- 

month period (that is, shift from 

monthly payments for equipment and 

contents to monthly payments for 

contents only), is expected to be $44.94 

($199.84–$154.90). Therefore, this is the 

level of monthly reimbursement that 

would be lost after the 36-month period 

for suppliers that furnish oxygen and 

oxygen equipment to beneficiaries in 

these situations and who continue to 

furnish contents to these beneficiaries. 

Based on current fee schedule amounts 

for all oxygen and oxygen equipment, 

this equates to an average reduction in 

payment (from $199.84 to $154.90) of 

approximately 22 percent. 

At the current monthly statewide fee 

schedule rates, which range from 

$194.48 to $200.41, suppliers of oxygen 

equipment are expected to be paid from 

$7,001.28 to $7,214.76 over 36 months. 

By comparison, a medical center 

operated by the Department of Veterans 

Affairs (VA) in Tampa, Florida, is the 

largest VA center in terms of number of 

veterans on oxygen therapy and services 

approximately 1,000 patients on oxygen 

by contracting with a locally based 

manufacturer to purchase the oxygen 

concentrators for $895 each. The 

medical center contracts with a local 


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supplier for $90 to deliver and set up 

the concentrator to the patient’s home. 

This local supplier also provides service 

and maintenance of the equipment at 

any time throughout the year for $48 per 

service episode. If the equipment needs 

to be replaced, the local supplier will 

furnish another concentrator for a $90 

fee. The VA total payments over 5 years 

for an oxygen concentrator used by a 

veteran in this center plus payment for 

10 episodes of maintenance and 

servicing, assuming servicing every 6 

months, will be $1,435, compared to 

total Medicare allowed charges of 

$7,164, on average, for a Medicare 

beneficiary. Based on this comparison, 

the Medicare payment amounts and 

methodology appear to be more than 

adequate. 

We do not anticipate that transfer of 

ownership for oxygen equipment to the 

beneficiary after 36 months of 

continuous use will be a significant 

financial burden to suppliers because 

the effect is limited to a maximum of 36 

percent of a supplier’s Medicare 

business and because suppliers of 

oxygen equipment primarily furnish 

lower cost oxygen concentrators. We 

also do not anticipate a significant 

change in the rate of assignment of 

claims for oxygen equipment based on 

our belief that suppliers will be 

adequately reimbursed for furnishing 

the oxygen equipment. 

In accordance with the statute and 

this final rule, suppliers will also 

receive payments for reasonable and 

necessary maintenance and servicing of 

beneficiary-owned oxygen equipment, 

including a general maintenance and 

servicing payment for certain oxygen 

equipment every 6 months, beginning 6 

months after the date that the 

beneficiary assumes ownership of the 

equipment. 

Finally, the new oxygen and oxygen 

equipment classes and national 

payment amounts that are established as 

part of this final rule, will likely result 

in a shift in utilization between the 

various oxygen equipment modalities, 

which could impact supplier revenues 

and sales volume for certain oxygen 

equipment manufacturers. However, 

since the payment amounts will be 

budget-neutral in accordance with 

section 1834(a)(9)(D)(ii) of the Act, there 

will not be a significant impact on 

overall Medicare payments to suppliers. 

3. Capped Rental DME 

This final rule, which limits to 13 

months the total number of continuous 

months for which Medicare would pay 

for capped rental DME, after which the 

ownership of the capped rental item 

would be transferred from the supplier 

to the beneficiary, will result in 

significant savings for the Medicare 

program. Savings will be realized 

through: (1) The gradual elimination of 

rental payments for the 14th and 15th 

months of continuous use; and (2) 

changing the semi-annual payment for 

maintenance and servicing to payment 

only when reasonable and necessary 

maintenance and servicing is needed. 

We anticipate that suppliers may lose 

money due to the loss of 1 to 2 months 

rental in cases where beneficiaries need 

the item for more than 13 months and 

would not have otherwise selected the 

purchase option currently described in 

§ 414.229(d). The average of the 2006 fee 

schedule amounts for all capped rental 

items for months 14 and 15 is 

approximately $152. We do not believe 

suppliers will suffer financially as a 

result of this provision based on data 

which show that in 2004, 97 percent of 

suppliers accepted assignment for 

beneficiaries who chose the purchase 

option (§ 414.229(d)) in the 10th month 

of a capped rental period. This is an 

indication that suppliers were willing to 

accept the Medicare payment as 

payment in full for the capped rental 

item, even though they had been 

informed that the beneficiary will take 

over ownership of the item after the 

13th month of continuous use. 

Therefore, we do not anticipate that 

transfer of ownership for capped rental 

equipment to the beneficiary after 13 

months of continuous use will be a 

significant financial burden to 

suppliers. 

For items for which the first rental 

payment falls on or after January 1, 

2006, Medicare will only pay for 

maintenance and servicing as necessary. 

In a June 2002 report (OEI–03–00–

00410), the Office of Inspector General 

(OIG) indicated that only 9 percent of 

the capped rental equipment with a 

June 2000 service date actually received 

any servicing between June and 

December 2000. Out of the $7.3 million 

Medicare paid for maintenance services 

from June 2000, OIG estimated that $6.5 

million was paid for equipment that 

received no actual servicing. The OIG 

recommended to CMS in 2002 that we 

eliminate the semi-annual maintenance 

payment currently allowed for capped 

rental equipment and pay only for 

repairs when needed. 

The combination of these two factors 

provides strong evidence that the 

Medicare rules for paying for 

maintenance and servicing of capped 

rental equipment furnished before 

January 1, 2006, were not cost-effective. 

Impact on Beneficiaries 

The DRA provisions and this final 

rule will result in savings for Medicare 

beneficiaries using oxygen equipment 

and capped rental items. For capped 

rental items, Medicare payments will be 

made for 13 continuous months and for 

oxygen equipment, payments will be 

made for 36 continuous months. After 

the rental period for each category of 

equipment expires, ownership of the 

equipment will transfer from the 

suppliers to the beneficiaries. 

Beneficiaries will continue to be 

financially responsible for a 20 percent 

coinsurance payment during the 13- or 

36-month rental periods for capped 

rental items and oxygen equipment, 

respectively. However, even though 

beneficiaries will still be required to 

make a 20 percent coinsurance payment 

in connection with each maintenance 

and servicing call, beneficiaries will no 

longer have to make a monthly 20 

percent coinsurance payment for oxygen 

equipment after they own it, or a 20 

percent coinsurance payment every 6 

months for maintenance and servicing 

of beneficiary-owned capped rental 

items, even if maintenance and 

servicing is not needed. This will result 

in significant savings to beneficiaries. 

For example, before the DRA, 

Medicare and the beneficiary made 

continuous payments for the rental of 

oxygen equipment that totaled about 

$200 per month. Of this amount, the 

beneficiary paid coinsurance of $40 

which will equal $480 for a single year’s 

rental, $1,440 over 36 months, and 

$2,400 over 5 years. After the DRA, 

beneficiaries will only pay a 

coinsurance amount for up to 36 months 

for the rental of oxygen equipment, after 

which time they will own the 

equipment. Thus, the DRA oxygen 

provisions result in savings of 

approximately $480 if beneficiaries use 

the equipment for 4 years, and $960 if 

they use the equipment for 5 years. As 

a result of the provision of this final rule 

that allows for a general maintenance 

and servicing call every 6 months, 

beneficiaries could pay approximately 

$6 in coinsurance payments for assigned 

claims, and more for unassigned claims 

for supplier labor associated with these 

services. However, the beneficiary can 

elect not to have these services 

performed if they feel that their 

equipment is not in need of servicing. 

For capped rental items, beneficiaries 

will save coinsurance by not being 

responsible for any equipment payment 

after the 13th rental month or the 

automatic semi-annual maintenance and 

servicing payment that was 

approximately equal to 10 percent of the 


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purchase price for the equipment. 

Before the DRA, Medicare and the 

beneficiary would pay up to 15 months 

for capped rental items, and Medicare 

and the beneficiary would also pay for 

maintenance and servicing every 6 

months. Thus, beneficiaries will save 

coinsurance payments related to both 

the equipment itself and the 

maintenance and servicing of that 

equipment. 

This final rule will assure 

beneficiaries that unless certain 

prescribed exceptions apply, suppliers 

that furnish the equipment for the first 

month will continue to furnish the 

equipment for the entire 36-month 

period of continuous use for oxygen 

equipment or the 13-month period of 

continuous use for capped rental. 

Beneficiaries will also be assured that 

their oxygen and capped rental 

equipment would not be impermissibly 

swapped by the supplier at any time 

during the rental period. Under the final 

rule, we require that a supplier may not 

provide different rented equipment to 

the beneficiary at any time during the 36 

rental months for oxygen equipment or 

the 13 rental months for capped rental 

DME unless one of the following three 

exceptions apply: (1) The supplier 

replaces an item with the same, or 

equivalent, make and model of 

equipment because the item initially 

furnished was lost, stolen, irreparably 

damaged, is being repaired, or no longer 

functions; (2) The physician orders a 

different equipment for the beneficiary. 

If the need for different equipment is 

based on medical necessity, the order 

must indicate why the equipment 

initially furnished is no longer 

appropriate or medically necessary, and 

the supplier must retain this order in 

the beneficiary’s medical record; (3) The 

beneficiary chooses to obtain a newer 

technology item or upgraded item and 

signs an ABN; or (4) CMS or the carrier 

determines that a change in equipment 

is warranted. 

We are requiring that suppliers inform 

beneficiaries whether they intend to 

accept or not accept assignment on all 

monthly rental claims during the 13- 

month rental period for capped rental 

items or the 36-month rental period for 

oxygen equipment in an upfront 

manner. 

This final rule will also assure 

beneficiaries that following the transfer 

of title, the supplier must replace an 

item at no cost to the beneficiary in 

cases where the carrier determines that 

the item furnished by the supplier will 

not last for the entire reasonable useful 

lifetime established for the equipment. 

In making this determination, the carrier 

may consider whether the accumulated 

costs of repair exceed 60 percent of the 

cost to replace the item. 

C. Accounting Statement 

As required by OMB Circular A–4 

(available at http:// 

www.whitehouse.gov/omb/circulars/ 

a004/a-4.pdf), in Table 14 below, we 

have prepared an accounting statement 

showing the classification of the 

expenditures associated with the 

provisions of this final rule. This table 

provides our best estimate of the 

increase in Medicare payments under 

the HH PPS as a result of the changes 

presented in this final rule based on the 

data for 7,370 HHAs in our database. All 

expenditures are classified as transfers 

to Medicare providers (that is, HHAs). 

TABLE 14.—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM CY 2006 TO CY 

2007 

[In millions] 

Category Transfers 

Annualized Monetized 

Transfers.

$410 

From Whom to 

Whom?.

Federal Government 

to HHAs. 

In Table 15 below, we have prepared 

an accounting statement showing the 

classification of the expenditures 

associated with the DME provisions of 

this final rule. This table provides our 

best estimate of the decrease in 

Medicare payments under the DME 

benefit as a result of the changes 

presented in this final rule based on the 

2004 allowed charge data for oxygen 

and capped rental DME in our database. 

All expenditures are classified as 

transfers to the Medicare program and 

its beneficiaries. 

TABLE 15.—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES

[In millions] 

Category Transfers 

Monetized Transfers 

in FY 2007.

$80 

Monetized Transfers 

in FY 2008.

$130 

Monetized Transfers 

in FY 2009.

$170 

Monetized Transfers 

in FY 2010.

$220 

Monetized Transfers 

in FY 2011.

$280 

From Whom to 

Whom?.

Suppliers to Federal 

Government and 

beneficiaries. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was reviewed by the Office of 

Management and Budget. 

List of Subjects 

42 CFR Part 414 

Administrative practice and 

procedure, Health facilities, Health 

professions, Kidney diseases, Medicare, 

Reporting and recordkeeping 

requirements. 

42 CFR Part 484 

Health facilities, Health professions, 

Medicare, Reporting and recordkeeping 

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 414—PAYMENT FOR PART B 

MEDICAL AND OTHER HEALTH 

SERVICES 

Subpart D—Payment for Durable 

Medical Equipment and Prosthetic and 

Orthotic Devices 

■ 1. The authority citation for part 414 

continues to read as follows: 

Authority: Secs. 1102, 1871, and 1881(b)(1) 

of the Social Security Act (42 U.S.C. 1302, 

1395(hh), and 1395rr(b)(1)). 

■ 2. Amend § 414.210 as follows: 

■ A. Revise paragraph (e). 

■ B. Revise the introductory text to 

paragraph (f). 

■ C. Revise paragraph (f)(2). 

■ D. Add new paragraphs (f)(3) and 

(f)(4). 

The revisions read as follows: 

§ 414.210 General payment rules. 

* * * * * 

(e) Maintenance and servicing—(1) 

General rule. Except as provided in 

paragraph (e)(2) of this section, the 

carrier pays the reasonable and 

necessary charges for maintenance and 

servicing of beneficiary-owned 

equipment. Reasonable and necessary 

charges are those made for parts and 

labor not otherwise covered under a 

manufacturer’s or supplier’s warranty. 

Payment is made for replacement parts 

in a lump sum based on the carrier’s 

consideration of the item. The carrier 

establishes a reasonable fee for labor 

associated with repairing, maintaining, 

and servicing the item. Payment is not 

made for maintenance and servicing of 

a rented item other than the 

maintenance and servicing fee for other 

durable medical equipment as described 

in § 414.229(e). 

(2) Additional maintenance and 

servicing payment for certain 


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beneficiary-owned oxygen equipment. In 

addition to the maintenance and 

servicing payments described in 

paragraph (e)(1) of this section, the 

carrier makes a maintenance and 

servicing payment for oxygen 

equipment other than liquid and 

gaseous equipment (stationary and 

portable) as follows: 

(i) For the first 6-month period 

following the date on which title to the 

equipment transfers to the beneficiary in 

accordance with § 414.226(f), no 

payments are to be made. 

(ii) During each succeeding 6-month 

period, payment may be made for 30 

minutes of labor for general 

maintenance and servicing of the 

equipment. 

(3) Additional payment for picking up 

oxygen tanks and cylinders. The carrier 

pays the reasonable and necessary 

charges for a supplier to pick up and 

store or dispose of beneficiary-owned 

oxygen tanks and cylinders that are no 

longer medically necessary. 

(4) Exception to Maintenance and 

Servicing Payments. For items 

purchased on or after June 1, 1989, no 

payment is made under the provisions 

of paragraph (e)(1) of this section for the 

maintenance and servicing of: 

(i) Items requiring frequent and 

substantial servicing, as defined in 

§ 414.222(a); 

(ii) Capped rental items, as defined in 

§ 414.229(a), that are not beneficiaryowned in accordance with § 414.229(d), 

§ 414.229(f)(2), or § 414.229(h); and 

(iii) Oxygen equipment, as described 

in § 414.226, that is not beneficiaryowned in accordance with § 414.226(f). 

(5) Supplier replacement of 

beneficiary-owned equipment based on 

accumulated repair costs. A supplier 

that transfers title to oxygen equipment 

or a capped rental item to a beneficiary 

in accordance with § 414.226(f) or 

§ 414.229(f)(2) is responsible for 

furnishing replacement equipment at no 

cost to the beneficiary or to the 

Medicare program if the carrier 

determines that the item furnished by 

the supplier will not last for the entire 

reasonable useful lifetime established 

for the equipment in accordance with 

§ 414.210(f)(1). In making this 

determination, the carrier may consider 

whether the accumulated costs of repair 

exceed 60 percent of the cost to replace 

the item. 

(f) Payment for replacement of 

equipment. If an item of DME or a 

prosthetic or orthotic device paid for 

under this subpart has been in 

continuous use by the patient for the 

equipment’s reasonable useful lifetime 

or if the carrier determines that the item 

is lost, stolen, or irreparably damaged, 

the patient may elect to obtain a new 

piece of equipment. 

* * * * * 

(2) If the beneficiary elects to obtain 

replacement oxygen equipment, 

payment is made in accordance with 

§ 414.226(a). 

(3) If the beneficiary elects to obtain 

a replacement capped rental item, 

payment is made in accordance with 

§ 414.229(a)(2) or (a)(3). 

(4) For all other beneficiary-owned 

items, if the beneficiary elects to obtain 

replacement equipment, payment is 

made on a purchase basis. 

■ 3. Amend § 414.226 by—

■ A. Revising paragraph (a) and the 

heading of paragraph (b). 

■ B. Revising paragraph (b)(3). 

■ C. Adding paragraphs (b)(4) and (b)(5). 

■ D. Redesignating paragraph (d) as 

paragraph (e). 

■ E. Redesignating paragraph (c) as 

paragraph (d). 

■ F. Revising newly redesignated 

paragraph (d). 

■ G. Adding a new paragraph (c). 

■ H. Revising newly redesignated 

paragraph (e)(1) introductory text. 

■ I. Revising newly redesignated 

paragraph (e)(1)(i). 

■ J. Revising newly redesignated 

paragraph (e)(2)(i). 

■ K. Revising newly redesignated 

paragraph (e)(2)(ii). 

■ L. Adding new paragraphs (f) and (g). 

The revisions and additions read as 

follows: 

§ 414.226 Oxygen and oxygen equipment. 

(a) Payment rules—(1) Oxygen 

equipment. Payment for rental of 

oxygen equipment is made based on a 

monthly fee schedule amount during 

the period of medical need, but for no 

longer than a period of continuous use 

of 36 months. A period of continuous 

use is determined under the provisions 

in § 414.230. 

(2) Oxygen contents. Payment for 

purchase of oxygen contents is made 

based on a monthly fee schedule 

amount until medical necessity ends. 

(b) Monthly fee schedule amount for 

items furnished prior to 2007. 

* * * * * 

(3) For 1991 through 2006, the fee 

schedule amounts for items described in 

paragraphs (b)(1)(iii) and (iv) of this 

section are determined using the 

methodology contained in § 414.220(d), 

(e), and (f). 

(4) For 1991 through 2006, the fee 

schedule amounts for items described in 

paragraphs (b)(1)(i) and (ii) of this 

section are determined using the 

methodology contained in § 414.220(d), 

(e), and (f). 

(5) For 2005 and 2006, the fee 

schedule amounts determined under 

paragraph (b)(4) of this section are 

reduced using the methodology 

described in section 1834(a)(21)(A) of 

the Act. 

(c) Monthly fee schedule amount for 

items furnished for years after 2006. (1) 

For 2007, national limited monthly 

payment rates are calculated and paid as 

the monthly fee schedule amounts for 

the following classes of items: 

(i) Stationary oxygen equipment 

(including stationary concentrators) and 

oxygen contents (stationary and 

portable). 

(ii) Portable equipment only (gaseous 

or liquid tanks). 

(iii) Oxygen generating portable 

equipment only. 

(iv) Stationary oxygen contents only. 

(v) Portable oxygen contents only. 

(2) The national limited monthly 

payment rate for items described in 

paragraph (c)(1)(i) of this section is 

equal to the weighted average fee 

schedule amount established under 

paragraph (b)(5) of this section reduced 

by $1.44. 

(3) The national limited monthly 

payment rate for items described in 

paragraph (c)(1)(ii) of this section is 

equal to the weighted average of the fee 

schedule amounts established under 

paragraph (b)(5) of this section. 

(4) The national limited monthly 

payment rate for items described in 

paragraph (c)(1)(iii) of this section is 

equal to the national limited monthly 

payment rate established under 

paragraph (c)(5) of this section, 

multiplied by 24, and divided by 36. 

(5) The national limited monthly 

payment rate for items described in 

paragraphs (c)(1)(iv) and (c)(1)(v) of this 

section is equal to 50 percent of the 

weighted average fee schedule amounts 

established under paragraph (b)(3) of 

this section for items described in 

paragraph (b)(1)(iii) of this section. 

(6) Beginning in 2008, CMS makes an 

annual adjustment to the national 

limited monthly payment rates for each 

class of items described in paragraph 

(c)(1) of this section to ensure that such 

payment rates do not result in 

expenditures for any year that are more 

or less than the expenditures that would 

have been made if such classes had not 

been established. 

(d) Application of monthly fee 

schedule amounts. (1) The fee schedule 

amount for items described in paragraph 

(c)(1)(i) of this section is paid when the 

beneficiary rents stationary oxygen 

equipment. 

(2) Subject to the limitation set forth 

in paragraph (e)(2) of this section, the 

fee schedule amount for items described 


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65934 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

in paragraphs (c)(1)(ii) and (c)(1)(iii) of 

this section is paid when the beneficiary 

rents portable oxygen equipment. 

(3) The fee schedule amount for items 

described in paragraph (c)(1)(iv) of this 

section is paid when the beneficiary 

owns stationary oxygen equipment that 

requires delivery of gaseous or liquid 

oxygen contents. 

(4) The fee schedule amount for items 

described in paragraph (c)(1)(v) of this 

section is paid when the beneficiary 

owns portable oxygen equipment 

described in paragraph (c)(1)(ii) of this 

section, or rents portable oxygen 

equipment described in paragraph 

(c)(1)(ii) of this section and does not 

rent stationary oxygen equipment. 

(e) Volume adjustments. (1) The fee 

schedule amount for an item described 

in paragraph (c)(1)(i) of this section is 

adjusted as follows: 

(i) If the attending physician 

prescribes an oxygen flow rate 

exceeding four liters per minute, the fee 

schedule amount is increased by 50 

percent, subject to the limit in 

paragraph (e)(2) of this section. 

* * * * * 

(2) * * * 

(i) The sum of the monthly fee 

schedule amount for the items described 

in paragraphs (c)(1)(i) and (c)(1)(ii) or 

(c)(1)(iii) of this section; or 

(ii) The adjusted fee schedule amount 

described in paragraph (e)(1)(i) of this 

section. 

* * * * * 

(f) Ownership of equipment. On the 

first day that begins after the 36th 

continuous month in which payment is 

made for oxygen equipment under 

paragraph (a)(1) of this section, the 

supplier must transfer title to the 

oxygen equipment to the beneficiary. At 

the time of title transfer, the supplier 

must provide information to the 

beneficiary on how to safely dispose of 

oxygen equipment that is no longer 

medically necessary and advise that the 

beneficiary must comply with all 

Federal, State, and local laws that apply 

to the disposal, transport, and resale of 

oxygen equipment. 

(g) Additional supplier requirements 

for rentals that begin on or after January 

1, 2007. (1) The supplier that furnishes 

oxygen equipment for the first month 

during which payment is made under 

this section must continue to furnish the 

equipment until medical necessity ends, 

or the 36-month period of continuous 

use ends, whichever is earlier, unless—

(i) The item becomes subject to a 

competitive acquisition program 

implemented in accordance with 

section 1847(a) of the Act; 

(ii) The beneficiary relocates to an 

area that is outside the normal service 

area of the supplier that initially 

furnished the equipment; 

(iii) The beneficiary elects to obtain 

oxygen equipment from a different 

supplier prior to the expiration of the 

36-month rental period; or 

(iv) CMS or the carrier determines 

that an exception should apply in an 

individual case based on the 

circumstances. 

(2) Oxygen equipment furnished 

under this section may not be replaced 

by the supplier prior to the expiration 

of the 36-month rental period unless: 

(i) The supplier replaces an item with 

the same, or equivalent, make and 

model of equipment because the item 

initially furnished was lost, stolen, 

irreparably damaged, is being repaired, 

or no longer functions; 

(ii) A physician orders different 

equipment for the beneficiary. If the 

order is based on medical necessity, 

then the order must indicate why the 

equipment initially furnished is no 

longer medically necessary and the 

supplier must retain this order in the 

beneficiary’s medical record; 

(iii) The beneficiary chooses to obtain 

a newer technology item or upgraded 

item and signs an advanced beneficiary 

notice (ABN); or 

(iv) CMS or the carrier determines 

that a change in equipment is 

warranted. 

(3) Before furnishing oxygen 

equipment, the supplier must disclose 

to the beneficiary its intentions 

regarding whether it will accept 

assignment of all monthly rental claims 

for the duration of the rental period. A 

supplier’s intentions could be expressed 

in the form of a written agreement 

between the supplier and the 

beneficiary. 

(4) No later than two months before 

the date on which the supplier must 

transfer title to oxygen equipment to the 

beneficiary, the supplier must disclose 

to the beneficiary—

(i) Whether it can maintain and 

service the equipment after the 

beneficiary acquires title to it; and 

(ii) Whether it can continue to deliver 

oxygen contents to the beneficiary after 

the beneficiary acquires title to the 

equipment. 

■ 4. Amend § 414.229 by—

■ A. Revising paragraphs (a), (f) and (g). 

■ B. Adding paragraph (h). 

The revisions and additions read as 

follows: 

§ 414.229 Other durable medical 

equipment-capped rental items. 

(a) General payment rule. Payment is 

made for other durable medical 

equipment that is not subject to the 

payment provisions set forth in 

§ 414.220 through § 414.228 as follows: 

(1) For items furnished prior to 

January 1, 2006, payment is made on a 

rental or purchase option basis in 

accordance with the rules set forth in 

paragraphs (b) through (e) of this 

section. 

(2) For items other than power-driven 

wheelchairs furnished on or after 

January 1, 2006, payment is made in 

accordance with the rules set forth in 

paragraph (f) of this section. 

(3) For power-driven wheelchairs 

furnished on or after January 1, 2006, 

payment is made in accordance with the 

rules set forth in paragraphs (f) or (h) of 

this section. 

* * * * * 

(f) Rules for capped rental items 

furnished beginning on or after January 

1, 2006. (1) For items furnished on or 

after January 1, 2006, payment is made 

based on a monthly rental fee schedule 

amount during the period of medical 

need, but for no longer than a period of 

continuous use of 13 months. A period 

of continuous use is determined under 

the provisions in § 414.230. 

(2) The supplier must transfer title to 

the item to the beneficiary on the first 

day that begins after the 13th 

continuous month in which payments 

are made under paragraph (f)(1) of this 

section. 

(3) Payment for maintenance and 

servicing of beneficiary-owned 

equipment is made in accordance with 

§ 414.210(e). 

(g) Additional supplier requirements 

for capped rental items that are 

furnished beginning on or after January 

1, 2007. (1) The supplier that furnishes 

an item for the first month during which 

payment is made using the methodology 

described in paragraph (f)(1) of this 

section must continue to furnish the 

equipment until medical necessity ends, 

or the 13-month period of continuous 

use ends, whichever is earlier, unless—

(i) The item becomes subject to a 

competitive acquisition program 

implemented in accordance with 

section 1847(a) of the Act; 

(ii) The beneficiary relocates to an 

area that is outside the normal service 

area of the supplier that initially 

furnished the equipment; 

(iii) The beneficiary elects to obtain 

the equipment from a different supplier 

prior to the expiration of the 13-month 

rental period; or 

(iv) CMS or the carrier determines 

that an exception should apply in an 

individual case based on the 

circumstances. 

(2) A capped rental item furnished 

under this section may not be replaced 

by the supplier prior to the expiration 

of the 13-month rental period unless: 


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(i) The supplier replaces an item with 

the same, or equivalent, make and 

model of equipment because the item 

initially furnished was lost, stolen, 

irreparably damaged, is being repaired, 

or no longer functions; 

(ii) A physician orders different 

equipment for the beneficiary. If the 

need for different equipment is based on 

medical necessity, then the order must 

indicate why the equipment initially 

furnished is no longer medically 

necessary and the supplier must retain 

this order in the beneficiary’s medical 

record; 

(iii) The beneficiary chooses to obtain 

a newer technology item or upgraded 

item and signs an advanced beneficiary 

notice (ABN); or 

(iv) CMS or the carrier determines 

that a change in equipment is 

warranted. 

(3) Before furnishing a capped rental 

item, the supplier must disclose to the 

beneficiary its intentions regarding 

whether it will accept assignment of all 

monthly rental claims for the duration 

of the rental period. A supplier’s 

intentions could be expressed in the 

form of a written agreement between the 

supplier and the beneficiary. 

(4) No later than two months before 

the date on which the supplier must 

transfer title to a capped rental item to 

the beneficiary, the supplier must 

disclose to the beneficiary whether it 

can maintain and service the item after 

the beneficiary acquires title to it. CMS 

or its carriers may make exceptions to 

this requirement on a case-by-case basis. 

(h) Purchase of power-driven 

wheelchairs furnished on or after 

January 1, 2006. Suppliers must offer 

beneficiaries the option to purchase 

power-driven wheelchairs at the time 

the equipment is initially furnished. 

Payment is made on a lump-sum 

purchase basis if the beneficiary chooses 

this option. 

■ 5. Amend § 414.230 by—

■ A. Revising paragraph (b). 

■ B. Revising paragraph (f). 

The revisions read as follows: 

§ 414.230 Determining a period of 

continuous use. 

* * * * * 

(b) Continuous use. (1) A period of 

continuous use begins with the first 

month of medical need and lasts until 

a beneficiary’s medical need for a 

particular item of durable medical 

equipment ends. 

(2) In the case of a beneficiary 

receiving oxygen equipment on 

December 31, 2005, the period of 

continuous use for the equipment 

begins on January 1, 2006. 

* * * * * 

(f) New equipment. (1) If a beneficiary 

changes equipment or requires 

additional equipment based on a 

physician’s prescription, and the new or 

additional equipment is found to be 

necessary, a new period of continuous 

use begins for the new or additional 

equipment. A new period of continuous 

use does not begin for base equipment 

that is modified by an addition. 

(2) A new period of continuous use 

does not begin when a beneficiary 

changes from one stationary oxygen 

equipment modality to another or from 

one portable oxygen equipment 

modality to another. 

* * * * * 

PART 484—HOME HEALTH SERVICES 

■ 6. 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. 

■ 7. Amend § 484.225 as follows: 

■ A. Revise paragraph (f). 

■ B. Redesignate paragraph (g) as 

paragraph (h). 

■ C. Add new paragraph (g). 

■ D. Revise newly redesignated 

paragraph (h). 

■ E. Add new paragraph (i). 

The revisions and additions read as 

follows: 

§ 484.225 Annual update of the unadjusted 

national prospective 60-day episode 

payment rate. 

* * * * * 

(f) For calendar year 2005, 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 calendar year 2006, the 

unadjusted national prospective 60-day 

episode payment rate is equal to the rate 

from calendar year 2005. 

(h) For 2007 and subsequent calendar 

years, in the case of a home health 

agency that submits home health quality 

data, as specified by the Secretary, the 

unadjusted national prospective 60-day 

episode rate is equal to the rate for the 

previous calendar year increased by the 

applicable home health market basket 

index amount. 

(i) For 2007 and subsequent calendar 

years, in the case of a home health 

agency that does not submit home 

health quality data, as specified by the 

Secretary, the unadjusted national 

prospective 60-day episode rate is equal 

to the rate for the previous calendar year 

increased by the applicable home health 

market basket index amount minus 2 

percentage points. Any reduction of the 

percentage change will apply only to the 

calendar year involved and will not be 

taken into account in computing the 

prospective payment amount for a 

subsequent calendar year. 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: October 20, 2006. 

Leslie V. Norwalk, 

Acting Administrator, Centers for Medicare 

& Medicaid Services. 

Approved: October 31, 2006. 

Michael O. Leavitt, 

Secretary. 

Note: The following addenda will not be 

published in the Code of Federal Regulations. 


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ADDENDUM A.—CY 2007 WAGE INDEX

FOR RURAL AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE INDEX

CBSA 

code Nonurban area Wage index 

01 ........ Alabama ........................ 0.7591 

02 ........ Alaska ........................... 1.0661 

03 ........ Arizona .......................... 0.8908 

04 ........ Arkansas ....................... 0.7307 

05 ........ California ....................... 1.1454 

06 ........ Colorado ....................... 0.9325 

07 ........ Connecticut ................... 1.1709 

08 ........ Delaware ....................... 0.9705 

10 ........ Florida ........................... 0.8594 

11 ........ Georgia ......................... 0.7593 

12 ........ Hawaii ........................... 1.0448 

13 ........ Idaho ............................. 0.8120 

14 ........ Illinois ............................ 0.8320 

15 ........ Indiana .......................... 0.8538 

16 ........ Iowa .............................. 0.8681 

17 ........ Kansas .......................... 0.7998 

18 ........ Kentucky ....................... 0.7768 

19 ........ Louisiana ....................... 0.7438 

20 ........ Maine ............................ 0.8443 

21 ........ Maryland ....................... 0.8926 

22 ........ Massachusetts 1 ............ 1.1661 

23 ........ Michigan ........................ 0.9062 

24 ........ Minnesota ..................... 0.9153 

ADDENDUM A.—CY 2007 WAGE INDEX

FOR RURAL AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued 

CBSA 

code Nonurban area Wage index 

25 ........ Mississippi ..................... 0.7738 

26 ........ Missouri ......................... 0.7927 

27 ........ Montana ........................ 0.8590 

28 ........ Nebraska ....................... 0.8677 

29 ........ Nevada .......................... 0.8944 

30 ........ New Hampshire ............ 1.0853 

31 ........ New Jersey 2 ................. ..............

32 ........ New Mexico .................. 0.8332 

33 ........ New York ...................... 0.8232 

34 ........ North Carolina ............... 0.8588 

35 ........ North Dakota ................. 0.7215 

36 ........ Ohio .............................. 0.8658 

37 ........ Oklahoma ...................... 0.7629 

38 ........ Oregon .......................... 0.9753 

39 ........ Pennsylvania ................. 0.8320 

40 ........ Puerto Rico 3 ................. 0.4047 

41 ........ Rhode Island 2 ............... ..............

42 ........ South Carolina .............. 0.8566 

43 ........ South Dakota ................ 0.8480 

44 ........ Tennessee .................... 0.7827 

45 ........ Texas ............................ 0.7965 

46 ........ Utah .............................. 0.8140 

ADDENDUM A.—CY 2007 WAGE INDEX

FOR RURAL AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED HOSPITAL WAGE

INDEX—Continued 

CBSA 

code Nonurban area Wage index 

47 ........ Vermont ........................ 0.9744 

48 ........ Virgin Islands ................ 0.8467 

49 ........ Virginia .......................... 0.7940 

50 ........ Washington ................... 1.0263 

51 ........ West Virginia ................. 0.7607 

52 ........ Wisconsin ...................... 0.9553 

53 ........ Wyoming ....................... 0.9295 

65 ........ Guam ............................ 0.9611 

1There are no short-term, acute care hospitals located in rural areas in Massachusetts 

from which to calculate a wage index for 

CY07. Therefore, the rural wage index for 

Massachusetts will be imputed using the 

methodology discussed in Section III of this 

rule. 2All counties within the State are classified 

as urban. 3There are no short-term, acute care hospitals located in rural areas in Puerto Rico 

from which to calculate a wage index for 

CY07. Therefore, we will continue to use the 

wage index from CY05 which was the last 

year in which we had ‘‘rural’’ hospital data. 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX

CBSA code Urban area (constituent counties) Wage 

index 

10180 ........... Abilene, TX. ....................................................................................................................................................................... 0.8000 

Callahan County, TX.

Jones County, TX.

Taylor County, TX.

10380 ........... Aguadilla-Isabela-San Sebastia ́n, PR ............................................................................................................................... 0.3915 

Aguada Municipio, PR.

Aguadilla Municipio, PR.

An ̃asco Municipio, PR.

Isabela Municipio, PR.

Lares Municipio, PR.

Moca Municipio, PR.

Rinco ́n Municipio, PR.

San Sebastia ́n Municipio, PR.

10420 ........... Akron, OH ......................................................................................................................................................................... 0.8654 

Portage County, OH.

Summit County, OH.

10500 ........... Albany, GA ........................................................................................................................................................................ 0.8991 

Baker County, GA.

Dougherty County, GA.

Lee County, GA.

Terrell County, GA.

Worth County, GA.

10580 ........... Albany-Schenectady-Troy, NY .......................................................................................................................................... 0.8720 

Albany County, NY.

Rensselaer County, NY.

Saratoga County, NY.

Schenectady County, NY.

Schoharie County, NY.

10740 ........... Albuquerque, NM .............................................................................................................................................................. 0.9458 

Bernalillo County, NM.

Sandoval County, NM.

Torrance County, NM.

Valencia County, NM.

10780 ........... Alexandria, LA ................................................................................................................................................................... 0.8006 

Grant Parish, LA.

Rapides Parish, LA.

10900 ........... Allentown-Bethlehem-Easton, PA-NJ ............................................................................................................................... 0.9947 


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65937 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Warren County, NJ.

Carbon County, PA.

Lehigh County, PA.

Northampton County, PA.

11020 ........... Altoona, PA ....................................................................................................................................................................... 0.8812 

Blair County, PA.

11100 ........... Amarillo, TX ....................................................................................................................................................................... 0.9169 

Armstrong County, TX.

Carson County, TX.

Potter County, TX.

Randall County, TX.

11180 ........... Ames, IA ............................................................................................................................................................................ 0.9760 

Story County, IA.

111260 ......... Anchorage, AK .................................................................................................................................................................. 1.2023 

Anchorage Municipality, AK.

Matanuska-Susitna Borough, AK.

11300 ........... Anderson, IN ..................................................................................................................................................................... 0.8681 

Madison County, IN.

11340 ........... Anderson, SC .................................................................................................................................................................... 0.9017 

Anderson County, SC.

11460 ........... Ann Arbor, MI .................................................................................................................................................................... 1.0826 

Washtenaw County, MI.

11500 ........... Anniston-Oxford, AL .......................................................................................................................................................... 0.7770 

Calhoun County, AL.

11540 ........... Appleton, WI ...................................................................................................................................................................... 0.9455 

Calumet County, WI.

Outagamie County, WI.

11700 ........... Asheville, NC ..................................................................................................................................................................... 0.9216 

Buncombe County, NC.

Haywood County, NC.

Henderson County, NC.

Madison County, NC.

2020 ............. Athens-Clarke County, GA ................................................................................................................................................ 0.9856 

Clarke County, GA.

Madison County, GA.

Oconee County, GA.

Oglethorpe County, GA.

12060 ........... Atlanta-Sandy Springs-Marietta, GA ................................................................................................................................. 0.9762 

Barrow County, GA.

Bartow County, GA.

Butts County, GA.

Carroll County, GA.

Cherokee County, GA.

Clayton County, GA.

Cobb County, GA.

Coweta County, GA.

Dawson County, GA.

DeKalb County, GA.

Douglas County, GA.

Fayette County, GA.

Forsyth County, GA.

Fulton County, GA.

Gwinnett County, GA.

Haralson County, GA.

Heard County, GA.

Henry County, GA.

Jasper County, GA.

Lamar County, GA.

Meriwether County, GA.

Newton County, GA.

Paulding County, GA.

Pickens County, GA.

Pike County, GA.

Rockdale County, GA.

Spalding County, GA.

Walton County, GA.

12100 ........... Atlantic City, NJ ................................................................................................................................................................. 1.1831 

Atlantic County, NJ.

2220 ............. Auburn-Opelika, AL ........................................................................................................................................................... 0.8096 

Lee County, AL.


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65938 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

12260 ........... Augusta-Richmond County, GA-SC .................................................................................................................................. 0.9667 

Burke County, GA.

Columbia County, GA.

McDuffie County, GA.

Richmond County, GA.

Aiken County, SC.

Edgefield County, SC.

12420 ........... Austin-Round Rock, TX .................................................................................................................................................... 0.9344 

Bastrop County, TX.

Caldwell County, TX.

Hays County, TX.

Travis County, TX.

Williamson County, TX.

12540 ........... Bakersfield, CA ................................................................................................................................................................. 1.0725 

Kern County, CA.

12580 ........... Baltimore-Towson, MD ...................................................................................................................................................... 1.0088 

Anne Arundel County, MD.

Baltimore County, MD.

Carroll County, MD.

Harford County, MD.

Howard County, MD.

Queen Anne’s County, MD.

Baltimore City, MD.

12620 ........... Bangor, ME ....................................................................................................................................................................... 0.9711 

Penobscot County, ME.

12700 ........... Barnstable Town, MA ........................................................................................................................................................ 1.2539 

Barnstable County, MA.

12940 ........... Baton Rouge, LA ............................................................................................................................................................... 0.8084 

Ascension Parish, LA.

East Baton Rouge Parish, LA.

East Feliciana Parish, LA.

Iberville Parish, LA.

Livingston Parish, LA.

Pointe Coupee Parish, LA.

St. Helena Parish, LA.

West Baton Rouge Parish, LA.

West Feliciana Parish, LA.

12980 ........... Battle Creek, MI ................................................................................................................................................................ 0.9762 

Calhoun County, MI.

13020 ........... Bay City, MI ....................................................................................................................................................................... 0.9251 

Bay County, MI.

13140 ........... Beaumont-Port Arthur, TX ................................................................................................................................................ 0.8595 

Hardin County, TX.

Jefferson County, TX.

Orange County, TX.

13380 ........... Bellingham, WA ................................................................................................................................................................. 1.1104 

Whatcom County, WA.

13460 ........... Bend, OR .......................................................................................................................................................................... 1.0743 

Deschutes County, OR.

13644 ........... Bethesda-Frederick-Gaithersburg, MD ............................................................................................................................. 1.0903 

Frederick County, MD.

Montgomery County, MD.

13740 ........... Billings, MT ........................................................................................................................................................................ 0.8712 

Carbon County, MT.

Yellowstone County, MT.

13780 ........... Binghamton, NY ................................................................................................................................................................ 0.8786 

Broome County, NY.

Tioga County, NY.

13820 ........... Birmingham-Hoover, AL .................................................................................................................................................... 0.8894 

Bibb County, AL.

Blount County, AL.

Chilton County, AL.

Jefferson County, AL.

St. Clair County, AL.

Shelby County, AL.

Walker County, AL.

13900 ........... Bismarck, ND .................................................................................................................................................................... 0.7240 

Burleigh County, ND.

Morton County, ND.

13980 ........... Blacksburg-Christiansburg-Radford, VA ........................................................................................................................... 0.8213 


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65939 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Giles County, VA.

Montgomery County, VA.

Pulaski County, VA.

Radford City, VA.

14020 ........... Bloomington, IN ................................................................................................................................................................. 0.8533 

Greene County, IN.

Monroe County, IN.

Owen County, IN.

14060 ........... Bloomington-Normal, IL .................................................................................................................................................... 0.8944 

McLean County, IL.

14260 ........... Boise City-Nampa, ID ....................................................................................................................................................... 0.9401 

Ada County, ID.

Boise County, ID.

Canyon County, ID.

Gem County, ID.

Owyhee County, ID.

14484 ........... Boston-Quincy, MA ........................................................................................................................................................... 1.1679 

Norfolk County, MA.

Plymouth County, MA.

Suffolk County, MA.

14500 ........... Boulder, CO ...................................................................................................................................................................... 1.0350 

Boulder County, CO.

14540 ........... Bowling Green, KY ............................................................................................................................................................ 0.8148 

Edmonson County, KY.

Warren County, KY.

14740 ........... Bremerton-Silverdale, WA ................................................................................................................................................. 1.0913 

Kitsap County, WA.

14860 ........... Bridgeport-Stamford-Norwalk, CT ..................................................................................................................................... 1.2659 

Fairfield County, CT.

15180 ........... Brownsville-Harlingen, TX ................................................................................................................................................. 0.9430 

Cameron County, TX.

15260 ........... Brunswick, GA ................................................................................................................................................................... 1.0164 

Brantley County, GA.

Glynn County, GA.

McIntosh County, GA.

15380 ........... Buffalo-Niagara Falls, NY ................................................................................................................................................. 0.9424 

Erie County, NY.

Niagara County, NY.

15500 ........... Burlington, NC ................................................................................................................................................................... 0.8674 

Alamance County, NC.

15540 ........... Burlington-South Burlington, VT ....................................................................................................................................... 0.9474 

Chittenden County, VT.

Franklin County, VT.

Grand Isle County, VT.

15764 ........... Cambridge-Newton-Framingham, MA ............................................................................................................................... 1.0970 

Middlesex County, MA.

5804 ............. Camden, NJ ...................................................................................................................................................................... 1.0392 

Burlington County, NJ.

Camden County, NJ.

Gloucester County, NJ.

15940 ........... Canton-Massillon, OH ....................................................................................................................................................... 0.9031 

Carroll County, OH.

Stark County, OH.

15980 ........... Cape Coral-Fort Myers, FL ............................................................................................................................................... 0.9342 

Lee County, FL.

16180 ........... Carson City, NV ................................................................................................................................................................ 1.0025 

Carson City, NV.

16220 ........... Casper, WY ....................................................................................................................................................................... 0.9145 

Natrona County, WY.

16300 ........... Cedar Rapids, IA ............................................................................................................................................................... 0.8888 

Benton County, IA.

Jones County, IA.

Linn County, IA.

16580 ........... Champaign-Urbana, IL ...................................................................................................................................................... 0.9644 

Champaign County, IL.

Ford County, IL.

Piatt County, IL.

16620 ........... Charleston, WV ................................................................................................................................................................. 0.8542 

Boone County, WV.

Clay County, WV.


rmajette on PROD1PC67 with RULES2
65940 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Kanawha County, WV.

Lincoln County, WV.

Putnam County, WV.

16700 ........... Charleston-North Charleston, SC ..................................................................................................................................... 0.9145 

Berkeley County, SC.

Charleston County, SC.

Dorchester County, SC.

16740 ........... Charlotte-Gastonia-Concord, NC-SC ................................................................................................................................ 0.9554 

Anson County, NC.

Cabarrus County, NC.

Gaston County, NC.

Mecklenburg County, NC.

Union County, NC.

York County, SC.

16820 ........... Charlottesville, VA ............................................................................................................................................................. 1.0125 

Albemarle County, VA.

Fluvanna County, VA.

Greene County, VA.

Nelson County, VA.

Charlottesville City, VA.

16860 ........... Chattanooga, TN-GA ........................................................................................................................................................ 0.8948 

Catoosa County, GA.

Dade County, GA.

Walker County, GA.

Hamilton County, TN.

Marion County, TN.

Sequatchie County, TN.

16940 ........... Cheyenne, WY .................................................................................................................................................................. 0.9060 

Laramie County, WY.

16974 ........... Chicago-Naperville-Joliet, IL ............................................................................................................................................. 1.0751 

Cook County, IL.

DeKalb County, IL.

DuPage County, IL.

Grundy County, IL.

Kane County, IL.

Kendall County, IL.

McHenry County, IL.

Will County, IL.

17020 ........... Chico, CA .......................................................................................................................................................................... 1.1053 

Butte County, CA.

17140 ........... Cincinnati-Middletown, OH-KY-IN ..................................................................................................................................... 0.9601 

Dearborn County, IN.

Franklin County, IN.

Ohio County, IN.

Boone County, KY.

Bracken County, KY.

Campbell County, KY.

Gallatin County, KY.

Grant County, KY.

Kenton County, KY.

Pendleton County, KY.

Brown County, OH.

Butler County, OH.

Clermont County, OH.

Hamilton County, OH.

Warren County, OH.

17300 ........... Clarksville, TN-KY ............................................................................................................................................................. 0.8436 

Christian County, KY.

Trigg County, KY.

Montgomery County, TN.

Stewart County, TN.

17420 ........... Cleveland, TN ................................................................................................................................................................... 0.8109 

Bradley County, TN.

Polk County, TN.

17460 ........... Cleveland-Elyria-Mentor, OH ............................................................................................................................................ 0.9400 

Cuyahoga County, OH.

Geauga County, OH.

Lake County, OH.

Lorain County, OH.

Medina County, OH.


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65941 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

17660 ........... Coeur d’Alene, ID .............................................................................................................................................................. 0.9344 

Kootenai County, ID.

17780 ........... College Station-Bryan, TX ................................................................................................................................................ 0.9045 

Brazos County, TX.

Burleson County, TX.

Robertson County, TX.

17820 ........... Colorado Springs, CO ....................................................................................................................................................... 0.9701 

El Paso County, CO.

Teller County, CO.

17860 ........... Columbia, MO ................................................................................................................................................................... 0.8542 

Boone County, MO.

Howard County, MO.

17900 ........... Columbia, SC .................................................................................................................................................................... 0.8933 

Calhoun County, SC.

Fairfield County, SC.

Kershaw County, SC.

Lexington County, SC.

Richland County, SC.

Saluda County, SC.

17980 ........... Columbus, GA-AL ............................................................................................................................................................. 0.8239 

Russell County, AL.

Chattahoochee County, GA.

Harris County, GA.

Marion County, GA.

Muscogee County, GA.

18020 ........... Columbus, IN .................................................................................................................................................................... 0.9318 

Bartholomew County, IN.

18140 ........... Columbus, OH ................................................................................................................................................................... 1.0107 

Delaware County, OH.

Fairfield County, OH.

Franklin County, OH.

Licking County, OH.

Madison County, OH.

Morrow County, OH.

Pickaway County, OH.

Union County, OH.

18580 ........... Corpus Christi, TX ............................................................................................................................................................. 0.8564 

Aransas County, TX.

Nueces County, TX.

San Patricio County, TX.

18700 ........... Corvallis, OR ..................................................................................................................................................................... 1.1546 

Benton County, OR.

19060 ........... Cumberland, MD-WV ........................................................................................................................................................ 0.8446 

Allegany County, MD.

Mineral County, WV.

19124 ........... Dallas-PlanoIrving, TX ...................................................................................................................................................... 1.0075 

Collin County, TX.

Dallas County, TX.

Delta County, TX.

Denton County, TX.

Ellis County, TX.

Hunt County, TX.

Kaufman County, TX.

Rockwall County, TX.

19140 ........... Dalton, GA ......................................................................................................................................................................... 0.9093 

Murray County, GA.

Whitfield County, GA.

19180 ........... Danville, IL ........................................................................................................................................................................ 0.9266 

Vermilion County, IL.

19260 ........... Danville, VA ....................................................................................................................................................................... 0.8451 

Pittsylvania County, VA.

Danville City, VA.

19340 ........... Davenport-Moline-Rock Island, IA-IL ................................................................................................................................ 0.8846 

Henry County, IL.

Mercer County, IL.

Rock Island County, IL.

Scott County, IA.

19380 ........... Dayton, OH ....................................................................................................................................................................... 0.9037 

Greene County, OH.

Miami County, OH.


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65942 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Montgomery County, OH.

Preble County, OH.

19460 ........... Decatur, AL ....................................................................................................................................................................... 0.8159 

Lawrence County, AL.

Morgan County, AL.

19500 ........... Decatur, IL ......................................................................................................................................................................... 0.8172 

Macon County, IL.

19660 ........... Deltona-Daytona Beach-Ormond Beach, FL .................................................................................................................... 0.9263 

Volusia County, FL.

19740 ........... Denver-Aurora, CO ........................................................................................................................................................... 1.0930 

Adams County, CO.

Arapahoe County, CO.

Broomfield County, CO.

Clear Creek County, CO.

Denver County, CO.

Douglas County, CO.

Elbert County, CO.

Gilpin County, CO.

Jefferson County, CO.

Park County, CO.

19780 ........... Des Moines, IA .................................................................................................................................................................. 0.9214 

Dallas County, IA.

Guthrie County, IA.

Madison County, IA.

Polk County, IA.

Warren County, IA.

19804 ........... Detroit-Livonia-Dearborn, MI ............................................................................................................................................. 1.0281 

Wayne County, MI.

20020 ........... Dothan, AL ........................................................................................................................................................................ 0.7381 

Geneva County, AL.

Henry County, AL.

Houston County, AL.

20100 ........... Dover, DE .......................................................................................................................................................................... 0.9847 

Kent County, DE.

20220 ........... Dubuque, IA ...................................................................................................................................................................... 0.9133 

Dubuque County, IA.

20260 ........... Duluth, MN-WI ................................................................................................................................................................... 1.0042 

Carlton County, MN.

St. Louis County, MN.

Douglas County, WI.

20500 ........... Durham, NC ...................................................................................................................................................................... 0.9826 

Chatham County, NC.

Durham County, NC.

Orange County, NC.

Person County, NC.

20740 ........... Eau Claire, WI ................................................................................................................................................................... 0.9630 

Chippewa County, WI.

Eau Claire County, WI.

20764 ........... Edison, NJ ......................................................................................................................................................................... 1.1190 

Middlesex County, NJ.

Monmouth County, NJ.

Ocean County, NJ.

Somerset County, NJ.

20940 ........... El Centro, CA .................................................................................................................................................................... 0.9076 

Imperial County, CA.

21060 ........... Elizabethtown, KY ............................................................................................................................................................. 0.8697 

Hardin County, KY.

Larue County, KY.

21140 ........... Elkhart-Goshen, IN ............................................................................................................................................................ 0.9426 

Elkhart County, IN.

21300 ........... Elmira, NY ......................................................................................................................................................................... 0.8240 

Chemung County, NY.

21340 ........... El Paso, TX ....................................................................................................................................................................... 0.9053 

El Paso County, TX.

21500 ........... Erie, PA ............................................................................................................................................................................. 0.8827 

Erie County, PA.

21604 ........... Essex County, MA ............................................................................................................................................................ 1.0418 

Essex County, MA.

21660 ........... Eugene-Springfield, OR .................................................................................................................................................... 1.0876 

Lane County, OR.


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65943 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

21780 ........... Evansville, IN-KY .............................................................................................................................................................. 0.9071 

Gibson County, IN.

Posey County, IN.

Vanderburgh County, IN.

Warrick County, IN.

Henderson County, KY.

Webster County, KY.

21820 ........... Fairbanks, AK .................................................................................................................................................................... 1.1059 

Fairbanks North Star Borough, AK.

21940 ........... Fajardo, PR ....................................................................................................................................................................... 0.4036 

Ceiba Municipio, PR.

Fajardo Municipio, PR.

Luquillo Municipio, PR.

22020 ........... Fargo, ND-MN ................................................................................................................................................................... 0.8250 

Cass County, ND.

Clay County, MN.

22140 ........... Farmington, NM ................................................................................................................................................................ 0.8589 

San Juan County, NM.

22180 ........... Fayetteville, NC ................................................................................................................................................................. 0.8945 

Cumberland County, NC.

Hoke County, NC.

22220 ........... Fayetteville-Springdale-Rogers, AR-MO ........................................................................................................................... 0.8865 

Benton County, AR.

Madison County, AR.

Washington County, AR.

McDonald County, MO.

22380 ........... Flagstaff, AZ ...................................................................................................................................................................... 1.1601 

Coconino County, AZ.

22420 ........... Flint, MI ............................................................................................................................................................................. 1.0969 

Genesee County, MI.

22500 ........... Florence, SC ..................................................................................................................................................................... 0.8388 

Darlington County, SC.

Florence County, SC.

22520 ........... Florence-Muscle Shoals, AL ............................................................................................................................................. 0.7843 

Colbert County, AL.

Lauderdale County, AL.

22540 ........... Fond du Lac, WI ............................................................................................................................................................... 1.0063 

Fond du Lac County, WI.

22660 ........... Fort Collins-Loveland, CO ................................................................................................................................................. 0.9544 

Larimer County, CO.

22744 ........... Fort Lauderdale-Pompano Beach-Deerfield Beach, FL .................................................................................................... 1.0133 

Broward County, FL.

22900 ........... Fort Smith, AR-OK ............................................................................................................................................................ 0.7731 

Crawford County, AR.

Franklin County, AR.

Sebastian County, AR.

Le Flore County, OK.

Sequoyah County, OK.

23020 ........... Fort Walton Beach-Crestview-Destin, FL .......................................................................................................................... 0.8643 

Okaloosa County, FL.

23060 ........... Fort Wayne, IN .................................................................................................................................................................. 0.9517 

Allen County, IN.

Wells County, IN.

Whitley County, IN.

23104 ........... Fort Worth-Arlington, TX ................................................................................................................................................... 0.9569 

Johnson County, TX.

Parker County, TX.

Tarrant County, TX.

Wise County, TX.

23420 ........... Fresno, CA ........................................................................................................................................................................ 1.0943 

Fresno County, CA.

23460 ........... Gadsden, AL ..................................................................................................................................................................... 0.8066 

Etowah County, AL.

23540 ........... Gainesville, FL .................................................................................................................................................................. 0.9277 

Alachua County, FL.

Gilchrist County, FL.

23580 ........... Gainesville, GA ................................................................................................................................................................. 0.8958 

Hall County, GA.

23844 ........... Gary, IN ............................................................................................................................................................................. 0.9334 

Jasper County, IN.


rmajette on PROD1PC67 with RULES2
65944 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Lake County, IN.

Newton County, IN.

Porter County, IN.

24020 ........... Glens Falls, NY ................................................................................................................................................................. 0.8324 

Warren County, NY.

Washington County, NY.

24140 ........... Goldsboro, NC .................................................................................................................................................................. 0.9171 

Wayne County, NC.

24220 ........... Grand Forks, ND-MN ........................................................................................................................................................ 0.7949 

Polk County, MN.

Grand Forks County, ND.

24300 ........... Grand Junction, CO .......................................................................................................................................................... 0.9668 

Mesa County, CO.

24340 ........... Grand Rapids-Wyoming, MI .............................................................................................................................................. 0.9455 

Barry County, MI.

Ionia County, MI.

Kent County, MI.

Newaygo County, MI.

24500 ........... Great Falls, MT ................................................................................................................................................................. 0.8598 

Cascade County, MT.

24540 ........... Greeley, CO ...................................................................................................................................................................... 0.9602 

Weld County, CO.

24580 ........... Green Bay, WI .................................................................................................................................................................. 0.9787 

Brown County, WI.

Kewaunee County, WI.

Oconto County, WI.

24660 ........... Greensboro-High Point, NC .............................................................................................................................................. 0.8866 

Guilford County, NC.

Randolph County, NC.

Rockingham County, NC.

24780 ........... Greenville, NC ................................................................................................................................................................... 0.9432 

Greene County, NC.

Pitt County, NC.

24860 ........... Greenville, SC ................................................................................................................................................................... 0.9804 

Greenville County, SC.

Laurens County, SC.

Pickens County, SC.

25020 ........... Guayama, PR .................................................................................................................................................................... 0.3235 

Arroyo Municipio, PR.

Guayama Municipio, PR.

Patillas Municipio, PR.

25060 ........... Gulfport-Biloxi, MS ............................................................................................................................................................ 0.8915 

Hancock County, MS.

Harrison County, MS.

Stone County, MS.

25180 ........... Hagerstown-Martinsburg, MD-WV .................................................................................................................................... 0.9038 

Washington County, MD.

Berkeley County, WV.

Morgan County, WV.

25260 ........... Hanford-Corcoran, CA ...................................................................................................................................................... 1.0282 

Kings County, CA.

25420 ........... Harrisburg-Carlisle, PA ..................................................................................................................................................... 0.9402 

Cumberland County, PA.

Dauphin County, PA.

Perry County, PA.

25500 ........... Harrisonburg, VA ............................................................................................................................................................... 0.9073 

Rockingham County, VA.

Harrisonburg City, VA.

25540 ........... Hartford-West Hartford-East Hartford, CT ........................................................................................................................ 1.0894 

Hartford County, CT.

Litchfield County, CT.

Middlesex County, CT.

Tolland County, CT.

25620 ........... Hattiesburg, MS ................................................................................................................................................................ 0.7430 

Forrest County, MS.

Lamar County, MS.

Perry County, MS.

25860 ........... Hickory-Lenoir-Morganton, NC ......................................................................................................................................... 0.9010 

Alexander County, NC.

Burke County, NC.


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65945 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Caldwell County, NC.

Catawba County, NC.

259801 ......... Hinesville-Fort Stewart, GA ............................................................................................................................................... 0.9178 

Liberty County, GA.

Long County, GA.

26100 ........... Holland-Grand Haven, MI ................................................................................................................................................. 0.9163 

Ottawa County, MI.

26180 ........... Honolulu, HI ...................................................................................................................................................................... 1.1096 

Honolulu County, HI.

26300 ........... Hot Springs, AR ................................................................................................................................................................ 0.8782 

Garland County, AR.

26380 ........... Houma-Bayou Cane-Thibodaux, LA ................................................................................................................................. 0.8082 

Lafourche Parish, LA.

Terrebonne Parish, LA.

26420 ........... Houston-Baytown-Sugar Land, TX ................................................................................................................................... 1.0008 

Austin County, TX.

Brazoria County, TX.

Chambers County, TX.

Fort Bend County, TX.

Galveston County, TX.

Harris County, TX.

Liberty County, TX.

Montgomery County, TX.

San Jacinto County, TX.

Waller County, TX.

26580 ........... Huntington-Ashland, WVKYOH ......................................................................................................................................... 0.8997 

Boyd County, KY.

Greenup County, KY.

Lawrence County, OH.

Cabell County, WV.

Wayne County, WV.

26620 ........... Huntsville, AL .................................................................................................................................................................... 0.9007 

Limestone County, AL.

Madison County, AL.

26820 ........... Idaho Falls, ID ................................................................................................................................................................... 0.9088 

Bonneville County, ID.

Jefferson County, ID.

26900 ........... Indianapolis, IN ................................................................................................................................................................. 0.9895 

Boone County, IN.

Brown County, IN.

Hamilton County, IN.

Hancock County, IN.

Hendricks County, IN.

Johnson County, IN.

Marion County, IN.

Morgan County, IN.

Putnam County, IN.

Shelby County, IN.

26980 ........... Iowa City, IA ...................................................................................................................................................................... 0.9714 

Johnson County, IA.

Washington County, IA.

27060 ........... Ithaca, NY ......................................................................................................................................................................... 0.9928 

Tompkins County, NY.

27100 ........... Jackson, MI ....................................................................................................................................................................... 0.9560 

Jackson County, MI.

27140 ........... Jackson, MS ...................................................................................................................................................................... 0.8271 

Copiah County, MS.

Hinds County, MS.

Madison County, MS.

Rankin County, MS.

Simpson County, MS.

27180 ........... Jackson, TN ...................................................................................................................................................................... 0.8853 

Chester County, TN.

Madison County, TN.

27260 ........... Jacksonville, FL ................................................................................................................................................................. 0.9165 

Baker County, FL.

Clay County, FL.

Duval County, FL.

Nassau County, FL.

St. Johns County, FL.


rmajette on PROD1PC67 with RULES2
65946 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

27340 ........... Jacksonville, NC ................................................................................................................................................................ 0.8231 

Onslow County, NC.

27500 ........... Janesville, WI .................................................................................................................................................................... 0.9655 

Rock County, WI.

27620 ........... Jefferson City, MO ............................................................................................................................................................ 0.8332 

Callaway County, MO.

Cole County, MO.

Moniteau County, MO.

Osage County, MO.

≤27740 ......... Johnson City, TN .............................................................................................................................................................. 0.8043 

Carter County, TN.

Unicoi County, TN.

Washington County, TN.

27780 ........... Johnstown, PA .................................................................................................................................................................. 0.8620 

Cambria County, PA.

27860 ........... Jonesboro, AR .................................................................................................................................................................. 0.7662 

Craighead County, AR.

Poinsett County, AR.

27900 ........... Joplin, MO ......................................................................................................................................................................... 0.8605 

Jasper County, MO.

Newton County, MO.

28020 ........... Kalamazoo-Portage, MI .................................................................................................................................................... 1.0704 

Kalamazoo County, MI.

Van Buren County, MI.

28100 ........... Kankakee-Bradley, IL ........................................................................................................................................................ 1.0083 

Kankakee County, IL.

28140 ........... Kansas City, MOKS .......................................................................................................................................................... 0.9495 

Franklin County, KS.

Johnson County, KS.

Leavenworth County, KS.

Linn County, KS.

Miami County, KS.

Wyandotte County, KS.

Bates County, MO.

Caldwell County, MO.

Cass County, MO.

Clay County, MO.

Clinton County, MO.

Jackson County, MO.

Lafayette County, MO.

Platte County, MO.

Ray County, MO.

28420 ........... Kennewick-Richland-Pasco, WA ....................................................................................................................................... 1.0343 

Benton County, WA.

Franklin County, WA.

28660 ........... Killeen-TempleFort Hood, TX ........................................................................................................................................... 0.8901 

Bell County, TX.

Coryell County, TX.

Lampasas County, TX.

28700 ........... Kingsport-Bristol-Bristol, TNVA ......................................................................................................................................... 0.7985 

Hawkins County, TN.

Sullivan County, TN.

Bristol City, VA.

Scott County, VA.

Washington County, VA.

28740 ........... Kingston, NY ..................................................................................................................................................................... 0.9367 

Ulster County, NY.

28940 ........... Knoxville, TN ..................................................................................................................................................................... 0.8249 

Anderson County, TN.

Blount County, TN.

Knox County, TN.

Loudon County, TN.

Union County, TN.

29020 ........... Kokomo, IN ....................................................................................................................................................................... 0.9669 

Howard County, IN.

Tipton County, IN.

29100 ........... La Crosse, WIMN .............................................................................................................................................................. 0.9426 

Houston County, MN.

La Crosse County, WI.

29140 ........... Lafayette, IN ...................................................................................................................................................................... 0.8931 


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65947 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Benton County, IN.

Carroll County, IN.

Tippecanoe County, IN.

29180 ........... Lafayette, LA ..................................................................................................................................................................... 0.8289 

Lafayette Parish, LA.

St. Martin Parish, LA.

29340 ........... Lake Charles, LA .............................................................................................................................................................. 0.7914 

Calcasieu Parish, LA.

Cameron Parish, LA.

29404 ........... Lake County-Kenosha County, IL-WI ............................................................................................................................... 1.0570 

Lake County, IL.

Kenosha County, WI.

29460 ........... Lakeland, FL ..................................................................................................................................................................... 0.8879 

Polk County, FL.

29540 ........... Lancaster, PA .................................................................................................................................................................... 0.9589 

Lancaster County, PA.

29620 ........... Lansing-East Lansing, MI ................................................................................................................................................. 1.0088 

Clinton County, MI.

Eaton County, MI.

Ingham County, MI.

29700 ........... Laredo, TX ........................................................................................................................................................................ 0.7811 

Webb County, TX.

29740 ........... Las Cruces, NM ................................................................................................................................................................ 0.9273 

Dona Ana County, NM.

29820 ........... Las Vegas-Paradise, NV ................................................................................................................................................... 1.1430 

Clark County, NV.

29940 ........... Lawrence, KS .................................................................................................................................................................... 0.8365 

Douglas County, KS.

30020 ........... Lawton, OK ....................................................................................................................................................................... 0.8065 

Comanche County, OK.

30140 ........... Lebanon, PA ..................................................................................................................................................................... 0.8679 

Lebanon County, PA.

30300 ........... Lewiston, ID-WA ............................................................................................................................................................... 0.9853 

Nez Perce County, ID.

Asotin County, WA.

30340 ........... LewistonAuburn, ME ......................................................................................................................................................... 0.9126 

Androscoggin County, ME.

30460 ........... Lexington-Fayette, KY ....................................................................................................................................................... 0.9181 

Bourbon County, KY.

Clark County, KY.

Fayette County, KY.

Jessamine County, KY.

Scott County, KY.

Woodford County, KY.

30620 ........... Lima, OH ........................................................................................................................................................................... 0.9042 

Allen County, OH.

30700 ........... Lincoln, NE ........................................................................................................................................................................ 1.0092 

Lancaster County, NE.

Seward County, NE.

30780 ........... Little Rock-North Little Rock, AR ...................................................................................................................................... 0.8890 

Faulkner County, AR.

Grant County, AR.

Lonoke County, AR.

Perry County, AR.

Pulaski County, AR.

Saline County, AR.

30860 ........... Logan, UT-ID ..................................................................................................................................................................... 0.9022 

Franklin County, ID.

Cache County, UT.

30980 ........... Longview, TX .................................................................................................................................................................... 0.8788 

Gregg County, TX.

Rusk County, TX.

Upshur County, TX.

31020 ........... Longview, WA ................................................................................................................................................................... 1.0011 

Cowlitz County, WA.

31084 ........... Los Angeles-Long Beach-Glendale, CA ........................................................................................................................... 1.1760 

Los Angeles County, CA.

31140 ........... Louisville, KY-IN ................................................................................................................................................................ 0.9118 

Clark County, IN.

Floyd County, IN.


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65948 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Harrison County, IN.

Washington County, IN.

Bullitt County, KY.

Henry County, KY.

Jefferson County, KY.

Meade County, KY.

Nelson County, KY.

Oldham County, KY.

Shelby County, KY.

Spencer County, KY.

Trimble County, KY.

31180 ........... Lubbock, TX ...................................................................................................................................................................... 0.8613 

Crosby County, TX.

Lubbock County, TX.

31340 ........... Lynchburg, VA ................................................................................................................................................................... 0.8694 

Amherst County, VA.

Appomattox County, VA.

Bedford County, VA.

Campbell County, VA.

Bedford City, VA.

Lynchburg City, VA.

31420 ........... Macon, GA ........................................................................................................................................................................ 0.9519 

Bibb County, GA.

Crawford County, GA.

Jones County, GA.

Monroe County, GA.

Twiggs County, GA.

31460 ........... Madera, CA ....................................................................................................................................................................... 0.8154 

Madera County, CA.

31540 ........... Madison, WI ...................................................................................................................................................................... 1.0840 

Columbia County, WI.

Dane County, WI.

Iowa County, WI.

31700 ........... Manchester-Nashua, NH ................................................................................................................................................... 1.0243 

Hillsborough County, NH.

Merrimack County, NH.

31900 ........... Mansfield, OH ................................................................................................................................................................... 0.9271 

Richland County, OH.

32420 ........... Mayagu ̈ez, PR ................................................................................................................................................................... 0.3848 

Hormigueros Municipio, PR.

Mayagu ̈ez Municipio, PR.

32580 ........... McAllen-Edinburg-Pharr, TX ............................................................................................................................................. 0.8773 

Hidalgo County, TX.

32780 ........... Medford, OR ...................................................................................................................................................................... 1.0818 

Jackson County, OR.

32820 ........... Memphis, TN-MS-AR ........................................................................................................................................................ 0.9373 

Crittenden County, AR.

DeSoto County, MS.

Marshall County, MS.

Tate County, MS.

Tunica County, MS.

Fayette County, TN.

Shelby County, TN.

Tipton County, TN.

32900 ........... Merced, CA ....................................................................................................................................................................... 1.1471 

Merced County, CA.

33124 ........... Miami-Miami Beach-Kendall, FL ....................................................................................................................................... 0.9812 

Miami-Dade County, FL.

33140 ........... Michigan City-La Porte, IN ................................................................................................................................................ 0.9118 

LaPorte County, IN.

33260 ........... Midland, TX ....................................................................................................................................................................... 0.9786 

Midland County, TX.

33340 ........... Milwaukee-Waukesha-West Allis, WI ................................................................................................................................ 1.0218 

Milwaukee County, WI.

Ozaukee County, WI.

Washington County, WI.

Waukesha County, WI.

33460 ........... Minneapolis-St. Paul-Bloomington, MN-WI ....................................................................................................................... 1.0946 

Anoka County, MN.

Carver County, MN.


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65949 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Chisago County, MN.

Dakota County, MN.

Hennepin County, MN.

Isanti County, MN.

Ramsey County, MN.

Scott County, MN.

Sherburne County, MN.

Washington County, MN.

Wright County, MN.

Pierce County, WI.

St. Croix County, WI.

33540 ........... Missoula, MT ..................................................................................................................................................................... 0.8928 

Missoula County, MT.

33660 ........... Mobile, AL ......................................................................................................................................................................... 0.7913 

Mobile County, AL.

33700 ........... Modesto, CA ..................................................................................................................................................................... 1.1729 

Stanislaus County, CA.

33740 ........... Monroe, LA ........................................................................................................................................................................ 0.7997 

Ouachita Parish, LA.

Union Parish, LA.

33780 ........... Monroe, MI ........................................................................................................................................................................ 0.9707 

Monroe County, MI.

33860 ........... Montgomery, AL ................................................................................................................................................................ 0.8009 

Autauga County, AL.

Elmore County, AL.

Lowndes County, AL.

Montgomery County, AL.

34060 ........... Morgantown, WV ............................................................................................................................................................... 0.8423 

Monongalia County, WV.

Preston County, WV.

34100 ........... Morristown, TN .................................................................................................................................................................. 0.7933 

Grainger County, TN.

Hamblen County, TN.

Jefferson County, TN.

34580 ........... Mount Vernon-Anacortes, WA .......................................................................................................................................... 1.0517 

Skagit County, WA.

34620 ........... Muncie, IN ......................................................................................................................................................................... 0.8562 

Delaware County, IN.

34740 ........... Muskegon-Norton Shores, MI ........................................................................................................................................... 0.9941 

Muskegon County, MI.

34820 ........... Myrtle Beach-Conway-North Myrtle Beach, SC ................................................................................................................ 0.8810 

Horry County, SC.

34900 ........... Napa, CA ........................................................................................................................................................................... 1.3374 

Napa County, CA.

34940 ........... Naples-Marco Island, FL ................................................................................................................................................... 0.9941 

Collier County, FL.

34980 ........... Nashville-Davidson-Murfreesboro, TN .............................................................................................................................. 0.9847 

Cannon County, TN.

Cheatham County, TN.

Davidson County, TN.

Dickson County, TN.

Hickman County, TN.

Macon County, TN.

Robertson County, TN.

Rutherford County, TN.

Smith County, TN.

Sumner County, TN.

Trousdale County, TN.

Williamson County, TN.

Wilson County, TN.

35004 ........... Nassau-Suffolk, NY ........................................................................................................................................................... 1.2662 

Nassau County, NY.

Suffolk County, NY.

35084 ........... Newark-Union, NJ-PA ....................................................................................................................................................... 1.1892 

Essex County, NJ.

Hunterdon County, NJ.

Morris County, NJ.

Sussex County, NJ.

Union County, NJ.

Pike County, PA.


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65950 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

35300 ........... New Haven-Milford, CT ..................................................................................................................................................... 1.1953 

New Haven County, CT.

35380 ........... New Orleans-Metairie-Kenner, LA .................................................................................................................................... 0.8831 

Jefferson Parish, LA.

Orleans Parish, LA.

Plaquemines Parish, LA.

St. Bernard Parish, LA.

St. Charles Parish, LA.

St. John the Baptist Parish, LA.

St. Tammany Parish, LA.

35644 ........... New York-Wayne-White Plains, NY-NJ ............................................................................................................................ 1.3177 

Bergen County, NJ.

Hudson County, NJ.

Passaic County, NJ.

Bronx County, NY.

Kings County, NY.

New York County, NY.

Putnam County, NY.

Queens County, NY.

Richmond County, NY.

Rockland County, NY.

Westchester County, NY.

35660 ........... Niles-Benton Harbor, MI ................................................................................................................................................... 0.8915 

Berrien County, MI.

35980 ........... Norwich-New London, CT ................................................................................................................................................. 1.1932 

New London County, CT.

36084 ........... Oakland-Fremont-Hayward, CA ........................................................................................................................................ 1.5819 

Alameda County, CA.

Contra Costa County, CA.

36100 ........... Ocala, FL ........................................................................................................................................................................... 0.8867 

Marion County, FL.

36140 ........... Ocean City, NJ .................................................................................................................................................................. 1.0472 

Cape May County, NJ.

36220 ........... Odessa, TX ....................................................................................................................................................................... 1.0073 

Ector County, TX.

36260 ........... Ogden-Clearfield, UT ........................................................................................................................................................ 0.8995 

Davis County, UT.

Morgan County, UT.

Weber County, UT.

36420 ........... Oklahoma City, OK ........................................................................................................................................................... 0.8843 

Canadian County, OK.

Cleveland County, OK.

Grady County, OK.

Lincoln County, OK.

Logan County, OK.

McClain County, OK.

Oklahoma County, OK.

36500 ........... Olympia, WA ..................................................................................................................................................................... 1.1081 

Thurston County, WA.

36540 ........... Omaha-Council Bluffs, NE-IA ........................................................................................................................................... 0.9450 

Harrison County, IA.

Mills County, IA.

Pottawattamie County, IA.

Cass County, NE.

Douglas County, NE.

Sarpy County, NE.

Saunders County, NE.

Washington County, NE.

36740 ........... Orlando, FL ....................................................................................................................................................................... 0.9452 

Lake County, FL.

Orange County, FL.

Osceola County, FL.

Seminole County, FL.

36780 ........... Oshkosh-Neenah, WI ........................................................................................................................................................ 0.9315 

Winnebago County, WI.

36980 ........... Owensboro, KY ................................................................................................................................................................. 0.8748 

Daviess County, KY.

Hancock County, KY.

McLean County, KY.

37100 ........... Oxnard-Thousand Oaks-Ventura, CA ............................................................................................................................... 1.1546 


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Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65951 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Ventura County, CA.

37340 ........... Palm Bay-Melbourne-Titusville, FL ................................................................................................................................... 0.9443 

Brevard County, FL.

37460 ........... Panama City-Lynn Haven, FL ........................................................................................................................................... 0.8027 

Bay County, FL.

37620 ........... Parkersburg-Marietta, WV-OH .......................................................................................................................................... 0.7977 

Washington County, OH.

Pleasants County, WV.

Wirt County, WV.

Wood County, WV.

37700 ........... Pascagoula, MS ................................................................................................................................................................ 0.8215 

George County, MS.

Jackson County, MS.

37860 ........... Pensacola-Ferry Pass-Brent, FL ....................................................................................................................................... 0.8000 

Escambia County, FL.

Santa Rosa County, FL.

37900 ........... Peoria, IL ........................................................................................................................................................................... 0.8982 

Marshall County, IL.

Peoria County, IL.

Stark County, IL.

Tazewell County, IL.

Woodford County, IL.

37964 ........... Philadelphia, PA ................................................................................................................................................................ 1.0996 

Bucks County, PA.

Chester County, PA.

Delaware County, PA.

Montgomery County, PA.

Philadelphia County, PA.

38060 ........... Phoenix-Mesa-Scottsdale, AZ ........................................................................................................................................... 1.0287 

Maricopa County, AZ.

Pinal County, AZ.

38220 ........... Pine Bluff, AR .................................................................................................................................................................... 0.8383 

Cleveland County, AR.

Jefferson County, AR.

Lincoln County, AR.

38300 ........... Pittsburgh, PA ................................................................................................................................................................... 0.8674 

Allegheny County, PA.

Armstrong County, PA.

Beaver County, PA.

Butler County, PA.

Fayette County, PA.

Washington County, PA.

Westmoreland County, PA.

38340 ........... Pittsfield, MA ..................................................................................................................................................................... 1.0266 

Berkshire County, MA.

38540 ........... Pocatello, ID ...................................................................................................................................................................... 0.9400 

Bannock County, ID.

Power County, ID.

38660 ........... Ponce, PR ......................................................................................................................................................................... 0.4842 

Juana Dı ́az Municipio, PR.

Ponce Municipio, PR.

Villalba Municipio, PR.

38860 ........... Portland-South Portland-Biddeford, ME ............................................................................................................................ 0.9908 

Cumberland County, ME.

Sagadahoc County, ME.

York County, ME.

38900 ........... Portland-Vancouver-Beaverton, OR-WA .......................................................................................................................... 1.1416 

Clackamas County, OR.

Columbia County, OR.

Multnomah County, OR.

Washington County, OR.

Yamhill County, OR.

Clark County, WA.

Skamania County, WA.

38940 ........... Port St. Lucie-Fort Pierce, FL ........................................................................................................................................... 0.9833 

Martin County, FL.

St. Lucie County, FL.

39100 ........... Poughkeepsie-Newburgh-Middletown, NY ........................................................................................................................ 1.0911 

Dutchess County, NY.

Orange County, NY.


rmajette on PROD1PC67 with RULES2
65952 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

39140 ........... Prescott, AZ ...................................................................................................................................................................... 0.9836 

Yavapai County, AZ.

39300 ........... Providence-New Bedford-Fall River, RI-MA ..................................................................................................................... 1.0783 

Bristol County, MA.

Bristol County, RI.

Kent County, RI.

Newport County, RI.

Providence County, RI.

Washington County, RI.

39340 ........... Provo-Orem, UT ................................................................................................................................................................ 0.9537 

Juab County, UT.

Utah County, UT.

39380 ........... Pueblo, CO ........................................................................................................................................................................ 0.8753 

Pueblo County, CO.

39460 ........... Punta Gorda, FL ............................................................................................................................................................... 0.9405 

Charlotte County, FL.

39540 ........... Racine, WI ......................................................................................................................................................................... 0.9356 

Racine County, WI.

39580 ........... Raleig-hCary, NC .............................................................................................................................................................. 0.9864 

Franklin County, NC.

Johnston County, NC.

Wake County, NC.

39660 ........... Rapid City, SD .................................................................................................................................................................. 0.8833 

Meade County, SD.

Pennington County, SD.

39740 ........... Reading, PA ...................................................................................................................................................................... 0.9622 

Berks County, PA.

39820 ........... Redding, CA ...................................................................................................................................................................... 1.3198 

Shasta County, CA.

39900 ........... Reno-Sparks, NV .............................................................................................................................................................. 1.1963 

Storey County, NV.

Washoe County, NV.

40060 ........... Richmond, VA ................................................................................................................................................................... 0.9177 

Amelia County, VA.

Caroline County, VA.

Charles City County, VA.

Chesterfield County, VA.

Cumberland County, VA.

Dinwiddie County, VA.

Goochland County, VA.

Hanover County, VA.

Henrico County, VA.

King and Queen County, VA.

King William County, VA.

Louisa County, VA.

New Kent County, VA.

Powhatan County, VA.

Prince George County, VA.

Sussex County, VA.

Colonial Heights City, VA.

Hopewell City, VA.

Petersburg City, VA.

Richmond City, VA.

40140 ........... Riverside-San Bernardino-Ontario, CA ............................................................................................................................. 1.0904 

Riverside County, CA.

San Bernardino County, CA.

40220 ........... Roanoke, VA ..................................................................................................................................................................... 0.8647 

Botetourt County, VA.

Craig County, VA.

Franklin County, VA.

Roanoke County, VA.

Roanoke City, VA.

Salem City, VA.

40340 ........... Rochester, MN .................................................................................................................................................................. 1.1408 

Dodge County, MN.

Olmsted County, MN.

Wabasha County, MN.

40380 ........... Rochester, NY ................................................................................................................................................................... 0.8994 

Livingston County, NY.

Monroe County, NY.


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65953 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Ontario County, NY.

Orleans County, NY.

Wayne County, NY.

40420 ........... Rockford, IL ....................................................................................................................................................................... 0.9989 

Boone County, IL.

Winnebago County, IL.

40484 ........... Rockingham County-Strafford County, NH ....................................................................................................................... 1.0159 

Rockingham County, NH.

Strafford County, NH.

40580 ........... Rocky Mount, NC .............................................................................................................................................................. 0.8854 

Edgecombe County, NC.

Nash County, NC.

40660 ........... Rome, GA ......................................................................................................................................................................... 0.9193 

Floyd County, GA.

40900 ........... Sacramento—Arden-Arcade—Roseville, CA .................................................................................................................... 1.3372 

El Dorado County, CA.

Placer County, CA.

Sacramento County, CA.

Yolo County, CA.

40980 ........... Saginaw-Saginaw Township North, MI ............................................................................................................................. 0.8874 

Saginaw County, MI.

41060 ........... St. Cloud, MN .................................................................................................................................................................... 1.0362 

Benton County, MN.

Stearns County, MN.

41100 ........... St. George, UT .................................................................................................................................................................. 0.9265 

Washington County, UT.

41140 ........... St. Joseph, MO-KS ........................................................................................................................................................... 1.0118 

Doniphan County, KS.

Andrew County, MO.

Buchanan County, MO.

DeKalb County, MO.

41180 ........... St. Louis, MO-IL ................................................................................................................................................................ 0.9005 

Bond County, IL.

Calhoun County, IL.

Clinton County, IL.

Jersey County, IL.

Macoupin County, IL.

Madison County, IL.

Monroe County, IL.

St. Clair County, IL.

Crawford County, MO.

Franklin County, MO.

Jefferson County, MO.

Lincoln County, MO.

St. Charles County, MO.

St. Louis County, MO.

Warren County, MO.

Washington County, MO.

St. Louis City, MO.

41420 ........... Salem, OR ......................................................................................................................................................................... 1.0438 

Marion County, OR.

Polk County, OR.

41500 ........... Salinas, CA ....................................................................................................................................................................... 1.4337 

Monterey County, CA.

41540 ........... Salisbury, MD .................................................................................................................................................................... 0.8953 

Somerset County, MD.

Wicomico County, MD.

41620 ........... Salt Lake City, UT ............................................................................................................................................................. 0.9402 

Salt Lake County, UT.

Summit County, UT.

Tooele County, UT.

41660 ........... San Angelo, TX ................................................................................................................................................................. 0.8362 

Irion County, TX.

Tom Green County, TX.

41700 ........... San Antonio, TX ................................................................................................................................................................ 0.8844 

Atascosa County, TX.

Bandera County, TX.

Bexar County, TX.

Comal County, TX.

Guadalupe County, TX.


rmajette on PROD1PC67 with RULES2
65954 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Kendall County, TX.

Medina County, TX.

Wilson County, TX.

41740 ........... San Diego-Carlsbad-San Marcos, CA .............................................................................................................................. 1.1354 

San Diego County, CA.

41780 ........... Sandusky, OH ................................................................................................................................................................... 0.9302 

Erie County, OH.

41884 ........... San Francisco-San Mateo-Redwood City, CA .................................................................................................................. 1.5165 

Marin County, CA.

San Francisco County, CA.

San Mateo County, CA.

41900 ........... San Germa ́n-Cabo Rojo, PR ............................................................................................................................................ 0.4885 

Cabo Rojo Municipio, PR.

Lajas Municipio, PR.

Sabana Grande Municipio, PR.

San Germa ́n Municipio, PR.

41940 ........... San Jose-Sunnyvale-Santa Clara, CA .............................................................................................................................. 1.5543 

San Benito County, CA.

Santa Clara County, CA.

41980 ........... San Juan-Caguas-Guaynabo, PR .................................................................................................................................... 0.4452 

Aguas Buenas Municipio, PR.

Aibonito Municipio, PR.

Arecibo Municipio, PR.

Barceloneta Municipio, PR.

Barranquitas Municipio, PR.

Bayamo ́n Municipio, PR.

Caguas Municipio, PR.

Camuy Municipio, PR.

Cano ́vanas Municipio, PR.

Carolina Municipio, PR.

Catan ̃o Municipio, PR.

Cayey Municipio, PR.

Ciales Municipio, PR.

Cidra Municipio, PR.

Comer ́ıo Municipio, PR.

Corozal Municipio, PR.

Dorado Municipio, PR.

Florida Municipio, PR.

Guaynabo Municipio, PR.

Gurabo Municipio, PR.

Hatillo Municipio, PR.

Humacao Municipio, PR.

Juncos Municipio, PR.

Las Piedras Municipio, PR.

Lo ́ıza Municipio, PR.

Manat ́ı Municipio, PR.

Maunabo Municipio, PR.

Morovis Municipio, PR.

Naguabo Municipio, PR.

Naranjito Municipio, PR.

Orocovis Municipio, PR.

Quebradillas Municipio, PR.

R ́ıo Grande Municipio, PR.

San Juan Municipio, PR.

San Lorenzo Municipio, PR.

Toa Alta Municipio, PR.

Toa Baja Municipio, PR.

Trujillo Alto Municipio, PR.

Vega Alta Municipio, PR.

Vega Baja Municipio, PR.

Yabucoa Municipio, PR.

42020 ........... San Luis Obispo-Paso Robles, CA ................................................................................................................................... 1.1598 

San Luis Obispo County, CA.

42044 ........... Santa Ana-Anaheim-Irvine, CA ......................................................................................................................................... 1.1473 

Orange County, CA.

42060 ........... Santa Barbara-Santa Maria-Goleta, CA ........................................................................................................................... 1.1091 

Santa Barbara County, CA.

42100 ........... Santa Cruz-Watsonville, CA ............................................................................................................................................. 1.5457 

Santa Cruz County, CA.

42140 ........... Santa Fe, NM .................................................................................................................................................................... 1.0824 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65955 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Santa Fe County, NM.

42220 ........... Santa Rosa-Petaluma, CA ................................................................................................................................................ 1.4464 

Sonoma County, CA.

42260 ........... Sarasota-Bradenton-Venice, FL ........................................................................................................................................ 0.9868 

Manatee County, FL.

Sarasota County, FL.

42340 ........... Savannah, GA ................................................................................................................................................................... 0.9351 

Bryan County, GA.

Chatham County, GA.

Effingham County, GA.

42540 ........... Scranton-Wilkes-Barre, PA ............................................................................................................................................... 0.8347 

Lackawanna County, PA.

Luzerne County, PA.

Wyoming County, PA.

42644 ........... Seattle-Bellevue-Everett, WA ............................................................................................................................................ 1.1434 

King County, WA.

Snohomish County, WA.

42680 ........... Sebastian-Vero Beach, FL ................................................................................................................................................ 0.9573 

43100 ........... Sheboygan, WI .................................................................................................................................................................. 0.9026 

Sheboygan County, WI.

43300 ........... Sherman-Denison, TX ....................................................................................................................................................... 0.8502 

Grayson County, TX.

43340 ........... Shreveport-Bossier City, LA .............................................................................................................................................. 0.8865 

Bossier Parish, LA.

Caddo Parish, LA.

De Soto Parish, LA.

43580 ........... Sioux City, IA-NE-SD ........................................................................................................................................................ 0.9200 

Woodbury County, IA.

Dakota County, NE.

Dixon County, NE.

Union County, SD.

43620 ........... Sioux Falls, SD ................................................................................................................................................................. 0.9559 

Lincoln County, SD.

McCook County, SD.

Minnehaha County, SD.

Turner County, SD.

43780 ........... South Bend-Mishawaka, IN-MI ......................................................................................................................................... 0.9842 

St. Joseph County, IN.

Cass County, MI.

43900 ........... Spartanburg, SC ............................................................................................................................................................... 0.9174 

Spartanburg County, SC.

44060 ........... Spokane, WA .................................................................................................................................................................... 1.0447 

Spokane County, WA.

44100 ........... Springfield, IL .................................................................................................................................................................... 0.8890 

Menard County, IL.

Sangamon County, IL.

44140 ........... Springfield, MA .................................................................................................................................................................. 1.0079 

Franklin County, MA.

Hampden County, MA.

Hampshire County, MA.

44180 ........... Springfield, MO ................................................................................................................................................................. 0.8469 

Christian County, MO.

Dallas County, MO.

Greene County, MO.

Polk County, MO.

Webster County, MO.

44220 ........... Springfield, OH .................................................................................................................................................................. 0.8593 

Clark County, OH.

44300 ........... State College, PA .............................................................................................................................................................. 0.8784 

Centre County, PA.

44700 ........... Stockton, CA ..................................................................................................................................................................... 1.1442 

San Joaquin County, CA.

44940 ........... Sumter, SC ........................................................................................................................................................................ 0.8083 

Sumter County, SC.

45060 ........... Syracuse, NY .................................................................................................................................................................... 0.9691 

Madison County, NY.

Onondaga County, NY.

Oswego County, NY.

45104 ........... Tacoma, WA ..................................................................................................................................................................... 1.0789 

Pierce County, WA.


rmajette on PROD1PC67 with RULES2
65956 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

45220 ........... Tallahassee, FL ................................................................................................................................................................. 0.8942 

Gadsden County, FL.

Jefferson County, FL.

Leon County, FL.

Wakulla County, FL.

45300 ........... Tampa-St. Petersburg-Clearwater, FL .............................................................................................................................. 0.9144 

Hernando County, FL.

Hillsborough County, FL.

Pasco County, FL.

Pinellas County, FL.

45460 ........... Terre Haute, IN ................................................................................................................................................................. 0.8765 

Clay County, IN.

Sullivan County, IN.

Vermillion County, IN.

Vigo County, IN.

45500 ........... Texarkana, TX-Texarkana, AR ......................................................................................................................................... 0.8104 

Miller County, AR.

Bowie County, TX.

45780 ........... Toledo, OH ........................................................................................................................................................................ 0.9586 

Fulton County, OH.

Lucas County, OH.

Ottawa County, OH.

Wood County, OH.

45820 ........... Topeka, KS ....................................................................................................................................................................... 0.8730 

Jackson County, KS.

Jefferson County, KS.

Osage County, KS.

Shawnee County, KS.

Wabaunsee County, KS.

45940 ........... Trenton-Ewing, NJ ............................................................................................................................................................ 1.0835 

Mercer County, NJ.

46060 ........... Tucson, AZ ........................................................................................................................................................................ 0.9202 

Pima County, AZ.

46140 ........... Tulsa, OK .......................................................................................................................................................................... 0.8103 

Creek County, OK.

Okmulgee County, OK.

Osage County, OK.

Pawnee County, OK.

Rogers County, OK.

Tulsa County, OK.

Wagoner County, OK.

46220 ........... Tuscaloosa, AL ................................................................................................................................................................. 0.8542 

Greene County, AL.

Hale County, AL.

Tuscaloosa County, AL.

46340 ........... Tyler, TX ............................................................................................................................................................................ 0.8811 

Smith County, TX.

46540 ........... Utica-Rome, NY ................................................................................................................................................................ 0.8396 

Herkimer County, NY.

Oneida County, NY.

46660 ........... Valdosta, GA ..................................................................................................................................................................... 0.8369 

Brooks County, GA.

Echols County, GA.

Lanier County, GA.

Lowndes County, GA.

46700 ........... Vallejo-Fairfield, CA .......................................................................................................................................................... 1.5137 

Solano County, CA.

47020 ........... Victoria, TX ........................................................................................................................................................................ 0.8560 

Calhoun County, TX.

Goliad County, TX.

Victoria County, TX.

47220 ........... Vineland-Millville-Bridgeton, NJ ........................................................................................................................................ 0.9832 

Cumberland County, NJ.

47260 ........... Virginia Beach-Norfolk-Newport News, VA-NC ................................................................................................................ 0.8790 

Currituck County, NC.

Gloucester County, VA.

Isle of Wight County, VA.

James City County, VA.

Mathews County, VA.

Surry County, VA.


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65957 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

York County, VA.

Chesapeake City, VA.

Hampton City, VA.

Newport News City, VA.

Norfolk City, VA.

Poquoson City, VA.

Portsmouth City, VA.

Suffolk City, VA.

Virginia Beach City, VA.

Williamsburg City, VA.

47300 ........... Visalia-Porterville, CA ....................................................................................................................................................... 0.9968 

Tulare County, CA.

47380 ........... Waco, TX .......................................................................................................................................................................... 0.8633 

McLennan County, TX.

47580 ........... Warner Robins, GA ........................................................................................................................................................... 0.8380 

Houston County, GA.

47644 ........... Warren-Farmington Hills-Troy, MI ..................................................................................................................................... 1.0054 

Lapeer County, MI.

Livingston County, MI.

Macomb County, MI.

Oakland County, MI.

St. Clair County, MI.

47894 ........... Washington-Arlington-Alexandria, DC-VA-MD-WV ........................................................................................................... 1.1054 

District of Columbia, DC.

Calvert County, MD.

Charles County, MD.

Prince George’s County, MD.

Arlington County, VA.

Clarke County, VA.

Fairfax County, VA.

Fauquier County, VA.

Loudoun County, VA.

Prince William County, VA.

Spotsylvania County, VA.

Stafford County, VA.

Warren County, VA.

Alexandria City, VA.

Fairfax City, VA.

Falls Church City, VA.

Fredericksburg City, VA.

Manassas City, VA.

Manassas Park City, VA.

Jefferson County, WV.

47940 ........... Waterloo-Cedar Falls, IA ................................................................................................................................................... 0.8408 

Black Hawk County, IA.

Bremer County, IA.

Grundy County, IA.

48140 ........... Wausau, WI ....................................................................................................................................................................... 0.9722 

Marathon County, WI.

48260 ........... Weirton-Steubenville, WV-OH ........................................................................................................................................... 0.8063 

Jefferson County, OH.

Brooke County, WV.

Hancock County, WV.

48300 ........... Wenatchee, WA ................................................................................................................................................................ 1.0346 

Chelan County, WA.

Douglas County, WA.

48424 ........... West Palm Beach-Boca Raton-Boynton Beach, FL ......................................................................................................... 0.9649 

Palm Beach County, FL.

48540 ........... Wheeling, WV-OH ............................................................................................................................................................. 0.7010 

Belmont County, OH.

Marshall County, WV.

Ohio County, WV.

48620 ........... Wichita, KS ........................................................................................................................................................................ 0.9063 

Butler County, KS.

Harvey County, KS.

Sedgwick County, KS.

Sumner County, KS.

48660 ........... Wichita Falls, TX ............................................................................................................................................................... 0.8311 

Archer County, TX.

Clay County, TX.


rmajette on PROD1PC67 with RULES2
65958 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM B.—CY 2007 WAGE INDEX FOR URBAN AREAS BY CBSA; APPLICABLE PRE-FLOOR AND PRE-RECLASSIFIED

HOSPITAL WAGE INDEX—Continued 

CBSA code Urban area (constituent counties) Wage 

index 

Wichita County, TX.

48700 ........... Williamsport, PA ................................................................................................................................................................ 0.8139 

Lycoming County, PA.

48864 ........... Wilmington, DE-MD-NJ ..................................................................................................................................................... 1.0684 

New Castle County, DE.

Cecil County, MD.

Salem County, NJ.

48900 ........... Wilmington, NC ................................................................................................................................................................. 0.9835 

Brunswick County, NC.

New Hanover County, NC.

Pender County, NC.

49020 ........... Winchester, VA-WV .......................................................................................................................................................... 1.0091 

Frederick County, VA.

Winchester City, VA.

Hampshire County, WV.

49180 ........... Winston-Salem, NC ........................................................................................................................................................... 0.9276 

Davie County, NC.

Forsyth County, NC.

Stokes County, NC.

Yadkin County, NC.

49340 ........... Worcester, MA .................................................................................................................................................................. 1.0722 

Worcester County, MA.

49420 ........... Yakima, WA ...................................................................................................................................................................... 0.9847 

Yakima County, WA.

49500 ........... Yauco, PR ......................................................................................................................................................................... 0.3854 

Gua ́nica Municipio, PR.

Guayanilla Municipio, PR.

Pen ̃uelas Municipio, PR.

Yauco Municipio, PR.

49620 ........... York-Hanover, PA ............................................................................................................................................................. 0.9397 

York County, PA.

49660 ........... Youngstown-Warren-Boardman, OH-PA .......................................................................................................................... 0.8802 

Mahoning County, OH.

Trumbull County, OH.

Mercer County, PA.

49700 ........... Yuba City, CA ................................................................................................................................................................... 1.0730 

Sutter County, CA.

Yuba County, CA.

49740 ........... Yuma, AZ .......................................................................................................................................................................... 0.9109 

Yuma County, AZ.

1At this time, there are no hospitals in these urban areas on which to base a wage index. Therefore, the urban wage index value is based on 

the average wage index of all urban areas within the State. 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

01000 ................ Autauga County, Alabama ............................................................... 33860 0.8618 0.8009 ¥7.07 

01010 ................ Baldwin County, Alabama ................................................................ 99901 0.7654 0.7591 ¥0.82 

01020 ................ Barbour County, Alabama ................................................................ 99901 0.7439 0.7591 2.04 

01030 ................ Bibb County, Alabama ..................................................................... 13820 0.8196 0.8894 8.52 

01040 ................ Blount County, Alabama .................................................................. 13820 0.8980 0.8894 ¥0.96 

01050 ................ Bullock County, Alabama ................................................................. 99901 0.7439 0.7591 2.04 

01060 ................ Butler County, Alabama ................................................................... 99901 0.7439 0.7591 2.04 

01070 ................ Calhoun County, Alabama ............................................................... 11500 0.7682 0.7770 1.15 

01080 ................ Chambers County, Alabama ............................................................ 99901 0.7439 0.7591 2.04 

01090 ................ Cherokee County, Alabama ............................................................. 99901 0.7439 0.7591 2.04 

01100 ................ Chilton County, Alabama ................................................................. 13820 0.8196 0.8894 8.52 

01110 ................ Choctaw County, Alabama ............................................................... 99901 0.7439 0.7591 2.04 

01120 ................ Clarke County, Alabama .................................................................. 99901 0.7439 0.7591 2.04 

01130 ................ Clay County, Alabama ..................................................................... 99901 0.7439 0.7591 2.04 

01140 ................ Cleburne County, Alabama .............................................................. 99901 0.7439 0.7591 2.04 

01150 ................ Coffee County, Alabama .................................................................. 99901 0.7439 0.7591 2.04 

01160 ................ Colbert County, Alabama ................................................................. 22520 0.8272 0.7843 ¥5.19 

01170 ................ Conecuh County, Alabama .............................................................. 99901 0.7439 0.7591 2.04 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65959 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

01180 ................ Coosa County, Alabama .................................................................. 99901 0.7439 0.7591 2.04 

01190 ................ Covington County, Alabama ............................................................ 99901 0.7439 0.7591 2.04 

01200 ................ Crenshaw County, Alabama ............................................................ 99901 0.7439 0.7591 2.04 

01210 ................ Cullman County, Alabama ............................................................... 99901 0.7439 0.7591 2.04 

01220 ................ Dale County, Alabama ..................................................................... 99901 0.7574 0.7591 0.22 

01230 ................ Dallas County, Alabama ................................................................... 99901 0.7439 0.7591 2.04 

01240 ................ De Kalb County, Alabama ................................................................ 99901 0.7439 0.7591 2.04 

01250 ................ Elmore County, Alabama ................................................................. 33860 0.8618 0.8009 ¥7.07 

01260 ................ Escambia County, Alabama ............................................................. 99901 0.7439 0.7591 2.04 

01270 ................ Etowah County, Alabama ................................................................. 23460 0.7938 0.8066 1.61 

01280 ................ Fayette County, Alabama ................................................................. 99901 0.7439 0.7591 2.04 

01290 ................ Franklin County, Alabama ................................................................ 99901 0.7439 0.7591 2.04 

01300 ................ Geneva County, Alabama ................................................................ 20020 0.7577 0.7381 ¥2.59 

01310 ................ Greene County, Alabama ................................................................. 46220 0.8039 0.8542 6.26 

01320 ................ Hale County, Alabama ..................................................................... 46220 0.8039 0.8542 6.26 

01330 ................ Henry County, Alabama ................................................................... 20020 0.7577 0.7381 ¥2.59 

01340 ................ Houston County, Alabama ............................................................... 20020 0.7711 0.7381 ¥4.28 

01350 ................ Jackson County, Alabama ............................................................... 99901 0.7439 0.7591 2.04 

01360 ................ Jefferson County, Alabama .............................................................. 13820 0.8980 0.8894 ¥0.96 

01370 ................ Lamar County, Alabama .................................................................. 99901 0.7439 0.7591 2.04 

01380 ................ Lauderdale County, Alabama ........................................................... 22520 0.8272 0.7843 ¥5.19 

01390 ................ Lawrence County, Alabama ............................................................. 19460 0.8469 0.8159 ¥3.66 

01400 ................ Lee County, Alabama ....................................................................... 12220 0.8100 0.8096 ¥0.05 

01410 ................ Limestone County, Alabama ............................................................ 26620 0.9146 0.9007 ¥1.52 

01420 ................ Lowndes County, Alabama .............................................................. 33860 0.8025 0.8009 ¥0.20 

01430 ................ Macon County, Alabama .................................................................. 99901 0.7439 0.7591 2.04 

01440 ................ Madison County, Alabama ............................................................... 26620 0.9146 0.9007 ¥1.52 

01450 ................ Marengo County, Alabama .............................................................. 99901 0.7439 0.7591 2.04 

01460 ................ Marion County, Alabama .................................................................. 99901 0.7439 0.7591 2.04 

01470 ................ Marshall County, Alabama ............................................................... 99901 0.7439 0.7591 2.04 

01480 ................ Mobile County, Alabama .................................................................. 33660 0.7876 0.7913 0.47 

01490 ................ Monroe County, Alabama ................................................................ 99901 0.7439 0.7591 2.04 

01500 ................ Montgomery County, Alabama ......................................................... 33860 0.8618 0.8009 ¥7.07 

01510 ................ Morgan County, Alabama ................................................................ 19460 0.8469 0.8159 ¥3.66 

01520 ................ Perry County, Alabama .................................................................... 99901 0.7439 0.7591 2.04 

01530 ................ Pickens County, Alabama ................................................................ 99901 0.7439 0.7591 2.04 

01540 ................ Pike County, Alabama ...................................................................... 99901 0.7439 0.7591 2.04 

01550 ................ Randolph County, Alabama ............................................................. 99901 0.7439 0.7591 2.04 

01560 ................ Russell County, Alabama ................................................................. 17980 0.8560 0.8239 ¥3.75 

01570 ................ St Clair County, Alabama ................................................................. 13820 0.8980 0.8894 ¥0.96 

01580 ................ Shelby County, Alabama .................................................................. 13820 0.8980 0.8894 ¥0.96 

01590 ................ Sumter County, Alabama ................................................................. 99901 0.7439 0.7591 2.04 

01600 ................ Talladega County, Alabama ............................................................. 99901 0.7439 0.7591 2.04 

01610 ................ Tallapoosa County, Alabama ........................................................... 99901 0.7439 0.7591 2.04 

01620 ................ Tuscaloosa County, Alabama .......................................................... 46220 0.8705 0.8542 ¥1.87 

01630 ................ Walker County, Alabama ................................................................. 13820 0.8196 0.8894 8.52 

01640 ................ Washington County, Alabama .......................................................... 99901 0.7439 0.7591 2.04 

01650 ................ Wilcox County, Alabama .................................................................. 99901 0.7439 0.7591 2.04 

01660 ................ Winston County, Alabama ................................................................ 99901 0.7439 0.7591 2.04 

02013 ................ Aleutians County East, Alaska ......................................................... 99902 1.1933 1.0661 ¥10.66 

02016 ................ Aleutians County West, Alaska ........................................................ 99902 1.1933 1.0661 ¥10.66 

02020 ................ Anchorage County, Alaska ............................................................... 11260 1.1840 1.2023 1.55 

02030 ................ Angoon County, Alaska .................................................................... 99902 1.1933 1.0661 ¥10.66 

02040 ................ Barrow-North Slope County, Alaska ................................................ 99902 1.1933 1.0661 ¥10.66 

02050 ................ Bethel County, Alaska ...................................................................... 99902 1.1933 1.0661 ¥10.66 

02060 ................ Bristol Bay Borough County, Alaska ................................................ 99902 1.1933 1.0661 ¥10.66 

02068 ................ Denali County, Alaska ...................................................................... 99902 1.1933 1.0661 ¥10.66 

02070 ................ Bristol Bay County, Alaska ............................................................... 99902 1.1933 1.0661 ¥10.66 

02080 ................ Cordova-Mc Carthy County, Alaska ................................................. 99902 1.1933 1.0661 ¥10.66 

02090 ................ Fairbanks County, Alaska ................................................................ 21820 1.1648 1.1059 ¥5.06 

02100 ................ Haines County, Alaska ..................................................................... 99902 1.1933 1.0661 ¥10.66 

02110 ................ Juneau County, Alaska .................................................................... 99902 1.1933 1.0661 ¥10.66 

02120 ................ Kenai-Cook Inlet County, Alaska ..................................................... 99902 1.1933 1.0661 ¥10.66 

02122 ................ Kenai Peninsula Borough, Alaska .................................................... 99902 1.1933 1.0661 ¥10.66 

02130 ................ Ketchikan County, Alaska ................................................................ 99902 1.1933 1.0661 ¥10.66 

02140 ................ Kobuk County, Alaska ...................................................................... 99902 1.1933 1.0661 ¥10.66 

02150 ................ Kodiak County, Alaska ..................................................................... 99902 1.1933 1.0661 ¥10.66 

02160 ................ Kuskokwin County, Alaska ............................................................... 99902 1.1933 1.0661 ¥10.66 


rmajette on PROD1PC67 with RULES2
65960 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

02164 ................ Lake and Peninsula Borough, Alaska .............................................. 99902 1.1933 1.0661 ¥10.66 

02170 ................ Matanuska County, Alaska .............................................................. 11260 1.1892 1.2023 1.10 

02180 ................ Nome County, Alaska ...................................................................... 99902 1.1933 1.0661 ¥10.66 

02185 ................ North Slope Borough, Alaska ........................................................... 99902 1.1933 1.0661 ¥10.66 

02188 ................ Northwest Arctic Borough, Alaska ................................................... 99902 1.1933 1.0661 ¥10.66 

02190 ................ Outer Ketchikan County, Alaska ...................................................... 99902 1.1933 1.0661 ¥10.66 

02200 ................ Prince Of Wales County, Alaska ...................................................... 99902 1.1933 1.0661 ¥10.66 

02201 ................ Prince of Wales-Outer Ketchikan Census Area,AK ......................... 99902 1.1933 1.0661 ¥10.66 

02210 ................ Seward County, Alaska .................................................................... 99902 1.1933 1.0661 ¥10.66 

02220 ................ Sitka County, Alaska ........................................................................ 99902 1.1933 1.0661 ¥10.66 

02230 ................ Skagway-Yakutat County, Alaska .................................................... 99902 1.1933 1.0661 ¥10.66 

02231 ................ Skagway-Yakutat-Angoon Census Area, Alaska ............................. 99902 1.1933 1.0661 ¥10.66 

02232 ................ Skagway-Hoonah-Angoon Census Area, Alaska ............................ 99902 1.1933 1.0661 ¥10.66 

02240 ................ Southeast Fairbanks County, Alaska ............................................... 99902 1.1933 1.0661 ¥10.66 

02250 ................ Upper Yukon County, Alaska ........................................................... 99902 1.1933 1.0661 ¥10.66 

02260 ................ Valdz-Chitna-Whitier County, Alaska ............................................... 99902 1.1933 1.0661 ¥10.66 

02261 ................ Valdex-Cordove Census Area, Alaska ............................................. 99902 1.1933 1.0661 ¥10.66 

02270 ................ Wade Hampton County, Alaska ....................................................... 99902 1.1933 1.0661 ¥10.66 

02280 ................ Wrangell-Petersburg County, Alaska ............................................... 99902 1.1933 1.0661 ¥10.66 

02282 ................ Yakutat Borough, Alaska .................................................................. 99902 1.1933 1.0661 ¥10.66 

02290 ................ Yukon-Koyukuk County, Alaska ....................................................... 99902 1.1933 1.0661 ¥10.66 

03000 ................ Apache County, Arizona .................................................................. 99903 0.8907 0.8908 0.01 

03010 ................ Cochise County, Arizona .................................................................. 99903 0.8907 0.8908 0.01 

03020 ................ Coconino County, Arizona ............................................................... 22380 1.1969 1.1601 ¥3.07 

03030 ................ Gila County, Arizona ........................................................................ 99903 0.8907 0.8908 0.01 

03040 ................ Graham County, Arizona .................................................................. 99903 0.8907 0.8908 0.01 

03050 ................ Greenlee County, Arizona ................................................................ 99903 0.8907 0.8908 0.01 

03055 ................ La Paz County, Arizona ................................................................... 99903 0.8907 0.8908 0.01 

03060 ................ Maricopa County, Arizona ................................................................ 38060 1.0127 1.0287 1.58 

03070 ................ Mohave County, Arizona .................................................................. 99903 0.9962 0.8908 ¥10.58 

03080 ................ Navajo County, Arizona ................................................................... 99903 0.8907 0.8908 0.01 

03090 ................ Pima County, Arizona ...................................................................... 46060 0.9007 0.9202 2.16 

03100 ................ Pinal County, Arizona ....................................................................... 38060 1.0127 1.0287 1.58 

03110 ................ Santa Cruz County, Arizona ............................................................ 99903 0.8907 0.8908 0.01 

03120 ................ Yavapai County, Arizona .................................................................. 39140 0.9457 0.9836 4.01 

03130 ................ Yuma County, Arizona ..................................................................... 49740 0.9126 0.9109 ¥0.19 

04000 ................ Arkansas County, Arkansas ............................................................. 99904 0.7605 0.7307 ¥3.92 

04010 ................ Ashley County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04020 ................ Baxter County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04030 ................ Benton County, Arkansas ................................................................ 22220 0.8661 0.8865 2.36 

04040 ................ Boone County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04050 ................ Bradley County, Arkansas ................................................................ 99904 0.7605 0.7307 ¥3.92 

04060 ................ Calhoun County, Arkansas .............................................................. 99904 0.7605 0.7307 ¥3.92 

04070 ................ Carroll County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04080 ................ Chicot County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04090 ................ Clark County, Arkansas ................................................................... 99904 0.7605 0.7307 ¥3.92 

04100 ................ Clay County, Arkansas ..................................................................... 99904 0.7605 0.7307 ¥3.92 

04110 ................ Cleburne County, Arkansas ............................................................. 99904 0.7605 0.7307 ¥3.92 

04120 ................ Cleveland County, Arkansas ............................................................ 38220 0.8212 0.8383 2.08 

04130 ................ Columbia County, Arkansas ............................................................. 99904 0.7605 0.7307 ¥3.92 

04140 ................ Conway County, Arkansas ............................................................... 99904 0.7605 0.7307 ¥3.92 

04150 ................ Craighead County, Arkansas ........................................................... 27860 0.7911 0.7662 ¥3.15 

04160 ................ Crawford County, Arkansas ............................................................. 22900 0.8238 0.7731 ¥6.15 

04170 ................ Crittenden County, Arkansas ........................................................... 32820 0.9407 0.9373 ¥0.36 

04180 ................ Cross County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04190 ................ Dallas County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04200 ................ Desha County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04210 ................ Drew County, Arkansas ................................................................... 99904 0.7605 0.7307 ¥3.92 

04220 ................ Faulkner County, Arkansas .............................................................. 30780 0.8747 0.8890 1.63 

04230 ................ Franklin County, Arkansas ............................................................... 22900 0.7987 0.7731 ¥3.21 

04240 ................ Fulton County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04250 ................ Garland County, Arkansas ............................................................... 26300 0.8375 0.8782 4.86 

04260 ................ Grant County, Arkansas ................................................................... 30780 0.8246 0.8890 7.81 

04270 ................ Greene County, Arkansas ................................................................ 99904 0.7605 0.7307 ¥3.92 

04280 ................ Hempstead County, Arkansas ......................................................... 99904 0.7605 0.7307 ¥3.92 

04290 ................ Hot Spring County, Arkansas ........................................................... 99904 0.7605 0.7307 ¥3.92 

04300 ................ Howard County, Arkansas ............................................................... 99904 0.7605 0.7307 ¥3.92 

04310 ................ Independence County, Arkansas ..................................................... 99904 0.7605 0.7307 ¥3.92 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65961 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

04320 ................ Izard County, Arkansas .................................................................... 99904 0.7605 0.7307 ¥3.92 

04330 ................ Jackson County, Arkansas ............................................................... 99904 0.7605 0.7307 ¥3.92 

04340 ................ Jefferson County, Arkansas ............................................................. 38220 0.8680 0.8383 ¥3.42 

04350 ................ Johnson County, Arkansas .............................................................. 99904 0.7605 0.7307 ¥3.92 

04360 ................ Lafayette County, Arkansas ............................................................. 99904 0.7605 0.7307 ¥3.92 

04370 ................ Lawrence County, Arkansas ............................................................ 99904 0.7605 0.7307 ¥3.92 

04380 ................ Lee County, Arkansas ...................................................................... 99904 0.7605 0.7307 ¥3.92 

04390 ................ Lincoln County, Arkansas ................................................................ 38220 0.8212 0.8383 2.08 

04400 ................ Little River County, Arkansas ........................................................... 99904 0.7605 0.7307 ¥3.92 

04410 ................ Logan County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04420 ................ Lonoke County, Arkansas ................................................................ 30780 0.8747 0.8890 1.63 

04430 ................ Madison County, Arkansas .............................................................. 22220 0.8203 0.8865 8.07 

04440 ................ Marion County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04450 ................ Miller County, Arkansas ................................................................... 45500 0.8283 0.8104 ¥2.16 

04460 ................ Mississippi County, Arkansas .......................................................... 99904 0.7605 0.7307 ¥3.92 

04470 ................ Monroe County, Arkansas ................................................................ 99904 0.7605 0.7307 ¥3.92 

04480 ................ Montgomery County, Arkansas ........................................................ 99904 0.7605 0.7307 ¥3.92 

04490 ................ Nevada County, Arkansas ............................................................... 99904 0.7605 0.7307 ¥3.92 

04500 ................ Newton County, Arkansas ................................................................ 99904 0.7605 0.7307 ¥3.92 

04510 ................ Ouachita County, Arkansas ............................................................. 99904 0.7605 0.7307 ¥3.92 

04520 ................ Perry County, Arkansas ................................................................... 30780 0.8246 0.8890 7.81 

04530 ................ Phillips County, Arkansas ................................................................ 99904 0.7605 0.7307 ¥3.92 

04540 ................ Pike County, Arkansas ..................................................................... 99904 0.7605 0.7307 ¥3.92 

04550 ................ Poinsett County, Arkansas ............................................................... 27860 0.7828 0.7662 ¥2.12 

04560 ................ Polk County, Arkansas ..................................................................... 99904 0.7605 0.7307 ¥3.92 

04570 ................ Pope County, Arkansas ................................................................... 99904 0.7605 0.7307 ¥3.92 

04580 ................ Prairie County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04590 ................ Pulaski County, Arkansas ................................................................ 30780 0.8747 0.8890 1.63 

04600 ................ Randolph County, Arkansas ............................................................ 99904 0.7605 0.7307 ¥3.92 

04610 ................ St Francis County, Arkansas ........................................................... 99904 0.7605 0.7307 ¥3.92 

04620 ................ Saline County, Arkansas .................................................................. 30780 0.8747 0.8890 1.63 

04630 ................ Scott County, Arkansas .................................................................... 99904 0.7605 0.7307 ¥3.92 

04640 ................ Searcy County, Arkansas ................................................................. 99904 0.7605 0.7307 ¥3.92 

04650 ................ Sebastian County, Arkansas ............................................................ 22900 0.8238 0.7731 ¥6.15 

04660 ................ Sevier County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04670 ................ Sharp County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04680 ................ Stone County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04690 ................ Union County, Arkansas .................................................................. 99904 0.7605 0.7307 ¥3.92 

04700 ................ Van Buren County, Arkansas ........................................................... 99904 0.7605 0.7307 ¥3.92 

04710 ................ Washington County, Arkansas ......................................................... 22220 0.8661 0.8865 2.36 

04720 ................ White County, Arkansas ................................................................... 99904 0.7605 0.7307 ¥3.92 

04730 ................ Woodruff County, Arkansas ............................................................. 99904 0.7605 0.7307 ¥3.92 

04740 ................ Yell County, Arkansas ...................................................................... 99904 0.7605 0.7307 ¥3.92 

05000 ................ Alameda County, California ............................................................. 36084 1.5346 1.5819 3.08 

05010 ................ Alpine County, California .................................................................. 99905 1.0915 1.1454 4.94 

05020 ................ Amador County, California ............................................................... 99905 1.0915 1.1454 4.94 

05030 ................ Butte County, California ................................................................... 17020 1.0511 1.1053 5.16 

05040 ................ Calaveras County, California ........................................................... 99905 1.0915 1.1454 4.94 

05050 ................ Colusa County, California ................................................................ 99905 1.0915 1.1454 4.94 

05060 ................ Contra Costa County, California ...................................................... 36084 1.5346 1.5819 3.08 

05070 ................ Del Norte County, California ............................................................ 99905 1.0915 1.1454 4.94 

05080 ................ Eldorado County, California ............................................................. 40900 1.3056 1.3372 2.42 

05090 ................ Fresno County, California ................................................................ 23420 1.0483 1.0943 4.39 

05100 ................ Glenn County, California .................................................................. 99905 1.0915 1.1454 4.94 

05110 ................ Humboldt County, California ............................................................ 99905 1.0915 1.1454 4.94 

05120 ................ Imperial County, California ............................................................... 20940 0.9841 0.9076 ¥7.77 

05130 ................ Inyo County, California ..................................................................... 99905 1.0915 1.1454 4.94 

05140 ................ Kern County, California .................................................................... 12540 1.0470 1.0725 2.44 

05150 ................ Kings County, California ................................................................... 25260 1.0406 1.0282 ¥1.19 

05160 ................ Lake County, California .................................................................... 99905 1.0915 1.1454 4.94 

05170 ................ Lassen County, California ................................................................ 99905 1.0915 1.1454 4.94 

05200 ................ Los Angeles County, California ........................................................ 31084 1.1783 1.1760 ¥0.20 

05210 ................ Los Angeles County, California ........................................................ 31084 1.1783 1.1760 ¥0.20 

05300 ................ Madera County, California ............................................................... 31460 0.9571 0.8154 ¥14.81 

05310 ................ Marin County, California ................................................................... 41884 1.4994 1.5165 1.14 

05320 ................ Mariposa County, California ............................................................. 99905 1.0915 1.1454 4.94 

05330 ................ Mendocino County, California .......................................................... 99905 1.0915 1.1454 4.94 

05340 ................ Merced County, California ................................................................ 32900 1.1109 1.1471 3.26 


rmajette on PROD1PC67 with RULES2
65962 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

05350 ................ Modoc County, California ................................................................. 99905 1.0915 1.1454 4.94 

05360 ................ Mono County, California ................................................................... 99905 1.0915 1.1454 4.94 

05370 ................ Monterey County, California ............................................................. 41500 1.4128 1.4337 1.48 

05380 ................ Napa County, California ................................................................... 34900 1.3313 1.3374 0.46 

05390 ................ Nevada County, California ............................................................... 99905 1.0915 1.1454 4.94 

05400 ................ Orange County, California ................................................................ 42044 1.1559 1.1473 ¥0.74 

05410 ................ Placer County, California ................................................................. 40900 1.3056 1.3372 2.42 

05420 ................ Plumas County, California ................................................................ 99905 1.0915 1.1454 4.94 

05430 ................ Riverside County, California ............................................................. 40140 1.1027 1.0904 ¥1.12 

05440 ................ Sacramento County, California ........................................................ 40900 1.3056 1.3372 2.42 

05450 ................ San Benito County, California .......................................................... 41940 1.2937 1.5543 20.14 

05460 ................ San Bernardino County, California .................................................. 40140 1.1027 1.0904 ¥1.12 

05470 ................ San Diego County, California ........................................................... 41740 1.1413 1.1354 ¥0.52 

05480 ................ San Francisco County, California .................................................... 41884 1.4994 1.5165 1.14 

05490 ................ San Joaquin County, California ....................................................... 44700 1.1307 1.1442 1.19 

05500 ................ San Luis Obispo County, California ................................................. 42020 1.1349 1.1598 2.19 

05510 ................ San Mateo County, California .......................................................... 41884 1.4994 1.5165 1.14 

05520 ................ Santa Barbara County, California .................................................... 42060 1.1694 1.1091 ¥5.16 

05530 ................ Santa Clara County, California ........................................................ 41940 1.5109 1.5543 2.87 

05540 ................ Santa Cruz County, California ......................................................... 42100 1.5166 1.5457 1.92 

05550 ................ Shasta County, California ................................................................ 39820 1.2203 1.3198 8.15 

05560 ................ Sierra County, California .................................................................. 99905 1.0915 1.1454 4.94 

05570 ................ Siskiyou County, California .............................................................. 99905 1.0915 1.1454 4.94 

05580 ................ Solano County, California ................................................................ 46700 1.4460 1.5137 4.68 

05590 ................ Sonoma County, California .............................................................. 42220 1.3493 1.4464 7.20 

05600 ................ Stanislaus County, California ........................................................... 33700 1.1885 1.1729 ¥1.31 

05610 ................ Sutter County, California .................................................................. 49700 1.0921 1.0730 ¥1.75 

05620 ................ Tehama County, California .............................................................. 99905 1.0915 1.1454 4.94 

05630 ................ Trinity County, California .................................................................. 99905 1.0915 1.1454 4.94 

05640 ................ Tulare County, California ................................................................. 47300 1.0123 0.9968 ¥1.53 

05650 ................ Tuolumne County, California ............................................................ 99905 1.0915 1.1454 4.94 

05660 ................ Ventura County, California ............................................................... 37100 1.1622 1.1546 ¥0.65 

05670 ................ Yolo County, California .................................................................... 40900 1.1460 1.3372 16.68 

05680 ................ Yuba County, California ................................................................... 49700 1.0921 1.0730 ¥1.75 

06000 ................ Adams County, Colorado ................................................................. 19740 1.0723 1.0930 1.93 

06010 ................ Alamosa County, Colorado .............................................................. 99906 0.9380 0.9325 ¥0.59 

06020 ................ Arapahoe County, Colorado ............................................................. 19740 1.0723 1.0930 1.93 

06030 ................ Archuleta County, Colorado ............................................................. 99906 0.9380 0.9325 ¥0.59 

06040 ................ Baca County, Colorado .................................................................... 99906 0.9380 0.9325 ¥0.59 

06050 ................ Bent County, Colorado ..................................................................... 99906 0.9380 0.9325 ¥0.59 

06060 ................ Boulder County, Colorado ................................................................ 14500 0.9734 1.0350 6.33 

06070 ................ Chaffee County, Colorado ................................................................ 99906 0.9380 0.9325 ¥0.59 

06080 ................ Cheyenne County, Colorado ............................................................ 99906 0.9380 0.9325 ¥0.59 

06090 ................ Clear Creek County, Colorado ......................................................... 19740 1.0052 1.0930 8.73 

06100 ................ Conejos County, Colorado ............................................................... 99906 0.9380 0.9325 ¥0.59 

06110 ................ Costilla County, Colorado ................................................................ 99906 0.9380 0.9325 ¥0.59 

06120 ................ Crowley County, Colorado ............................................................... 99906 0.9380 0.9325 ¥0.59 

06130 ................ Custer County, Colorado .................................................................. 99906 0.9380 0.9325 ¥0.59 

06140 ................ Delta County, Colorado .................................................................... 99906 0.9380 0.9325 ¥0.59 

06150 ................ Denver County, Colorado ................................................................. 19740 1.0723 1.0930 1.93 

06160 ................ Dolores County, Colorado ................................................................ 99906 0.9380 0.9325 ¥0.59 

06170 ................ Douglas County, Colorado ............................................................... 19740 1.0723 1.0930 1.93 

06180 ................ Eagle County, Colorado ................................................................... 99906 0.9380 0.9325 ¥0.59 

06190 ................ Elbert County, Colorado ................................................................... 19740 1.0052 1.0930 8.73 

06200 ................ El Paso County, Colorado ................................................................ 17820 0.9468 0.9701 2.46 

06210 ................ Fremont County, Colorado ............................................................... 99906 0.9380 0.9325 ¥0.59 

06220 ................ Garfield County, Colorado ................................................................ 99906 0.9380 0.9325 ¥0.59 

06230 ................ Gilpin County, Colorado ................................................................... 19740 1.0052 1.0930 8.73 

06240 ................ Grand County, Colorado .................................................................. 99906 0.9380 0.9325 ¥0.59 

06250 ................ Gunnison County, Colorado ............................................................. 99906 0.9380 0.9325 ¥0.59 

06260 ................ Hinsdale County, Colorado .............................................................. 99906 0.9380 0.9325 ¥0.59 

06270 ................ Huerfano County, Colorado ............................................................. 99906 0.9380 0.9325 ¥0.59 

06280 ................ Jackson County, Colorado ............................................................... 99906 0.9380 0.9325 ¥0.59 

06290 ................ Jefferson County, Colorado ............................................................. 19740 1.0723 1.0930 1.93 

06300 ................ Kiowa County, Colorado .................................................................. 99906 0.9380 0.9325 ¥0.59 

06310 ................ Kit Carson County, Colorado ........................................................... 99906 0.9380 0.9325 ¥0.59 

06320 ................ Lake County, Colorado .................................................................... 99906 0.9380 0.9325 ¥0.59 

06330 ................ La Plata County, Colorado ............................................................... 99906 0.9380 0.9325 ¥0.59 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65963 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

06340 ................ Larimer County, Colorado ................................................................ 22660 1.0122 0.9544 ¥5.71 

06350 ................ Las Animas County, Colorado ......................................................... 99906 0.9380 0.9325 ¥0.59 

06360 ................ Lincoln County, Colorado ................................................................. 99906 0.9380 0.9325 ¥0.59 

06370 ................ Logan County, Colorado .................................................................. 99906 0.9380 0.9325 ¥0.59 

06380 ................ Mesa County, Colorado ................................................................... 24300 0.9550 0.9668 1.24 

06390 ................ Mineral County, Colorado ................................................................ 99906 0.9380 0.9325 ¥0.59 

06400 ................ Moffat County, Colorado .................................................................. 99906 0.9380 0.9325 ¥0.59 

06410 ................ Montezuma County, Colorado ......................................................... 99906 0.9380 0.9325 ¥0.59 

06420 ................ Montrose County, Colorado ............................................................. 99906 0.9380 0.9325 ¥0.59 

06430 ................ Morgan County, Colorado ................................................................ 99906 0.9380 0.9325 ¥0.59 

06440 ................ Otero County, Colorado ................................................................... 99906 0.9380 0.9325 ¥0.59 

06450 ................ Ouray County, Colorado .................................................................. 99906 0.9380 0.9325 ¥0.59 

06460 ................ Park County, Colorado ..................................................................... 19740 1.0052 1.0930 8.73 

06470 ................ Phillips County, Colorado ................................................................. 99906 0.9380 0.9325 ¥0.59 

06480 ................ Pitkin County, Colorado ................................................................... 99906 0.9380 0.9325 ¥0.59 

06490 ................ Prowers County, Colorado ............................................................... 99906 0.9380 0.9325 ¥0.59 

06500 ................ Pueblo County, Colorado ................................................................. 39380 0.8623 0.8753 1.51 

06510 ................ Rio Blanco County, Colorado ........................................................... 99906 0.9380 0.9325 ¥0.59 

06520 ................ Rio Grande County, Colorado .......................................................... 99906 0.9380 0.9325 ¥0.59 

06530 ................ Routt County, Colorado .................................................................... 99906 0.9380 0.9325 ¥0.59 

06540 ................ Saguache County, Colorado ............................................................ 99906 0.9380 0.9325 ¥0.59 

06550 ................ San Juan County, Colorado ............................................................. 99906 0.9380 0.9325 ¥0.59 

06560 ................ San Miguel County, Colorado .......................................................... 99906 0.9380 0.9325 ¥0.59 

06570 ................ Sedgwick County, Colorado ............................................................. 99906 0.9380 0.9325 ¥0.59 

06580 ................ Summit County, Colorado ................................................................ 99906 0.9380 0.9325 ¥0.59 

06590 ................ Teller County, Colorado ................................................................... 17820 0.9424 0.9701 2.94 

06600 ................ Washington County, Colorado ......................................................... 99906 0.9380 0.9325 ¥0.59 

06610 ................ Weld County, Colorado .................................................................... 24540 0.9570 0.9602 0.33 

06620 ................ Yuma County, Colorado ................................................................... 99906 0.9380 0.9325 ¥0.59 

06630 ................ Broomfield County, Colorado ........................................................... 19740 1.0723 1.0930 1.93 

07000 ................ Fairfield County, Connecticut ........................................................... 14860 1.2394 1.2659 2.14 

07010 ................ Hartford County, Connecticut ........................................................... 25540 1.1073 1.0894 ¥1.62 

07020 ................ Litchfield County, Connecticut .......................................................... 25540 1.1073 1.0894 ¥1.62 

07030 ................ Middlesex County, Connecticut ........................................................ 25540 1.1073 1.0894 ¥1.62 

07040 ................ New Haven County, Connecticut ..................................................... 35300 1.2042 1.1953 ¥0.74 

07050 ................ New London County, Connecticut ................................................... 35980 1.1345 1.1932 5.17 

07060 ................ Tolland County, Connecticut ............................................................ 25540 1.1073 1.0894 ¥1.62 

07070 ................ Windham County, Connecticut ......................................................... 99907 1.1730 1.1709 ¥0.18 

08000 ................ Kent County, Delaware .................................................................... 20100 0.9776 0.9847 0.73 

08010 ................ New Castle County, Delaware ......................................................... 48864 1.0499 1.0684 1.76 

08020 ................ Sussex County, Delaware ................................................................ 99908 0.9579 0.9705 1.32 

09000 ................ Washington DC County, Dist Of Col ................................................ 47894 1.0951 1.1054 0.94 

10000 ................ Alachua County, Florida ................................................................... 23540 0.9388 0.9277 ¥1.18 

10010 ................ Baker County, Florida ...................................................................... 27260 0.8984 0.9165 2.01 

10020 ................ Bay County, Florida .......................................................................... 37460 0.8005 0.8027 0.27 

10030 ................ Bradford County, Florida .................................................................. 99910 0.8623 0.8594 ¥0.34 

10040 ................ Brevard County, Florida ................................................................... 37340 0.9839 0.9443 ¥4.02 

10050 ................ Broward County, Florida .................................................................. 22744 1.0432 1.0133 ¥2.87 

10060 ................ Calhoun County, Florida .................................................................. 99910 0.8623 0.8594 ¥0.34 

10070 ................ Charlotte County, Florida ................................................................. 39460 0.9255 0.9405 1.62 

10080 ................ Citrus County, Florida ...................................................................... 99910 0.8623 0.8594 ¥0.34 

10090 ................ Clay County, Florida ......................................................................... 27260 0.9295 0.9165 ¥1.40 

10100 ................ Collier County, Florida ...................................................................... 34940 1.0139 0.9941 ¥1.95 

10110 ................ Columbia County, Florida ................................................................. 99910 0.8623 0.8594 ¥0.34 

10120 ................ Dade County, Florida ....................................................................... 33124 0.9750 0.9812 0.64 

10130 ................ De Soto County, Florida ................................................................... 99910 0.8623 0.8594 ¥0.34 

10140 ................ Dixie County, Florida ........................................................................ 99910 0.8623 0.8594 ¥0.34 

10150 ................ Duval County, Florida ....................................................................... 27260 0.9295 0.9165 ¥1.40 

10160 ................ Escambia County, Florida ................................................................ 37860 0.8096 0.8000 ¥1.19 

10170 ................ Flagler County, Florida ..................................................................... 99910 0.8947 0.8594 ¥3.95 

10180 ................ Franklin County, Florida ................................................................... 99910 0.8623 0.8594 ¥0.34 

10190 ................ Gadsden County, Florida ................................................................. 45220 0.8688 0.8942 2.92 

10200 ................ Gilchrist County, Florida ................................................................... 23540 0.9033 0.9277 2.70 

10210 ................ Glades County, Florida .................................................................... 99910 0.8623 0.8594 ¥0.34 

10220 ................ Gulf County, Florida ......................................................................... 99910 0.8623 0.8594 ¥0.34 

10230 ................ Hamilton County, Florida .................................................................. 99910 0.8623 0.8594 ¥0.34 

10240 ................ Hardee County, Florida .................................................................... 99910 0.8623 0.8594 ¥0.34 

10250 ................ Hendry County, Florida .................................................................... 99910 0.8623 0.8594 ¥0.34 


rmajette on PROD1PC67 with RULES2
65964 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

10260 ................ Hernando County, Florida ................................................................ 45300 0.9233 0.9144 ¥0.96 

10270 ................ Highlands County, Florida ................................................................ 99910 0.8623 0.8594 ¥0.34 

10280 ................ Hillsborough County, Florida ............................................................ 45300 0.9233 0.9144 ¥0.96 

10290 ................ Holmes County, Florida .................................................................... 99910 0.8623 0.8594 ¥0.34 

10300 ................ Indian River County, Florida ............................................................ 42680 0.9056 0.9573 5.71 

10310 ................ Jackson County, Florida ................................................................... 99910 0.8623 0.8594 ¥0.34 

10320 ................ Jefferson County, Florida ................................................................. 45220 0.8683 0.8942 2.98 

10330 ................ Lafayette County, Florida ................................................................. 99910 0.8623 0.8594 ¥0.34 

10340 ................ Lake County, Florida ........................................................................ 36740 0.9464 0.9452 ¥0.13 

10350 ................ Lee County, Florida .......................................................................... 15980 0.9356 0.9342 ¥0.15 

10360 ................ Leon County, Florida ........................................................................ 45220 0.8688 0.8942 2.92 

10370 ................ Levy County, Florida ........................................................................ 99910 0.8623 0.8594 ¥0.34 

10380 ................ Liberty County, Florida ..................................................................... 99910 0.8623 0.8594 ¥0.34 

10390 ................ Madison County, Florida .................................................................. 99910 0.8623 0.8594 ¥0.34 

10400 ................ Manatee County, Florida .................................................................. 42260 0.9639 0.9868 2.38 

10410 ................ Marion County, Florida ..................................................................... 36100 0.8925 0.8867 ¥0.65 

10420 ................ Martin County, Florida ...................................................................... 38940 1.0123 0.9833 ¥2.86 

10430 ................ Monroe County, Florida .................................................................... 99910 0.8623 0.8594 ¥0.34 

10440 ................ Nassau County, Florida .................................................................... 27260 0.9295 0.9165 ¥1.40 

10450 ................ Okaloosa County, Florida ................................................................. 23020 0.8872 0.8643 ¥2.58 

10460 ................ Okeechobee County, Florida ........................................................... 99910 0.8623 0.8594 ¥0.34 

10470 ................ Orange County, Florida .................................................................... 36740 0.9464 0.9452 ¥0.13 

10480 ................ Osceola County, Florida ................................................................... 36740 0.9464 0.9452 ¥0.13 

10490 ................ Palm Beach County, Florida ............................................................ 48424 1.0067 0.9649 ¥4.15 

10500 ................ Pasco County, Florida ...................................................................... 45300 0.9233 0.9144 ¥0.96 

10510 ................ Pinellas County, Florida ................................................................... 45300 0.9233 0.9144 ¥0.96 

10520 ................ Polk County, Florida ......................................................................... 29460 0.8912 0.8879 ¥0.37 

10530 ................ Putnam County, Florida ................................................................... 99910 0.8623 0.8594 ¥0.34 

10540 ................ Johns County, Florida ...................................................................... 27260 0.9295 0.9165 ¥1.40 

10550 ................ St Lucie County, Florida ................................................................... 38940 1.0123 0.9833 ¥2.86 

10560 ................ Santa Rosa County, Florida ............................................................. 37860 0.8096 0.8000 ¥1.19 

10570 ................ Sarasota County, Florida ................................................................. 42260 0.9639 0.9868 2.38 

10580 ................ Seminole County, Florida ................................................................. 36740 0.9464 0.9452 ¥0.13 

10590 ................ Sumter County, Florida .................................................................... 99910 0.8623 0.8594 ¥0.34 

10600 ................ Suwannee County, Florida ............................................................... 99910 0.8623 0.8594 ¥0.34 

10610 ................ Taylor County, Florida ...................................................................... 99910 0.8623 0.8594 ¥0.34 

10620 ................ Union County, Florida ...................................................................... 99910 0.8623 0.8594 ¥0.34 

10630 ................ Volusia County, Florida .................................................................... 19660 0.9312 0.9263 ¥0.53 

10640 ................ Wakulla County, Florida ................................................................... 45220 0.8683 0.8942 2.98 

10650 ................ Walton County, Florida ..................................................................... 99910 0.8623 0.8594 ¥0.34 

10660 ................ Washington County, Florida ............................................................. 99910 0.8623 0.8594 ¥0.34 

11000 ................ Appling County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11010 ................ Atkinson County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11011 ................ Bacon County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11020 ................ Baker County, Georgia ..................................................................... 10500 0.8397 0.8991 7.07 

11030 ................ Baldwin County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11040 ................ Banks County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11050 ................ Barrow County, Georgia ................................................................... 12060 0.9793 0.9762 ¥0.32 

11060 ................ Bartow County, Georgia ................................................................... 12060 0.9793 0.9762 ¥0.32 

11070 ................ Ben Hill County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11080 ................ Berrien County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11090 ................ Bibb County, Georgia ....................................................................... 31420 0.9360 0.9519 1.70 

11100 ................ Bleckley County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11110 ................ Brantley County, Georgia ................................................................. 15260 0.8739 1.0164 16.31 

11120 ................ Brooks County, Georgia ................................................................... 46660 0.8516 0.8369 ¥1.73 

11130 ................ Bryan County, Georgia ..................................................................... 42340 0.9461 0.9351 ¥1.16 

11140 ................ Bulloch County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11150 ................ Burke County, Georgia ..................................................................... 12260 0.8957 0.9667 7.93 

11160 ................ Butts County, Georgia ...................................................................... 12060 0.8980 0.9762 8.71 

11161 ................ Calhoun County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11170 ................ Camden County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11180 ................ Candler County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11190 ................ Carroll County, Georgia ................................................................... 12060 0.9793 0.9762 ¥0.32 

11200 ................ Catoosa County, Georgia ................................................................. 16860 0.9088 0.8948 ¥1.54 

11210 ................ Charlton County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11220 ................ Chatham County, Georgia ............................................................... 42340 0.9461 0.9351 ¥1.16 

11230 ................ Chattahoochee County, Georgia ...................................................... 17980 0.8560 0.8239 ¥3.75 

11240 ................ Chattooga County, Georgia ............................................................. 99911 0.7914 0.7593 ¥4.06 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65965 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

11250 ................ Cherokee County, Georgia .............................................................. 12060 0.9793 0.9762 ¥0.32 

11260 ................ Clarke County, Georgia .................................................................... 12020 0.9855 0.9856 0.01 

11270 ................ Clay County, Georgia ....................................................................... 99911 0.7914 0.7593 ¥4.06 

11280 ................ Clayton County, Georgia .................................................................. 12060 0.9793 0.9762 ¥0.32 

11281 ................ Clinch County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11290 ................ Cobb County, Georgia ..................................................................... 12060 0.9793 0.9762 ¥0.32 

11291 ................ Coffee County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11300 ................ Colquitt County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11310 ................ Columbia County, Georgia ............................................................... 12260 0.9778 0.9667 ¥1.14 

11311 ................ Cook County, Georgia ...................................................................... 99911 0.7914 0.7593 ¥4.06 

11320 ................ Coweta County, Georgia .................................................................. 12060 0.9793 0.9762 ¥0.32 

11330 ................ Crawford County, Georgia ............................................................... 31420 0.8805 0.9519 8.11 

11340 ................ Crisp County, Georgia ...................................................................... 99911 0.7914 0.7593 ¥4.06 

11341 ................ Dade County, Georgia ..................................................................... 16860 0.9088 0.8948 ¥1.54 

11350 ................ Dawson County, Georgia ................................................................. 12060 0.8980 0.9762 8.71 

11360 ................ Decatur County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11370 ................ De Kalb County, Georgia ................................................................. 12060 0.9793 0.9762 ¥0.32 

11380 ................ Dodge County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11381 ................ Dooly County, Georgia ..................................................................... 99911 0.7914 0.7593 ¥4.06 

11390 ................ Dougherty County, Georgia ............................................................. 10500 0.8628 0.8991 4.21 

11400 ................ Douglas County, Georgia ................................................................. 12060 0.9793 0.9762 ¥0.32 

11410 ................ Early County, Georgia ...................................................................... 99911 0.7914 0.7593 ¥4.06 

11420 ................ Echols County, Georgia ................................................................... 46660 0.8516 0.8369 ¥1.73 

11421 ................ Effingham County, Georgia .............................................................. 42340 0.9461 0.9351 ¥1.16 

11430 ................ Elbert County, Georgia ..................................................................... 99911 0.7914 0.7593 ¥4.06 

11440 ................ Emanuel County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11441 ................ Evans County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11450 ................ Fannin County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11451 ................ Fayette County, Georgia .................................................................. 12060 0.9793 0.9762 ¥0.32 

11460 ................ Floyd County, Georgia ..................................................................... 40660 0.8790 0.9193 4.58 

11461 ................ Forsyth County, Georgia .................................................................. 12060 0.9793 0.9762 ¥0.32 

11462 ................ Franklin County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11470 ................ Fulton County, Georgia .................................................................... 12060 0.9793 0.9762 ¥0.32 

11471 ................ Gilmer County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11480 ................ Glascock County, Georgia ............................................................... 99911 0.7914 0.7593 ¥4.06 

11490 ................ Glynn County, Georgia ..................................................................... 15260 0.8739 1.0164 16.31 

11500 ................ Gordon County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11510 ................ Grady County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11520 ................ Greene County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11530 ................ Gwinnett County, Georgia ................................................................ 12060 0.9793 0.9762 ¥0.32 

11540 ................ Habersham County, Georgia ........................................................... 99911 0.7914 0.7593 ¥4.06 

11550 ................ Hall County, Georgia ........................................................................ 23580 0.8520 0.8958 5.14 

11560 ................ Hancock County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11570 ................ Haralson County, Georgia ................................................................ 12060 0.8980 0.9762 8.71 

11580 ................ Harris County, Georgia .................................................................... 17980 0.8560 0.8239 ¥3.75 

11581 ................ Hart County, Georgia ....................................................................... 99911 0.7914 0.7593 ¥4.06 

11590 ................ Heard County, Georgia .................................................................... 12060 0.8980 0.9762 8.71 

11591 ................ Henry County, Georgia .................................................................... 12060 0.9793 0.9762 ¥0.32 

11600 ................ Houston County, Georgia ................................................................. 47580 0.8961 0.8380 ¥6.48 

11601 ................ Irwin County, Georgia ...................................................................... 99911 0.7914 0.7593 ¥4.06 

11610 ................ Jackson County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11611 ................ Jasper County, Georgia ................................................................... 12060 0.8980 0.9762 8.71 

11612 ................ Jeff Davis County, Georgia .............................................................. 99911 0.7914 0.7593 ¥4.06 

11620 ................ Jefferson County, Georgia ............................................................... 99911 0.7914 0.7593 ¥4.06 

11630 ................ Jenkins County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11640 ................ Johnson County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11650 ................ Jones County, Georgia .................................................................... 31420 0.9360 0.9519 1.70 

11651 ................ Lamar County, Georgia .................................................................... 12060 0.8980 0.9762 8.71 

11652 ................ Lanier County, Georgia .................................................................... 46660 0.8516 0.8369 ¥1.73 

11660 ................ Laurens County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11670 ................ Lee County, Georgia ........................................................................ 10500 0.8628 0.8991 4.21 

11680 ................ Liberty County, Georgia ................................................................... 25980 0.8973 0.9178 2.28 

11690 ................ Lincoln County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11691 ................ Long County, Georgia ...................................................................... 25980 0.8973 0.9178 2.28 

11700 ................ Lowndes County, Georgia ................................................................ 46660 0.8516 0.8369 ¥1.73 

11701 ................ Lumpkin County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11702 ................ Mc Duffie County, Georgia ............................................................... 12260 0.9778 0.9667 ¥1.14 

11703 ................ Mc Intosh County, Georgia .............................................................. 15260 0.8739 1.0164 16.31 


rmajette on PROD1PC67 with RULES2
65966 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

11710 ................ Macon County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11720 ................ Madison County, Georgia ................................................................ 12020 0.9855 0.9856 0.01 

11730 ................ Marion County, Georgia ................................................................... 17980 0.8363 0.8239 ¥1.48 

11740 ................ Meriwether County, Georgia ............................................................ 12060 0.8980 0.9762 8.71 

11741 ................ Miller County, Georgia ..................................................................... 99911 0.7914 0.7593 ¥4.06 

11750 ................ Mitchell County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11760 ................ Monroe County, Georgia .................................................................. 31420 0.8805 0.9519 8.11 

11770 ................ Montgomery County, Georgia .......................................................... 99911 0.7914 0.7593 ¥4.06 

11771 ................ Morgan County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11772 ................ Murray County, Georgia ................................................................... 19140 0.8623 0.9093 5.45 

11780 ................ Muscogee County, Georgia ............................................................. 17980 0.8560 0.8239 ¥3.75 

11790 ................ Newton County, Georgia .................................................................. 12060 0.9793 0.9762 ¥0.32 

11800 ................ Oconee County, Georgia ................................................................. 12020 0.9855 0.9856 0.01 

11801 ................ Oglethorpe County, Georgia ............................................................ 12020 0.9011 0.9856 9.38 

11810 ................ Paulding County, Georgia ................................................................ 12060 0.9793 0.9762 ¥0.32 

11811 ................ Peach County, Georgia .................................................................... 99911 0.8470 0.7593 ¥10.35 

11812 ................ Pickens County, Georgia ................................................................. 12060 0.9793 0.9762 ¥0.32 

11820 ................ Pierce County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11821 ................ Pike County, Georgia ....................................................................... 12060 0.8980 0.9762 8.71 

11830 ................ Polk County, Georgia ....................................................................... 99911 0.7914 0.7593 ¥4.06 

11831 ................ Pulaski County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11832 ................ Putnam County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11833 ................ Quitman County, Georgia ................................................................ 99911 0.7914 0.7593 ¥4.06 

11834 ................ Rabun County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11835 ................ Randolph County, Georgia ............................................................... 99911 0.7914 0.7593 ¥4.06 

11840 ................ Richmond County, Georgia .............................................................. 12260 0.9778 0.9667 ¥1.14 

11841 ................ Rockdale County, Georgia ............................................................... 12060 0.9793 0.9762 ¥0.32 

11842 ................ Schley County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11850 ................ Screven County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11851 ................ Seminole County, Georgia ............................................................... 99911 0.7914 0.7593 ¥4.06 

11860 ................ Spalding County, Georgia ................................................................ 12060 0.9793 0.9762 ¥0.32 

11861 ................ Stephens County, Georgia ............................................................... 99911 0.7914 0.7593 ¥4.06 

11862 ................ Stewart County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11870 ................ Sumter County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11880 ................ Talbot County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11881 ................ Taliaferro County, Georgia ............................................................... 99911 0.7914 0.7593 ¥4.06 

11882 ................ Tattnall County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11883 ................ Taylor County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11884 ................ Telfair County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11885 ................ Terrell County, Georgia .................................................................... 10500 0.8397 0.8991 7.07 

11890 ................ Thomas County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11900 ................ Tift County, Georgia ......................................................................... 99911 0.7914 0.7593 ¥4.06 

11901 ................ Toombs County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11902 ................ Towns County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11903 ................ Treutlen County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11910 ................ Troup County, Georgia ..................................................................... 99911 0.7914 0.7593 ¥4.06 

11911 ................ Turner County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11912 ................ Twiggs County, Georgia ................................................................... 31420 0.9360 0.9519 1.70 

11913 ................ Union County, Georgia ..................................................................... 99911 0.7914 0.7593 ¥4.06 

11920 ................ Upson County, Georgia .................................................................... 99911 0.7914 0.7593 ¥4.06 

11921 ................ Walker County, Georgia ................................................................... 16860 0.9088 0.8948 ¥1.54 

11930 ................ Walton County, Georgia ................................................................... 12060 0.9793 0.9762 ¥0.32 

11940 ................ Ware County, Georgia ..................................................................... 99911 0.7914 0.7593 ¥4.06 

11941 ................ Warren County, Georgia .................................................................. 99911 0.7914 0.7593 ¥4.06 

11950 ................ Washington County, Georgia ........................................................... 99911 0.7914 0.7593 ¥4.06 

11960 ................ Wayne County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11961 ................ Webster County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11962 ................ Wheeler County, Georgia ................................................................. 99911 0.7914 0.7593 ¥4.06 

11963 ................ White County, Georgia ..................................................................... 99911 0.7914 0.7593 ¥4.06 

11970 ................ Whitfield County, Georgia ................................................................ 19140 0.8623 0.9093 5.45 

11971 ................ Wilcox County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11972 ................ Wilkes County, Georgia ................................................................... 99911 0.7914 0.7593 ¥4.06 

11973 ................ Wilkinson County, Georgia ............................................................... 99911 0.7914 0.7593 ¥4.06 

11980 ................ Worth County, Georgia .................................................................... 10500 0.8397 0.8991 7.07 

12005 ................ Kalawao County, Hawaii .................................................................. 99912 1.0551 1.0448 ¥0.98 

12010 ................ Hawaii County, Hawaii ..................................................................... 99912 1.0551 1.0448 ¥0.98 

12020 ................ Honolulu County, Hawaii .................................................................. 26180 1.1214 1.1096 ¥1.05 

12040 ................ Kauai County, Hawaii ....................................................................... 99912 1.0551 1.0448 ¥0.98 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65967 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

12050 ................ Maui County, Hawaii ........................................................................ 99912 1.0551 1.0448 ¥0.98 

13000 ................ Ada County, Idaho ........................................................................... 14260 0.9052 0.9401 3.86 

13010 ................ Adams County, Idaho ....................................................................... 99913 0.8567 0.8120 ¥5.22 

13020 ................ Bannock County, Idaho .................................................................... 38540 0.9351 0.9400 0.52 

13030 ................ Bear Lake County, Idaho ................................................................. 99913 0.8567 0.8120 ¥5.22 

13040 ................ Benewah County, Idaho ................................................................... 99913 0.8567 0.8120 ¥5.22 

13050 ................ Bingham County, Idaho .................................................................... 99913 0.8567 0.8120 ¥5.22 

13060 ................ Blaine County, Idaho ........................................................................ 99913 0.8567 0.8120 ¥5.22 

13070 ................ Boise County, Idaho ......................................................................... 14260 0.9075 0.9401 3.59 

13080 ................ Bonner County, Idaho ...................................................................... 99913 0.8567 0.8120 ¥5.22 

13090 ................ Bonneville County, Idaho ................................................................. 26820 0.9259 0.9088 ¥1.85 

13100 ................ Boundary County, Idaho .................................................................. 99913 0.8567 0.8120 ¥5.22 

13110 ................ Butte County, Idaho ......................................................................... 99913 0.8567 0.8120 ¥5.22 

13120 ................ Camas County, Idaho ...................................................................... 99913 0.8567 0.8120 ¥5.22 

13130 ................ Canyon County, Idaho ..................................................................... 14260 0.9052 0.9401 3.86 

13140 ................ Caribou County, Idaho ..................................................................... 99913 0.8567 0.8120 ¥5.22 

13150 ................ Cassia County, Idaho ....................................................................... 99913 0.8567 0.8120 ¥5.22 

13160 ................ Clark County, Idaho ......................................................................... 99913 0.8567 0.8120 ¥5.22 

13170 ................ Clearwater County, Idaho ................................................................ 99913 0.8567 0.8120 ¥5.22 

13180 ................ Custer County, Idaho ....................................................................... 99913 0.8567 0.8120 ¥5.22 

13190 ................ Elmore County, Idaho ...................................................................... 99913 0.8567 0.8120 ¥5.22 

13200 ................ Franklin County, Idaho ..................................................................... 30860 0.9131 0.9022 ¥1.19 

13210 ................ Fremont County, Idaho .................................................................... 99913 0.8567 0.8120 ¥5.22 

13220 ................ Gem County, Idaho .......................................................................... 14260 0.9075 0.9401 3.59 

13230 ................ Gooding County, Idaho .................................................................... 99913 0.8567 0.8120 ¥5.22 

13240 ................ Idaho County, Idaho ......................................................................... 99913 0.8567 0.8120 ¥5.22 

13250 ................ Jefferson County, Idaho ................................................................... 26820 0.9259 0.9088 ¥1.85 

13260 ................ Jerome County, Idaho ...................................................................... 99913 0.8567 0.8120 ¥5.22 

13270 ................ Kootenai County, Idaho .................................................................... 17660 0.9372 0.9344 ¥0.30 

13280 ................ Latah County, Idaho ......................................................................... 99913 0.8567 0.8120 ¥5.22 

13290 ................ Lemhi County, Idaho ........................................................................ 99913 0.8567 0.8120 ¥5.22 

13300 ................ Lewis County, Idaho ......................................................................... 99913 0.8567 0.8120 ¥5.22 

13310 ................ Lincoln County, Idaho ...................................................................... 99913 0.8567 0.8120 ¥5.22 

13320 ................ Madison County, Idaho .................................................................... 99913 0.8567 0.8120 ¥5.22 

13330 ................ Minidoka County, Idaho ................................................................... 99913 0.8567 0.8120 ¥5.22 

13340 ................ Nez Perce County, Idaho ................................................................. 30300 0.9492 0.9853 3.80 

13350 ................ Oneida County, Idaho ...................................................................... 99913 0.8567 0.8120 ¥5.22 

13360 ................ Owyhee County, Idaho ..................................................................... 14260 0.9075 0.9401 3.59 

13370 ................ Payette County, Idaho ...................................................................... 99913 0.8567 0.8120 ¥5.22 

13380 ................ Power County, Idaho ........................................................................ 38540 0.9224 0.9400 1.91 

13390 ................ Shoshone County, Idaho .................................................................. 99913 0.8567 0.8120 ¥5.22 

13400 ................ Teton County, Idaho ......................................................................... 99913 0.8567 0.8120 ¥5.22 

13410 ................ Twin Falls County, Idaho ................................................................. 99913 0.8567 0.8120 ¥5.22 

13420 ................ Valley County, Idaho ........................................................................ 99913 0.8567 0.8120 ¥5.22 

13430 ................ Washington County, Idaho ............................................................... 99913 0.8567 0.8120 ¥5.22 

14000 ................ Adams County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14010 ................ Alexander County, Illinois ................................................................. 99914 0.8286 0.8320 0.41 

14020 ................ Bond County, Illinois ........................................................................ 41180 0.8628 0.9005 4.37 

14030 ................ Boone County, Illinois ...................................................................... 40420 0.9984 0.9989 0.05 

14040 ................ Brown County, Illinois ....................................................................... 99914 0.8286 0.8320 0.41 

14050 ................ Bureau County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14060 ................ Calhoun County, Illinois ................................................................... 41180 0.8628 0.9005 4.37 

14070 ................ Carroll County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14080 ................ Cass County, Illinois ......................................................................... 99914 0.8286 0.8320 0.41 

14090 ................ Champaign County, Illinois .............................................................. 16580 0.9594 0.9644 0.52 

14100 ................ Christian County, Illinois ................................................................... 99914 0.8286 0.8320 0.41 

14110 ................ Clark County, Illinois ........................................................................ 99914 0.8286 0.8320 0.41 

14120 ................ Clay County, Illinois .......................................................................... 99914 0.8286 0.8320 0.41 

14130 ................ Clinton County, Illinois ...................................................................... 41180 0.8958 0.9005 0.52 

14140 ................ Coles County, Illinois ........................................................................ 99914 0.8286 0.8320 0.41 

14141 ................ Cook County, Illinois ........................................................................ 16974 1.0787 1.0751 ¥0.33 

14150 ................ Crawford County, Illinois .................................................................. 99914 0.8286 0.8320 0.41 

14160 ................ Cumberland County, Illinois ............................................................. 99914 0.8286 0.8320 0.41 

14170 ................ De Kalb County, Illinois .................................................................... 16974 1.0787 1.0751 ¥0.33 

14180 ................ De Witt County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14190 ................ Douglas County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14250 ................ Du Page County, Illinois ................................................................... 16974 1.0787 1.0751 ¥0.33 

14310 ................ Edgar County, Illinois ....................................................................... 99914 0.8286 0.8320 0.41 


rmajette on PROD1PC67 with RULES2
65968 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

14320 ................ Edwards County, Illinois ................................................................... 99914 0.8286 0.8320 0.41 

14330 ................ Effingham County, Illinois ................................................................. 99914 0.8286 0.8320 0.41 

14340 ................ Fayette County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14350 ................ Ford County, Illinois ......................................................................... 16580 0.8948 0.9644 7.78 

14360 ................ Franklin County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14370 ................ Fulton County, Illinois ....................................................................... 99914 0.8286 0.8320 0.41 

14380 ................ Gallatin County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14390 ................ Greene County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14400 ................ Grundy County, Illinois ..................................................................... 16974 1.0787 1.0751 ¥0.33 

14410 ................ Hamilton County, Illinois ................................................................... 99914 0.8286 0.8320 0.41 

14420 ................ Hancock County, Illinois ................................................................... 99914 0.8286 0.8320 0.41 

14421 ................ Hardin County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14440 ................ Henderson County, Illinois ............................................................... 99914 0.8286 0.8320 0.41 

14450 ................ Henry County, Illinois ....................................................................... 19340 0.8724 0.8846 1.40 

14460 ................ Iroquois County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14470 ................ Jackson County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14480 ................ Jasper County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14490 ................ Jefferson County, Illinois .................................................................. 99914 0.8286 0.8320 0.41 

14500 ................ Jersey County, Illinois ...................................................................... 41180 0.8958 0.9005 0.52 

14510 ................ Jo Daviess County, Illinois ............................................................... 99914 0.8286 0.8320 0.41 

14520 ................ Johnson County, Illinois ................................................................... 99914 0.8286 0.8320 0.41 

14530 ................ Kane County, Illinois ........................................................................ 16974 1.0787 1.0751 ¥0.33 

14540 ................ Kankakee County, Illinois ................................................................. 28100 1.0721 1.0083 ¥5.95 

14550 ................ Kendall County, Illinois ..................................................................... 16974 1.0787 1.0751 ¥0.33 

14560 ................ Knox County, Illinois ......................................................................... 99914 0.8286 0.8320 0.41 

14570 ................ Lake County, Illinois ......................................................................... 29404 1.0606 1.0570 ¥0.34 

14580 ................ La Salle County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14590 ................ Lawrence County, Illinois ................................................................. 99914 0.8286 0.8320 0.41 

14600 ................ Lee County, Illinois ........................................................................... 99914 0.8286 0.8320 0.41 

14610 ................ Livingston County, Illinois ................................................................. 99914 0.8286 0.8320 0.41 

14620 ................ Logan County, Illinois ....................................................................... 99914 0.8286 0.8320 0.41 

14630 ................ Mc Donough County, Illinois ............................................................ 99914 0.8286 0.8320 0.41 

14640 ................ Mc Henry County, Illinois ................................................................. 16974 1.0787 1.0751 ¥0.33 

14650 ................ Mclean County, Illinois ..................................................................... 14060 0.9075 0.8944 ¥1.44 

14660 ................ Macon County, Illinois ...................................................................... 19500 0.8067 0.8172 1.30 

14670 ................ Macoupin County, Illinois ................................................................. 41180 0.8628 0.9005 4.37 

14680 ................ Madison County, Illinois ................................................................... 41180 0.8958 0.9005 0.52 

14690 ................ Marion County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14700 ................ Marshall County, Illinois ................................................................... 37900 0.8586 0.8982 4.61 

14710 ................ Mason County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14720 ................ Massac County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14730 ................ Menard County, Illinois ..................................................................... 44100 0.8792 0.8890 1.11 

14740 ................ Mercer County, Illinois ...................................................................... 19340 0.8513 0.8846 3.91 

14750 ................ Monroe County, Illinois ..................................................................... 41180 0.8958 0.9005 0.52 

14760 ................ Montgomery County, Illinois ............................................................. 99914 0.8286 0.8320 0.41 

14770 ................ Morgan County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14780 ................ Moultrie County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14790 ................ Ogle County, Illinois ......................................................................... 99914 0.9128 0.8320 ¥8.85 

14800 ................ Peoria County, Illinois ...................................................................... 37900 0.8870 0.8982 1.26 

14810 ................ Perry County, Illinois ........................................................................ 99914 0.8286 0.8320 0.41 

14820 ................ Piatt County, Illinois .......................................................................... 16580 0.8948 0.9644 7.78 

14830 ................ Pike County, Illinois .......................................................................... 99914 0.8286 0.8320 0.41 

14831 ................ Pope County, Illinois ........................................................................ 99914 0.8286 0.8320 0.41 

14850 ................ Pulaski County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14860 ................ Putnam County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14870 ................ Randolph County, Illinois ................................................................. 99914 0.8286 0.8320 0.41 

14880 ................ Richland County, Illinois ................................................................... 99914 0.8286 0.8320 0.41 

14890 ................ Rock Island County, Illinois .............................................................. 19340 0.8724 0.8846 1.40 

14900 ................ St Clair County, Illinois ..................................................................... 41180 0.8958 0.9005 0.52 

14910 ................ Saline County, Illinois ....................................................................... 99914 0.8286 0.8320 0.41 

14920 ................ Sangamon County, Illinois ............................................................... 44100 0.8792 0.8890 1.11 

14921 ................ Schuyler County, Illinois ................................................................... 99914 0.8286 0.8320 0.41 

14940 ................ Scott County, Illinois ......................................................................... 99914 0.8286 0.8320 0.41 

14950 ................ Shelby County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14960 ................ Stark County, Illinois ........................................................................ 37900 0.8586 0.8982 4.61 

14970 ................ Stephenson County, Illinois .............................................................. 99914 0.8286 0.8320 0.41 

14980 ................ Tazewell County, Illinois ................................................................... 37900 0.8870 0.8982 1.26 

14981 ................ Union County, Illinois ....................................................................... 99914 0.8286 0.8320 0.41 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65969 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

14982 ................ Vermilion County, Illinois .................................................................. 19180 0.8665 0.9266 6.94 

14983 ................ Wabash County, Illinois .................................................................... 99914 0.8286 0.8320 0.41 

14984 ................ Warren County, Illinois ..................................................................... 99914 0.8286 0.8320 0.41 

14985 ................ Washington County, Illinois .............................................................. 99914 0.8286 0.8320 0.41 

14986 ................ Wayne County, Illinois ...................................................................... 99914 0.8286 0.8320 0.41 

14987 ................ White County, Illinois ........................................................................ 99914 0.8286 0.8320 0.41 

14988 ................ Whiteside County, Illinois ................................................................. 99914 0.8286 0.8320 0.41 

14989 ................ Will County, Illinois ........................................................................... 16974 1.0787 1.0751 ¥0.33 

14990 ................ Williamson County, Illinois ............................................................... 99914 0.8286 0.8320 0.41 

14991 ................ Winnebago County, Illinois ............................................................... 40420 0.9984 0.9989 0.05 

14992 ................ Woodford County, Illinois ................................................................. 37900 0.8870 0.8982 1.26 

15000 ................ Adams County, Indiana .................................................................... 99915 0.9165 0.8538 ¥6.84 

15010 ................ Allen County, Indiana ....................................................................... 23060 0.9750 0.9517 ¥2.39 

15020 ................ Bartholomew County, Indiana .......................................................... 18020 0.9164 0.9318 1.68 

15030 ................ Benton County, Indiana .................................................................... 29140 0.8738 0.8931 2.21 

15040 ................ Blackford County, Indiana ................................................................ 99915 0.8682 0.8538 ¥1.66 

15050 ................ Boone County, Indiana ..................................................................... 26900 0.9893 0.9895 0.02 

15060 ................ Brown County, Indiana ..................................................................... 26900 0.9330 0.9895 6.06 

15070 ................ Carroll County, Indiana .................................................................... 29140 0.8738 0.8931 2.21 

15080 ................ Cass County, Indiana ....................................................................... 99915 0.8682 0.8538 ¥1.66 

15090 ................ Clark County, Indiana ....................................................................... 31140 0.9272 0.9118 ¥1.66 

15100 ................ Clay County, Indiana ........................................................................ 45460 0.8321 0.8765 5.34 

15110 ................ Clinton County, Indiana .................................................................... 99915 0.8680 0.8538 ¥1.64 

15120 ................ Crawford County, Indiana ................................................................ 99915 0.8682 0.8538 ¥1.66 

15130 ................ Daviess County, Indiana .................................................................. 99915 0.8682 0.8538 ¥1.66 

15140 ................ Dearborn County, Indiana ................................................................ 17140 0.9675 0.9601 ¥0.76 

15150 ................ Decatur County, Indiana .................................................................. 99915 0.8682 0.8538 ¥1.66 

15160 ................ De Kalb County, Indiana .................................................................. 99915 0.9165 0.8538 ¥6.84 

15170 ................ Delaware County, Indiana ................................................................ 34620 0.8930 0.8562 ¥4.12 

15180 ................ Dubois County, Indiana .................................................................... 99915 0.8682 0.8538 ¥1.66 

15190 ................ Elkhart County, Indiana .................................................................... 21140 0.9627 0.9426 ¥2.09 

15200 ................ Fayette County, Indiana ................................................................... 99915 0.8682 0.8538 ¥1.66 

15210 ................ Floyd County, Indiana ...................................................................... 31140 0.9272 0.9118 ¥1.66 

15220 ................ Fountain County, Indiana ................................................................. 99915 0.8682 0.8538 ¥1.66 

15230 ................ Franklin County, Indiana .................................................................. 17140 0.9177 0.9601 4.62 

15240 ................ Fulton County, Indiana ..................................................................... 99915 0.8682 0.8538 ¥1.66 

15250 ................ Gibson County, Indiana .................................................................... 21780 0.8726 0.9071 3.95 

15260 ................ Grant County, Indiana ...................................................................... 99915 0.8682 0.8538 ¥1.66 

15270 ................ Greene County, Indiana ................................................................... 14020 0.8593 0.8533 ¥0.70 

15280 ................ Hamilton County, Indiana ................................................................. 26900 0.9893 0.9895 0.02 

15290 ................ Hancock County, Indiana ................................................................. 26900 0.9893 0.9895 0.02 

15300 ................ Harrison County, Indiana ................................................................. 31140 0.9272 0.9118 ¥1.66 

15310 ................ Hendricks County, Indiana ............................................................... 26900 0.9893 0.9895 0.02 

15320 ................ Henry County, Indiana ..................................................................... 99915 0.8682 0.8538 ¥1.66 

15330 ................ Howard County, Indiana ................................................................... 29020 0.9508 0.9669 1.69 

15340 ................ Huntington County, Indiana .............................................................. 99915 0.9165 0.8538 ¥6.84 

15350 ................ Jackson County, Indiana .................................................................. 99915 0.8682 0.8538 ¥1.66 

15360 ................ Jasper County, Indiana .................................................................... 23844 0.9067 0.9334 2.94 

15370 ................ Jay County, Indiana ......................................................................... 99915 0.8682 0.8538 ¥1.66 

15380 ................ Jefferson County, Indiana ................................................................ 99915 0.8682 0.8538 ¥1.66 

15390 ................ Jennings County, Indiana ................................................................. 99915 0.8682 0.8538 ¥1.66 

15400 ................ Johnson County, Indiana ................................................................. 26900 0.9893 0.9895 0.02 

15410 ................ Knox County, Indiana ....................................................................... 99915 0.8682 0.8538 ¥1.66 

15420 ................ Kosciusko County, Indiana ............................................................... 99915 0.8682 0.8538 ¥1.66 

15430 ................ Lagrange County, Indiana ................................................................ 99915 0.8682 0.8538 ¥1.66 

15440 ................ Lake County, Indiana ....................................................................... 23844 0.9395 0.9334 ¥0.65 

15450 ................ La Porte County, Indiana ................................................................. 33140 0.9069 0.9118 0.54 

15460 ................ Lawrence County, Indiana ............................................................... 99915 0.8682 0.8538 ¥1.66 

15470 ................ Madison County, Indiana ................................................................. 11300 0.9226 0.8681 ¥5.91 

15480 ................ Marion County, Indiana .................................................................... 26900 0.9893 0.9895 0.02 

15490 ................ Marshall County, Indiana ................................................................. 99915 0.8682 0.8538 ¥1.66 

15500 ................ Martin County, Indiana ..................................................................... 99915 0.8682 0.8538 ¥1.66 

15510 ................ Miami County, Indiana ..................................................................... 99915 0.8682 0.8538 ¥1.66 

15520 ................ Monroe County, Indiana ................................................................... 14020 0.8447 0.8533 1.02 

15530 ................ Montgomery County, Indiana ........................................................... 99915 0.8682 0.8538 ¥1.66 

15540 ................ Morgan County, Indiana ................................................................... 26900 0.9893 0.9895 0.02 

15550 ................ Newton County, Indiana ................................................................... 23844 0.9067 0.9334 2.94 

15560 ................ Noble County, Indiana ...................................................................... 99915 0.8682 0.8538 ¥1.66 


rmajette on PROD1PC67 with RULES2
65970 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

15570 ................ Ohio County, Indiana ....................................................................... 17140 0.9675 0.9601 ¥0.76 

15580 ................ Orange County, Indiana ................................................................... 99915 0.8682 0.8538 ¥1.66 

15590 ................ Owen County, Indiana ...................................................................... 14020 0.8593 0.8533 ¥0.70 

15600 ................ Parke County, Indiana ...................................................................... 99915 0.8682 0.8538 ¥1.66 

15610 ................ Perry County, Indiana ...................................................................... 99915 0.8682 0.8538 ¥1.66 

15620 ................ Pike County, Indiana ........................................................................ 99915 0.8682 0.8538 ¥1.66 

15630 ................ Porter County, Indiana ..................................................................... 23844 0.9395 0.9334 ¥0.65 

15640 ................ Posey County, Indiana ..................................................................... 21780 0.8713 0.9071 4.11 

15650 ................ Pulaski County, Indiana ................................................................... 99915 0.8682 0.8538 ¥1.66 

15660 ................ Putnam County, Indiana ................................................................... 26900 0.9330 0.9895 6.06 

15670 ................ Randolph County, Indiana ................................................................ 99915 0.8682 0.8538 ¥1.66 

15680 ................ Ripley County, Indiana ..................................................................... 99915 0.8682 0.8538 ¥1.66 

15690 ................ Rush County, Indiana ....................................................................... 99915 0.8682 0.8538 ¥1.66 

15700 ................ St Joseph County, Indiana ............................................................... 43780 0.9788 0.9842 0.55 

15710 ................ Scott County, Indiana ....................................................................... 99915 0.8959 0.8538 ¥4.70 

15720 ................ Shelby County, Indiana .................................................................... 26900 0.9893 0.9895 0.02 

15730 ................ Spencer County, Indiana .................................................................. 99915 0.8682 0.8538 ¥1.66 

15740 ................ Starke County, Indiana ..................................................................... 99915 0.8682 0.8538 ¥1.66 

15750 ................ Steuben County, Indiana .................................................................. 99915 0.8682 0.8538 ¥1.66 

15760 ................ Sullivan County, Indiana .................................................................. 45460 0.8522 0.8765 2.85 

15770 ................ Switzerland County, Indiana ............................................................ 99915 0.8682 0.8538 ¥1.66 

15780 ................ Tippecanoe County, Indiana ............................................................ 29140 0.8736 0.8931 2.23 

15790 ................ Tipton County, Indiana ..................................................................... 29020 0.9508 0.9669 1.69 

15800 ................ Union County, Indiana ...................................................................... 99915 0.8682 0.8538 ¥1.66 

15810 ................ Vanderburgh County, Indiana .......................................................... 21780 0.8713 0.9071 4.11 

15820 ................ Vermillion County, Indiana ............................................................... 45460 0.8321 0.8765 5.34 

15830 ................ Vigo County, Indiana ........................................................................ 45460 0.8321 0.8765 5.34 

15840 ................ Wabash County, Indiana .................................................................. 99915 0.8682 0.8538 ¥1.66 

15850 ................ Warren County, Indiana ................................................................... 99915 0.8682 0.8538 ¥1.66 

15860 ................ Warrick County, Indiana ................................................................... 21780 0.8713 0.9071 4.11 

15870 ................ Washington County, Indiana ............................................................ 31140 0.8995 0.9118 1.37 

15880 ................ Wayne County, Indiana .................................................................... 99915 0.8682 0.8538 ¥1.66 

15890 ................ Wells County, Indiana ...................................................................... 23060 0.9750 0.9517 ¥2.39 

15900 ................ White County, Indiana ...................................................................... 99915 0.8682 0.8538 ¥1.66 

15910 ................ Whitley County, Indiana ................................................................... 23060 0.9750 0.9517 ¥2.39 

16000 ................ Adair County, Iowa ........................................................................... 99916 0.8552 0.8681 1.51 

16010 ................ Adams County, Iowa ........................................................................ 99916 0.8552 0.8681 1.51 

16020 ................ Allamakee County, Iowa .................................................................. 99916 0.8552 0.8681 1.51 

16030 ................ Appanoose County, Iowa ................................................................. 99916 0.8552 0.8681 1.51 

16040 ................ Audubon County, Iowa ..................................................................... 99916 0.8552 0.8681 1.51 

16050 ................ Benton County, Iowa ........................................................................ 16300 0.8710 0.8888 2.04 

16060 ................ Black Hawk County, Iowa ................................................................ 47940 0.8557 0.8408 ¥1.74 

16070 ................ Boone County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

16080 ................ Bremer County, Iowa ....................................................................... 47940 0.8576 0.8408 ¥1.96 

16090 ................ Buchanan County, Iowa ................................................................... 99916 0.8552 0.8681 1.51 

16100 ................ Buena Vista County, Iowa ................................................................ 99916 0.8552 0.8681 1.51 

16110 ................ Butler County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16120 ................ Calhoun County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16130 ................ Carroll County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

16140 ................ Cass County, Iowa ........................................................................... 99916 0.8552 0.8681 1.51 

16150 ................ Cedar County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

16160 ................ Cerro Gordo County, Iowa ............................................................... 99916 0.8552 0.8681 1.51 

16170 ................ Cherokee County, Iowa .................................................................... 99916 0.8552 0.8681 1.51 

16180 ................ Chickasaw County, Iowa .................................................................. 99916 0.8552 0.8681 1.51 

16190 ................ Clarke County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

16200 ................ Clay County, Iowa ............................................................................ 99916 0.8552 0.8681 1.51 

16210 ................ Clayton County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16220 ................ Clinton County, Iowa ........................................................................ 99916 0.8552 0.8681 1.51 

16230 ................ Crawford County, Iowa ..................................................................... 99916 0.8552 0.8681 1.51 

16240 ................ Dallas County, Iowa ......................................................................... 19780 0.9669 0.9214 ¥4.71 

16250 ................ Davis County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16260 ................ Decatur County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16270 ................ Delaware County, Iowa .................................................................... 99916 0.8552 0.8681 1.51 

16280 ................ Des Moines County, Iowa ................................................................ 99916 0.8552 0.8681 1.51 

16290 ................ Dickinson County, Iowa .................................................................... 99916 0.8552 0.8681 1.51 

16300 ................ Dubuque County, Iowa ..................................................................... 20220 0.9024 0.9133 1.21 

16310 ................ Emmet County, Iowa ........................................................................ 99916 0.8552 0.8681 1.51 

16320 ................ Fayette County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65971 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

16330 ................ Floyd County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16340 ................ Franklin County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16350 ................ Fremont County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16360 ................ Greene County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16370 ................ Grundy County, Iowa ....................................................................... 47940 0.8576 0.8408 ¥1.96 

16380 ................ Guthrie County, Iowa ....................................................................... 19780 0.9132 0.9214 0.90 

16390 ................ Hamilton County, Iowa ..................................................................... 99916 0.8552 0.8681 1.51 

16400 ................ Hancock County, Iowa ..................................................................... 99916 0.8552 0.8681 1.51 

16410 ................ Hardin County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

16420 ................ Harrison County, Iowa ...................................................................... 36540 0.9077 0.9450 4.11 

16430 ................ Henry County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16440 ................ Howard County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16450 ................ Humboldt County, Iowa .................................................................... 99916 0.8552 0.8681 1.51 

16460 ................ Ida County, Iowa .............................................................................. 99916 0.8552 0.8681 1.51 

16470 ................ Iowa County, Iowa ............................................................................ 99916 0.8552 0.8681 1.51 

16480 ................ Jackson County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16490 ................ Jasper County, Iowa ........................................................................ 99916 0.8552 0.8681 1.51 

16500 ................ Jefferson County, Iowa .................................................................... 99916 0.8552 0.8681 1.51 

16510 ................ Johnson County, Iowa ...................................................................... 26980 0.9747 0.9714 ¥0.34 

16520 ................ Jones County, Iowa .......................................................................... 16300 0.8710 0.8888 2.04 

16530 ................ Keokuk County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16540 ................ Kossuth County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16550 ................ Lee County, Iowa ............................................................................. 99916 0.8552 0.8681 1.51 

16560 ................ Linn County, Iowa ............................................................................ 16300 0.8825 0.8888 0.71 

16570 ................ Louisa County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

16580 ................ Lucas County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16590 ................ Lyon County, Iowa ........................................................................... 99916 0.8552 0.8681 1.51 

16600 ................ Madison County, Iowa ...................................................................... 19780 0.9132 0.9214 0.90 

16610 ................ Mahaska County, Iowa ..................................................................... 99916 0.8552 0.8681 1.51 

16620 ................ Marion County, Iowa ........................................................................ 99916 0.8552 0.8681 1.51 

16630 ................ Marshall County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16640 ................ Mills County, Iowa ............................................................................ 36540 0.9077 0.9450 4.11 

16650 ................ Mitchell County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16660 ................ Monona County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16670 ................ Monroe County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16680 ................ Montgomery County, Iowa ............................................................... 99916 0.8552 0.8681 1.51 

16690 ................ Muscatine County, Iowa ................................................................... 99916 0.8552 0.8681 1.51 

16700 ................ O Brien County, Iowa ....................................................................... 99916 0.8552 0.8681 1.51 

16710 ................ Osceola County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16720 ................ Page County, Iowa ........................................................................... 99916 0.8552 0.8681 1.51 

16730 ................ Palo Alto County, Iowa ..................................................................... 99916 0.8552 0.8681 1.51 

16740 ................ Plymouth County, Iowa .................................................................... 99916 0.8552 0.8681 1.51 

16750 ................ Pocahontas County, Iowa ................................................................ 99916 0.8552 0.8681 1.51 

16760 ................ Polk County, Iowa ............................................................................ 19780 0.9669 0.9214 ¥4.71 

16770 ................ Pottawattamie County, Iowa ............................................................ 36540 0.9560 0.9450 ¥1.15 

16780 ................ Poweshiek County, Iowa .................................................................. 99916 0.8552 0.8681 1.51 

16790 ................ Ringgold County, Iowa ..................................................................... 99916 0.8552 0.8681 1.51 

16800 ................ Sac County, Iowa ............................................................................. 99916 0.8552 0.8681 1.51 

16810 ................ Scott County, Iowa ........................................................................... 19340 0.8724 0.8846 1.40 

16820 ................ Shelby County, Iowa ........................................................................ 99916 0.8552 0.8681 1.51 

16830 ................ Sioux County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16840 ................ Story County, Iowa ........................................................................... 11180 0.9065 0.9760 7.67 

16850 ................ Tama County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16860 ................ Taylor County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

16870 ................ Union County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16880 ................ Van Buren County, Iowa .................................................................. 99916 0.8552 0.8681 1.51 

16890 ................ Wapello County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16900 ................ Warren County, Iowa ....................................................................... 19780 0.9669 0.9214 ¥4.71 

16910 ................ Washington County, Iowa ................................................................ 26980 0.9171 0.9714 5.92 

16920 ................ Wayne County, Iowa ........................................................................ 99916 0.8552 0.8681 1.51 

16930 ................ Webster County, Iowa ...................................................................... 99916 0.8552 0.8681 1.51 

16940 ................ Winnebago County, Iowa ................................................................. 99916 0.8552 0.8681 1.51 

16950 ................ Winneshiek County, Iowa ................................................................. 99916 0.8552 0.8681 1.51 

16960 ................ Woodbury County, Iowa ................................................................... 43580 0.9399 0.9200 ¥2.12 

16970 ................ Worth County, Iowa .......................................................................... 99916 0.8552 0.8681 1.51 

16980 ................ Wright County, Iowa ......................................................................... 99916 0.8552 0.8681 1.51 

17000 ................ Allen County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17010 ................ Anderson County, Kansas ............................................................... 99917 0.8038 0.7998 ¥0.50 


rmajette on PROD1PC67 with RULES2
65972 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

17020 ................ Atchison County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17030 ................ Barber County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17040 ................ Barton County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17050 ................ Bourbon County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17060 ................ Brown County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17070 ................ Butler County, Kansas ..................................................................... 48620 0.9164 0.9063 ¥1.10 

17080 ................ Chase County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17090 ................ Chautauqua County, Kansas ........................................................... 99917 0.8038 0.7998 ¥0.50 

17100 ................ Cherokee County, Kansas ............................................................... 99917 0.8038 0.7998 ¥0.50 

17110 ................ Cheyenne County, Kansas .............................................................. 99917 0.8038 0.7998 ¥0.50 

17120 ................ Clark County, Kansas ...................................................................... 99917 0.8038 0.7998 ¥0.50 

17130 ................ Clay County, Kansas ........................................................................ 99917 0.8038 0.7998 ¥0.50 

17140 ................ Cloud County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17150 ................ Coffey County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17160 ................ Comanche County, Kansas ............................................................. 99917 0.8038 0.7998 ¥0.50 

17170 ................ Cowley County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17180 ................ Crawford County, Kansas ................................................................ 99917 0.8038 0.7998 ¥0.50 

17190 ................ Decatur County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17200 ................ Dickinson County, Kansas ............................................................... 99917 0.8038 0.7998 ¥0.50 

17210 ................ Doniphan County, Kansas ............................................................... 41140 0.8780 1.0118 15.24 

17220 ................ Douglas County, Kansas .................................................................. 29940 0.8537 0.8365 ¥2.01 

17230 ................ Edwards County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17240 ................ Elk County, Kansas .......................................................................... 99917 0.8038 0.7998 ¥0.50 

17250 ................ Ellis County, Kansas ........................................................................ 99917 0.8038 0.7998 ¥0.50 

17260 ................ Ellsworth County, Kansas ................................................................ 99917 0.8038 0.7998 ¥0.50 

17270 ................ Finney County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17280 ................ Ford County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17290 ................ Franklin County, Kansas .................................................................. 28140 0.8758 0.9495 8.42 

17300 ................ Geary County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17310 ................ Gove County, Kansas ...................................................................... 99917 0.8038 0.7998 ¥0.50 

17320 ................ Graham County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17330 ................ Grant County, Kansas ...................................................................... 99917 0.8038 0.7998 ¥0.50 

17340 ................ Gray County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17350 ................ Greeley County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17360 ................ Greenwood County, Kansas ............................................................ 99917 0.8038 0.7998 ¥0.50 

17370 ................ Hamilton County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17380 ................ Harper County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17390 ................ Harvey County, Kansas ................................................................... 48620 0.9164 0.9063 ¥1.10 

17391 ................ Haskell County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17410 ................ Hodgeman County, Kansas ............................................................. 99917 0.8038 0.7998 ¥0.50 

17420 ................ Jackson County, Kansas .................................................................. 45820 0.8480 0.8730 2.95 

17430 ................ Jefferson County, Kansas ................................................................ 45820 0.8480 0.8730 2.95 

17440 ................ Jewell County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17450 ................ Johnson County, Kansas ................................................................. 28140 0.9483 0.9495 0.13 

17451 ................ Kearny County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17470 ................ Kingman County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17480 ................ Kiowa County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17490 ................ Labette County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17500 ................ Lane County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17510 ................ Leavenworth County, Kansas .......................................................... 28140 0.9483 0.9495 0.13 

17520 ................ Lincoln County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17530 ................ Linn County, Kansas ........................................................................ 28140 0.8758 0.9495 8.42 

17540 ................ Logan County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17550 ................ Lyon County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17560 ................ Mc Pherson County, Kansas ........................................................... 99917 0.8038 0.7998 ¥0.50 

17570 ................ Marion County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17580 ................ Marshall County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17590 ................ Meade County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17600 ................ Miami County, Kansas ..................................................................... 28140 0.9483 0.9495 0.13 

17610 ................ Mitchell County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17620 ................ Montgomery County, Kansas ........................................................... 99917 0.8038 0.7998 ¥0.50 

17630 ................ Morris County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17640 ................ Morton County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17650 ................ Nemaha County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17660 ................ Neosho County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17670 ................ Ness County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17680 ................ Norton County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17690 ................ Osage County, Kansas .................................................................... 45820 0.8480 0.8730 2.95 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65973 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

17700 ................ Osborne County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17710 ................ Ottawa County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17720 ................ Pawnee County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17730 ................ Phillips County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17740 ................ Pottawatomie County, Kansas ......................................................... 99917 0.8038 0.7998 ¥0.50 

17750 ................ Pratt County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17760 ................ Rawlins County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17770 ................ Reno County, Kansas ...................................................................... 99917 0.8038 0.7998 ¥0.50 

17780 ................ Republic County, Kansas ................................................................. 99917 0.8038 0.7998 ¥0.50 

17790 ................ Rice County, Kansas ........................................................................ 99917 0.8038 0.7998 ¥0.50 

17800 ................ Riley County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17810 ................ Rooks County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17820 ................ Rush County, Kansas ...................................................................... 99917 0.8038 0.7998 ¥0.50 

17830 ................ Russell County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17840 ................ Saline County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17841 ................ Scott County, Kansas ....................................................................... 99917 0.8038 0.7998 ¥0.50 

17860 ................ Sedgwick County, Kansas ............................................................... 48620 0.9164 0.9063 ¥1.10 

17870 ................ Seward County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17880 ................ Shawnee County, Kansas ................................................................ 45820 0.8920 0.8730 ¥2.13 

17890 ................ Sheridan County, Kansas ................................................................ 99917 0.8038 0.7998 ¥0.50 

17900 ................ Sherman County, Kansas ................................................................ 99917 0.8038 0.7998 ¥0.50 

17910 ................ Smith County, Kansas ...................................................................... 99917 0.8038 0.7998 ¥0.50 

17920 ................ Stafford County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17921 ................ Stanton County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17940 ................ Stevens County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17950 ................ Sumner County, Kansas .................................................................. 48620 0.8597 0.9063 5.42 

17960 ................ Thomas County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17970 ................ Trego County, Kansas ..................................................................... 99917 0.8038 0.7998 ¥0.50 

17980 ................ Wabaunsee County, Kansas ............................................................ 45820 0.8480 0.8730 2.95 

17981 ................ Wallace County, Kansas .................................................................. 99917 0.8038 0.7998 ¥0.50 

17982 ................ Washington County, Kansas ............................................................ 99917 0.8038 0.7998 ¥0.50 

17983 ................ Wichita County, Kansas ................................................................... 99917 0.8038 0.7998 ¥0.50 

17984 ................ Wilson County, Kansas .................................................................... 99917 0.8038 0.7998 ¥0.50 

17985 ................ Woodson County, Kansas ................................................................ 99917 0.8038 0.7998 ¥0.50 

17986 ................ Wyandotte County, Kansas .............................................................. 28140 0.9483 0.9495 0.13 

18000 ................ Adair County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 

18010 ................ Allen County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 

18020 ................ Anderson County, Kentucky ............................................................. 99918 0.7812 0.7768 ¥0.56 

18030 ................ Ballard County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18040 ................ Barren County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18050 ................ Bath County, Kentucky ..................................................................... 99918 0.7812 0.7768 ¥0.56 

18060 ................ Bell County, Kentucky ...................................................................... 99918 0.7812 0.7768 ¥0.56 

18070 ................ Boone County, Kentucky .................................................................. 17140 0.9675 0.9601 ¥0.76 

18080 ................ Bourbon County, Kentucky .............................................................. 30460 0.9032 0.9181 1.65 

18090 ................ Boyd County, Kentucky .................................................................... 26580 0.9477 0.8997 ¥5.06 

18100 ................ Boyle County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18110 ................ Bracken County, Kentucky ............................................................... 17140 0.8737 0.9601 9.89 

18120 ................ Breathitt County, Kentucky ............................................................... 99918 0.7812 0.7768 ¥0.56 

18130 ................ Breckinridge County, Kentucky ........................................................ 99918 0.7812 0.7768 ¥0.56 

18140 ................ Bullitt County, Kentucky ................................................................... 31140 0.9272 0.9118 ¥1.66 

18150 ................ Butler County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18160 ................ Caldwell County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18170 ................ Calloway County, Kentucky ............................................................. 99918 0.7812 0.7768 ¥0.56 

18180 ................ Campbell County, Kentucky ............................................................. 17140 0.9675 0.9601 ¥0.76 

18190 ................ Carlisle County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18191 ................ Carroll County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18210 ................ Carter County, Kentucky .................................................................. 99918 0.8622 0.7768 ¥9.90 

18220 ................ Casey County, Kentucky .................................................................. 99918 0.7812 0.7768 ¥0.56 

18230 ................ Christian County, Kentucky .............................................................. 17300 0.8284 0.8436 1.83 

18240 ................ Clark County, Kentucky .................................................................... 30460 0.9032 0.9181 1.65 

18250 ................ Clay County, Kentucky ..................................................................... 99918 0.7812 0.7768 ¥0.56 

18260 ................ Clinton County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18270 ................ Crittenden County, Kentucky ........................................................... 99918 0.7812 0.7768 ¥0.56 

18271 ................ Cumberland County, Kentucky ........................................................ 99918 0.7812 0.7768 ¥0.56 

18290 ................ Daviess County, Kentucky ............................................................... 36980 0.8780 0.8748 ¥0.36 

18291 ................ Edmonson County, Kentucky ........................................................... 14540 0.8035 0.8148 1.41 

18310 ................ Elliott County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18320 ................ Estill County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 


rmajette on PROD1PC67 with RULES2
65974 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

18330 ................ Fayette County, Kentucky ................................................................ 30460 0.9032 0.9181 1.65 

18340 ................ Fleming County, Kentucky ............................................................... 99918 0.7812 0.7768 ¥0.56 

18350 ................ Floyd County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18360 ................ Franklin County, Kentucky ............................................................... 99918 0.7812 0.7768 ¥0.56 

18361 ................ Fulton County, Kentucky .................................................................. 99918 0.7812 0.7768 ¥0.56 

18362 ................ Gallatin County, Kentucky ................................................................ 17140 0.9675 0.9601 ¥0.76 

18390 ................ Garrard County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18400 ................ Grant County, Kentucky ................................................................... 17140 0.9675 0.9601 ¥0.76 

18410 ................ Graves County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18420 ................ Grayson County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18421 ................ Green County, Kentucky .................................................................. 99918 0.7812 0.7768 ¥0.56 

18440 ................ Greenup County, Kentucky .............................................................. 26580 0.9477 0.8997 ¥5.06 

18450 ................ Hancock County, Kentucky .............................................................. 36980 0.8319 0.8748 5.16 

18460 ................ Hardin County, Kentucky ................................................................. 21060 0.8330 0.8697 4.41 

18470 ................ Harlan County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18480 ................ Harrison County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18490 ................ Hart County, Kentucky ..................................................................... 99918 0.7812 0.7768 ¥0.56 

18500 ................ Henderson County, Kentucky .......................................................... 21780 0.8713 0.9071 4.11 

18510 ................ Henry County, Kentucky .................................................................. 31140 0.8555 0.9118 6.58 

18511 ................ Hickman County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18530 ................ Hopkins County, Kentucky ............................................................... 99918 0.7812 0.7768 ¥0.56 

18540 ................ Jackson County, Kentucky ............................................................... 99918 0.7812 0.7768 ¥0.56 

18550 ................ Jefferson County, Kentucky ............................................................. 31140 0.9272 0.9118 ¥1.66 

18560 ................ Jessamine County, Kentucky ........................................................... 30460 0.9032 0.9181 1.65 

18570 ................ Johnson County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18580 ................ Kenton County, Kentucky ................................................................. 17140 0.9675 0.9601 ¥0.76 

18590 ................ Knott County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 

18600 ................ Knox County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 

18610 ................ Larue County, Kentucky ................................................................... 21060 0.8330 0.8697 4.41 

18620 ................ Laurel County, Kentucky .................................................................. 99918 0.7812 0.7768 ¥0.56 

18630 ................ Lawrence County, Kentucky ............................................................ 99918 0.7812 0.7768 ¥0.56 

18640 ................ Lee County, Kentucky ...................................................................... 99918 0.7812 0.7768 ¥0.56 

18650 ................ Leslie County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18660 ................ Letcher County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18670 ................ Lewis County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18680 ................ Lincoln County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18690 ................ Livingston County, Kentucky ............................................................ 99918 0.7812 0.7768 ¥0.56 

18700 ................ Logan County, Kentucky .................................................................. 99918 0.7812 0.7768 ¥0.56 

18710 ................ Lyon County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 

18720 ................ Mc Cracken County, Kentucky ......................................................... 99918 0.7812 0.7768 ¥0.56 

18730 ................ Mc Creary County, Kentucky ........................................................... 99918 0.7812 0.7768 ¥0.56 

18740 ................ Mc Lean County, Kentucky .............................................................. 36980 0.8319 0.8748 5.16 

18750 ................ Madison County, Kentucky .............................................................. 99918 0.8377 0.7768 ¥7.27 

18760 ................ Magoffin County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18770 ................ Marion County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18780 ................ Marshall County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18790 ................ Martin County, Kentucky .................................................................. 99918 0.7812 0.7768 ¥0.56 

18800 ................ Mason County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18801 ................ Meade County, Kentucky ................................................................. 31140 0.8555 0.9118 6.58 

18802 ................ Menifee County, Kentucky ............................................................... 99918 0.7812 0.7768 ¥0.56 

18830 ................ Mercer County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18831 ................ Metcalfe County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18850 ................ Monroe County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18860 ................ Montgomery County, Kentucky ........................................................ 99918 0.7812 0.7768 ¥0.56 

18861 ................ Morgan County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18880 ................ Muhlenberg County, Kentucky ......................................................... 99918 0.7812 0.7768 ¥0.56 

18890 ................ Nelson County, Kentucky ................................................................. 31140 0.8555 0.9118 6.58 

18900 ................ Nicholas County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18910 ................ Ohio County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 

18920 ................ Oldham County, Kentucky ............................................................... 31140 0.9272 0.9118 ¥1.66 

18930 ................ Owen County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18931 ................ Owsley County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18932 ................ Pendleton County, Kentucky ............................................................ 17140 0.9675 0.9601 ¥0.76 

18960 ................ Perry County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18970 ................ Pike County, Kentucky ..................................................................... 99918 0.7812 0.7768 ¥0.56 

18971 ................ Powell County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18972 ................ Pulaski County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18973 ................ Robertson County, Kentucky ........................................................... 99918 0.7812 0.7768 ¥0.56 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65975 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

18974 ................ Rockcastle County, Kentucky .......................................................... 99918 0.7812 0.7768 ¥0.56 

18975 ................ Rowan County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18976 ................ Russell County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18977 ................ Scott County, Kentucky .................................................................... 30460 0.9032 0.9181 1.65 

18978 ................ Shelby County, Kentucky ................................................................. 31140 0.8555 0.9118 6.58 

18979 ................ Simpson County, Kentucky .............................................................. 99918 0.7812 0.7768 ¥0.56 

18980 ................ Spencer County, Kentucky ............................................................... 31140 0.8555 0.9118 6.58 

18981 ................ Taylor County, Kentucky .................................................................. 99918 0.7812 0.7768 ¥0.56 

18982 ................ Todd County, Kentucky .................................................................... 99918 0.7812 0.7768 ¥0.56 

18983 ................ Trigg County, Kentucky .................................................................... 17300 0.8071 0.8436 4.52 

18984 ................ Trimble County, Kentucky ................................................................ 31140 0.8555 0.9118 6.58 

18985 ................ Union County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18986 ................ Warren County, Kentucky ................................................................ 14540 0.8035 0.8148 1.41 

18987 ................ Washington County, Kentucky ......................................................... 99918 0.7812 0.7768 ¥0.56 

18988 ................ Wayne County, Kentucky ................................................................. 99918 0.7812 0.7768 ¥0.56 

18989 ................ Webster County, Kentucky ............................................................... 21780 0.8286 0.9071 9.47 

18990 ................ Whitley County, Kentucky ................................................................ 99918 0.7812 0.7768 ¥0.56 

18991 ................ Wolfe County, Kentucky ................................................................... 99918 0.7812 0.7768 ¥0.56 

18992 ................ Woodford County, Kentucky ............................................................ 30460 0.9032 0.9181 1.65 

19000 ................ Acadia County, Louisiana ................................................................ 99919 0.7831 0.7438 ¥5.02 

19010 ................ Allen County, Louisiana ................................................................... 99919 0.7376 0.7438 0.84 

19020 ................ Ascension County, Louisiana ........................................................... 12940 0.8618 0.8084 ¥6.20 

19030 ................ Assumption County, Louisiana ......................................................... 99919 0.7376 0.7438 0.84 

19040 ................ Avoyelles County, Louisiana ............................................................ 99919 0.7376 0.7438 0.84 

19050 ................ Beauregard County, Louisiana ......................................................... 99919 0.7376 0.7438 0.84 

19060 ................ Bienville County, Louisiana .............................................................. 99919 0.7376 0.7438 0.84 

19070 ................ Bossier County, Louisiana ............................................................... 43340 0.8749 0.8865 1.33 

19080 ................ Caddo County, Louisiana ................................................................. 43340 0.8749 0.8865 1.33 

19090 ................ Calcasieu County, Louisiana ............................................................ 29340 0.7846 0.7914 0.87 

19100 ................ Caldwell County, Louisiana .............................................................. 99919 0.7376 0.7438 0.84 

19110 ................ Cameron County, Louisiana ............................................................. 29340 0.7587 0.7914 4.31 

19120 ................ Catahoula County, Louisiana ........................................................... 99919 0.7376 0.7438 0.84 

19130 ................ Claiborne County, Louisiana ............................................................ 99919 0.7376 0.7438 0.84 

19140 ................ Concordia County, Louisiana ........................................................... 99919 0.7376 0.7438 0.84 

19150 ................ De Soto County, Louisiana .............................................................. 43340 0.8050 0.8865 10.12 

19160 ................ East Baton Rouge County, Louisiana .............................................. 12940 0.8618 0.8084 ¥6.20 

19170 ................ East Carroll County, Louisiana ........................................................ 99919 0.7376 0.7438 0.84 

19180 ................ East Feliciana County, Louisiana ..................................................... 12940 0.7967 0.8084 1.47 

19190 ................ Evangeline County, Louisiana .......................................................... 99919 0.7376 0.7438 0.84 

19200 ................ Franklin County, Louisiana ............................................................... 99919 0.7376 0.7438 0.84 

19210 ................ Grant County, Louisiana .................................................................. 10780 0.7687 0.8006 4.15 

19220 ................ Iberia County, Louisiana .................................................................. 99919 0.7376 0.7438 0.84 

19230 ................ Iberville County, Louisiana ............................................................... 12940 0.7967 0.8084 1.47 

19240 ................ Jackson County, Louisiana .............................................................. 99919 0.7376 0.7438 0.84 

19250 ................ Jefferson County, Louisiana ............................................................. 35380 0.8995 0.8831 ¥1.82 

19260 ................ Jefferson Davis County, Louisiana .................................................. 99919 0.7376 0.7438 0.84 

19270 ................ Lafayette County, Louisiana ............................................................. 29180 0.8340 0.8289 ¥0.61 

19280 ................ Lafourche County, Louisiana ........................................................... 26380 0.7894 0.8082 2.38 

19290 ................ La Salle County, Louisiana .............................................................. 99919 0.7376 0.7438 0.84 

19300 ................ Lincoln County, Louisiana ................................................................ 99919 0.7376 0.7438 0.84 

19310 ................ Livingston County, Louisiana ........................................................... 12940 0.8618 0.8084 ¥6.20 

19320 ................ Madison County, Louisiana .............................................................. 99919 0.7376 0.7438 0.84 

19330 ................ Morehouse County, Louisiana ......................................................... 99919 0.7376 0.7438 0.84 

19340 ................ Natchitoches County, Louisiana ....................................................... 99919 0.7376 0.7438 0.84 

19350 ................ Orleans County, Louisiana ............................................................... 35380 0.8995 0.8831 ¥1.82 

19360 ................ Ouachita County, Louisiana ............................................................. 33740 0.8038 0.7997 ¥0.51 

19370 ................ Plaquemines County, Louisiana ....................................................... 35380 0.8995 0.8831 ¥1.82 

19380 ................ Pointe Coupee County, Louisiana ................................................... 12940 0.7967 0.8084 1.47

19390 ................ Rapides County, Louisiana .............................................................. 10780 0.8033 0.8006 ¥0.34 

19400 ................ Red River County, Louisiana ........................................................... 99919 0.7376 0.7438 0.84 

19410 ................ Richland County, Louisiana ............................................................. 99919 0.7376 0.7438 0.84 

19420 ................ Sabine County, Louisiana ................................................................ 99919 0.7376 0.7438 0.84 

19430 ................ St Bernard County, Louisiana .......................................................... 35380 0.8995 0.8831 ¥1.82 

19440 ................ St Charles County, Louisiana .......................................................... 35380 0.8995 0.8831 ¥1.82 

19450 ................ St Helena County, Louisiana ........................................................... 12940 0.7967 0.8084 1.47 

19460 ................ St James County, Louisiana ............................................................ 99919 0.8203 0.7438 ¥9.33 

19470 ................ St John Baptist County, Louisiana ................................................... 35380 0.8995 0.8831 ¥1.82 

19480 ................ St Landry County, Louisiana ............................................................ 99919 0.7831 0.7438 ¥5.02 


rmajette on PROD1PC67 with RULES2
65976 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

19490 ................ St Martin County, Louisiana ............................................................. 29180 0.8340 0.8289 ¥0.61 

19500 ................ St Mary County, Louisiana ............................................................... 99919 0.7376 0.7438 0.84 

19510 ................ St Tammany County, Louisiana ....................................................... 35380 0.8995 0.8831 ¥1.82 

19520 ................ Tangipahoa County, Louisiana ........................................................ 99919 0.7376 0.7438 0.84 

19530 ................ Tensas County, Louisiana ................................................................ 99919 0.7376 0.7438 0.84 

19540 ................ Terrebonne County, Louisiana ......................................................... 26380 0.7894 0.8082 2.38 

19550 ................ Union County, Louisiana .................................................................. 33740 0.7686 0.7997 4.05 

19560 ................ Vermilion County, Louisiana ............................................................ 99919 0.7376 0.7438 0.84 

19570 ................ Vernon County, Louisiana ................................................................ 99919 0.7376 0.7438 0.84 

19580 ................ Washington County, Louisiana ........................................................ 99919 0.7376 0.7438 0.84 

19590 ................ Webster County, Louisiana .............................................................. 99919 0.8074 0.7438 ¥7.88 

19600 ................ West Baton Rouge County, Louisiana ............................................. 12940 0.8618 0.8084 ¥6.20 

19610 ................ West Carroll County, Louisiana ....................................................... 99919 0.7376 0.7438 0.84 

19620 ................ West Feliciana County, Louisiana .................................................... 12940 0.7967 0.8084 1.47 

19630 ................ Winn County, Louisiana ................................................................... 99919 0.7376 0.7438 0.84 

20000 ................ Androscoggin County, Maine ........................................................... 30340 0.9331 0.9126 ¥2.20 

20010 ................ Aroostook County, Maine ................................................................. 99920 0.8843 0.8443 ¥4.52 

20020 ................ Cumberland County, Maine ............................................................. 38860 1.0382 0.9908 ¥4.57 

20030 ................ Franklin County, Maine .................................................................... 99920 0.8843 0.8443 ¥4.52 

20040 ................ Hancock County, Maine ................................................................... 99920 0.8843 0.8443 ¥4.52 

20050 ................ Kennebec County, Maine ................................................................. 99920 0.8843 0.8443 ¥4.52 

20060 ................ Knox County, Maine ......................................................................... 99920 0.8843 0.8443 ¥4.52 

20070 ................ Lincoln County, Maine ...................................................................... 99920 0.8843 0.8443 ¥4.52 

20080 ................ Oxford County, Maine ...................................................................... 99920 0.8843 0.8443 ¥4.52 

20090 ................ Penobscot County, Maine ................................................................ 12620 0.9993 0.9711 ¥2.82 

20100 ................ Piscataquis County, Maine ............................................................... 99920 0.8843 0.8443 ¥4.52 

20110 ................ Sagadahoc County, Maine ............................................................... 38860 1.0382 0.9908 ¥4.57 

20120 ................ Somerset County, Maine .................................................................. 99920 0.8843 0.8443 ¥4.52 

20130 ................ Waldo County, Maine ....................................................................... 99920 0.8843 0.8443 ¥4.52 

20140 ................ Washington County, Maine .............................................................. 99920 0.8843 0.8443 ¥4.52 

20150 ................ York County, Maine .......................................................................... 38860 1.0382 0.9908 ¥4.57 

21000 ................ Allegany County, Maryland .............................................................. 19060 0.9317 0.8446 ¥9.35 

21010 ................ Anne Arundel County, Maryland ...................................................... 12580 0.9897 1.0088 1.93 

21020 ................ Baltimore County, Maryland ............................................................. 12580 0.9897 1.0088 1.93 

21030 ................ Baltimore City County, Maryland ..................................................... 12580 0.9897 1.0088 1.93 

21040 ................ Calvert County, Maryland ................................................................. 47894 1.0951 1.1054 0.94 

21050 ................ Caroline County, Maryland ............................................................... 99921 0.9292 0.8926 ¥3.94 

21060 ................ Carroll County, Maryland ................................................................. 12580 0.9897 1.0088 1.93 

21070 ................ Cecil County, Maryland .................................................................... 48864 1.0499 1.0684 1.76 

21080 ................ Charles County, Maryland ................................................................ 47894 1.0951 1.1054 0.94 

21090 ................ Dorchester County, Maryland .......................................................... 99921 0.9292 0.8926 ¥3.94 

21100 ................ Frederick County, Maryland ............................................................. 13644 1.1230 1.0903 ¥2.91 

21110 ................ Garrett County, Maryland ................................................................. 99921 0.9292 0.8926 ¥3.94 

21120 ................ Harford County, Maryland ................................................................ 12580 0.9897 1.0088 1.93 

21130 ................ Howard County, Maryland ................................................................ 12580 0.9897 1.0088 1.93 

21140 ................ Kent County, Maryland ..................................................................... 99921 0.9292 0.8926 ¥3.94 

21150 ................ Montgomery County, Maryland ........................................................ 13644 1.1230 1.0903 ¥2.91 

21160 ................ Prince Georges County, Maryland ................................................... 47894 1.0951 1.1054 0.94

21170 ................ Queen Annes County, Maryland ...................................................... 12580 0.9897 1.0088 1.93

21180 ................ St Marys County, Maryland .............................................................. 99921 0.9292 0.8926 ¥3.94 

21190 ................ Somerset County, Maryland ............................................................. 41540 0.9147 0.8953 ¥2.12 

21200 ................ Talbot County, Maryland .................................................................. 99921 0.9292 0.8926 ¥3.94 

21210 ................ Washington County, Maryland ......................................................... 25180 0.9679 0.9038 ¥6.62 

21220 ................ Wicomico County, Maryland ............................................................ 41540 0.9147 0.8953 ¥2.12 

21230 ................ Worcester County, Maryland ............................................................ 99921 0.9292 0.8926 ¥3.94 

22000 ................ Barnstable County, Massachusetts .................................................. 12700 1.2600 1.2539 ¥0.48 

22010 ................ Berkshire County, Massachusetts .................................................... 38340 1.0181 1.0266 0.83 

22020 ................ Bristol County, Massachusetts ......................................................... 39300 1.1072 1.0783 ¥2.61 

22030 ................ Dukes County, Massachusetts ......................................................... 99922 1.0216 1.1661 14.14 

22040 ................ Essex County, Massachusetts ......................................................... 21604 1.0858 1.0418 ¥4.05 

22060 ................ Franklin County, Massachusetts ...................................................... 44140 1.0232 1.0079 ¥0.64 

22070 ................ Hampden County, Massachusetts ................................................... 44140 1.0256 1.0079 ¥1.73 

22080 ................ Hampshire County, Massachusetts ................................................. 44140 1.0256 1.0079 ¥1.73 

22090 ................ Middlesex County, Massachusetts ................................................... 15764 1.1175 1.0970 ¥1.83 

22120 ................ Nantucket County, Massachusetts ................................................... 99922 1.0216 1.1661 14.14 

22130 ................ Norfolk County, Massachusetts ....................................................... 14484 1.1368 1.1679 2.74 

22150 ................ Plymouth County, Massachusetts .................................................... 14484 1.1368 1.1679 2.74

22160 ................ Suffolk County, Massachusetts ........................................................ 14484 1.1368 1.1679 2.74 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65977 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

22170 ................ Worcester County, Massachusetts .................................................. 49340 1.1103 1.0722 ¥3.43 

23000 ................ Alcona County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23010 ................ Alger County, Michigan .................................................................... 99923 0.8860 0.9062 2.28 

23020 ................ Allegan County, Michigan ................................................................ 99923 0.9170 0.9062 ¥1.18 

23030 ................ Alpena County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23040 ................ Antrim County, Michigan .................................................................. 99923 0.8860 0.9062 2.28 

23050 ................ Arenac County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23060 ................ Baraga County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23070 ................ Barry County, Michigan .................................................................... 24340 0.9107 0.9455 3.82 

23080 ................ Bay County, Michigan ...................................................................... 13020 0.9292 0.9251 ¥0.44 

23090 ................ Benzie County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23100 ................ Berrien County, Michigan ................................................................. 35660 0.8879 0.8915 0.41 

23110 ................ Branch County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23120 ................ Calhoun County, Michigan ............................................................... 12980 0.9826 0.9762 ¥0.65 

23130 ................ Cass County, Michigan .................................................................... 43780 0.9306 0.9842 5.76 

23140 ................ Charlevoix County, Michigan ........................................................... 99923 0.8860 0.9062 2.28 

23150 ................ Cheboygan County, Michigan .......................................................... 99923 0.8860 0.9062 2.28 

23160 ................ Chippewa County, Michigan ............................................................ 99923 0.8860 0.9062 2.28 

23170 ................ Clare County, Michigan .................................................................... 99923 0.8860 0.9062 2.28 

23180 ................ Clinton County, Michigan ................................................................. 29620 0.9794 1.0088 3.00 

23190 ................ Crawford County, Michigan .............................................................. 99923 0.8860 0.9062 2.28 

23200 ................ Delta County, Michigan .................................................................... 99923 0.8860 0.9062 2.28 

23210 ................ Dickinson County, Michigan ............................................................. 99923 0.8860 0.9062 2.28 

23220 ................ Eaton County, Michigan ................................................................... 29620 0.9794 1.0088 3.00 

23230 ................ Emmet County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23240 ................ Genesee County, Michigan .............................................................. 22420 1.0655 1.0969 2.95 

23250 ................ Gladwin County, Michigan ............................................................... 99923 0.8860 0.9062 2.28 

23260 ................ Gogebic County, Michigan ............................................................... 99923 0.8860 0.9062 2.28 

23270 ................ Grand Traverse County, Michigan ................................................... 99923 0.8860 0.9062 2.28

23280 ................ Gratiot County, Michigan .................................................................. 99923 0.8860 0.9062 2.28 

23290 ................ Hillsdale County, Michigan ............................................................... 99923 0.8860 0.9062 2.28 

23300 ................ Houghton County, Michigan ............................................................. 99923 0.8860 0.9062 2.28 

23310 ................ Huron County, Michigan ................................................................... 99923 0.8860 0.9062 2.28 

23320 ................ Ingham County, Michigan ................................................................ 29620 0.9794 1.0088 3.00 

23330 ................ Ionia County, Michigan ..................................................................... 24340 0.9107 0.9455 3.82 

23340 ................ Iosco County, Michigan .................................................................... 99923 0.8860 0.9062 2.28 

23350 ................ Iron County, Michigan ...................................................................... 99923 0.8860 0.9062 2.28 

23360 ................ Isabella County, Michigan ................................................................ 99923 0.8860 0.9062 2.28 

23370 ................ Jackson County, Michigan ............................................................... 27100 0.9304 0.9560 2.75 

23380 ................ Kalamazoo County, Michigan .......................................................... 28020 1.0262 1.0704 4.31 

23390 ................ Kalkaska County, Michigan .............................................................. 99923 0.8860 0.9062 2.28 

23400 ................ Kent County, Michigan ..................................................................... 24340 0.9418 0.9455 0.39 

23410 ................ Keweenaw County, Michigan ........................................................... 99923 0.8860 0.9062 2.28 

23420 ................ Lake County, Michigan ..................................................................... 99923 0.8860 0.9062 2.28 

23430 ................ Lapeer County, Michigan ................................................................. 47644 1.0009 1.0054 0.45 

23440 ................ Leelanau County, Michigan .............................................................. 99923 0.8860 0.9062 2.28 

23450 ................ Lenawee County, Michigan .............................................................. 99923 0.9801 0.9062 ¥7.54 

23460 ................ Livingston County, Michigan ............................................................ 47644 1.0289 1.0054 ¥2.28 

23470 ................ Luce County, Michigan ..................................................................... 99923 0.8860 0.9062 2.28 

23480 ................ Mackinac County, Michigan ............................................................. 99923 0.8860 0.9062 2.28 

23490 ................ Macomb County, Michigan ............................................................... 47644 1.0009 1.0054 0.45 

23500 ................ Manistee County, Michigan .............................................................. 99923 0.8860 0.9062 2.28 

23510 ................ Marquette County, Michigan ............................................................ 99923 0.8860 0.9062 2.28 

23520 ................ Mason County, Michigan .................................................................. 99923 0.8860 0.9062 2.28 

23530 ................ Mecosta County, Michigan ............................................................... 99923 0.8860 0.9062 2.28 

23540 ................ Menominee County, Michigan .......................................................... 99923 0.8860 0.9062 2.28 

23550 ................ Midland County, Michigan ................................................................ 99923 0.9068 0.9062 ¥0.07 

23560 ................ Missaukee County, Michigan ........................................................... 99923 0.8860 0.9062 2.28 

23570 ................ Monroe County, Michigan ................................................................ 33780 0.9808 0.9707 ¥1.03 

23580 ................ Montcalm County, Michigan ............................................................. 99923 0.8860 0.9062 2.28 

23590 ................ Montmorency County, Michigan ....................................................... 99923 0.8860 0.9062 2.28 

23600 ................ Muskegon County, Michigan ............................................................ 34740 0.9555 0.9941 4.04 

23610 ................ Newaygo County, Michigan ............................................................. 24340 0.9107 0.9455 3.82 

23620 ................ Oakland County, Michigan ............................................................... 47644 1.0009 1.0054 0.45 

23630 ................ Oceana County, Michigan ................................................................ 99923 0.8860 0.9062 2.28 

23640 ................ Ogemaw County, Michigan .............................................................. 99923 0.8860 0.9062 2.28 

23650 ................ Ontonagon County, Michigan ........................................................... 99923 0.8860 0.9062 2.28 

23660 ................ Osceola County, Michigan ............................................................... 99923 0.8860 0.9062 2.28 


rmajette on PROD1PC67 with RULES2
65978 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

23670 ................ Oscoda County, Michigan ................................................................ 99923 0.8860 0.9062 2.28 

23680 ................ Otsego County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23690 ................ Ottawa County, Michigan ................................................................. 26100 0.9250 0.9163 ¥0.94 

23700 ................ Presque Isle County, Michigan ........................................................ 99923 0.8860 0.9062 2.28 

23710 ................ Roscommon County, Michigan ........................................................ 99923 0.8860 0.9062 2.28

23720 ................ Saginaw County, Michigan ............................................................... 40980 0.9165 0.8874 ¥3.18 

23730 ................ St Clair County, Michigan ................................................................ 47644 1.0009 1.0054 0.45 

23740 ................ St Joseph County, Michigan ............................................................ 99923 0.8860 0.9062 2.28 

23750 ................ Sanilac County, Michigan ................................................................. 99923 0.8860 0.9062 2.28 

23760 ................ Schoolcraft County, Michigan .......................................................... 99923 0.8860 0.9062 2.28 

23770 ................ Shiawassee County, Michigan ......................................................... 99923 0.8860 0.9062 2.28 

23780 ................ Tuscola County, Michigan ................................................................ 99923 0.8860 0.9062 2.28 

23790 ................ Van Buren County, Michigan ........................................................... 28020 1.0262 1.0704 4.31 

23800 ................ Washtenaw County, Michigan .......................................................... 11460 1.0783 1.0826 0.40 

23810 ................ Wayne County, Michigan ................................................................. 19804 1.0286 1.0281 ¥0.05 

23830 ................ Wexford County, Michigan ............................................................... 99923 0.8860 0.9062 2.28 

24000 ................ Aitkin County, Minnesota ................................................................. 99924 0.9132 0.9153 0.23 

24010 ................ Anoka County, Minnesota ................................................................ 33460 1.1075 1.0946 ¥1.16 

24020 ................ Becker County, Minnesota ............................................................... 99924 0.9132 0.9153 0.23 

24030 ................ Beltrami County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24040 ................ Benton County, Minnesota ............................................................... 41060 0.9965 1.0362 3.98 

24050 ................ Big Stone County, Minnesota .......................................................... 99924 0.9132 0.9153 0.23 

24060 ................ Blue Earth County, Minnesota ......................................................... 99924 0.9132 0.9153 0.23 

24070 ................ Brown County, Minnesota ................................................................ 99924 0.9132 0.9153 0.23 

24080 ................ Carlton County, Minnesota ............................................................... 20260 0.9673 1.0042 3.81 

24090 ................ Carver County, Minnesota ............................................................... 33460 1.1075 1.0946 ¥1.16 

24100 ................ Cass County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24110 ................ Chippewa County, Minnesota .......................................................... 99924 0.9132 0.9153 0.23 

24120 ................ Chisago County, Minnesota ............................................................. 33460 1.1075 1.0946 ¥1.16 

24130 ................ Clay County, Minnesota ................................................................... 22020 0.8486 0.8250 ¥2.78 

24140 ................ Clearwater County, Minnesota ......................................................... 99924 0.9132 0.9153 0.23 

24150 ................ Cook County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24160 ................ Cottonwood County, Minnesota ....................................................... 99924 0.9132 0.9153 0.23 

24170 ................ Crow Wing County, Minnesota ........................................................ 99924 0.9132 0.9153 0.23 

24180 ................ Dakota County, Minnesota ............................................................... 33460 1.1075 1.0946 ¥1.16 

24190 ................ Dodge County, Minnesota ................................................................ 40340 1.0132 1.1408 12.59 

24200 ................ Douglas County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24210 ................ Faribault County, Minnesota ............................................................ 99924 0.9132 0.9153 0.23 

24220 ................ Fillmore County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24230 ................ Freeborn County, Minnesota ............................................................ 99924 0.9132 0.9153 0.23 

24240 ................ Goodhue County, Minnesota ........................................................... 99924 0.9132 0.9153 0.23 

24250 ................ Grant County, Minnesota ................................................................. 99924 0.9132 0.9153 0.23 

24260 ................ Hennepin County, Minnesota ........................................................... 33460 1.1075 1.0946 ¥1.16 

24270 ................ Houston County, Minnesota ............................................................. 29100 0.9564 0.9426 ¥1.44 

24280 ................ Hubbard County, Minnesota ............................................................ 99924 0.9132 0.9153 0.23 

24290 ................ Isanti County, Minnesota .................................................................. 33460 1.1075 1.0946 ¥1.16 

24300 ................ Itasca County, Minnesota ................................................................. 99924 0.9132 0.9153 0.23 

24310 ................ Jackson County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24320 ................ Kanabec County, Minnesota ............................................................ 99924 0.9132 0.9153 0.23 

24330 ................ Kandiyohi County, Minnesota .......................................................... 99924 0.9132 0.9153 0.23 

24340 ................ Kittson County, Minnesota ............................................................... 99924 0.9132 0.9153 0.23 

24350 ................ Koochiching County, Minnesota ....................................................... 99924 0.9132 0.9153 0.23 

24360 ................ Lac Qui Parle County, Minnesota .................................................... 99924 0.9132 0.9153 0.23 

24370 ................ Lake County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24380 ................ Lake Of Woods County, Minnesota ................................................. 99924 0.9132 0.9153 0.23 

24390 ................ Le Sueur County, Minnesota ........................................................... 99924 0.9132 0.9153 0.23 

24400 ................ Lincoln County, Minnesota ............................................................... 99924 0.9132 0.9153 0.23 

24410 ................ Lyon County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24420 ................ Mc Leod County, Minnesota ............................................................ 99924 0.9132 0.9153 0.23 

24430 ................ Mahnomen County, Minnesota ........................................................ 99924 0.9132 0.9153 0.23

24440 ................ Marshall County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24450 ................ Martin County, Minnesota ................................................................ 99924 0.9132 0.9153 0.23 

24460 ................ Meeker County, Minnesota .............................................................. 99924 0.9132 0.9153 0.23 

24470 ................ Mille Lacs County, Minnesota .......................................................... 99924 0.9132 0.9153 0.23 

24480 ................ Morrison County, Minnesota ............................................................ 99924 0.9132 0.9153 0.23 

24490 ................ Mower County, Minnesota ............................................................... 99924 0.9132 0.9153 0.23 

24500 ................ Murray County, Minnesota ............................................................... 99924 0.9132 0.9153 0.23 

24510 ................ Nicollet County, Minnesota .............................................................. 99924 0.9132 0.9153 0.23 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65979 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

24520 ................ Nobles County, Minnesota ............................................................... 99924 0.9132 0.9153 0.23 

24530 ................ Norman County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24540 ................ Olmsted County, Minnesota ............................................................. 40340 1.1131 1.1408 2.49 

24550 ................ Otter Tail County, Minnesota ........................................................... 99924 0.9132 0.9153 0.23 

24560 ................ Pennington County, Minnesota ........................................................ 99924 0.9132 0.9153 0.23 

24570 ................ Pine County, Minnesota ................................................................... 99924 0.9132 0.9153 0.23 

24580 ................ Pipestone County, Minnesota .......................................................... 99924 0.9132 0.9153 0.23 

24590 ................ Polk County, Minnesota ................................................................... 24220 0.7901 0.7949 0.61 

24600 ................ Pope County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24610 ................ Ramsey County, Minnesota ............................................................. 33460 1.1075 1.0946 ¥1.16 

24620 ................ Red Lake County, Minnesota ........................................................... 99924 0.9132 0.9153 0.23 

24630 ................ Redwood County, Minnesota ........................................................... 99924 0.9132 0.9153 0.23 

24640 ................ Renville County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24650 ................ Rice County, Minnesota ................................................................... 99924 0.9132 0.9153 0.23 

24660 ................ Rock County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24670 ................ Roseau County, Minnesota .............................................................. 99924 0.9132 0.9153 0.23 

24680 ................ St Louis County, Minnesota ............................................................. 20260 1.0213 1.0042 ¥1.67 

24690 ................ Scott County, Minnesota .................................................................. 33460 1.1075 1.0946 ¥1.16 

24700 ................ Sherburne County, Minnesota ......................................................... 33460 1.1075 1.0946 ¥1.16 

24710 ................ Sibley County, Minnesota ................................................................ 99924 0.9132 0.9153 0.23 

24720 ................ Stearns County, Minnesota .............................................................. 41060 0.9965 1.0362 3.98 

24730 ................ Steele County, Minnesota ................................................................ 99924 0.9132 0.9153 0.23 

24740 ................ Stevens County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24750 ................ Swift County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24760 ................ Todd County, Minnesota .................................................................. 99924 0.9132 0.9153 0.23 

24770 ................ Traverse County, Minnesota ............................................................ 99924 0.9132 0.9153 0.23 

24780 ................ Wabasha County, Minnesota ........................................................... 40340 1.0132 1.1408 12.59 

24790 ................ Wadena County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24800 ................ Waseca County, Minnesota ............................................................. 99924 0.9132 0.9153 0.23 

24810 ................ Washington County, Minnesota ....................................................... 33460 1.1075 1.0946 ¥1.16 

24820 ................ Watonwan County, Minnesota ......................................................... 99924 0.9132 0.9153 0.23 

24830 ................ Wilkin County, Minnesota ................................................................. 99924 0.9132 0.9153 0.23 

24840 ................ Winona County, Minnesota .............................................................. 99924 0.9132 0.9153 0.23 

24850 ................ Wright County, Minnesota ................................................................ 33460 1.1075 1.0946 ¥1.16 

24860 ................ Yellow Medicine County, Minnesota ................................................ 99924 0.9132 0.9153 0.23 

25000 ................ Adams County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25010 ................ Alcorn County, Mississippi ............................................................... 99925 0.7654 0.7738 1.10 

25020 ................ Amite County, Mississippi ................................................................ 99925 0.7654 0.7738 1.10 

25030 ................ Attala County, Mississippi ................................................................ 99925 0.7654 0.7738 1.10 

25040 ................ Benton County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25050 ................ Bolivar County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25060 ................ Calhoun County, Mississippi ............................................................ 99925 0.7654 0.7738 1.10 

25070 ................ Carroll County, Mississippi ............................................................... 99925 0.7654 0.7738 1.10 

25080 ................ Chickasaw County, Mississippi ........................................................ 99925 0.7654 0.7738 1.10 

25090 ................ Choctaw County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25100 ................ Claiborne County, Mississippi .......................................................... 99925 0.7654 0.7738 1.10 

25110 ................ Clarke County, Mississippi ............................................................... 99925 0.7654 0.7738 1.10 

25120 ................ Clay County, Mississippi .................................................................. 99925 0.7654 0.7738 1.10 

25130 ................ Coahoma County, Mississippi .......................................................... 99925 0.7654 0.7738 1.10 

25140 ................ Copiah County, Mississippi .............................................................. 27140 0.7973 0.8271 3.74 

25150 ................ Covington County, Mississippi ......................................................... 99925 0.7654 0.7738 1.10 

25160 ................ Desoto County, Mississippi .............................................................. 32820 0.9407 0.9373 ¥0.36 

25170 ................ Forrest County, Mississippi .............................................................. 25620 0.7601 0.7430 ¥2.25 

25180 ................ Franklin County, Mississippi ............................................................. 99925 0.7654 0.7738 1.10 

25190 ................ George County, Mississippi ............................................................. 37700 0.7895 0.8215 4.05 

25200 ................ Greene County, Mississippi ............................................................. 99925 0.7654 0.7738 1.10 

25210 ................ Grenada County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25220 ................ Hancock County, Mississippi ........................................................... 25060 0.8818 0.8915 1.10 

25230 ................ Harrison County, Mississippi ............................................................ 25060 0.8818 0.8915 1.10 

25240 ................ Hinds County, Mississippi ................................................................ 27140 0.8347 0.8271 ¥0.91 

25250 ................ Holmes County, Mississippi ............................................................. 99925 0.7654 0.7738 1.10 

25260 ................ Humphreys County, Mississippi ....................................................... 99925 0.7654 0.7738 1.10 

25270 ................ Issaquena County, Mississippi ......................................................... 99925 0.7654 0.7738 1.10 

25280 ................ Itawamba County, Mississippi .......................................................... 99925 0.7654 0.7738 1.10 

25290 ................ Jackson County, Mississippi ............................................................ 37700 0.8431 0.8215 ¥2.56 

25300 ................ Jasper County, Mississippi ............................................................... 99925 0.7654 0.7738 1.10 

25310 ................ Jefferson County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25320 ................ Jefferson Davis County, Mississippi ................................................ 99925 0.7654 0.7738 1.10 


rmajette on PROD1PC67 with RULES2
65980 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

25330 ................ Jones County, Mississippi ................................................................ 99925 0.7654 0.7738 1.10 

25340 ................ Kemper County, Mississippi ............................................................. 99925 0.7654 0.7738 1.10 

25350 ................ Lafayette County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25360 ................ Lamar County, Mississippi ............................................................... 25620 0.7601 0.7430 ¥2.25 

25370 ................ Lauderdale County, Mississippi ....................................................... 99925 0.7654 0.7738 1.10 

25380 ................ Lawrence County, Mississippi .......................................................... 99925 0.7654 0.7738 1.10 

25390 ................ Leake County, Mississippi ................................................................ 99925 0.7654 0.7738 1.10 

25400 ................ Lee County, Mississippi ................................................................... 99925 0.7654 0.7738 1.10 

25410 ................ Leflore County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25420 ................ Lincoln County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25430 ................ Lowndes County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25440 ................ Madison County, Mississippi ............................................................ 27140 0.8347 0.8271 ¥0.91 

25450 ................ Marion County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25460 ................ Marshall County, Mississippi ............................................................ 32820 0.8516 0.9373 10.06 

25470 ................ Monroe County, Mississippi ............................................................. 99925 0.7654 0.7738 1.10 

25480 ................ Montgomery County, Mississippi ..................................................... 99925 0.7654 0.7738 1.10 

25490 ................ Neshoba County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25500 ................ Newton County, Mississippi ............................................................. 99925 0.7654 0.7738 1.10 

25510 ................ Noxubee County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25520 ................ Oktibbeha County, Mississippi ......................................................... 99925 0.7654 0.7738 1.10 

25530 ................ Panola County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25540 ................ Pearl River County, Mississippi ....................................................... 99925 0.7654 0.7738 1.10 

25550 ................ Perry County, Mississippi ................................................................. 25620 0.7618 0.7430 ¥2.47 

25560 ................ Pike County, Mississippi .................................................................. 99925 0.7654 0.7738 1.10 

25570 ................ Pontotoc County, Mississippi ........................................................... 99925 0.7654 0.7738 1.10 

25580 ................ Prentiss County, Mississippi ............................................................ 99925 0.7654 0.7738 1.10 

25590 ................ Quitman County, Mississippi ............................................................ 99925 0.7654 0.7738 1.10 

25600 ................ Rankin County, Mississippi .............................................................. 27140 0.8347 0.8271 ¥0.91 

25610 ................ Scott County, Mississippi ................................................................. 99925 0.7654 0.7738 1.10 

25620 ................ Sharkey County, Mississippi ............................................................ 99925 0.7654 0.7738 1.10 

25630 ................ Simpson County, Mississippi ........................................................... 27140 0.7973 0.8271 3.74 

25640 ................ Smith County, Mississippi ................................................................ 99925 0.7654 0.7738 1.10 

25650 ................ Stone County, Mississippi ................................................................ 25060 0.8282 0.8915 7.64 

25660 ................ Sunflower County, Mississippi ......................................................... 99925 0.7654 0.7738 1.10 

25670 ................ Tallahatchie County, Mississippi ...................................................... 99925 0.7654 0.7738 1.10 

25680 ................ Tate County, Mississippi .................................................................. 32820 0.8516 0.9373 10.06 

25690 ................ Tippah County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25700 ................ Tishomingo County, Mississippi ....................................................... 99925 0.7654 0.7738 1.10 

25710 ................ Tunica County, Mississippi ............................................................... 32820 0.8516 0.9373 10.06 

25720 ................ Union County, Mississippi ................................................................ 99925 0.7654 0.7738 1.10 

25730 ................ Walthall County, Mississippi ............................................................. 99925 0.7654 0.7738 1.10 

25740 ................ Warren County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25750 ................ Washington County, Mississippi ...................................................... 99925 0.7654 0.7738 1.10 

25760 ................ Wayne County, Mississippi .............................................................. 99925 0.7654 0.7738 1.10 

25770 ................ Webster County, Mississippi ............................................................ 99925 0.7654 0.7738 1.10 

25780 ................ Wilkinson County, Mississippi .......................................................... 99925 0.7654 0.7738 1.10 

25790 ................ Winston County, Mississippi ............................................................ 99925 0.7654 0.7738 1.10 

25800 ................ Yalobusha County, Mississippi ........................................................ 99925 0.7654 0.7738 1.10 

25810 ................ Yazoo County, Mississippi ............................................................... 99925 0.7654 0.7738 1.10 

26000 ................ Adair County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26010 ................ Andrew County, Missouri ................................................................. 41140 0.9519 1.0118 6.29 

26020 ................ Atchison County, Missouri ................................................................ 99926 0.7930 0.7927 ¥0.04 

26030 ................ Audrain County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26040 ................ Barry County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26050 ................ Barton County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26060 ................ Bates County, Missouri .................................................................... 28140 0.8718 0.9495 8.91 

26070 ................ Benton County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26080 ................ Bollinger County, Missouri ............................................................... 99926 0.7930 0.7927 ¥0.04 

26090 ................ Boone County, Missouri ................................................................... 17860 0.8345 0.8542 2.36 

26100 ................ Buchanan County, Missouri ............................................................. 41140 0.9519 1.0118 6.29 

26110 ................ Butler County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26120 ................ Caldwell County, Missouri ................................................................ 28140 0.8718 0.9495 8.91 

26130 ................ Callaway County, Missouri ............................................................... 27620 0.8173 0.8332 1.95 

26140 ................ Camden County, Missouri ................................................................ 99926 0.7930 0.7927 ¥0.04 

26150 ................ Cape Girardeau County, Missouri .................................................... 99926 0.7930 0.7927 ¥0.04 

26160 ................ Carroll County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26170 ................ Carter County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26180 ................ Cass County, Missouri ..................................................................... 28140 0.9483 0.9495 0.13 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65981 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

26190 ................ Cedar County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26200 ................ Chariton County, Missouri ................................................................ 99926 0.7930 0.7927 ¥0.04 

26210 ................ Christian County, Missouri ............................................................... 44180 0.8244 0.8469 2.73 

26220 ................ Clark County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26230 ................ Clay County, Missouri ...................................................................... 28140 0.9483 0.9495 0.13 

26240 ................ Clinton County, Missouri .................................................................. 28140 0.9483 0.9495 0.13 

26250 ................ Cole County, Missouri ...................................................................... 27620 0.8173 0.8332 1.95 

26260 ................ Cooper County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26270 ................ Crawford County, Missouri ............................................................... 41180 0.8457 0.9005 6.48 

26280 ................ Dade County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26290 ................ Dallas County, Missouri ................................................................... 44180 0.8098 0.8469 4.58 

26300 ................ Daviess County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26310 ................ De Kalb County, Missouri ................................................................ 41140 0.8739 1.0118 15.78 

26320 ................ Dent County, Missouri ...................................................................... 99926 0.7930 0.7927 ¥0.04 

26330 ................ Douglas County, Missouri ................................................................ 99926 0.7930 0.7927 ¥0.04 

26340 ................ Dunklin County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26350 ................ Franklin County, Missouri ................................................................. 41180 0.8958 0.9005 0.52 

26360 ................ Gasconade County, Missouri ........................................................... 99926 0.7930 0.7927 ¥0.04 

26370 ................ Gentry County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26380 ................ Greene County, Missouri ................................................................. 44180 0.8244 0.8469 2.73 

26390 ................ Grundy County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26400 ................ Harrison County, Missouri ................................................................ 99926 0.7930 0.7927 ¥0.04 

26410 ................ Henry County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26411 ................ Hickory County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26412 ................ Holt County, Missouri ....................................................................... 99926 0.7930 0.7927 ¥0.04 

26440 ................ Howard County, Missouri ................................................................. 17860 0.8152 0.8542 4.78 

26450 ................ Howell County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26460 ................ Iron County, Missouri ....................................................................... 99926 0.7930 0.7927 ¥0.04 

26470 ................ Jackson County, Missouri ................................................................ 28140 0.9483 0.9495 0.13 

26480 ................ Jasper County, Missouri ................................................................... 27900 0.8582 0.8605 0.27 

26490 ................ Jefferson County, Missouri ............................................................... 41180 0.8958 0.9005 0.52 

26500 ................ Johnson County, Missouri ................................................................ 99926 0.7930 0.7927 ¥0.04 

26510 ................ Knox County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26520 ................ Laclede County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26530 ................ Lafayette County, Missouri ............................................................... 28140 0.9483 0.9495 0.13 

26540 ................ Lawrence County, Missouri .............................................................. 99926 0.7930 0.7927 ¥0.04 

26541 ................ Lewis County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26560 ................ Lincoln County, Missouri .................................................................. 41180 0.8958 0.9005 0.52 

26570 ................ Linn County, Missouri ....................................................................... 99926 0.7930 0.7927 ¥0.04 

26580 ................ Livingston County, Missouri ............................................................. 99926 0.7930 0.7927 ¥0.04 

26590 ................ Mc Donald County, Missouri ............................................................ 22220 0.8310 0.8865 6.68 

26600 ................ Macon County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26601 ................ Madison County, Missouri ................................................................ 99926 0.7930 0.7927 ¥0.04 

26620 ................ Maries County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26630 ................ Marion County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26631 ................ Mercer County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26650 ................ Miller County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26660 ................ Mississippi County, Missouri ............................................................ 99926 0.7930 0.7927 ¥0.04 

26670 ................ Moniteau County, Missouri ............................................................... 27620 0.8173 0.8332 1.95 

26680 ................ Monroe County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26690 ................ Montgomery County, Missouri ......................................................... 99926 0.7930 0.7927 ¥0.04 

26700 ................ Morgan County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26710 ................ New Madrid County, Missouri .......................................................... 99926 0.7930 0.7927 ¥0.04 

26720 ................ Newton County, Missouri ................................................................. 27900 0.8582 0.8605 0.27 

26730 ................ Nodaway County, Missouri .............................................................. 99926 0.7930 0.7927 ¥0.04 

26740 ................ Oregon County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26750 ................ Osage County, Missouri ................................................................... 27620 0.8173 0.8332 1.95 

26751 ................ Ozark County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26770 ................ Pemiscot County, Missouri ............................................................... 99926 0.7930 0.7927 ¥0.04 

26780 ................ Perry County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26790 ................ Pettis County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26800 ................ Phelps County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26810 ................ Pike County, Missouri ...................................................................... 99926 0.7930 0.7927 ¥0.04 

26820 ................ Platte County, Missouri .................................................................... 28140 0.9483 0.9495 0.13 

26821 ................ Polk County, Missouri ...................................................................... 44180 0.8098 0.8469 4.58 

26840 ................ Pulaski County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26850 ................ Putnam County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26860 ................ Ralls County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 


rmajette on PROD1PC67 with RULES2
65982 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

26870 ................ Randolph County, Missouri .............................................................. 99926 0.7930 0.7927 ¥0.04 

26880 ................ Ray County, Missouri ....................................................................... 28140 0.9483 0.9495 0.13 

26881 ................ Reynolds County, Missouri .............................................................. 99926 0.7930 0.7927 ¥0.04 

26900 ................ Ripley County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26910 ................ St Charles County, Missouri ............................................................ 41180 0.8958 0.9005 0.52 

26911 ................ St Clair County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26930 ................ St Francois County, Missouri ........................................................... 99926 0.7930 0.7927 ¥0.04 

26940 ................ St Louis County, Missouri ................................................................ 41180 0.8958 0.9005 0.52 

26950 ................ St Louis City County, Missouri ......................................................... 41180 0.8958 0.9005 0.52 

26960 ................ Ste Genevieve County, Missouri ...................................................... 99926 0.7930 0.7927 ¥0.04 

26970 ................ Saline County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26980 ................ Schuyler County, Missouri ............................................................... 99926 0.7930 0.7927 ¥0.04 

26981 ................ Scotland County, Missouri ............................................................... 99926 0.7930 0.7927 ¥0.04 

26982 ................ Scott County, Missouri ..................................................................... 99926 0.7930 0.7927 ¥0.04 

26983 ................ Shannon County, Missouri ............................................................... 99926 0.7930 0.7927 ¥0.04 

26984 ................ Shelby County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26985 ................ Stoddard County, Missouri ............................................................... 99926 0.7930 0.7927 ¥0.04 

26986 ................ Stone County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26987 ................ Sullivan County, Missouri ................................................................. 99926 0.7930 0.7927 ¥0.04 

26988 ................ Taney County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

26989 ................ Texas County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26990 ................ Vernon County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26991 ................ Warren County, Missouri .................................................................. 41180 0.8958 0.9005 0.52 

26992 ................ Washington County, Missouri .......................................................... 41180 0.8457 0.9005 6.48 

26993 ................ Wayne County, Missouri .................................................................. 99926 0.7930 0.7927 ¥0.04 

26994 ................ Webster County, Missouri ................................................................ 44180 0.8244 0.8469 2.73 

26995 ................ Worth County, Missouri .................................................................... 99926 0.7930 0.7927 ¥0.04 

26996 ................ Wright County, Missouri ................................................................... 99926 0.7930 0.7927 ¥0.04 

27000 ................ Beaverhead County, Montana ......................................................... 99927 0.8762 0.8590 ¥1.96 

27010 ................ Big Horn County, Montana ............................................................... 99927 0.8762 0.8590 ¥1.96 

27020 ................ Blaine County, Montana ................................................................... 99927 0.8762 0.8590 ¥1.96 

27030 ................ Broadwater County, Montana .......................................................... 99927 0.8762 0.8590 ¥1.96 

27040 ................ Carbon County, Montana ................................................................. 13740 0.8798 0.8712 ¥0.98 

27050 ................ Carter County, Montana ................................................................... 99927 0.8762 0.8590 ¥1.96 

27060 ................ Cascade County, Montana ............................................................... 24500 0.9052 0.8598 ¥5.02 

27070 ................ Chouteau County, Montana ............................................................. 99927 0.8762 0.8590 ¥1.96 

27080 ................ Custer County, Montana .................................................................. 99927 0.8762 0.8590 ¥1.96 

27090 ................ Daniels County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27100 ................ Dawson County, Montana ................................................................ 99927 0.8762 0.8590 ¥1.96 

27110 ................ Deer Lodge County, Montana .......................................................... 99927 0.8762 0.8590 ¥1.96 

27113 ................ Yellowstone National Park, Montana ............................................... 99927 0.8762 0.8590 ¥1.96 

27120 ................ Fallon County, Montana ................................................................... 99927 0.8762 0.8590 ¥1.96 

27130 ................ Fergus County, Montana .................................................................. 99927 0.8762 0.8590 ¥1.96 

27140 ................ Flathead County, Montana ............................................................... 99927 0.8762 0.8590 ¥1.96 

27150 ................ Gallatin County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27160 ................ Garfield County, Montana ................................................................ 99927 0.8762 0.8590 ¥1.96 

27170 ................ Glacier County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27180 ................ Golden Valley County, Montana ...................................................... 99927 0.8762 0.8590 ¥1.96 

27190 ................ Granite County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27200 ................ Hill County, Montana ........................................................................ 99927 0.8762 0.8590 ¥1.96 

27210 ................ Jefferson County, Montana .............................................................. 99927 0.8762 0.8590 ¥1.96 

27220 ................ Judith Basin County, Montana ......................................................... 99927 0.8762 0.8590 ¥1.96 

27230 ................ Lake County, Montana ..................................................................... 99927 0.8762 0.8590 ¥1.96 

27240 ................ Lewis And Clark County, Montana .................................................. 99927 0.8762 0.8590 ¥1.96 

27250 ................ Liberty County, Montana .................................................................. 99927 0.8762 0.8590 ¥1.96 

27260 ................ Lincoln County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27270 ................ Mc Cone County, Montana .............................................................. 99927 0.8762 0.8590 ¥1.96 

27280 ................ Madison County, Montana ............................................................... 99927 0.8762 0.8590 ¥1.96 

27290 ................ Meagher County, Montana ............................................................... 99927 0.8762 0.8590 ¥1.96 

27300 ................ Mineral County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27310 ................ Missoula County, Montana ............................................................... 33540 0.9473 0.8928 ¥5.75 

27320 ................ Musselshell County, Montana .......................................................... 99927 0.8762 0.8590 ¥1.96 

27330 ................ Park County, Montana ..................................................................... 99927 0.8762 0.8590 ¥1.96 

27340 ................ Petroleum County, Montana ............................................................ 99927 0.8762 0.8590 ¥1.96 

27350 ................ Phillips County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27360 ................ Pondera County, Montana ............................................................... 99927 0.8762 0.8590 ¥1.96 

27370 ................ Powder River County, Montana ....................................................... 99927 0.8762 0.8590 ¥1.96 

27380 ................ Powell County, Montana .................................................................. 99927 0.8762 0.8590 ¥1.96 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65983 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

27390 ................ Prairie County, Montana .................................................................. 99927 0.8762 0.8590 ¥1.96 

27400 ................ Ravalli County, Montana .................................................................. 99927 0.8762 0.8590 ¥1.96 

27410 ................ Richland County, Montana ............................................................... 99927 0.8762 0.8590 ¥1.96 

27420 ................ Roosevelt County, Montana ............................................................. 99927 0.8762 0.8590 ¥1.96 

27430 ................ Rosebud County, Montana .............................................................. 99927 0.8762 0.8590 ¥1.96 

27440 ................ Sanders County, Montana ............................................................... 99927 0.8762 0.8590 ¥1.96 

27450 ................ Sheridan County, Montana .............................................................. 99927 0.8762 0.8590 ¥1.96 

27460 ................ Silver Bow County, Montana ............................................................ 99927 0.8762 0.8590 ¥1.96 

27470 ................ Stillwater County, Montana .............................................................. 99927 0.8762 0.8590 ¥1.96 

27480 ................ Sweet Grass County, Montana ........................................................ 99927 0.8762 0.8590 ¥1.96 

27490 ................ Teton County, Montana .................................................................... 99927 0.8762 0.8590 ¥1.96 

27500 ................ Toole County, Montana .................................................................... 99927 0.8762 0.8590 ¥1.96 

27510 ................ Treasure County, Montana .............................................................. 99927 0.8762 0.8590 ¥1.96 

27520 ................ Valley County, Montana ................................................................... 99927 0.8762 0.8590 ¥1.96 

27530 ................ Wheatland County, Montana ............................................................ 99927 0.8762 0.8590 ¥1.96 

27540 ................ Wibaux County, Montana ................................................................. 99927 0.8762 0.8590 ¥1.96 

27550 ................ Yellowstone County, Montana ......................................................... 13740 0.8834 0.8712 ¥1.38 

28000 ................ Adams County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28010 ................ Antelope County, Nebraska ............................................................. 99928 0.8657 0.8677 0.23 

28020 ................ Arthur County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28030 ................ Banner County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28040 ................ Blaine County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28050 ................ Boone County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28060 ................ Box Butte County, Nebraska ............................................................ 99928 0.8657 0.8677 0.23 

28070 ................ Boyd County, Nebraska ................................................................... 99928 0.8657 0.8677 0.23 

28080 ................ Brown County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28090 ................ Buffalo County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28100 ................ Burt County, Nebraska ..................................................................... 99928 0.8657 0.8677 0.23 

28110 ................ Butler County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28120 ................ Cass County, Nebraska ................................................................... 36540 0.9560 0.9450 ¥1.15 

28130 ................ Cedar County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28140 ................ Chase County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28150 ................ Cherry County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28160 ................ Cheyenne County, Nebraska ........................................................... 99928 0.8657 0.8677 0.23 

28170 ................ Clay County, Nebraska .................................................................... 99928 0.8657 0.8677 0.23 

28180 ................ Colfax County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28190 ................ Cuming County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28200 ................ Custer County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28210 ................ Dakota County, Nebraska ................................................................ 43580 0.9399 0.9200 ¥2.12 

28220 ................ Dawes County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28230 ................ Dawson County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28240 ................ Deuel County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28250 ................ Dixon County, Nebraska .................................................................. 43580 0.9019 0.9200 2.01 

28260 ................ Dodge County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28270 ................ Douglas County, Nebraska .............................................................. 36540 0.9560 0.9450 ¥1.15 

28280 ................ Dundy County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28290 ................ Fillmore County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28300 ................ Franklin County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28310 ................ Frontier County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28320 ................ Furnas County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28330 ................ Gage County, Nebraska ................................................................... 99928 0.8657 0.8677 0.23 

28340 ................ Garden County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28350 ................ Garfield County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28360 ................ Gosper County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28370 ................ Grant County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28380 ................ Greeley County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28390 ................ Hall County, Nebraska ..................................................................... 99928 0.8657 0.8677 0.23 

28400 ................ Hamilton County, Nebraska ............................................................. 99928 0.8657 0.8677 0.23 

28410 ................ Harlan County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28420 ................ Hayes County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28430 ................ Hitchcock County, Nebraska ............................................................ 99928 0.8657 0.8677 0.23 

28440 ................ Holt County, Nebraska ..................................................................... 99928 0.8657 0.8677 0.23 

28450 ................ Hooker County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28460 ................ Howard County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28470 ................ Jefferson County, Nebraska ............................................................. 99928 0.8657 0.8677 0.23 

28480 ................ Johnson County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28490 ................ Kearney County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28500 ................ Keith County, Nebraska ................................................................... 99928 0.8657 0.8677 0.23 


rmajette on PROD1PC67 with RULES2
65984 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

28510 ................ Keya Paha County, Nebraska .......................................................... 99928 0.8657 0.8677 0.23 

28520 ................ Kimball County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28530 ................ Knox County, Nebraska ................................................................... 99928 0.8657 0.8677 0.23 

28540 ................ Lancaster County, Nebraska ............................................................ 30700 1.0214 1.0092 ¥1.19 

28550 ................ Lincoln County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28560 ................ Logan County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28570 ................ Loup County, Nebraska ................................................................... 99928 0.8657 0.8677 0.23 

28580 ................ Mc Pherson County, Nebraska ........................................................ 99928 0.8657 0.8677 0.23 

28590 ................ Madison County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28600 ................ Merrick County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28610 ................ Morrill County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28620 ................ Nance County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28630 ................ Nemaha County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28640 ................ Nuckolls County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28650 ................ Otoe County, Nebraska .................................................................... 99928 0.8657 0.8677 0.23 

28660 ................ Pawnee County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28670 ................ Perkins County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28680 ................ Phelps County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28690 ................ Pierce County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28700 ................ Platte County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28710 ................ Polk County, Nebraska .................................................................... 99928 0.8657 0.8677 0.23 

28720 ................ Redwillow County, Nebraska ........................................................... 99928 0.8657 0.8677 0.23 

28730 ................ Richardson County, Nebraska ......................................................... 99928 0.8657 0.8677 0.23 

28740 ................ Rock County, Nebraska ................................................................... 99928 0.8657 0.8677 0.23 

28750 ................ Saline County, Nebraska ................................................................. 99928 0.8657 0.8677 0.23 

28760 ................ Sarpy County, Nebraska .................................................................. 36540 0.9560 0.9450 ¥1.15 

28770 ................ Saunders County, Nebraska ............................................................ 36540 0.9109 0.9450 3.74 

28780 ................ Scotts Bluff County, Nebraska ......................................................... 99928 0.8657 0.8677 0.23 

28790 ................ Seward County, Nebraska ............................................................... 30700 0.9436 1.0092 6.95 

28800 ................ Sheridan County, Nebraska ............................................................. 99928 0.8657 0.8677 0.23 

28810 ................ Sherman County, Nebraska ............................................................. 99928 0.8657 0.8677 0.23 

28820 ................ Sioux County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28830 ................ Stanton County, Nebraska ............................................................... 99928 0.8657 0.8677 0.23 

28840 ................ Thayer County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28850 ................ Thomas County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28860 ................ Thurston County, Nebraska ............................................................. 99928 0.8657 0.8677 0.23 

28870 ................ Valley County, Nebraska .................................................................. 99928 0.8657 0.8677 0.23 

28880 ................ Washington County, Nebraska ........................................................ 36540 0.9560 0.9450 ¥1.15 

28890 ................ Wayne County, Nebraska ................................................................ 99928 0.8657 0.8677 0.23 

28900 ................ Webster County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28910 ................ Wheeler County, Nebraska .............................................................. 99928 0.8657 0.8677 0.23 

28920 ................ York County, Nebraska .................................................................... 99928 0.8657 0.8677 0.23 

29000 ................ Churchill County, Nevada ................................................................ 99929 0.9376 0.8944 ¥4.61 

29010 ................ Clark County, Nevada ...................................................................... 29820 1.1296 1.1430 1.19 

29020 ................ Douglas County, Nevada ................................................................. 99929 0.9376 0.8944 ¥4.61 

29030 ................ Elko County, Nevada ....................................................................... 99929 0.9376 0.8944 ¥4.61 

29040 ................ Esmeralda County, Nevada ............................................................. 99929 0.9376 0.8944 ¥4.61 

29050 ................ Eureka County, Nevada ................................................................... 99929 0.9376 0.8944 ¥4.61 

29060 ................ Humboldt County, Nevada ............................................................... 99929 0.9376 0.8944 ¥4.61 

29070 ................ Lander County, Nevada ................................................................... 99929 0.9376 0.8944 ¥4.61 

29080 ................ Lincoln County, Nevada ................................................................... 99929 0.9376 0.8944 ¥4.61 

29090 ................ Lyon County, Nevada ....................................................................... 99929 0.9376 0.8944 ¥4.61 

29100 ................ Mineral County, Nevada ................................................................... 99929 0.9376 0.8944 ¥4.61 

29110 ................ Nye County, Nevada ........................................................................ 99929 1.0110 0.8944 ¥11.53 

29120 ................ Carson City County, Nevada ........................................................... 16180 0.9961 1.0025 0.64 

29130 ................ Pershing County, Nevada ................................................................ 99929 0.9376 0.8944 ¥4.61 

29140 ................ Storey County, Nevada .................................................................... 39900 1.0335 1.1963 15.75 

29150 ................ Washoe County, Nevada ................................................................. 39900 1.0982 1.1963 8.93 

29160 ................ White Pine County, Nevada ............................................................. 99929 0.9376 0.8944 ¥4.61 

30000 ................ Belknap County, New Hampshire .................................................... 99930 1.0817 1.0853 0.33 

30010 ................ Carroll County, New Hampshire ...................................................... 99930 1.0817 1.0853 0.33 

30020 ................ Cheshire County, New Hampshire ................................................... 99930 1.0817 1.0853 0.33 

30030 ................ Coos County, New Hampshire ......................................................... 99930 1.0817 1.0853 0.33 

30040 ................ Grafton County, New Hampshire ..................................................... 99930 1.0817 1.0853 0.33

30050 ................ Hillsboro County, New Hampshire ................................................... 31700 1.0766 1.0243 ¥4.86 

30060 ................ Merrimack County, New Hampshire ................................................ 31700 1.0766 1.0243 ¥4.86 

30070 ................ Rockingham County, New Hampshire ............................................. 40484 1.0776 1.0159 ¥5.73 

30080 ................ Strafford County, New Hampshire ................................................... 40484 1.0776 1.0159 ¥5.73 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65985 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

30090 ................ Sullivan County, New Hampshire .................................................... 99930 1.0817 1.0853 0.33

31000 ................ Atlantic County, New Jersey ............................................................ 12100 1.1556 1.1831 2.38 

31100 ................ Bergen County, New Jersey ............................................................ 35644 1.2420 1.3177 6.10 

31150 ................ Burlington County, New Jersey ........................................................ 15804 1.0720 1.0392 ¥3.06 

31160 ................ Camden County, New Jersey .......................................................... 15804 1.0720 1.0392 ¥3.06 

31180 ................ Cape May County, New Jersey ....................................................... 36140 1.1254 1.0472 ¥6.95 

31190 ................ Cumberland County, New Jersey .................................................... 47220 0.9827 0.9832 0.05 

31200 ................ Essex County, New Jersey .............................................................. 35084 1.1859 1.1892 0.28 

31220 ................ Gloucester County, New Jersey ...................................................... 15804 1.0720 1.0392 ¥3.06 

31230 ................ Hudson County, New Jersey ........................................................... 35644 1.2263 1.3177 7.45 

31250 ................ Hunterdon County, New Jersey ....................................................... 35084 1.1525 1.1892 3.18 

31260 ................ Mercer County, New Jersey ............................................................. 45940 1.0834 1.0835 0.01 

31270 ................ Middlesex County, New Jersey ........................................................ 20764 1.1208 1.1190 ¥0.16 

31290 ................ Monmouth County, New Jersey ....................................................... 20764 1.1255 1.1190 ¥0.58 

31300 ................ Morris County, New Jersey .............................................................. 35084 1.1859 1.1892 0.28 

31310 ................ Ocean County, New Jersey ............................................................. 20764 1.1255 1.1190 ¥0.58 

31320 ................ Passaic County, New Jersey ........................................................... 35644 1.2420 1.3177 6.10 

31340 ................ Salem County, New Jersey .............................................................. 48864 1.0697 1.0684 ¥0.12 

31350 ................ Somerset County, New Jersey ........................................................ 20764 1.1208 1.1190 ¥0.16 

31360 ................ Sussex County, New Jersey ............................................................ 35084 1.1859 1.1892 0.28 

31370 ................ Union County, New Jersey .............................................................. 35084 1.1859 1.1892 0.28 

31390 ................ Warren County, New Jersey ............................................................ 10900 1.0826 0.9947 ¥8.12 

32000 ................ Bernalillo County, New Mexico ........................................................ 10740 0.9684 0.9458 ¥2.33 

32010 ................ Catron County, New Mexico ............................................................ 99932 0.8599 0.8332 ¥3.11 

32020 ................ Chaves County, New Mexico ........................................................... 99932 0.8599 0.8332 ¥3.11 

32025 ................ Cibola County, New Mexico ............................................................. 99932 0.8599 0.8332 ¥3.11 

32030 ................ Colfax County, New Mexico ............................................................. 99932 0.8599 0.8332 ¥3.11 

32040 ................ Curry County, New Mexico .............................................................. 99932 0.8599 0.8332 ¥3.11 

32050 ................ De Baca County, New Mexico ......................................................... 99932 0.8599 0.8332 ¥3.11 

32060 ................ Dona Ana County, New Mexico ....................................................... 29740 0.8467 0.9273 9.52

32070 ................ Eddy County, New Mexico ............................................................... 99932 0.8599 0.8332 ¥3.11 

32080 ................ Grant County, New Mexico .............................................................. 99932 0.8599 0.8332 ¥3.11 

32090 ................ Guadalupe County, New Mexico ..................................................... 99932 0.8599 0.8332 ¥3.11 

32100 ................ Harding County, New Mexico .......................................................... 99932 0.8599 0.8332 ¥3.11 

32110 ................ Hidalgo County, New Mexico ........................................................... 99932 0.8599 0.8332 ¥3.11 

32120 ................ Lea County, New Mexico ................................................................. 99932 0.8599 0.8332 ¥3.11 

32130 ................ Lincoln County, New Mexico ............................................................ 99932 0.8599 0.8332 ¥3.11 

32131 ................ Los Alamos County, New Mexico .................................................... 99932 0.9692 0.8332 ¥14.03 

32140 ................ Luna County, New Mexico ............................................................... 99932 0.8599 0.8332 ¥3.11 

32150 ................ Mc Kinley County, New Mexico ....................................................... 99932 0.8599 0.8332 ¥3.11 

32160 ................ Mora County, New Mexico ............................................................... 99932 0.8599 0.8332 ¥3.11 

32170 ................ Otero County, New Mexico .............................................................. 99932 0.8599 0.8332 ¥3.11 

32180 ................ Quay County, New Mexico .............................................................. 99932 0.8599 0.8332 ¥3.11 

32190 ................ Rio Arriba County, New Mexico ....................................................... 99932 0.8599 0.8332 ¥3.11 

32200 ................ Roosevelt County, New Mexico ....................................................... 99932 0.8599 0.8332 ¥3.11 

32210 ................ Sandoval County, New Mexico ........................................................ 10740 0.9684 0.9458 ¥2.33 

32220 ................ San Juan County, New Mexico ........................................................ 22140 0.8536 0.8589 0.62 

32230 ................ San Miguel County, New Mexico ..................................................... 99932 0.8599 0.8332 ¥3.11 

32240 ................ Santa Fe County, New Mexico ........................................................ 42140 1.0834 1.0824 ¥0.09 

32250 ................ Sierra County, New Mexico ............................................................. 99932 0.8599 0.8332 ¥3.11 

32260 ................ Socorro County, New Mexico .......................................................... 99932 0.8599 0.8332 ¥3.11 

32270 ................ Taos County, New Mexico ............................................................... 99932 0.8599 0.8332 ¥3.11 

32280 ................ Torrance County, New Mexico ......................................................... 10740 0.9124 0.9458 3.66 

32290 ................ Union County, New Mexico .............................................................. 99932 0.8599 0.8332 ¥3.11 

32300 ................ Valencia County, New Mexico ......................................................... 10740 0.9684 0.9458 ¥2.33 

33000 ................ Albany County, New York ................................................................ 10580 0.8574 0.8720 1.70 

33010 ................ Allegany County, New York ............................................................. 99933 0.8275 0.8232 ¥0.52 

33020 ................ Bronx County, New York .................................................................. 35644 1.3326 1.3177 ¥1.12 

33030 ................ Broome County, New York .............................................................. 13780 0.8562 0.8786 2.62 

33040 ................ Cattaraugus County, New York ....................................................... 99933 0.8275 0.8232 ¥0.52 

33050 ................ Cayuga County, New York ............................................................... 99933 0.8823 0.8232 ¥6.70 

33060 ................ Chautauqua County, New York ....................................................... 99933 0.7849 0.8232 4.88

33070 ................ Chemung County, New York ........................................................... 21300 0.8250 0.8240 ¥0.12 

33080 ................ Chenango County, New York .......................................................... 99933 0.8275 0.8232 ¥0.52 

33090 ................ Clinton County, New York ................................................................ 99933 0.8275 0.8232 ¥0.52 

33200 ................ Columbia County, New York ............................................................ 99933 0.8275 0.8232 ¥0.52 

33210 ................ Cortland County, New York ............................................................. 99933 0.8275 0.8232 ¥0.52 

33220 ................ Delaware County, New York ............................................................ 99933 0.8275 0.8232 ¥0.52 


rmajette on PROD1PC67 with RULES2
65986 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

33230 ................ Dutchess County, New York ............................................................ 39100 1.0683 1.0911 2.13 

33240 ................ Erie County, New York ..................................................................... 15380 0.9511 0.9424 ¥0.91 

33260 ................ Essex County, New York ................................................................. 99933 0.8275 0.8232 ¥0.52 

33270 ................ Franklin County, New York .............................................................. 99933 0.8275 0.8232 ¥0.52 

33280 ................ Fulton County, New York ................................................................. 99933 0.8275 0.8232 ¥0.52 

33290 ................ Genesee County, New York ............................................................ 99933 0.8602 0.8232 ¥4.30 

33300 ................ Greene County, New York ............................................................... 99933 0.8275 0.8232 ¥0.52 

33310 ................ Hamilton County, New York ............................................................. 99933 0.8275 0.8232 ¥0.52 

33320 ................ Herkimer County, New York ............................................................ 46540 0.8358 0.8396 0.45 

33330 ................ Jefferson County, New York ............................................................ 99933 0.8275 0.8232 ¥0.52 

33331 ................ Kings County, New York .................................................................. 35644 1.3326 1.3177 ¥1.12 

33340 ................ Lewis County, New York .................................................................. 99933 0.8275 0.8232 ¥0.52 

33350 ................ Livingston County, New York ........................................................... 40380 0.9085 0.8994 ¥1.00 

33360 ................ Madison County, New York ............................................................. 45060 0.9533 0.9691 1.66 

33370 ................ Monroe County, New York ............................................................... 40380 0.9085 0.8994 ¥1.00 

33380 ................ Montgomery County, New York ....................................................... 99933 0.8357 0.8232 ¥1.50 

33400 ................ Nassau County, New York ............................................................... 35004 1.2719 1.2662 ¥0.45 

33420 ................ New York County, New York ........................................................... 35644 1.3326 1.3177 ¥1.12 

33500 ................ Niagara County, New York .............................................................. 15380 0.9511 0.9424 ¥0.91 

33510 ................ Oneida County, New York ............................................................... 46540 0.8358 0.8396 0.45 

33520 ................ Onondaga County, New York .......................................................... 45060 0.9533 0.9691 1.66 

33530 ................ Ontario County, New York ............................................................... 40380 0.9085 0.8994 ¥1.00 

33540 ................ Orange County, New York ............................................................... 39100 1.1049 1.0911 ¥1.25 

33550 ................ Orleans County, New York .............................................................. 40380 0.9085 0.8994 ¥1.00 

33560 ................ Oswego County, New York .............................................................. 45060 0.9533 0.9691 1.66 

33570 ................ Otsego County, New York ............................................................... 99933 0.8275 0.8232 ¥0.52 

33580 ................ Putnam County, New York ............................................................... 35644 1.3326 1.3177 ¥1.12 

33590 ................ Queens County, New York .............................................................. 35644 1.3326 1.3177 ¥1.12 

33600 ................ Rensselaer County, New York ......................................................... 10580 0.8574 0.8720 1.70 

33610 ................ Richmond County, New York ........................................................... 35644 1.3326 1.3177 ¥1.12 

33620 ................ Rockland County, New York ............................................................ 35644 1.3326 1.3177 ¥1.12 

33630 ................ St Lawrence County, New York ....................................................... 99933 0.8275 0.8232 ¥0.52 

33640 ................ Saratoga County, New York ............................................................ 10580 0.8574 0.8720 1.70 

33650 ................ Schenectady County, New York ...................................................... 10580 0.8574 0.8720 1.70

33660 ................ Schoharie County, New York ........................................................... 10580 0.8574 0.8720 1.70 

33670 ................ Schuyler County, New York ............................................................. 99933 0.8275 0.8232 ¥0.52 

33680 ................ Seneca County, New York ............................................................... 99933 0.8275 0.8232 ¥0.52 

33690 ................ Steuben County, New York .............................................................. 99933 0.8275 0.8232 ¥0.52 

33700 ................ Suffolk County, New York ................................................................ 35004 1.2719 1.2662 ¥0.45 

33710 ................ Sullivan County, New York .............................................................. 99933 0.8275 0.8232 ¥0.52 

33720 ................ Tioga County, New York .................................................................. 13780 0.8562 0.8786 2.62 

33730 ................ Tompkins County, New York ........................................................... 27060 0.9094 0.9928 9.17 

33740 ................ Ulster County, New York .................................................................. 28740 0.8825 0.9367 6.14 

33750 ................ Warren County, New York ............................................................... 24020 0.8559 0.8324 ¥2.75 

33760 ................ Washington County, New York ........................................................ 24020 0.8559 0.8324 ¥2.75 

33770 ................ Wayne County, New York ................................................................ 40380 0.9085 0.8994 ¥1.00 

33800 ................ Westchester County, New York ....................................................... 35644 1.3326 1.3177 ¥1.12 

33900 ................ Wyoming County, New York ............................................................ 99933 0.8275 0.8232 ¥0.52 

33910 ................ Yates County, New York .................................................................. 99933 0.8275 0.8232 ¥0.52 

34000 ................ Alamance County, N Carolina .......................................................... 15500 0.8962 0.8674 ¥3.21 

34010 ................ Alexander County, N Carolina ......................................................... 25860 0.8921 0.9010 1.00 

34020 ................ Alleghany County, N Carolina .......................................................... 99934 0.8501 0.8588 1.02 

34030 ................ Anson County, N Carolina ............................................................... 16740 0.9106 0.9554 4.92 

34040 ................ Ashe County, N Carolina ................................................................. 99934 0.8501 0.8588 1.02 

34050 ................ Avery County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34060 ................ Beaufort County, N Carolina ............................................................ 99934 0.8501 0.8588 1.02 

34070 ................ Bertie County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34080 ................ Bladen County, N Carolina .............................................................. 99934 0.8501 0.8588 1.02 

34090 ................ Brunswick County, N Carolina ......................................................... 48900 0.9582 0.9835 2.64 

34100 ................ Buncombe County, N Carolina ........................................................ 11700 0.9511 0.9216 ¥3.10 

34110 ................ Burke County, N Carolina ................................................................ 25860 0.8921 0.9010 1.00 

34120 ................ Cabarrus County, N Carolina ........................................................... 16740 0.9733 0.9554 ¥1.84 

34130 ................ Caldwell County, N Carolina ............................................................ 25860 0.8921 0.9010 1.00 

34140 ................ Camden County, N Carolina ............................................................ 99934 0.8501 0.8588 1.02 

34150 ................ Carteret County, N Carolina ............................................................. 99934 0.8501 0.8588 1.02 

34160 ................ Caswell County, N Carolina ............................................................. 99934 0.8501 0.8588 1.02 

34170 ................ Catawba County, N Carolina ........................................................... 25860 0.8921 0.9010 1.00 

34180 ................ Chatham County, N Carolina ........................................................... 20500 1.0139 0.9826 ¥3.09 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65987 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

34190 ................ Cherokee County, N Carolina .......................................................... 99934 0.8501 0.8588 1.02 

34200 ................ Chowan County, N Carolina ............................................................ 99934 0.8501 0.8588 1.02 

34210 ................ Clay County, N Carolina .................................................................. 99934 0.8501 0.8588 1.02 

34220 ................ Cleveland County, N Carolina .......................................................... 99934 0.8501 0.8588 1.02 

34230 ................ Columbus County, N Carolina ......................................................... 99934 0.8501 0.8588 1.02 

34240 ................ Craven County, N Carolina .............................................................. 99934 0.8501 0.8588 1.02 

34250 ................ Cumberland County, N Carolina ...................................................... 22180 0.9416 0.8945 ¥5.00 

34251 ................ Currituck County, N Carolina ........................................................... 47260 0.8799 0.8790 ¥0.10 

34270 ................ Dare County, N Carolina .................................................................. 99934 0.8501 0.8588 1.02 

34280 ................ Davidson County, N Carolina ........................................................... 99934 0.8779 0.8588 ¥2.18 

34290 ................ Davie County, N Carolina ................................................................ 49180 0.8981 0.9276 3.28 

34300 ................ Duplin County, N Carolina ............................................................... 99934 0.8501 0.8588 1.02 

34310 ................ Durham County, N Carolina ............................................................. 20500 1.0139 0.9826 ¥3.09 

34320 ................ Edgecombe County, N Carolina ...................................................... 40580 0.8915 0.8854 ¥0.68 

34330 ................ Forsyth County, N Carolina .............................................................. 49180 0.8981 0.9276 3.28 

34340 ................ Franklin County, N Carolina ............................................................. 39580 0.9863 0.9864 0.01 

34350 ................ Gaston County, N Carolina .............................................................. 16740 0.9733 0.9554 ¥1.84 

34360 ................ Gates County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34370 ................ Graham County, N Carolina ............................................................. 99934 0.8501 0.8588 1.02 

34380 ................ Granville County, N Carolina ........................................................... 99934 0.8501 0.8588 1.02 

34390 ................ Greene County, N Carolina .............................................................. 24780 0.8944 0.9432 5.46 

34400 ................ Guilford County, N Carolina ............................................................. 24660 0.9061 0.8866 ¥2.15 

34410 ................ Halifax County, N Carolina ............................................................... 99934 0.8501 0.8588 1.02 

34420 ................ Harnett County, N Carolina .............................................................. 99934 0.8501 0.8588 1.02 

34430 ................ Haywood County, N Carolina ........................................................... 11700 0.8874 0.9216 3.85 

34440 ................ Henderson County, N Carolina ........................................................ 11700 0.8874 0.9216 3.85 

34450 ................ Hertford County, N Carolina ............................................................. 99934 0.8501 0.8588 1.02 

34460 ................ Hoke County, N Carolina ................................................................. 22180 0.8939 0.8945 0.07 

34470 ................ Hyde County, N Carolina ................................................................. 99934 0.8501 0.8588 1.02 

34480 ................ Iredell County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34490 ................ Jackson County, N Carolina ............................................................ 99934 0.8501 0.8588 1.02 

34500 ................ Johnston County, N Carolina ........................................................... 39580 0.9863 0.9864 0.01 

34510 ................ Jones County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34520 ................ Lee County, N Carolina .................................................................... 99934 0.8501 0.8588 1.02 

34530 ................ Lenoir County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34540 ................ Lincoln County, N Carolina .............................................................. 99934 0.9128 0.8588 ¥5.92 

34550 ................ Mc Dowell County, N Carolina ......................................................... 99934 0.8501 0.8588 1.02 

34560 ................ Macon County, N Carolina ............................................................... 99934 0.8501 0.8588 1.02 

34570 ................ Madison County, N Carolina ............................................................ 11700 0.9511 0.9216 ¥3.10 

34580 ................ Martin County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34590 ................ Mecklenburg County, N Carolina ..................................................... 16740 0.9733 0.9554 ¥1.84 

34600 ................ Mitchell County, N Carolina ............................................................. 99934 0.8501 0.8588 1.02 

34610 ................ Montgomery County, N Carolina ...................................................... 99934 0.8501 0.8588 1.02 

34620 ................ Moore County, N Carolina ............................................................... 99934 0.8501 0.8588 1.02 

34630 ................ Nash County, N Carolina ................................................................. 40580 0.8915 0.8854 ¥0.68 

34640 ................ New Hanover County, N Carolina .................................................... 48900 0.9582 0.9835 2.64

34650 ................ Northampton County, N Carolina ..................................................... 99934 0.8501 0.8588 1.02 

34660 ................ Onslow County, N Carolina .............................................................. 27340 0.8236 0.8231 ¥0.06 

34670 ................ Orange County, N Carolina .............................................................. 20500 1.0139 0.9826 ¥3.09 

34680 ................ Pamlico County, N Carolina ............................................................. 99934 0.8501 0.8588 1.02 

34690 ................ Pasquotank County, N Carolina ....................................................... 99934 0.8501 0.8588 1.02 

34700 ................ Pender County, N Carolina .............................................................. 48900 0.9022 0.9835 9.01 

34710 ................ Perquimans County, N Carolina ...................................................... 99934 0.8501 0.8588 1.02 

34720 ................ Person County, N Carolina .............................................................. 20500 0.9353 0.9826 5.06 

34730 ................ Pitt County, N Carolina .................................................................... 24780 0.9425 0.9432 0.07 

34740 ................ Polk County, N Carolina ................................................................... 99934 0.8501 0.8588 1.02 

34750 ................ Randolph County, N Carolina .......................................................... 24660 0.9061 0.8866 ¥2.15 

34760 ................ Richmond County, N Carolina ......................................................... 99934 0.8501 0.8588 1.02 

34770 ................ Robeson County, N Carolina ........................................................... 99934 0.8501 0.8588 1.02 

34780 ................ Rockingham County, N Carolina ...................................................... 24660 0.8783 0.8866 0.95 

34790 ................ Rowan County, N Carolina .............................................................. 99934 0.9128 0.8588 ¥5.92 

34800 ................ Rutherford County, N Carolina ......................................................... 99934 0.8501 0.8588 1.02 

34810 ................ Sampson County, N Carolina .......................................................... 99934 0.8501 0.8588 1.02 

34820 ................ Scotland County, N Carolina ............................................................ 99934 0.8501 0.8588 1.02 

34830 ................ Stanly County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34840 ................ Stokes County, N Carolina ............................................................... 49180 0.8981 0.9276 3.28 

34850 ................ Surry County, N Carolina ................................................................. 99934 0.8501 0.8588 1.02 

34860 ................ Swain County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 


rmajette on PROD1PC67 with RULES2
65988 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

34870 ................ Transylvania County, N Carolina ..................................................... 99934 0.8501 0.8588 1.02 

34880 ................ Tyrrell County, N Carolina ................................................................ 99934 0.8501 0.8588 1.02 

34890 ................ Union County, N Carolina ................................................................ 16740 0.9733 0.9554 ¥1.84 

34900 ................ Vance County, N Carolina ............................................................... 99934 0.8501 0.8588 1.02 

34910 ................ Wake County, N Carolina ................................................................ 39580 0.9863 0.9864 0.01 

34920 ................ Warren County, N Carolina .............................................................. 99934 0.8501 0.8588 1.02 

34930 ................ Washington County, N Carolina ....................................................... 99934 0.8501 0.8588 1.02 

34940 ................ Watauga County, N Carolina ........................................................... 99934 0.8501 0.8588 1.02 

34950 ................ Wayne County, N Carolina .............................................................. 24140 0.8775 0.9171 4.51 

34960 ................ Wilkes County, N Carolina ............................................................... 99934 0.8501 0.8588 1.02 

34970 ................ Wilson County, N Carolina ............................................................... 99934 0.8501 0.8588 1.02 

34980 ................ Yadkin County, N Carolina ............................................................... 49180 0.8981 0.9276 3.28 

34981 ................ Yancey County, N Carolina .............................................................. 99934 0.8501 0.8588 1.02 

35000 ................ Adams County, N Dakota ................................................................ 99935 0.7261 0.7215 ¥0.63 

35010 ................ Barnes County, N Dakota ................................................................ 99935 0.7261 0.7215 ¥0.63 

35020 ................ Benson County, N Dakota ............................................................... 99935 0.7261 0.7215 ¥0.63 

35030 ................ Billings County, N Dakota ................................................................ 99935 0.7261 0.7215 ¥0.63 

35040 ................ Bottineau County, N Dakota ............................................................ 99935 0.7261 0.7215 ¥0.63 

35050 ................ Bowman County, N Dakota .............................................................. 99935 0.7261 0.7215 ¥0.63 

35060 ................ Burke County, N Dakota .................................................................. 99935 0.7261 0.7215 ¥0.63 

35070 ................ Burleigh County, N Dakota .............................................................. 13900 0.7574 0.7240 ¥4.41 

35080 ................ Cass County, N Dakota ................................................................... 22020 0.8486 0.8250 ¥2.78 

35090 ................ Cavalier County, N Dakota .............................................................. 99935 0.7261 0.7215 ¥0.63 

35100 ................ Dickey County, N Dakota ................................................................. 99935 0.7261 0.7215 ¥0.63 

35110 ................ Divide County, N Dakota .................................................................. 99935 0.7261 0.7215 ¥0.63 

35120 ................ Dunn County, N Dakota ................................................................... 99935 0.7261 0.7215 ¥0.63 

35130 ................ Eddy County, N Dakota ................................................................... 99935 0.7261 0.7215 ¥0.63 

35140 ................ Emmons County, N Dakota ............................................................. 99935 0.7261 0.7215 ¥0.63 

35150 ................ Foster County, N Dakota ................................................................. 99935 0.7261 0.7215 ¥0.63 

35160 ................ Golden Valley County, N Dakota ..................................................... 99935 0.7261 0.7215 ¥0.63 

35170 ................ Grand Forks County, N Dakota ....................................................... 24220 0.7901 0.7949 0.61 

35180 ................ Grant County, N Dakota ................................................................... 99935 0.7261 0.7215 ¥0.63 

35190 ................ Griggs County, N Dakota ................................................................. 99935 0.7261 0.7215 ¥0.63 

35200 ................ Hettinger County, N Dakota ............................................................. 99935 0.7261 0.7215 ¥0.63 

35210 ................ Kidder County, N Dakota ................................................................. 99935 0.7261 0.7215 ¥0.63 

35220 ................ La Moure County, N Dakota ............................................................ 99935 0.7261 0.7215 ¥0.63 

35230 ................ Logan County, N Dakota .................................................................. 99935 0.7261 0.7215 ¥0.63 

35240 ................ Mc Henry County, N Dakota ............................................................ 99935 0.7261 0.7215 ¥0.63 

35250 ................ Mc Intosh County, N Dakota ............................................................ 99935 0.7261 0.7215 ¥0.63 

35260 ................ Mc Kenzie County, N Dakota ........................................................... 99935 0.7261 0.7215 ¥0.63 

35270 ................ Mc Lean County, N Dakota .............................................................. 99935 0.7261 0.7215 ¥0.63 

35280 ................ Mercer County, N Dakota ................................................................ 99935 0.7261 0.7215 ¥0.63 

35290 ................ Morton County, N Dakota ................................................................ 13900 0.7574 0.7240 ¥4.41 

35300 ................ Mountrail County, N Dakota ............................................................. 99935 0.7261 0.7215 ¥0.63 

35310 ................ Nelson County, N Dakota ................................................................ 99935 0.7261 0.7215 ¥0.63 

35320 ................ Oliver County, N Dakota .................................................................. 99935 0.7261 0.7215 ¥0.63 

35330 ................ Pembina County, N Dakota ............................................................. 99935 0.7261 0.7215 ¥0.63 

35340 ................ Pierce County, N Dakota ................................................................. 99935 0.7261 0.7215 ¥0.63 

35350 ................ Ramsey County, N Dakota .............................................................. 99935 0.7261 0.7215 ¥0.63 

35360 ................ Ransom County, N Dakota .............................................................. 99935 0.7261 0.7215 ¥0.63 

35370 ................ Renville County, N Dakota ............................................................... 99935 0.7261 0.7215 ¥0.63 

35380 ................ Richland County, N Dakota .............................................................. 99935 0.7261 0.7215 ¥0.63 

35390 ................ Rolette County, N Dakota ................................................................ 99935 0.7261 0.7215 ¥0.63 

35400 ................ Sargent County, N Dakota ............................................................... 99935 0.7261 0.7215 ¥0.63 

35410 ................ Sheridan County, N Dakota ............................................................. 99935 0.7261 0.7215 ¥0.63 

35420 ................ Sioux County, N Dakota ................................................................... 99935 0.7261 0.7215 ¥0.63 

35430 ................ Slope County, N Dakota .................................................................. 99935 0.7261 0.7215 ¥0.63 

35440 ................ Stark County, N Dakota ................................................................... 99935 0.7261 0.7215 ¥0.63 

35450 ................ Steele County, N Dakota ................................................................. 99935 0.7261 0.7215 ¥0.63 

35460 ................ Stutsman County, N Dakota ............................................................ 99935 0.7261 0.7215 ¥0.63 

35470 ................ Towner County, N Dakota ................................................................ 99935 0.7261 0.7215 ¥0.63 

35480 ................ Traill County, N Dakota .................................................................... 99935 0.7261 0.7215 ¥0.63 

35490 ................ Walsh County, N Dakota .................................................................. 99935 0.7261 0.7215 ¥0.63 

35500 ................ Ward County, N Dakota ................................................................... 99935 0.7261 0.7215 ¥0.63 

35510 ................ Wells County, N Dakota ................................................................... 99935 0.7261 0.7215 ¥0.63 

35520 ................ Williams County, N Dakota .............................................................. 99935 0.7261 0.7215 ¥0.63 

36000 ................ Adams County, Ohio ........................................................................ 99936 0.8874 0.8658 ¥2.43 

36010 ................ Allen County, Ohio ........................................................................... 30620 0.9172 0.9042 ¥1.42 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65989 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

36020 ................ Ashland County, Ohio ...................................................................... 99936 0.8874 0.8658 ¥2.43 

36030 ................ Ashtabula County, Ohio ................................................................... 99936 0.9005 0.8658 ¥3.85 

36040 ................ Athens County, Ohio ........................................................................ 99936 0.8874 0.8658 ¥2.43 

36050 ................ Auglaize County, Ohio ..................................................................... 99936 0.8973 0.8658 ¥3.51 

36060 ................ Belmont County, Ohio ...................................................................... 48540 0.7161 0.7010 ¥2.11 

36070 ................ Brown County, Ohio ......................................................................... 17140 0.9675 0.9601 ¥0.76 

36080 ................ Butler County, Ohio .......................................................................... 17140 0.9283 0.9601 3.43 

36090 ................ Carroll County, Ohio ......................................................................... 15940 0.8935 0.9031 1.07 

36100 ................ Champaign County, Ohio ................................................................. 99936 0.8874 0.8658 ¥2.43 

36110 ................ Clark County, Ohio ........................................................................... 44220 0.8688 0.8593 ¥1.09 

36120 ................ Clermont County, Ohio ..................................................................... 17140 0.9675 0.9601 ¥0.76 

36130 ................ Clinton County, Ohio ........................................................................ 99936 0.8874 0.8658 ¥2.43 

36140 ................ Columbiana County, Ohio ................................................................ 99936 0.8837 0.8658 ¥2.03 

36150 ................ Coshocton County, Ohio .................................................................. 99936 0.8874 0.8658 ¥2.43 

36160 ................ Crawford County, Ohio ..................................................................... 99936 0.9359 0.8658 ¥7.49 

36170 ................ Cuyahoga County, Ohio ................................................................... 17460 0.9198 0.9400 2.20 

36190 ................ Darke County, Ohio .......................................................................... 99936 0.8874 0.8658 ¥2.43 

36200 ................ Defiance County, Ohio ..................................................................... 99936 0.8874 0.8658 ¥2.43 

36210 ................ Delaware County, Ohio .................................................................... 18140 0.9867 1.0107 2.43 

36220 ................ Erie County, Ohio ............................................................................. 41780 0.8970 0.9302 3.70 

36230 ................ Fairfield County, Ohio ...................................................................... 18140 0.9867 1.0107 2.43 

36240 ................ Fayette County, Ohio ....................................................................... 99936 0.8874 0.8658 ¥2.43 

36250 ................ Franklin County, Ohio ...................................................................... 18140 0.9867 1.0107 2.43 

36260 ................ Fulton County, Ohio ......................................................................... 45780 0.9574 0.9586 0.13 

36270 ................ Gallia County, Ohio .......................................................................... 99936 0.8874 0.8658 ¥2.43 

36280 ................ Geauga County, Ohio ...................................................................... 17460 0.9198 0.9400 2.20 

36290 ................ Greene County, Ohio ....................................................................... 19380 0.9022 0.9037 0.17 

36300 ................ Guernsey County, Ohio .................................................................... 99936 0.8874 0.8658 ¥2.43 

36310 ................ Hamilton County, Ohio ..................................................................... 17140 0.9675 0.9601 ¥0.76 

36330 ................ Hancock County, Ohio ..................................................................... 99936 0.8874 0.8658 ¥2.43 

36340 ................ Hardin County, Ohio ......................................................................... 99936 0.8874 0.8658 ¥2.43 

36350 ................ Harrison County, Ohio ...................................................................... 99936 0.8874 0.8658 ¥2.43 

36360 ................ Henry County, Ohio .......................................................................... 99936 0.8874 0.8658 ¥2.43 

36370 ................ Highland County, Ohio ..................................................................... 99936 0.8874 0.8658 ¥2.43 

36380 ................ Hocking County, Ohio ...................................................................... 99936 0.8874 0.8658 ¥2.43 

36390 ................ Holmes County, Ohio ....................................................................... 99936 0.8874 0.8658 ¥2.43 

36400 ................ Huron County, Ohio ......................................................................... 99936 0.8874 0.8658 ¥2.43 

36410 ................ Jackson County, Ohio ...................................................................... 99936 0.8874 0.8658 ¥2.43 

36420 ................ Jefferson County, Ohio .................................................................... 48260 0.7819 0.8063 3.12 

36430 ................ Knox County, Ohio ........................................................................... 99936 0.8874 0.8658 ¥2.43 

36440 ................ Lake County, Ohio ........................................................................... 17460 0.9198 0.9400 2.20 

36450 ................ Lawrence County, Ohio .................................................................... 26580 0.9477 0.8997 ¥5.06 

36460 ................ Licking County, Ohio ........................................................................ 18140 0.9867 1.0107 2.43 

36470 ................ Logan County, Ohio ......................................................................... 99936 0.8874 0.8658 ¥2.43 

36480 ................ Lorain County, Ohio ......................................................................... 17460 0.9198 0.9400 2.20 

36490 ................ Lucas County, Ohio .......................................................................... 45780 0.9574 0.9586 0.13 

36500 ................ Madison County, Ohio ...................................................................... 18140 0.9867 1.0107 2.43 

36510 ................ Mahoning County, Ohio ................................................................... 49660 0.8726 0.8802 0.87 

36520 ................ Marion County, Ohio ........................................................................ 99936 0.8874 0.8658 ¥2.43 

36530 ................ Medina County, Ohio ....................................................................... 17460 0.9198 0.9400 2.20 

36540 ................ Meigs County, Ohio .......................................................................... 99936 0.8874 0.8658 ¥2.43 

36550 ................ Mercer County, Ohio ........................................................................ 99936 0.8874 0.8658 ¥2.43 

36560 ................ Miami County, Ohio .......................................................................... 19380 0.9022 0.9037 0.17 

36570 ................ Monroe County, Ohio ....................................................................... 99936 0.8874 0.8658 ¥2.43 

36580 ................ Montgomery County, Ohio ............................................................... 19380 0.9022 0.9037 0.17 

36590 ................ Morgan County, Ohio ....................................................................... 99936 0.8874 0.8658 ¥2.43 

36600 ................ Morrow County, Ohio ....................................................................... 18140 0.9391 1.0107 7.62 

36610 ................ Muskingum County, Ohio ................................................................. 99936 0.8874 0.8658 ¥2.43 

36620 ................ Noble County, Ohio .......................................................................... 99936 0.8874 0.8658 ¥2.43 

36630 ................ Ottawa County, Ohio ........................................................................ 45780 0.9248 0.9586 3.65 

36640 ................ Paulding County, Ohio ..................................................................... 99936 0.8874 0.8658 ¥2.43 

36650 ................ Perry County, Ohio ........................................................................... 99936 0.8874 0.8658 ¥2.43 

36660 ................ Pickaway County, Ohio .................................................................... 18140 0.9867 1.0107 2.43 

36670 ................ Pike County, Ohio ............................................................................ 99936 0.8874 0.8658 ¥2.43 

36680 ................ Portage County, Ohio ....................................................................... 10420 0.8982 0.8654 ¥3.65 

36690 ................ Preble County, Ohio ......................................................................... 19380 0.8993 0.9037 0.49 

36700 ................ Putnam County, Ohio ....................................................................... 99936 0.8874 0.8658 ¥2.43 

36710 ................ Richland County, Ohio ..................................................................... 31900 0.9891 0.9271 ¥6.27 


rmajette on PROD1PC67 with RULES2
65990 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

36720 ................ Ross County, Ohio ........................................................................... 99936 0.8874 0.8658 ¥2.43 

36730 ................ Sandusky County, Ohio ................................................................... 99936 0.8874 0.8658 ¥2.43 

36740 ................ Scioto County, Ohio ......................................................................... 99936 0.8874 0.8658 ¥2.43 

36750 ................ Seneca County, Ohio ....................................................................... 99936 0.8874 0.8658 ¥2.43 

36760 ................ Shelby County, Ohio ........................................................................ 99936 0.8874 0.8658 ¥2.43 

36770 ................ Stark County, Ohio ........................................................................... 15940 0.8935 0.9031 1.07 

36780 ................ Summit County, Ohio ....................................................................... 10420 0.8982 0.8654 ¥3.65 

36790 ................ Trumbull County, Ohio ..................................................................... 49660 0.8726 0.8802 0.87 

36800 ................ Tuscarawas County, Ohio ................................................................ 99936 0.8874 0.8658 ¥2.43 

36810 ................ Union County, Ohio .......................................................................... 18140 0.9391 1.0107 7.62 

36820 ................ Van Wert County, Ohio .................................................................... 99936 0.8874 0.8658 ¥2.43 

36830 ................ Vinton County, Ohio ......................................................................... 99936 0.8874 0.8658 ¥2.43 

36840 ................ Warren County, Ohio ....................................................................... 17140 0.9675 0.9601 ¥0.76 

36850 ................ Washington County, Ohio ................................................................ 37620 0.8270 0.7977 ¥3.54 

36860 ................ Wayne County, Ohio ........................................................................ 99936 0.8874 0.8658 ¥2.43 

36870 ................ Williams County, Ohio ...................................................................... 99936 0.8874 0.8658 ¥2.43 

36880 ................ Wood County, Ohio .......................................................................... 45780 0.9574 0.9586 0.13 

36890 ................ Wyandot County, Ohio ..................................................................... 99936 0.8874 0.8658 ¥2.43 

37000 ................ Adair County, Oklahoma .................................................................. 99937 0.7512 0.7629 1.56 

37010 ................ Alfalfa County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37020 ................ Atoka County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37030 ................ Beaver County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 

37040 ................ Beckham County, Oklahoma ........................................................... 99937 0.7512 0.7629 1.56 

37050 ................ Blaine County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37060 ................ Bryan County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37070 ................ Caddo County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37080 ................ Canadian County, Oklahoma ........................................................... 36420 0.9028 0.8843 ¥2.05 

37090 ................ Carter County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37100 ................ Cherokee County, Oklahoma ........................................................... 99937 0.7512 0.7629 1.56 

37110 ................ Choctaw County, Oklahoma ............................................................ 99937 0.7512 0.7629 1.56 

37120 ................ Cimarron County, Oklahoma ............................................................ 99937 0.7512 0.7629 1.56 

37130 ................ Cleveland County, Oklahoma .......................................................... 36420 0.9028 0.8843 ¥2.05 

37140 ................ Coal County, Oklahoma ................................................................... 99937 0.7512 0.7629 1.56 

37150 ................ Comanche County, Oklahoma ......................................................... 30020 0.7872 0.8065 2.45

37160 ................ Cotton County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37170 ................ Craig County, Oklahoma .................................................................. 99937 0.7512 0.7629 1.56 

37180 ................ Creek County, Oklahoma ................................................................. 46140 0.8565 0.8103 ¥5.39 

37190 ................ Custer County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37200 ................ Delaware County, Oklahoma ........................................................... 99937 0.7512 0.7629 1.56 

37210 ................ Dewey County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 

37220 ................ Ellis County, Oklahoma .................................................................... 99937 0.7512 0.7629 1.56 

37230 ................ Garfield County, Oklahoma .............................................................. 99937 0.8124 0.7629 ¥6.09 

37240 ................ Garvin County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37250 ................ Grady County, Oklahoma ................................................................. 36420 0.8237 0.8843 7.36 

37260 ................ Grant County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37270 ................ Greer County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37280 ................ Harmon County, Oklahoma .............................................................. 99937 0.7512 0.7629 1.56 

37290 ................ Harper County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 

37300 ................ Haskell County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 

37310 ................ Hughes County, Oklahoma .............................................................. 99937 0.7512 0.7629 1.56 

37320 ................ Jackson County, Oklahoma ............................................................. 99937 0.7512 0.7629 1.56 

37330 ................ Jefferson County, Oklahoma ............................................................ 99937 0.7512 0.7629 1.56 

37340 ................ Johnston County, Oklahoma ............................................................ 99937 0.7512 0.7629 1.56 

37350 ................ Kay County, Oklahoma .................................................................... 99937 0.7512 0.7629 1.56 

37360 ................ Kingfisher County, Oklahoma .......................................................... 99937 0.7512 0.7629 1.56 

37370 ................ Kiowa County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37380 ................ Latimer County, Oklahoma .............................................................. 99937 0.7512 0.7629 1.56 

37390 ................ Le Flore County, Oklahoma ............................................................. 22900 0.7836 0.7731 ¥1.34 

37400 ................ Lincoln County, Oklahoma ............................................................... 36420 0.8237 0.8843 7.36 

37410 ................ Logan County, Oklahoma ................................................................ 36420 0.9028 0.8843 ¥2.05 

37420 ................ Love County, Oklahoma ................................................................... 99937 0.7512 0.7629 1.56 

37430 ................ Mc Clain County, Oklahoma ............................................................ 36420 0.9028 0.8843 ¥2.05 

37440 ................ Mc Curtain County, Oklahoma ......................................................... 99937 0.7512 0.7629 1.56 

37450 ................ Mc Intosh County, Oklahoma ........................................................... 99937 0.7512 0.7629 1.56 

37460 ................ Major County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37470 ................ Marshall County, Oklahoma ............................................................. 99937 0.7512 0.7629 1.56 

37480 ................ Mayes County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37490 ................ Murray County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65991 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

37500 ................ Muskogee County, Oklahoma .......................................................... 99937 0.7512 0.7629 1.56 

37510 ................ Noble County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37520 ................ Nowata County, Oklahoma .............................................................. 99937 0.7512 0.7629 1.56 

37530 ................ Okfuskee County, Oklahoma ........................................................... 99937 0.7512 0.7629 1.56 

37540 ................ Oklahoma County, Oklahoma .......................................................... 36420 0.9028 0.8843 ¥2.05 

37550 ................ Okmulgee County, Oklahoma .......................................................... 46140 0.7993 0.8103 1.38 

37560 ................ Osage County, Oklahoma ................................................................ 46140 0.8565 0.8103 ¥5.39 

37570 ................ Ottawa County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 

37580 ................ Pawnee County, Oklahoma ............................................................. 46140 0.7993 0.8103 1.38 

37590 ................ Payne County, Oklahoma ................................................................ 99937 0.7512 0.7629 1.56 

37600 ................ Pittsburg County, Oklahoma ............................................................ 99937 0.7512 0.7629 1.56 

37610 ................ Pontotoc County, Oklahoma ............................................................ 99937 0.7512 0.7629 1.56 

37620 ................ Pottawatomie County, Oklahoma ..................................................... 99937 0.8303 0.7629 ¥8.12 

37630 ................ Pushmataha County, Oklahoma ...................................................... 99937 0.7512 0.7629 1.56 

37640 ................ Roger Mills County, Oklahoma ........................................................ 99937 0.7512 0.7629 1.56 

37650 ................ Rogers County, Oklahoma ............................................................... 46140 0.8565 0.8103 ¥5.39 

37660 ................ Seminole County, Oklahoma ........................................................... 99937 0.7512 0.7629 1.56 

37670 ................ Sequoyah County, Oklahoma .......................................................... 22900 0.8238 0.7731 ¥6.15 

37680 ................ Stephens County, Oklahoma ........................................................... 99937 0.7512 0.7629 1.56 

37690 ................ Texas County, Oklahoma ................................................................. 99937 0.7512 0.7629 1.56 

37700 ................ Tillman County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 

37710 ................ Tulsa County, Oklahoma .................................................................. 46140 0.8565 0.8103 ¥5.39 

37720 ................ Wagoner County, Oklahoma ............................................................ 46140 0.8565 0.8103 ¥5.39 

37730 ................ Washington County, Oklahoma ....................................................... 99937 0.7512 0.7629 1.56

37740 ................ Washita County, Oklahoma ............................................................. 99937 0.7512 0.7629 1.56 

37750 ................ Woods County, Oklahoma ............................................................... 99937 0.7512 0.7629 1.56 

37760 ................ Woodward County, Oklahoma ......................................................... 99937 0.7512 0.7629 1.56

38000 ................ Baker County, Oregon ..................................................................... 99938 0.9939 0.9753 ¥1.87 

38010 ................ Benton County, Oregon ................................................................... 18700 1.0729 1.1546 7.61 

38020 ................ Clackamas County, Oregon ............................................................. 38900 1.1266 1.1416 1.33 

38030 ................ Clatsop County, Oregon ................................................................... 99938 0.9939 0.9753 ¥1.87 

38040 ................ Columbia County, Oregon ................................................................ 38900 1.1266 1.1416 1.33 

38050 ................ Coos County, Oregon ...................................................................... 99938 0.9939 0.9753 ¥1.87 

38060 ................ Crook County, Oregon ..................................................................... 99938 0.9939 0.9753 ¥1.87 

38070 ................ Curry County, Oregon ...................................................................... 99938 0.9939 0.9753 ¥1.87 

38080 ................ Deschutes County, Oregon .............................................................. 13460 1.0419 1.0743 3.11 

38090 ................ Douglas County, Oregon .................................................................. 99938 0.9939 0.9753 ¥1.87 

38100 ................ Gilliam County, Oregon .................................................................... 99938 0.9939 0.9753 ¥1.87 

38110 ................ Grant County, Oregon ...................................................................... 99938 0.9939 0.9753 ¥1.87 

38120 ................ Harney County, Oregon ................................................................... 99938 0.9939 0.9753 ¥1.87 

38130 ................ Hood River County, Oregon ............................................................. 99938 0.9939 0.9753 ¥1.87 

38140 ................ Jackson County, Oregon .................................................................. 32780 1.0225 1.0818 5.80 

38150 ................ Jefferson County, Oregon ................................................................ 99938 0.9939 0.9753 ¥1.87 

38160 ................ Josephine County, Oregon .............................................................. 99938 0.9939 0.9753 ¥1.87 

38170 ................ Klamath County, Oregon .................................................................. 99938 0.9939 0.9753 ¥1.87 

38180 ................ Lake County, Oregon ....................................................................... 99938 0.9939 0.9753 ¥1.87 

38190 ................ Lane County, Oregon ....................................................................... 21660 1.0818 1.0876 0.54 

38200 ................ Lincoln County, Oregon ................................................................... 99938 0.9939 0.9753 ¥1.87 

38210 ................ Linn County, Oregon ........................................................................ 99938 0.9939 0.9753 ¥1.87 

38220 ................ Malheur County, Oregon .................................................................. 99938 0.9939 0.9753 ¥1.87 

38230 ................ Marion County, Oregon .................................................................... 41420 1.0442 1.0438 ¥0.04 

38240 ................ Morrow County, Oregon ................................................................... 99938 0.9939 0.9753 ¥1.87 

38250 ................ Multnomah County, Oregon ............................................................. 38900 1.1266 1.1416 1.33 

38260 ................ Polk County, Oregon ........................................................................ 41420 1.0442 1.0438 ¥0.04 

38270 ................ Sherman County, Oregon ................................................................ 99938 0.9939 0.9753 ¥1.87 

38280 ................ Tillamook County, Oregon ............................................................... 99938 0.9939 0.9753 ¥1.87 

38290 ................ Umatilla County, Oregon .................................................................. 99938 0.9939 0.9753 ¥1.87 

38300 ................ Union County, Oregon ..................................................................... 99938 0.9939 0.9753 ¥1.87 

38310 ................ Wallowa County, Oregon ................................................................. 99938 0.9939 0.9753 ¥1.87 

38320 ................ Wasco County, Oregon .................................................................... 99938 0.9939 0.9753 ¥1.87 

38330 ................ Washington County, Oregon ............................................................ 38900 1.1266 1.1416 1.33 

38340 ................ Wheeler County, Oregon ................................................................. 99938 0.9939 0.9753 ¥1.87 

38350 ................ Yamhill County, Oregon ................................................................... 38900 1.1266 1.1416 1.33 

39000 ................ Adams County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39010 ................ Allegheny County, Pennsylvania ...................................................... 38300 0.8853 0.8674 ¥2.02 

39070 ................ Armstrong County, Pennsylvania ..................................................... 38300 0.8582 0.8674 1.07 

39080 ................ Beaver County, Pennsylvania .......................................................... 38300 0.8853 0.8674 ¥2.02 

39100 ................ Bedford County, Pennsylvania ......................................................... 99939 0.8305 0.8320 0.18 


rmajette on PROD1PC67 with RULES2
65992 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

39110 ................ Berks County, Pennsylvania ............................................................ 39740 0.9686 0.9622 ¥0.66 

39120 ................ Blair County, Pennsylvania .............................................................. 11020 0.8944 0.8812 ¥1.48 

39130 ................ Bradford County, Pennsylvania ........................................................ 99939 0.8305 0.8320 0.18 

39140 ................ Bucks County, Pennsylvania ............................................................ 37964 1.0980 1.0996 0.15 

39150 ................ Butler County, Pennsylvania ............................................................ 38300 0.8853 0.8674 ¥2.02 

39160 ................ Cambria County, Pennsylvania ........................................................ 27780 0.8220 0.8620 4.87 

39180 ................ Cameron County, Pennsylvania ....................................................... 99939 0.8305 0.8320 0.18 

39190 ................ Carbon County, Pennsylvania .......................................................... 10900 0.9832 0.9947 1.17 

39200 ................ Centre County, Pennsylvania ........................................................... 44300 0.8356 0.8784 5.12 

39210 ................ Chester County, Pennsylvania ......................................................... 37964 1.0980 1.0996 0.15 

39220 ................ Clarion County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39230 ................ Clearfield County, Pennsylvania ...................................................... 99939 0.8305 0.8320 0.18 

39240 ................ Clinton County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39250 ................ Columbia County, Pennsylvania ...................................................... 99939 0.8408 0.8320 ¥1.05 

39260 ................ Crawford County, Pennsylvania ....................................................... 99939 0.8305 0.8320 0.18 

39270 ................ Cumberland County, Pennsylvania .................................................. 25420 0.9273 0.9402 1.39 

39280 ................ Dauphin County, Pennsylvania ........................................................ 25420 0.9273 0.9402 1.39 

39290 ................ Delaware County, Pennsylvania ...................................................... 37964 1.0980 1.0996 0.15 

39310 ................ Elk County, Pennsylvania ................................................................ 99939 0.8305 0.8320 0.18 

39320 ................ Erie County, Pennsylvania ............................................................... 21500 0.8737 0.8827 1.03 

39330 ................ Fayette County, Pennsylvania ......................................................... 38300 0.8853 0.8674 ¥2.02 

39340 ................ Forest County, Pennsylvania ........................................................... 99939 0.8305 0.8320 0.18 

39350 ................ Franklin County, Pennsylvania ......................................................... 99939 0.8305 0.8320 0.18 

39360 ................ Fulton County, Pennsylvania ........................................................... 99939 0.8305 0.8320 0.18 

39370 ................ Greene County, Pennsylvania ......................................................... 99939 0.8305 0.8320 0.18 

39380 ................ Huntingdon County, Pennsylvania ................................................... 99939 0.8305 0.8320 0.18

39390 ................ Indiana County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39400 ................ Jefferson County, Pennsylvania ....................................................... 99939 0.8305 0.8320 0.18 

39410 ................ Juniata County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39420 ................ Lackawanna County, Pennsylvania ................................................. 42540 0.8532 0.8347 ¥2.17 

39440 ................ Lancaster County, Pennsylvania ...................................................... 29540 0.9694 0.9589 ¥1.08 

39450 ................ Lawrence County, Pennsylvania ...................................................... 99939 0.8305 0.8320 0.18 

39460 ................ Lebanon County, Pennsylvania ....................................................... 30140 0.8846 0.8679 ¥1.89 

39470 ................ Lehigh County, Pennsylvania ........................................................... 10900 0.9832 0.9947 1.17 

39480 ................ Luzerne County, Pennsylvania ........................................................ 42540 0.8532 0.8347 ¥2.17 

39510 ................ Lycoming County, Pennsylvania ...................................................... 48700 0.8364 0.8139 ¥2.69 

39520 ................ Mc Kean County, Pennsylvania ....................................................... 99939 0.8305 0.8320 0.18 

39530 ................ Mercer County, Pennsylvania .......................................................... 49660 0.8198 0.8802 7.37 

39540 ................ Mifflin County, Pennsylvania ............................................................ 99939 0.8305 0.8320 0.18 

39550 ................ Monroe County, Pennsylvania ......................................................... 99939 0.8305 0.8320 0.18 

39560 ................ Montgomery County, Pennsylvania ................................................. 37964 1.0980 1.0996 0.15 

39580 ................ Montour County, Pennsylvania ........................................................ 99939 0.8305 0.8320 0.18 

90 Nor ............... thampton County, Pennsylvania ...................................................... 10900 0.9832 0.9947 1.17 

39600 ................ Northumberland County, Pennsylvania ............................................ 99939 0.8305 0.8320 0.18 

39610 ................ Perry County, Pennsylvania ............................................................. 25420 0.9273 0.9402 1.39 

39620 ................ Philadelphia County, Pennsylvania .................................................. 37964 1.0980 1.0996 0.15 

39630 ................ Pike County, Pennsylvania .............................................................. 35084 1.1545 1.1892 3.01 

39640 ................ Potter County, Pennsylvania ............................................................ 99939 0.8305 0.8320 0.18 

39650 ................ Schuylkill County, Pennsylvania ...................................................... 99939 0.8305 0.8320 0.18 

39670 ................ Snyder County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39680 ................ Somerset County, Pennsylvania ...................................................... 99939 0.8189 0.8320 1.60 

39690 ................ Sullivan County, Pennsylvania ......................................................... 99939 0.8305 0.8320 0.18 

39700 ................ Susquehanna County, Pennsylvania ............................................... 99939 0.8305 0.8320 0.18 

39710 ................ Tioga County, Pennsylvania ............................................................ 99939 0.8305 0.8320 0.18 

39720 ................ Union County, Pennsylvania ............................................................ 99939 0.8305 0.8320 0.18 

39730 ................ Venango County, Pennsylvania ....................................................... 99939 0.8305 0.8320 0.18 

39740 ................ Warren County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39750 ................ Washington County, Pennsylvania .................................................. 38300 0.8853 0.8674 ¥2.02 

39760 ................ Wayne County, Pennsylvania .......................................................... 99939 0.8305 0.8320 0.18 

39770 ................ Westmoreland County, Pennsylvania .............................................. 38300 0.8853 0.8674 ¥2.02 

39790 ................ Wyoming County, Pennsylvania ...................................................... 42540 0.8532 0.8347 ¥2.17 

39800 ................ York County, Pennsylvania .............................................................. 49620 0.9347 0.9397 0.53 

40010 ................ Adjuntas County, Puerto Rico .......................................................... 99940 0.3826 0.4047 5.78 

40020 ................ Aguada County, Puerto Rico ........................................................... 10380 0.4807 0.3915 ¥18.56 

40030 ................ Aguadilla County, Puerto Rico ......................................................... 10380 0.4807 0.3915 ¥18.56 

40040 ................ Aguas Buenas County, Puerto Rico ................................................ 41980 0.4687 0.4452 ¥5.01 

40050 ................ Aibonito County, Puerto Rico ........................................................... 41980 0.4113 0.4452 8.24 

40060 ................ Anasco County, Puerto Rico ............................................................ 10380 0.4491 0.3915 ¥12.83 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65993 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

40070 ................ Arecibo County, Puerto Rico ............................................................ 41980 0.4367 0.4452 1.95 

40080 ................ Arroyo County, Puerto Rico ............................................................. 25020 0.3393 0.3235 ¥4.66 

40090 ................ Barceloneta County, Puerto Rico ..................................................... 41980 0.4687 0.4452 ¥5.01 

40100 ................ Barranquitas County, Puerto Rico ................................................... 41980 0.4113 0.4452 8.24 

40110 ................ Bayamon County, Puerto Rico ......................................................... 41980 0.4687 0.4452 ¥5.01 

40120 ................ Cabo Rojo County, Puerto Rico ....................................................... 41900 0.4447 0.4885 9.85 

40130 ................ Caguas County, Puerto Rico ........................................................... 41980 0.4371 0.4452 1.85 

40140 ................ Camuy County, Puerto Rico ............................................................ 41980 0.4367 0.4452 1.95 

40145 ................ Canovanas County, Puerto Rico ...................................................... 41980 0.4687 0.4452 ¥5.01 

40150 ................ Carolina County, Puerto Rico .......................................................... 41980 0.4687 0.4452 ¥5.01 

40160 ................ Catano County, Puerto Rico ............................................................ 41980 0.4687 0.4452 ¥5.01 

40170 ................ Cayey County, Puerto Rico .............................................................. 41980 0.4371 0.4452 1.85 

40180 ................ Ceiba County, Puerto Rico .............................................................. 21940 0.4453 0.4036 ¥9.36 

40190 ................ Ciales County, Puerto Rico .............................................................. 41980 0.4113 0.4452 8.24 

40200 ................ Cidra County, Puerto Rico ............................................................... 41980 0.4371 0.4452 1.85 

40210 ................ Coamo County, Puerto Rico ............................................................ 99940 0.3826 0.4047 5.78 

40220 ................ Comerio County, Puerto Rico .......................................................... 41980 0.4687 0.4452 ¥5.01 

40230 ................ Corozal County, Puerto Rico ........................................................... 41980 0.4687 0.4452 ¥5.01 

40240 ................ Culebra County, Puerto Rico ........................................................... 99940 0.3826 0.4047 5.78 

40250 ................ Dorado County, Puerto Rico ............................................................ 41980 0.4687 0.4452 ¥5.01 

40260 ................ Fajardo County, Puerto Rico ............................................................ 21940 0.4453 0.4036 ¥9.36 

40265 ................ Florida County, Puerto Rico ............................................................. 41980 0.4687 0.4452 ¥5.01 

40270 ................ Guanica County, Puerto Rico .......................................................... 49500 0.4006 0.3854 ¥3.79 

40280 ................ Guayama County, Puerto Rico ........................................................ 25020 0.3393 0.3235 ¥4.66 

40290 ................ Guayanilla County, Puerto Rico ....................................................... 49500 0.4645 0.3854 ¥17.03 

40300 ................ Guaynabo County, Puerto Rico ....................................................... 41980 0.4687 0.4452 ¥5.01 

40310 ................ Gurabo County, Puerto Rico ............................................................ 41980 0.4371 0.4452 1.85 

40320 ................ Hatillo County, Puerto Rico .............................................................. 41980 0.4367 0.4452 1.95 

40330 ................ Hormigueros County, Puerto Rico ................................................... 32420 0.4132 0.3848 ¥6.87 

40340 ................ Humacao County, Puerto Rico ........................................................ 41980 0.4687 0.4452 ¥5.01 

40350 ................ Isabela County, Puerto Rico ............................................................ 10380 0.4171 0.3915 ¥6.14 

40360 ................ Jayuya County, Puerto Rico ............................................................ 99940 0.3826 0.4047 5.78 

40370 ................ Juana Diaz County, Puerto Rico ...................................................... 38660 0.4910 0.4842 ¥1.38 

40380 ................ Juncos County, Puerto Rico ............................................................ 41980 0.4687 0.4452 ¥5.01 

40390 ................ Lajas County, Puerto Rico ............................................................... 41900 0.4127 0.4885 18.37 

40400 ................ Lares County, Puerto Rico ............................................................... 10380 0.4171 0.3915 ¥6.14 

40410 ................ Las Marias County, Puerto Rico ...................................................... 99940 0.3826 0.4047 5.78 

40420 ................ Las Piedras County, Puerto Rico ..................................................... 41980 0.4687 0.4452 ¥5.01 

40430 ................ Loiza County, Puerto Rico ............................................................... 41980 0.4687 0.4452 ¥5.01 

40440 ................ Luquillo County, Puerto Rico ........................................................... 21940 0.4453 0.4036 ¥9.36 

40450 ................ Manati County, Puerto Rico ............................................................. 41980 0.4687 0.4452 ¥5.01 

40460 ................ Maricao County, Puerto Rico ........................................................... 99940 0.3826 0.4047 5.78 

40470 ................ Maunabo County, Puerto Rico ......................................................... 41980 0.4113 0.4452 8.24 

40480 ................ Mayaguez County, Puerto Rico ....................................................... 32420 0.4132 0.3848 ¥6.87 

40490 ................ Moca County, Puerto Rico ............................................................... 10380 0.4807 0.3915 ¥18.56 

40500 ................ Morovis County, Puerto Rico ........................................................... 41980 0.4687 0.4452 ¥5.01 

40510 ................ Naguabo County, Puerto Rico ......................................................... 41980 0.4687 0.4452 ¥5.01 

40520 ................ Naranjito County, Puerto Rico ......................................................... 41980 0.4687 0.4452 ¥5.01 

40530 ................ Orocovis County, Puerto Rico .......................................................... 41980 0.4113 0.4452 8.24 

40540 ................ Patillas County, Puerto Rico ............................................................ 25020 0.3393 0.3235 ¥4.66 

40550 ................ Penuelas County, Puerto Rico ......................................................... 49500 0.4645 0.3854 ¥17.03 

40560 ................ Ponce County, Puerto Rico .............................................................. 38660 0.4910 0.4842 ¥1.38 

40570 ................ Quebradillas County, Puerto Rico .................................................... 41980 0.4113 0.4452 8.24 

40580 ................ Rincon County, Puerto Rico ............................................................. 10380 0.4171 0.3915 ¥6.14 

40590 ................ Rio Grande County, Puerto Rico ..................................................... 41980 0.4687 0.4452 ¥5.01 

40610 ................ Sabana Grande County, Puerto Rico .............................................. 41900 0.4447 0.4885 9.85 

40620 ................ Salinas County, Puerto Rico ............................................................ 99940 0.3826 0.4047 5.78 

40630 ................ San German County, Puerto Rico ................................................... 41900 0.4447 0.4885 9.85 

40640 ................ San Juan County, Puerto Rico ........................................................ 41980 0.4687 0.4452 ¥5.01 

40650 ................ San Lorenzo County, Puerto Rico ................................................... 41980 0.4371 0.4452 1.85

40660 ................ San Sebastian County, Puerto Rico ................................................ 10380 0.4171 0.3915 ¥6.14 

40670 ................ Santa Isabel County, Puerto Rico .................................................... 99940 0.3826 0.4047 5.78 

40680 ................ Toa Alta County, Puerto Rico .......................................................... 41980 0.4687 0.4452 ¥5.01 

40690 ................ Toa Baja County, Puerto Rico ......................................................... 41980 0.4687 0.4452 ¥5.01 

40700 ................ Trujillo Alto County, Puerto Rico ...................................................... 41980 0.4687 0.4452 ¥5.01 

40710 ................ Utuado County, Puerto Rico ............................................................ 99940 0.3826 0.4047 5.78 

40720 ................ Vega Alta County, Puerto Rico ........................................................ 41980 0.4687 0.4452 ¥5.01 

40730 ................ Vega Baja County, Puerto Rico ....................................................... 41980 0.4687 0.4452 ¥5.01 


rmajette on PROD1PC67 with RULES2
65994 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

40740 ................ Vieques County, Puerto Rico ........................................................... 99940 0.3826 0.4047 5.78 

40750 ................ Villalba County, Puerto Rico ............................................................ 38660 0.4910 0.4842 ¥1.38 

40760 ................ Yabucoa County, Puerto Rico .......................................................... 41980 0.4687 0.4452 ¥5.01 

40770 ................ Yauco County, Puerto Rico .............................................................. 49500 0.4645 0.3854 ¥17.03 

41000 ................ Bristol County, Rhode Island ........................................................... 39300 1.1012 1.0783 ¥2.08 

41010 ................ Kent County, Rhode Island .............................................................. 39300 1.1012 1.0783 ¥2.08 

41020 ................ Newport County, Rhode Island ........................................................ 39300 1.1012 1.0783 ¥2.08 

41030 ................ Providence County, Rhode Island ................................................... 39300 1.1012 1.0783 ¥2.08 

41050 ................ Washington County, Rhode Island .................................................. 39300 1.1012 1.0783 ¥2.08 

42000 ................ Abbeville County, S Carolina ........................................................... 99942 0.8635 0.8566 ¥0.80 

42010 ................ Aiken County, S Carolina ................................................................. 12260 0.9778 0.9667 ¥1.14 

42020 ................ Allendale County, S Carolina ........................................................... 99942 0.8635 0.8566 ¥0.80 

42030 ................ Anderson County, S Carolina .......................................................... 11340 0.9306 0.9017 ¥3.11 

42040 ................ Bamberg County, S Carolina ........................................................... 99942 0.8635 0.8566 ¥0.80 

42050 ................ Barnwell County, S Carolina ............................................................ 99942 0.8635 0.8566 ¥0.80 

42060 ................ Beaufort County, S Carolina ............................................................ 99942 0.8635 0.8566 ¥0.80 

42070 ................ Berkeley County, S Carolina ............................................................ 16700 0.9245 0.9145 ¥1.08 

42080 ................ Calhoun County, S Carolina ............................................................ 17900 0.8844 0.8933 1.01 

42090 ................ Charleston County, S Carolina ........................................................ 16700 0.9245 0.9145 ¥1.08 

42100 ................ Cherokee County, S Carolina .......................................................... 99942 0.9127 0.8566 ¥6.15 

42110 ................ Chester County, S Carolina ............................................................. 99942 0.8635 0.8566 ¥0.80 

42120 ................ Chesterfield County, S Carolina ....................................................... 99942 0.8635 0.8566 ¥0.80 

42130 ................ Clarendon County, S Carolina ......................................................... 99942 0.8635 0.8566 ¥0.80 

42140 ................ Colleton County, S Carolina ............................................................. 99942 0.8635 0.8566 ¥0.80 

42150 ................ Darlington County, S Carolina ......................................................... 22500 0.8789 0.8388 ¥4.56 

42160 ................ Dillon County, S Carolina ................................................................. 99942 0.8635 0.8566 ¥0.80 

42170 ................ Dorchester County, S Carolina ........................................................ 16700 0.9245 0.9145 ¥1.08 

42180 ................ Edgefield County, S Carolina ........................................................... 12260 0.9778 0.9667 ¥1.14 

42190 ................ Fairfield County, S Carolina ............................................................. 17900 0.8844 0.8933 1.01 

42200 ................ Florence County, S Carolina ............................................................ 22500 0.8995 0.8388 ¥6.75 

42210 ................ Georgetown County, S Carolina ...................................................... 99942 0.8635 0.8566 ¥0.80 

42220 ................ Greenville County, S Carolina .......................................................... 24860 0.9821 0.9804 ¥0.17 

42230 ................ Greenwood County, S Carolina ....................................................... 99942 0.8635 0.8566 ¥0.80 

42240 ................ Hampton County, S Carolina ........................................................... 99942 0.8635 0.8566 ¥0.80 

42250 ................ Horry County, S Carolina ................................................................. 34820 0.8934 0.8810 ¥1.39 

42260 ................ Jasper County, S Carolina ............................................................... 99942 0.8635 0.8566 ¥0.80 

42270 ................ Kershaw County, S Carolina ............................................................ 17900 0.8844 0.8933 1.01 

42280 ................ Lancaster County, S Carolina .......................................................... 99942 0.8635 0.8566 ¥0.80 

42290 ................ Laurens County, S Carolina ............................................................. 24860 0.9329 0.9804 5.09 

42300 ................ Lee County, S Carolina .................................................................... 99942 0.8635 0.8566 ¥0.80 

42310 ................ Lexington County, S Carolina .......................................................... 17900 0.9070 0.8933 ¥1.51 

42320 ................ Mc Cormick County, S Carolina ....................................................... 99942 0.8635 0.8566 ¥0.80 

42330 ................ Marion County, S Carolina ............................................................... 99942 0.8635 0.8566 ¥0.80 

42340 ................ Marlboro County, S Carolina ............................................................ 99942 0.8635 0.8566 ¥0.80 

42350 ................ Newberry County, S Carolina .......................................................... 99942 0.8635 0.8566 ¥0.80 

42360 ................ Oconee County, S Carolina ............................................................. 99942 0.8635 0.8566 ¥0.80 

42370 ................ Orangeburg County, S Carolina ....................................................... 99942 0.8635 0.8566 ¥0.80 

42380 ................ Pickens County, S Carolina ............................................................. 24860 0.9821 0.9804 ¥0.17 

42390 ................ Richland County, S Carolina ............................................................ 17900 0.9070 0.8933 ¥1.51 

42400 ................ Saluda County, S Carolina ............................................................... 17900 0.8844 0.8933 1.01 

42410 ................ Spartanburg County, S Carolina ...................................................... 43900 0.9394 0.9174 ¥2.34 

42420 ................ Sumter County, S Carolina .............................................................. 44940 0.8377 0.8083 ¥3.51 

42430 ................ Union County, S Carolina ................................................................ 99942 0.8635 0.8566 ¥0.80 

42440 ................ Williamsburg County, S Carolina ..................................................... 99942 0.8635 0.8566 ¥0.80 

42450 ................ York County, S Carolina .................................................................. 16740 0.9733 0.9554 ¥1.84 

43010 ................ Aurora County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43020 ................ Beadle County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43030 ................ Bennett County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43040 ................ Bon Homme County, S Dakota ........................................................ 99943 0.8556 0.8480 ¥0.89 

43050 ................ Brookings County, S Dakota ............................................................ 99943 0.8556 0.8480 ¥0.89 

43060 ................ Brown County, S Dakota .................................................................. 99943 0.8556 0.8480 ¥0.89 

43070 ................ Brule County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43080 ................ Buffalo County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43090 ................ Butte County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43100 ................ Campbell County, S Dakota ............................................................. 99943 0.8556 0.8480 ¥0.89 

43110 ................ Charles Mix County, S Dakota ......................................................... 99943 0.8556 0.8480 ¥0.89 

43120 ................ Clark County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43130 ................ Clay County, S Dakota ..................................................................... 99943 0.8556 0.8480 ¥0.89 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65995 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

43140 ................ Codington County, S Dakota ........................................................... 99943 0.8556 0.8480 ¥0.89 

43150 ................ Corson County, S Dakota ................................................................ 99943 0.8556 0.8480 ¥0.89 

43160 ................ Custer County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43170 ................ Davison County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43180 ................ Day County, S Dakota ..................................................................... 99943 0.8556 0.8480 ¥0.89 

43190 ................ Deuel County, S Dakota .................................................................. 99943 0.8556 0.8480 ¥0.89 

43200 ................ Dewey County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43210 ................ Douglas County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43220 ................ Edmunds County, S Dakota ............................................................. 99943 0.8556 0.8480 ¥0.89 

43230 ................ Fall River County, S Dakota ............................................................ 99943 0.8556 0.8480 ¥0.89 

43240 ................ Faulk County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43250 ................ Grant County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43260 ................ Gregory County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43270 ................ Haakon County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43280 ................ Hamlin County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43290 ................ Hand County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43300 ................ Hanson County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43310 ................ Harding County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43320 ................ Hughes County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43330 ................ Hutchinson County, S Dakota .......................................................... 99943 0.8556 0.8480 ¥0.89 

43340 ................ Hyde County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43350 ................ Jackson County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43360 ................ Jerauld County, S Dakota ................................................................ 99943 0.8556 0.8480 ¥0.89 

43370 ................ Jones County, S Dakota .................................................................. 99943 0.8556 0.8480 ¥0.89 

43380 ................ Kingsbury County, S Dakota ............................................................ 99943 0.8556 0.8480 ¥0.89 

43390 ................ Lake County, S Dakota .................................................................... 99943 0.8556 0.8480 ¥0.89 

43400 ................ Lawrence County, S Dakota ............................................................ 99943 0.8556 0.8480 ¥0.89 

43410 ................ Lincoln County, S Dakota ................................................................ 43620 0.9635 0.9559 ¥0.79 

43420 ................ Lyman County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43430 ................ Mc Cook County, S Dakota ............................................................. 43620 0.9093 0.9559 5.12 

43440 ................ Mc Pherson County, S Dakota ........................................................ 99943 0.8556 0.8480 ¥0.89 

43450 ................ Marshall County, S Dakota .............................................................. 99943 0.8556 0.8480 ¥0.89 

43460 ................ Meade County, S Dakota ................................................................. 39660 0.8769 0.8833 0.73 

43470 ................ Mellette County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43480 ................ Miner County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43490 ................ Minnehaha County, S Dakota .......................................................... 43620 0.9635 0.9559 ¥0.79 

43500 ................ Moody County, S Dakota ................................................................. 99943 0.8556 0.8480 ¥0.89 

43510 ................ Pennington County, S Dakota .......................................................... 39660 0.8987 0.8833 ¥1.71 

43520 ................ Perkins County, S Dakota ................................................................ 99943 0.8556 0.8480 ¥0.89 

43530 ................ Potter County, S Dakota .................................................................. 99943 0.8556 0.8480 ¥0.89 

43540 ................ Roberts County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43550 ................ Sanborn County, S Dakota .............................................................. 99943 0.8556 0.8480 ¥0.89 

43560 ................ Shannon County, S Dakota ............................................................. 99943 0.8556 0.8480 ¥0.89 

43570 ................ Spink County, S Dakota ................................................................... 99943 0.8556 0.8480 ¥0.89 

43580 ................ Stanley County, S Dakota ................................................................ 99943 0.8556 0.8480 ¥0.89 

43590 ................ Sully County, S Dakota .................................................................... 99943 0.8556 0.8480 ¥0.89 

43600 ................ Todd County, S Dakota .................................................................... 99943 0.8556 0.8480 ¥0.89 

43610 ................ Tripp County, S Dakota .................................................................... 99943 0.8556 0.8480 ¥0.89 

43620 ................ Turner County, S Dakota ................................................................. 43620 0.9093 0.9559 5.12 

43630 ................ Union County, S Dakota .................................................................. 43580 0.8966 0.9200 2.61 

43640 ................ Walworth County, S Dakota ............................................................. 99943 0.8556 0.8480 ¥0.89 

43650 ................ Washabaugh County, S Dakota ....................................................... 99943 0.8556 0.8480 ¥0.89 

43670 ................ Yankton County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

43680 ................ Ziebach County, S Dakota ............................................................... 99943 0.8556 0.8480 ¥0.89 

44000 ................ Anderson County, Tennessee .......................................................... 28940 0.8419 0.8249 ¥2.02 

44010 ................ Bedford County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44020 ................ Benton County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44030 ................ Bledsoe County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44040 ................ Blount County, Tennessee ............................................................... 28940 0.8419 0.8249 ¥2.02 

44050 ................ Bradley County, Tennessee ............................................................. 17420 0.8037 0.8109 0.90 

44060 ................ Campbell County, Tennessee .......................................................... 99944 0.7915 0.7827 ¥1.11 

44070 ................ Cannon County, Tennessee ............................................................ 34980 0.8838 0.9847 11.42 

44080 ................ Carroll County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44090 ................ Carter County, Tennessee ............................................................... 27740 0.7972 0.8043 0.89 

44100 ................ Cheatham County, Tennessee ........................................................ 34980 0.9751 0.9847 0.98

44110 ................ Chester County, Tennessee ............................................................ 27180 0.8964 0.8853 ¥1.24 

44120 ................ Claiborne County, Tennessee .......................................................... 99944 0.7915 0.7827 ¥1.11 

44130 ................ Clay County, Tennessee .................................................................. 99944 0.7915 0.7827 ¥1.11 


rmajette on PROD1PC67 with RULES2
65996 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

44140 ................ Cocke County, Tennessee ............................................................... 99944 0.7915 0.7827 ¥1.11 

44150 ................ Coffee County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44160 ................ Crockett County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44170 ................ Cumberland County, Tennessee ..................................................... 99944 0.7915 0.7827 ¥1.11 

44180 ................ Davidson County, Tennessee .......................................................... 34980 0.9751 0.9847 0.98 

44190 ................ Decatur County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44200 ................ De Kalb County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44210 ................ Dickson County, Tennessee ............................................................ 34980 0.9751 0.9847 0.98 

44220 ................ Dyer County, Tennessee ................................................................. 99944 0.7915 0.7827 ¥1.11 

44230 ................ Fayette County, Tennessee ............................................................. 32820 0.9407 0.9373 ¥0.36 

44240 ................ Fentress County, Tennessee ........................................................... 99944 0.7915 0.7827 ¥1.11 

44250 ................ Franklin County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44260 ................ Gibson County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44270 ................ Giles County, Tennessee ................................................................. 99944 0.7915 0.7827 ¥1.11 

44280 ................ Grainger County, Tennessee ........................................................... 34100 0.7948 0.7933 ¥0.19 

44290 ................ Greene County, Tennessee ............................................................. 99944 0.7915 0.7827 ¥1.11 

44300 ................ Grundy County, Tennessee ............................................................. 99944 0.7915 0.7827 ¥1.11 

44310 ................ Hamblen County, Tennessee ........................................................... 34100 0.7948 0.7933 ¥0.19 

44320 ................ Hamilton County, Tennessee ........................................................... 16860 0.9088 0.8948 ¥1.54 

44330 ................ Hancock County, Tennessee ........................................................... 99944 0.7915 0.7827 ¥1.11 

44340 ................ Hardeman County, Tennessee ........................................................ 99944 0.7915 0.7827 ¥1.11 

44350 ................ Hardin County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44360 ................ Hawkins County, Tennessee ........................................................... 28700 0.8031 0.7985 ¥0.57 

44370 ................ Haywood County, Tennessee .......................................................... 99944 0.7915 0.7827 ¥1.11 

44380 ................ Henderson County, Tennessee ....................................................... 99944 0.7915 0.7827 ¥1.11 

44390 ................ Henry County, Tennessee ............................................................... 99944 0.7915 0.7827 ¥1.11 

44400 ................ Hickman County, Tennessee ........................................................... 34980 0.8838 0.9847 11.42 

44410 ................ Houston County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44420 ................ Humphreys County, Tennessee ....................................................... 99944 0.7915 0.7827 ¥1.11 

44430 ................ Jackson County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44440 ................ Jefferson County, Tennessee .......................................................... 34100 0.7948 0.7933 ¥0.19 

44450 ................ Johnson County, Tennessee ........................................................... 99944 0.7915 0.7827 ¥1.11 

44460 ................ Knox County, Tennessee ................................................................. 28940 0.8419 0.8249 ¥2.02 

44470 ................ Lake County, Tennessee ................................................................. 99944 0.7915 0.7827 ¥1.11 

44480 ................ Lauderdale County, Tennessee ....................................................... 99944 0.7915 0.7827 ¥1.11 

44490 ................ Lawrence County, Tennessee ......................................................... 99944 0.7915 0.7827 ¥1.11 

44500 ................ Lewis County, Tennessee ................................................................ 99944 0.7915 0.7827 ¥1.11 

44510 ................ Lincoln County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44520 ................ Loudon County, Tennessee ............................................................. 28940 0.8419 0.8249 ¥2.02 

44530 ................ Mc Minn County, Tennessee ........................................................... 99944 0.7915 0.7827 ¥1.11 

44540 ................ Mc Nairy County, Tennessee ........................................................... 99944 0.7915 0.7827 ¥1.11 

44550 ................ Macon County, Tennessee .............................................................. 34980 0.8838 0.9847 11.42 

44560 ................ Madison County, Tennessee ........................................................... 27180 0.8964 0.8853 ¥1.24 

44570 ................ Marion County, Tennessee .............................................................. 16860 0.9088 0.8948 ¥1.54 

44580 ................ Marshall County, Tennessee ........................................................... 99944 0.7915 0.7827 ¥1.11 

44590 ................ Maury County, Tennessee ............................................................... 99944 0.7915 0.7827 ¥1.11 

44600 ................ Meigs County, Tennessee ............................................................... 99944 0.7915 0.7827 ¥1.11 

44610 ................ Monroe County, Tennessee ............................................................. 99944 0.7915 0.7827 ¥1.11 

44620 ................ Montgomery County, Tennessee ..................................................... 17300 0.8284 0.8436 1.83 

44630 ................ Moore County, Tennessee ............................................................... 99944 0.7915 0.7827 ¥1.11 

44640 ................ Morgan County, Tennessee ............................................................. 99944 0.7915 0.7827 ¥1.11 

44650 ................ Obion County, Tennessee ............................................................... 99944 0.7915 0.7827 ¥1.11 

44660 ................ Overton County, Tennessee ............................................................ 99944 0.7915 0.7827 ¥1.11 

44670 ................ Perry County, Tennessee ................................................................ 99944 0.7915 0.7827 ¥1.11 

44680 ................ Pickett County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44690 ................ Polk County, Tennessee .................................................................. 17420 0.8037 0.8109 0.90 

44700 ................ Putnam County, Tennessee ............................................................. 99944 0.7915 0.7827 ¥1.11 

44710 ................ Rhea County, Tennessee ................................................................ 99944 0.7915 0.7827 ¥1.11 

44720 ................ Roane County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44730 ................ Robertson County, Tennessee ........................................................ 34980 0.9751 0.9847 0.98 

44740 ................ Rutherford County, Tennessee ........................................................ 34980 0.9751 0.9847 0.98 

44750 ................ Scott County, Tennessee ................................................................. 99944 0.7915 0.7827 ¥1.11 

44760 ................ Sequatchie County, Tennessee ....................................................... 16860 0.8512 0.8948 5.12 

44770 ................ Sevier County, Tennessee ............................................................... 99944 0.8146 0.7827 ¥3.92 

44780 ................ Shelby County, Tennessee .............................................................. 32820 0.9407 0.9373 ¥0.36 

44790 ................ Smith County, Tennessee ................................................................ 34980 0.8838 0.9847 11.42 

44800 ................ Stewart County, Tennessee ............................................................. 17300 0.8110 0.8436 4.02 

44810 ................ Sullivan County, Tennessee ............................................................ 28700 0.8031 0.7985 ¥0.57 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65997 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

44820 ................ Sumner County, Tennessee ............................................................ 34980 0.9751 0.9847 0.98 

44830 ................ Tipton County, Tennessee ............................................................... 32820 0.9407 0.9373 ¥0.36 

44840 ................ Trousdale County, Tennessee ......................................................... 34980 0.8838 0.9847 11.42 

44850 ................ Unicoi County, Tennessee ............................................................... 27740 0.7972 0.8043 0.89 

44860 ................ Union County, Tennessee ................................................................ 28940 0.8419 0.8249 ¥2.02 

44870 ................ Van Buren County, Tennessee ........................................................ 99944 0.7915 0.7827 ¥1.11 

44880 ................ Warren County, Tennessee ............................................................. 99944 0.7915 0.7827 ¥1.11 

44890 ................ Washington County, Tennessee ...................................................... 27740 0.7972 0.8043 0.89

44900 ................ Wayne County, Tennessee .............................................................. 99944 0.7915 0.7827 ¥1.11 

44910 ................ Weakley County, Tennessee ........................................................... 99944 0.7915 0.7827 ¥1.11 

44920 ................ White County, Tennessee ................................................................ 99944 0.7915 0.7827 ¥1.11 

44930 ................ Williamson County, Tennessee ........................................................ 34980 0.9751 0.9847 0.98 

44940 ................ Wilson County, Tennessee .............................................................. 34980 0.9751 0.9847 0.98 

45000 ................ Anderson County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45010 ................ Andrews County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45020 ................ Angelina County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45030 ................ Aransas County, Texas .................................................................... 18580 0.8241 0.8564 3.92 

45040 ................ Archer County, Texas ...................................................................... 48660 0.8325 0.8311 ¥0.17 

45050 ................ Armstrong County, Texas ................................................................ 11100 0.8544 0.9169 7.32 

45060 ................ Atascosa County, Texas .................................................................. 41700 0.8456 0.8844 4.59 

45070 ................ Austin County, Texas ....................................................................... 26420 0.8962 1.0008 11.67 

45080 ................ Bailey County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45090 ................ Bandera County, Texas ................................................................... 41700 0.8456 0.8844 4.59 

45100 ................ Bastrop County, Texas ..................................................................... 12420 0.9437 0.9344 ¥0.99 

45110 ................ Baylor County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45113 ................ Bee County, Texas ........................................................................... 99945 0.7967 0.7965 ¥0.03 

45120 ................ Bell County, Texas ........................................................................... 28660 0.8526 0.8901 4.40 

45130 ................ Bexar County, Texas ........................................................................ 41700 0.8982 0.8844 ¥1.54 

45140 ................ Blanco County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45150 ................ Borden County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45160 ................ Bosque County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45170 ................ Bowie County, Texas ....................................................................... 45500 0.8283 0.8104 ¥2.16 

45180 ................ Brazoria County, Texas .................................................................... 26420 0.9278 1.0008 7.87 

45190 ................ Brazos County, Texas ...................................................................... 17780 0.8900 0.9045 1.63 

45200 ................ Brewster County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45201 ................ Briscoe County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45210 ................ Brooks County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45220 ................ Brown County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45221 ................ Burleson County, Texas ................................................................... 17780 0.8416 0.9045 7.47 

45222 ................ Burnet County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45223 ................ Caldwell County, Texas ................................................................... 12420 0.9437 0.9344 ¥0.99 

45224 ................ Calhoun County, Texas .................................................................... 47020 0.8046 0.8560 6.39 

45230 ................ Callahan County, Texas ................................................................... 10180 0.7914 0.8000 1.09 

45240 ................ Cameron County, Texas .................................................................. 15180 0.9804 0.9430 ¥3.81 

45250 ................ Camp County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45251 ................ Carson County, Texas ..................................................................... 11100 0.8544 0.9169 7.32 

45260 ................ Cass County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45270 ................ Castro County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45280 ................ Chambers County, Texas ................................................................ 26420 1.0040 1.0008 ¥0.32 

45281 ................ Cherokee County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45290 ................ Childress County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45291 ................ Clay County, Texas .......................................................................... 48660 0.8108 0.8311 2.50 

45292 ................ Cochran County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45300 ................ Coke County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45301 ................ Coleman County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45310 ................ Collin County, Texas ........................................................................ 19124 1.0217 1.0075 ¥1.39 

45311 ................ Collingsworth County, Texas ........................................................... 99945 0.7967 0.7965 ¥0.03 

45312 ................ Colorado County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45320 ................ Comal County, Texas ....................................................................... 41700 0.8982 0.8844 ¥1.54 

45321 ................ Comanche County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45330 ................ Concho County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45340 ................ Cooke County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45341 ................ Coryell County, Texas ...................................................................... 28660 0.8526 0.8901 4.40 

45350 ................ Cottle County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45360 ................ Crane County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45361 ................ Crockett County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45362 ................ Crosby County, Texas ...................................................................... 31180 0.8357 0.8613 3.06 

45370 ................ Culberson County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 


rmajette on PROD1PC67 with RULES2
65998 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

45380 ................ Dallam County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45390 ................ Dallas County, Texas ....................................................................... 19124 1.0217 1.0075 ¥1.39 

45391 ................ Dawson County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45392 ................ Deaf Smith County, Texas ............................................................... 99945 0.7967 0.7965 ¥0.03 

45400 ................ Delta County, Texas ......................................................................... 19124 0.9080 1.0075 10.96 

45410 ................ Denton County, Texas ..................................................................... 19124 1.0217 1.0075 ¥1.39 

45420 ................ De Witt County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45421 ................ Dickens County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45430 ................ Dimmit County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45431 ................ Donley County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45440 ................ Duval County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45450 ................ Eastland County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45451 ................ Ector County, Texas ......................................................................... 36220 0.9813 1.0073 2.65 

45460 ................ Edwards County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45470 ................ Ellis County, Texas .......................................................................... 19124 1.0217 1.0075 ¥1.39 

45480 ................ El Paso County, Texas .................................................................... 21340 0.8977 0.9053 0.85 

45490 ................ Erath County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45500 ................ Falls County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45510 ................ Fannin County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45511 ................ Fayette County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45520 ................ Fisher County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45521 ................ Floyd County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45522 ................ Foard County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45530 ................ Fort Bend County, Texas ................................................................. 26420 1.0040 1.0008 ¥0.32 

45531 ................ Franklin County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45540 ................ Freestone County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45541 ................ Frio County, Texas ........................................................................... 99945 0.7967 0.7965 ¥0.03 

45542 ................ Gaines County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45550 ................ Galveston County, Texas ................................................................. 26420 0.9814 1.0008 1.98 

45551 ................ Garza County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45552 ................ Gillespie County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45560 ................ Glasscock County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45561 ................ Goliad County, Texas ....................................................................... 47020 0.8046 0.8560 6.39 

45562 ................ Gonzales County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45563 ................ Gray County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45564 ................ Grayson County, Texas ................................................................... 43300 0.9507 0.8502 ¥10.57 

45570 ................ Gregg County, Texas ....................................................................... 30980 0.8809 0.8788 ¥0.24 

45580 ................ Grimes County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45581 ................ Guadaloupe County, Texas ............................................................. 41700 0.8982 0.8844 ¥1.54 

45582 ................ Hale County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45583 ................ Hall County, Texas ........................................................................... 99945 0.7967 0.7965 ¥0.03 

45590 ................ Hamilton County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45591 ................ Hansford County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45592 ................ Hardeman County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45600 ................ Hardin County, Texas ...................................................................... 13140 0.8412 0.8595 2.18 

45610 ................ Harris County, Texas ....................................................................... 26420 1.0040 1.0008 ¥0.32 

45620 ................ Harrison County, Texas ................................................................... 99945 0.8446 0.7965 ¥5.70 

45621 ................ Hartley County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45630 ................ Haskell County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45631 ................ Hays County, Texas ......................................................................... 12420 0.9437 0.9344 ¥0.99 

45632 ................ Hemphill County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45640 ................ Henderson County, Texas ............................................................... 99945 0.9104 0.7965 ¥12.51 

45650 ................ Hidalgo County, Texas ..................................................................... 32580 0.8934 0.8773 ¥1.80 

45651 ................ Hill County, Texas ............................................................................ 99945 0.7967 0.7965 ¥0.03 

45652 ................ Hockley County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45653 ................ Hood County, Texas ........................................................................ 99945 0.8763 0.7965 ¥9.11 

45654 ................ Hopkins County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45660 ................ Houston County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45661 ................ Howard County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45662 ................ Hudspeth County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45670 ................ Hunt County, Texas ......................................................................... 19124 1.0217 1.0075 ¥1.39 

45671 ................ Hutchinson County, Texas ............................................................... 99945 0.7967 0.7965 ¥0.03 

45672 ................ Irion County, Texas .......................................................................... 41660 0.8101 0.8362 3.22 

45680 ................ Jack County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45681 ................ Jackson County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45690 ................ Jasper County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45691 ................ Jeff Davis County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45700 ................ Jefferson County, Texas .................................................................. 13140 0.8412 0.8595 2.18 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 65999 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

45710 ................ Jim Hogg County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45711 ................ Jim Wells County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45720 ................ Johnson County, Texas ................................................................... 23104 0.9504 0.9569 0.68 

45721 ................ Jones County, Texas ....................................................................... 10180 0.7914 0.8000 1.09 

45722 ................ Karnes County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45730 ................ Kaufman County, Texas ................................................................... 19124 1.0217 1.0075 ¥1.39 

45731 ................ Kendall County, Texas ..................................................................... 41700 0.8456 0.8844 4.59 

45732 ................ Kenedy County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45733 ................ Kent County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45734 ................ Kerr County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45740 ................ Kimble County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45741 ................ King County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45742 ................ Kinney County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45743 ................ Kleberg County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45744 ................ Knox County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45750 ................ Lamar County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45751 ................ Lamb County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45752 ................ Lampasas County, Texas ................................................................ 28660 0.8229 0.8901 8.17 

45753 ................ La Salle County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45754 ................ Lavaca County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45755 ................ Lee County, Texas ........................................................................... 99945 0.7967 0.7965 ¥0.03 

45756 ................ Leon County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45757 ................ Liberty County, Texas ...................................................................... 26420 1.0040 1.0008 ¥0.32 

45758 ................ Limestone County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45759 ................ Lipscomb County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45760 ................ Live Oak County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45761 ................ Llano County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45762 ................ Loving County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45770 ................ Lubbock County, Texas ................................................................... 31180 0.8783 0.8613 ¥1.94 

45771 ................ Lynn County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45772 ................ Mc Culloch County, Texas ............................................................... 99945 0.7967 0.7965 ¥0.03 

45780 ................ Mc Lennan County, Texas ............................................................... 47380 0.8518 0.8633 1.35 

45781 ................ Mc Mullen County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45782 ................ Madison County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45783 ................ Marion County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45784 ................ Martin County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45785 ................ Mason County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45790 ................ Matagorda County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45791 ................ Maverick County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45792 ................ Medina County, Texas ..................................................................... 41700 0.8456 0.8844 4.59 

45793 ................ Menard County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45794 ................ Midland County, Texas .................................................................... 33260 0.9628 0.9786 1.64 

45795 ................ Milam County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45796 ................ Mills County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45797 ................ Mitchell County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45800 ................ Montague County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45801 ................ Montgomery County, Texas ............................................................. 26420 1.0040 1.0008 ¥0.32 

45802 ................ Moore County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45803 ................ Morris County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45804 ................ Motley County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45810 ................ Nacogdoches County, Texas ........................................................... 99945 0.7967 0.7965 ¥0.03 

45820 ................ Navarro County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45821 ................ Newton County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45822 ................ Nolan County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45830 ................ Nueces County, Texas ..................................................................... 18580 0.8550 0.8564 0.16 

45831 ................ Ochiltree County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45832 ................ Oldham County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45840 ................ Orange County, Texas ..................................................................... 13140 0.8412 0.8595 2.18 

45841 ................ Palo Pinto County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45842 ................ Panola County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45843 ................ Parker County, Texas ...................................................................... 23104 0.9504 0.9569 0.68 

45844 ................ Parmer County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45845 ................ Pecos County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45850 ................ Polk County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45860 ................ Potter County, Texas ....................................................................... 11100 0.9156 0.9169 0.14 

45861 ................ Presidio County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45870 ................ Rains County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45871 ................ Randall County, Texas ..................................................................... 11100 0.9156 0.9169 0.14 


rmajette on PROD1PC67 with RULES2
66000 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

45872 ................ Reagan County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45873 ................ Real County, Texas .......................................................................... 99945 0.7967 0.7965 ¥0.03 

45874 ................ Red River County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45875 ................ Reeves County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45876 ................ Refugio County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45877 ................ Roberts County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45878 ................ Robertson County, Texas ................................................................ 17780 0.8416 0.9045 7.47 

45879 ................ Rockwall County, Texas ................................................................... 19124 1.0217 1.0075 ¥1.39 

45880 ................ Runnels County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45881 ................ Rusk County, Texas ......................................................................... 30980 0.8331 0.8788 5.49 

45882 ................ Sabine County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45883 ................ San Augustine County, Texas ......................................................... 99945 0.7967 0.7965 ¥0.03 

45884 ................ San Jacinto County, Texas .............................................................. 26420 0.8962 1.0008 11.67 

45885 ................ San Patricio County, Texas ............................................................. 18580 0.8550 0.8564 0.16 

45886 ................ San Saba County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45887 ................ Schleicher County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45888 ................ Scurry County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45889 ................ Shackelford County, Texas .............................................................. 99945 0.7967 0.7965 ¥0.03 

45890 ................ Shelby County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45891 ................ Sherman County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45892 ................ Smith County, Texas ........................................................................ 46340 0.9168 0.8811 ¥3.89 

45893 ................ Somervell County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45900 ................ Starr County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45901 ................ Stephens County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45902 ................ Sterling County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45903 ................ Stonewall County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45904 ................ Sutton County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45905 ................ Swisher County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45910 ................ Tarrant County, Texas ..................................................................... 23104 0.9504 0.9569 0.68 

45911 ................ Taylor County, Texas ....................................................................... 10180 0.7975 0.8000 0.31 

45912 ................ Terrell County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45913 ................ Terry County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45920 ................ Throckmorton County, Texas ........................................................... 99945 0.7967 0.7965 ¥0.03 

45921 ................ Titus County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45930 ................ Tom Green County, Texas ............................................................... 41660 0.8271 0.8362 1.10 

45940 ................ Travis County, Texas ....................................................................... 12420 0.9437 0.9344 ¥0.99 

45941 ................ Trinity County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45942 ................ Tyler County, Texas ......................................................................... 99945 0.7967 0.7965 ¥0.03 

45943 ................ Upshur County, Texas ..................................................................... 30980 0.8809 0.8788 ¥0.24 

45944 ................ Upton County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45945 ................ Uvalde County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45946 ................ Val Verde County, Texas ................................................................. 99945 0.7967 0.7965 ¥0.03 

45947 ................ Van Zandt County, Texas ................................................................ 99945 0.7967 0.7965 ¥0.03 

45948 ................ Victoria County, Texas ..................................................................... 47020 0.8160 0.8560 4.90 

45949 ................ Walker County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45950 ................ Waller County, Texas ....................................................................... 26420 1.0040 1.0008 ¥0.32 

45951 ................ Ward County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45952 ................ Washington County, Texas .............................................................. 99945 0.7967 0.7965 ¥0.03 

45953 ................ Webb County, Texas ........................................................................ 29700 0.8068 0.7811 ¥3.19 

45954 ................ Wharton County, Texas ................................................................... 99945 0.7967 0.7965 ¥0.03 

45955 ................ Wheeler County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45960 ................ Wichita County, Texas ..................................................................... 48660 0.8325 0.8311 ¥0.17 

45961 ................ Wilbarger County, Texas .................................................................. 99945 0.7967 0.7965 ¥0.03 

45962 ................ Willacy County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45970 ................ Williamson County, Texas ................................................................ 12420 0.9437 0.9344 ¥0.99 

45971 ................ Wilson County, Texas ...................................................................... 41700 0.8982 0.8844 ¥1.54 

45972 ................ Winkler County, Texas ..................................................................... 99945 0.7967 0.7965 ¥0.03 

45973 ................ Wise County, Texas ......................................................................... 23104 0.8709 0.9569 9.87 

45974 ................ Wood County, Texas ........................................................................ 99945 0.7967 0.7965 ¥0.03 

45980 ................ Yoakum County, Texas .................................................................... 99945 0.7967 0.7965 ¥0.03 

45981 ................ Young County, Texas ....................................................................... 99945 0.7967 0.7965 ¥0.03 

45982 ................ Zapata County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

45983 ................ Zavala County, Texas ...................................................................... 99945 0.7967 0.7965 ¥0.03 

46000 ................ Beaver County, Utah ........................................................................ 99946 0.8440 0.8140 ¥3.55 

46010 ................ Box Elder County, Utah ................................................................... 99946 0.8440 0.8140 ¥3.55 

46020 ................ Cache County, Utah ......................................................................... 30860 0.8963 0.9022 0.66 

46030 ................ Carbon County, Utah ....................................................................... 99946 0.8440 0.8140 ¥3.55 

46040 ................ Daggett County, Utah ....................................................................... 99946 0.8440 0.8140 ¥3.55 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 66001 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

46050 ................ Davis County, Utah .......................................................................... 36260 0.9185 0.8995 ¥2.07 

46060 ................ Duchesne County, Utah ................................................................... 99946 0.8440 0.8140 ¥3.55 

46070 ................ Emery County, Utah ......................................................................... 99946 0.8440 0.8140 ¥3.55 

46080 ................ Garfield County, Utah ....................................................................... 99946 0.8440 0.8140 ¥3.55 

46090 ................ Grand County, Utah ......................................................................... 99946 0.8440 0.8140 ¥3.55 

46100 ................ Iron County, Utah ............................................................................. 99946 0.8440 0.8140 ¥3.55 

46110 ................ Juab County, Utah ........................................................................... 39340 0.9131 0.9537 4.45 

46120 ................ Kane County, Utah ........................................................................... 99946 0.9982 0.8140 ¥18.45 

46130 ................ Millard County, Utah ......................................................................... 99946 0.8440 0.8140 ¥3.55 

46140 ................ Morgan County, Utah ....................................................................... 36260 0.8896 0.8995 1.11 

46150 ................ Piute County, Utah ........................................................................... 99946 0.8440 0.8140 ¥3.55 

46160 ................ Rich County, Utah ............................................................................ 99946 0.8440 0.8140 ¥3.55 

46170 ................ Salt Lake County, Utah .................................................................... 41620 0.9381 0.9402 0.22 

46180 ................ San Juan County, Utah .................................................................... 99946 0.8440 0.8140 ¥3.55 

46190 ................ Sanpete County, Utah ...................................................................... 99946 0.8440 0.8140 ¥3.55 

46200 ................ Sevier County, Utah ......................................................................... 99946 0.8440 0.8140 ¥3.55 

46210 ................ Summit County, Utah ....................................................................... 41620 0.9092 0.9402 3.41 

46220 ................ Tooele County, Utah ........................................................................ 41620 0.9092 0.9402 3.41 

46230 ................ Uintah County, Utah ......................................................................... 99946 0.8440 0.8140 ¥3.55 

46240 ................ Utah County, Utah ............................................................................ 39340 0.9500 0.9537 0.39 

46250 ................ Wasatch County, Utah ..................................................................... 99946 0.8440 0.8140 ¥3.55 

46260 ................ Washington County, Utah ................................................................ 41100 0.9077 0.9265 2.07 

46270 ................ Wayne County, Utah ........................................................................ 99946 0.8440 0.8140 ¥3.55 

46280 ................ Weber County, Utah ......................................................................... 36260 0.9185 0.8995 ¥2.07 

47000 ................ Addison County, Vermont ................................................................ 99947 0.9830 0.9744 ¥0.87 

47010 ................ Bennington County, Vermont ........................................................... 99947 0.9830 0.9744 ¥0.87 

47020 ................ Caledonia County, Vermont ............................................................. 99947 0.9830 0.9744 ¥0.87 

47030 ................ Chittenden County, Vermont ............................................................ 15540 0.9410 0.9474 0.68 

47040 ................ Essex County, Vermont ................................................................... 99947 0.9830 0.9744 ¥0.87 

47050 ................ Franklin County, Vermont ................................................................ 15540 0.9410 0.9474 0.68 

47060 ................ Grand Isle County, Vermont ............................................................ 15540 0.9410 0.9474 0.68 

47070 ................ Lamoille County, Vermont ................................................................ 99947 0.9830 0.9744 ¥0.87 

47080 ................ Orange County, Vermont ................................................................. 99947 0.9830 0.9744 ¥0.87 

47090 ................ Orleans County, Vermont ................................................................. 99947 0.9830 0.9744 ¥0.87 

47100 ................ Rutland County, Vermont ................................................................. 99947 0.9830 0.9744 ¥0.87 

47110 ................ Washington County, Vermont .......................................................... 99947 0.9830 0.9744 ¥0.87 

47120 ................ Windham County, Vermont .............................................................. 99947 0.9830 0.9744 ¥0.87 

47130 ................ Windsor County, Vermont ................................................................ 99947 0.9830 0.9744 ¥0.87 

48010 ................ St Croix County, Virgin Islands ........................................................ 99948 0.7615 0.8467 11.19 

48020 ................ St Thomas-John County, Virgin Islands .......................................... 99948 0.7615 0.8467 11.19 

49000 ................ Accomack County, Virginia .............................................................. 99949 0.8215 0.7940 ¥3.35 

49010 ................ Albemarle County, Virginia ............................................................... 16820 1.0187 1.0125 ¥0.61 

49011 ................ Alexandria City County, Virginia ...................................................... 47894 1.0951 1.1054 0.94 

49020 ................ Alleghany County, Virginia ............................................................... 99949 0.8215 0.7940 ¥3.35 

49030 ................ Amelia County, Virginia .................................................................... 40060 0.8873 0.9177 3.43 

49040 ................ Amherst County, Virginia ................................................................. 31340 0.8691 0.8694 0.03 

49050 ................ Appomattox County, Virginia ............................................................ 31340 0.8554 0.8694 1.64 

49060 ................ Arlington County, Virginia ................................................................. 47894 1.0951 1.1054 0.94 

49070 ................ Augusta County, Virginia .................................................................. 99949 0.8215 0.7940 ¥3.35 

49080 ................ Bath County, Virginia ....................................................................... 99949 0.8215 0.7940 ¥3.35 

49088 ................ Bedford City County, Virginia ........................................................... 31340 0.8691 0.8694 0.03 

49090 ................ Bedford County, Virginia .................................................................. 31340 0.8691 0.8694 0.03 

49100 ................ Bland County, Virginia ...................................................................... 99949 0.8215 0.7940 ¥3.35 

49110 ................ Botetourt County, Virginia ................................................................ 40220 0.8381 0.8647 3.17 

49111 ................ Bristol City County, Virginia ............................................................. 28700 0.8031 0.7985 ¥0.57 

49120 ................ Brunswick County, Virginia .............................................................. 99949 0.8215 0.7940 ¥3.35 

49130 ................ Buchanan County, Virginia ............................................................... 99949 0.8215 0.7940 ¥3.35 

49140 ................ Buckingham County, Virginia ........................................................... 99949 0.8215 0.7940 ¥3.35 

49141 ................ Buena Vista City County, Virginia .................................................... 99949 0.8215 0.7940 ¥3.35 

49150 ................ Campbell County, Virginia ................................................................ 31340 0.8691 0.8694 0.03 

49160 ................ Caroline County, Virginia ................................................................. 40060 0.8873 0.9177 3.43 

49170 ................ Carroll County, Virginia .................................................................... 99949 0.8215 0.7940 ¥3.35 

49180 ................ Charles City County, Virginia ........................................................... 40060 0.9328 0.9177 ¥1.62 

49190 ................ Charlotte County, Virginia ................................................................ 99949 0.8215 0.7940 ¥3.35 

49191 ................ Charlottesville City County, Virginia ................................................. 16820 1.0187 1.0125 ¥0.61 

49194 ................ Chesapeake County, Virginia ........................................................... 47260 0.8799 0.8790 ¥0.10 

49200 ................ Chesterfield County, Virginia ............................................................ 40060 0.9328 0.9177 ¥1.62 

49210 ................ Clarke County, Virginia .................................................................... 47894 1.0951 1.1054 0.94 


rmajette on PROD1PC67 with RULES2
66002 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

49211 ................ Clifton Forge City County, Virginia ................................................... 99949 0.8215 0.7940 ¥3.35 

49212 ................ Colonial Heights County, Virginia .................................................... 40060 0.9328 0.9177 ¥1.62 

49213 ................ Covington City County, Virginia ....................................................... 99949 0.8215 0.7940 ¥3.35 

49220 ................ Craig County, Virginia ...................................................................... 40220 0.8396 0.8647 2.99 

49230 ................ Culpeper County, Virginia ................................................................ 99949 0.9495 0.7940 ¥16.38 

49240 ................ Cumberland County, Virginia ........................................................... 40060 0.8873 0.9177 3.43 

49241 ................ Danville City County, Virginia ........................................................... 19260 0.8489 0.8451 ¥0.45 

49250 ................ Dickenson County, Virginia .............................................................. 99949 0.8215 0.7940 ¥3.35 

49260 ................ Dinniddie County, Virginia ................................................................ 40060 0.9328 0.9177 ¥1.62 

49270 ................ Emporia County, Virginia ................................................................. 99949 0.8215 0.7940 ¥3.35 

49280 ................ Essex County, Virginia ..................................................................... 99949 0.8215 0.7940 ¥3.35 

49288 ................ Fairfax City County, Virginia ............................................................ 47894 1.0951 1.1054 0.94 

49290 ................ Fairfax County, Virginia .................................................................... 47894 1.0951 1.1054 0.94 

49291 ................ Falls Church City County, Virginia ................................................... 47894 1.0951 1.1054 0.94 

49300 ................ Fauquier County, Virginia ................................................................. 47894 1.0951 1.1054 0.94 

49310 ................ Floyd County, Virginia ...................................................................... 99949 0.8215 0.7940 ¥3.35 

49320 ................ Fluvanna County, Virginia ................................................................ 16820 1.0187 1.0125 ¥0.61 

49328 ................ Franklin City County, Virginia ........................................................... 99949 0.8215 0.7940 ¥3.35 

49330 ................ Franklin County, Virginia .................................................................. 40220 0.8396 0.8647 2.99 

49340 ................ Frederick County, Virginia ................................................................ 49020 0.9316 1.0091 8.32 

49342 ................ Fredericksburg City County, Virginia ............................................... 47894 1.0951 1.1054 0.94 

49343 ................ Galax City County, Virginia .............................................................. 99949 0.8215 0.7940 ¥3.35 

49350 ................ Giles County, Virginia ....................................................................... 13980 0.8186 0.8213 0.33 

49360 ................ Gloucester County, Virginia ............................................................. 47260 0.8799 0.8790 ¥0.10 

49370 ................ Goochland County, Virginia ............................................................. 40060 0.9328 0.9177 ¥1.62 

49380 ................ Grayson County, Virginia ................................................................. 99949 0.8215 0.7940 ¥3.35 

49390 ................ Greene County, Virginia ................................................................... 16820 1.0187 1.0125 ¥0.61 

49400 ................ Greensville County, Virginia ............................................................. 99949 0.8215 0.7940 ¥3.35 

49410 ................ Halifax County, Virginia .................................................................... 99949 0.8215 0.7940 ¥3.35 

49411 ................ Hampton City County, Virginia ......................................................... 47260 0.8799 0.8790 ¥0.10 

49420 ................ Hanover County, Virginia ................................................................. 40060 0.9328 0.9177 ¥1.62 

49421 ................ Harrisonburg City County, Virginia ................................................... 25500 0.8753 0.9073 3.66 

49430 ................ Henrico County, Virginia .................................................................. 40060 0.9328 0.9177 ¥1.62 

49440 ................ Henry County, Virginia ..................................................................... 99949 0.8215 0.7940 ¥3.35 

49450 ................ Highland County, Virginia ................................................................. 99949 0.8215 0.7940 ¥3.35 

49451 ................ Hopewell City County, Virginia ......................................................... 40060 0.9328 0.9177 ¥1.62 

49460 ................ Isle Of Wight County, Virginia .......................................................... 47260 0.8799 0.8790 ¥0.10 

49470 ................ James City Co County, Virginia ....................................................... 47260 0.8799 0.8790 ¥0.10 

49480 ................ King And Queen County, Virginia .................................................... 40060 0.8873 0.9177 3.43 

49490 ................ King George County, Virginia .......................................................... 99949 0.9495 0.7940 ¥16.38 

49500 ................ King William County, Virginia ........................................................... 40060 0.8873 0.9177 3.43 

49510 ................ Lancaster County, Virginia ............................................................... 99949 0.8215 0.7940 ¥3.35 

49520 ................ Lee County, Virginia ......................................................................... 99949 0.8215 0.7940 ¥3.35 

49522 ................ Lexington County, Virginia ............................................................... 99949 0.8215 0.7940 ¥3.35 

49530 ................ Loudoun County, Virginia ................................................................. 47894 1.0951 1.1054 0.94 

49540 ................ Louisa County, Virginia .................................................................... 40060 0.8873 0.9177 3.43 

49550 ................ Lunenburg County, Virginia .............................................................. 99949 0.8215 0.7940 ¥3.35 

49551 ................ Lynchburg City County, Virginia ....................................................... 31340 0.8691 0.8694 0.03 

49560 ................ Madison County, Virginia ................................................................. 99949 0.8215 0.7940 ¥3.35 

49561 ................ Martinsville City County, Virginia ..................................................... 99949 0.8215 0.7940 ¥3.35 

49563 ................ Manassas City County, Virginia ....................................................... 47894 1.0951 1.1054 0.94 

49565 ................ Manassas Park City County, Virginia .............................................. 47894 1.0951 1.1054 0.94 

49570 ................ Mathews County, Virginia ................................................................ 47260 0.8799 0.8790 ¥0.10 

49580 ................ Mecklenburg County, Virginia .......................................................... 99949 0.8215 0.7940 ¥3.35 

49590 ................ Middlesex County, Virginia ............................................................... 99949 0.8215 0.7940 ¥3.35 

49600 ................ Montgomery County, Virginia ........................................................... 13980 0.8186 0.8213 0.33 

49610 ................ Nansemond, Virginia ........................................................................ 99949 0.8215 0.7940 ¥3.35 

49620 ................ Nelson County, Virginia .................................................................... 16820 0.9302 1.0125 8.85 

49621 ................ New Kent County, Virginia ............................................................... 40060 0.9328 0.9177 ¥1.62 

49622 ................ Newport News City County, Virginia ................................................ 47260 0.8799 0.8790 ¥0.10 

49641 ................ Norfolk City County, Virginia ............................................................ 47260 0.8799 0.8790 ¥0.10 

49650 ................ Northampton County, Virginia .......................................................... 99949 0.8215 0.7940 ¥3.35 

49660 ................ Northumberland County, Virginia ..................................................... 99949 0.8215 0.7940 ¥3.35 

49661 ................ Norton City County, Virginia ............................................................. 99949 0.8215 0.7940 ¥3.35 

49670 ................ Nottoway County, Virginia ................................................................ 99949 0.8215 0.7940 ¥3.35 

49680 ................ Orange County, Virginia ................................................................... 99949 0.8215 0.7940 ¥3.35 

49690 ................ Page County, Virginia ...................................................................... 99949 0.8215 0.7940 ¥3.35 

49700 ................ Patrick County, Virginia .................................................................... 99949 0.8215 0.7940 ¥3.35 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 66003 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

49701 ................ Petersburg City County, Virginia ...................................................... 40060 0.9328 0.9177 ¥1.62 

49710 ................ Pittsylvania County, Virginia ............................................................. 19260 0.8489 0.8451 ¥0.45 

49711 ................ Portsmouth City County, Virginia ..................................................... 47260 0.8799 0.8790 ¥0.10 

49712 ................ Poquoson City County, Virginia ....................................................... 47260 0.8799 0.8790 ¥0.10 

49720 ................ Powhatan County, Virginia ............................................................... 40060 0.9328 0.9177 ¥1.62 

49730 ................ Prince Edward County, Virginia ....................................................... 99949 0.8215 0.7940 ¥3.35 

49740 ................ Prince George County, Virginia ....................................................... 40060 0.9328 0.9177 ¥1.62 

49750 ................ Prince William County, Virginia ........................................................ 47894 1.0951 1.1054 0.94 

49770 ................ Pulaski County, Virginia ................................................................... 13980 0.8186 0.8213 0.33 

49771 ................ Radford City County, Virginia ........................................................... 13980 0.8186 0.8213 0.33 

49780 ................ Rappahannock County, Virginia ....................................................... 99949 0.8215 0.7940 ¥3.35 

49790 ................ Richmond County, Virginia ............................................................... 99949 0.8215 0.7940 ¥3.35 

49791 ................ Richmond City County, Virginia ....................................................... 40060 0.9328 0.9177 ¥1.62 

49800 ................ Roanoke County, Virginia ................................................................ 40220 0.8381 0.8647 3.17 

49801 ................ Roanoke City County, Virginia ......................................................... 40220 0.8381 0.8647 3.17 

49810 ................ Rockbridge County, Virginia ............................................................. 99949 0.8215 0.7940 ¥3.35 

49820 ................ Rockingham County, Virginia ........................................................... 25500 0.8753 0.9073 3.66 

49830 ................ Russell County, Virginia ................................................................... 99949 0.8215 0.7940 ¥3.35 

49838 ................ Salem County, Virginia ..................................................................... 40220 0.8381 0.8647 3.17 

49840 ................ Scott County, Virginia ....................................................................... 28700 0.8031 0.7985 ¥0.57 

49850 ................ Shenandoah County, Virginia .......................................................... 99949 0.8215 0.7940 ¥3.35 

49860 ................ Smyth County, Virginia ..................................................................... 99949 0.8215 0.7940 ¥3.35 

49867 ................ South Boston City County, Virginia .................................................. 99949 0.8215 0.7940 ¥3.35 

49870 ................ Southampton County, Virginia ......................................................... 99949 0.8215 0.7940 ¥3.35 

49880 ................ Spotsylvania County, Virginia .......................................................... 47894 1.0951 1.1054 0.94 

49890 ................ Stafford County, Virginia .................................................................. 47894 1.0951 1.1054 0.94 

49891 ................ Staunton City County, Virginia ......................................................... 99949 0.8215 0.7940 ¥3.35 

49892 ................ Suffolk City County, Virginia ............................................................ 47260 0.8799 0.8790 ¥0.10 

49900 ................ Surry County, Virginia ...................................................................... 47260 0.8608 0.8790 2.11 

49910 ................ Sussex County, Virginia ................................................................... 40060 0.8873 0.9177 3.43 

49920 ................ Tazewell County, Virginia ................................................................. 99949 0.8215 0.7940 ¥3.35 

49921 ................ Virginia Beach City County, Virginia ................................................ 47260 0.8799 0.8790 ¥0.10 

49930 ................ Warren County, Virginia ................................................................... 47894 1.0951 1.1054 0.94 

49950 ................ Washington County, Virginia ............................................................ 28700 0.8031 0.7985 ¥0.57 

49951 ................ Waynesboro City County, Virginia ................................................... 99949 0.8215 0.7940 ¥3.35 

49960 ................ Westmoreland County, Virginia ........................................................ 99949 0.8215 0.7940 ¥3.35 

49961 ................ Williamsburg City County, Virginia ................................................... 47260 0.8799 0.8790 ¥0.10 

49962 ................ Winchester City County, Virginia ..................................................... 49020 0.9316 1.0091 8.32 

49970 ................ Wise County, Virginia ....................................................................... 99949 0.8215 0.7940 ¥3.35 

49980 ................ Wythe County, Virginia ..................................................................... 99949 0.8215 0.7940 ¥3.35 

49981 ................ York County, Virginia ....................................................................... 47260 0.8799 0.8790 ¥0.10 

50000 ................ Adams County, Washington ............................................................. 99950 1.0364 1.0263 ¥0.97 

50010 ................ Asotin County, Washington .............................................................. 30300 1.0052 0.9853 ¥1.98 

50020 ................ Benton County, Washington ............................................................ 28420 1.0619 1.0343 ¥2.60 

50030 ................ Chelan County, Washington ............................................................ 48300 1.0144 1.0346 1.99 

50040 ................ Clallam County, Washington ............................................................ 99950 1.0364 1.0263 ¥0.97 

50050 ................ Clark County, Washington ............................................................... 38900 1.1266 1.1416 1.33 

50060 ................ Columbia County, Washington ......................................................... 99950 1.0364 1.0263 ¥0.97 

50070 ................ Cowlitz County, Washington ............................................................ 31020 0.9898 1.0011 1.14 

50080 ................ Douglas County, Washington ........................................................... 48300 1.0144 1.0346 1.99 

50090 ................ Ferry County, Washington ............................................................... 99950 1.0364 1.0263 ¥0.97 

50100 ................ Franklin County, Washington ........................................................... 28420 1.0619 1.0343 ¥2.60 

50110 ................ Garfield County, Washington ........................................................... 99950 1.0364 1.0263 ¥0.97 

50120 ................ Grant County, Washington ............................................................... 99950 1.0364 1.0263 ¥0.97 

50130 ................ Grays Harbor County, Washington .................................................. 99950 1.0364 1.0263 ¥0.97 

50140 ................ Island County, Washington .............................................................. 99950 1.1039 1.0263 ¥7.03 

50150 ................ Jefferson County, Washington ......................................................... 99950 1.0364 1.0263 ¥0.97 

50160 ................ King County, Washington ................................................................. 42644 1.1572 1.1434 ¥1.19 

50170 ................ Kitsap County, Washington .............................................................. 14740 1.0675 1.0913 2.23 

50180 ................ Kittitas County, Washington ............................................................. 99950 1.0364 1.0263 ¥0.97 

50190 ................ Klickitat County, Washington ........................................................... 99950 1.0364 1.0263 ¥0.97 

50200 ................ Lewis County, Washington ............................................................... 99950 1.0364 1.0263 ¥0.97 

50210 ................ Lincoln County, Washington ............................................................ 99950 1.0364 1.0263 ¥0.97 

50220 ................ Mason County, Washington ............................................................. 99950 1.0364 1.0263 ¥0.97 

50230 ................ Okanogan County, Washington ....................................................... 99950 1.0364 1.0263 ¥0.97 

50240 ................ Pacific County, Washington ............................................................. 99950 1.0364 1.0263 ¥0.97 

50250 ................ Pend Oreille County, Washington .................................................... 99950 1.0364 1.0263 ¥0.97 

50260 ................ Pierce County, Washington .............................................................. 45104 1.0742 1.0789 0.44 


rmajette on PROD1PC67 with RULES2
66004 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

50270 ................ San Juan County, Washington ........................................................ 99950 1.0364 1.0263 ¥0.97 

50280 ................ Skagit County, Washington .............................................................. 34580 1.0336 1.0517 1.75 

50290 ................ Skamania County, Washington ........................................................ 38900 1.0742 1.1416 6.27 

50300 ................ Snohomish County, Washington ...................................................... 42644 1.1572 1.1434 ¥1.19 

50310 ................ Spokane County, Washington .......................................................... 44060 1.0905 1.0447 ¥4.20 

50320 ................ Stevens County, Washington ........................................................... 99950 1.0364 1.0263 ¥0.97 

50330 ................ Thurston County, Washington .......................................................... 36500 1.0927 1.1081 1.41 

50340 ................ Wahkiakum County, Washington ..................................................... 99950 1.0364 1.0263 ¥0.97 

50350 ................ Walla Walla County, Washington ..................................................... 99950 1.0364 1.0263 ¥0.97 

50360 ................ Whatcom County, Washington ......................................................... 13380 1.1731 1.1104 ¥5.34 

50370 ................ Whitman County, Washington .......................................................... 99950 1.0364 1.0263 ¥0.97 

50380 ................ Yakima County, Washington ............................................................ 49420 1.0155 0.9847 ¥3.03 

51000 ................ Barbour County, W Virginia ............................................................. 99951 0.7809 0.7607 ¥2.59 

51010 ................ Berkeley County, W Virginia ............................................................ 25180 1.0233 0.9038 ¥11.68 

51020 ................ Boone County, W Virginia ................................................................ 16620 0.8173 0.8542 4.51 

51030 ................ Braxton County, W Virginia .............................................................. 99951 0.7809 0.7607 ¥2.59 

51040 ................ Brooke County, W Virginia ............................................................... 48260 0.7819 0.8063 3.12 

51050 ................ Cabell County, W Virginia ................................................................ 26580 0.9477 0.8997 ¥5.06 

51060 ................ Calhoun County, W Virginia ............................................................. 99951 0.7809 0.7607 ¥2.59 

51070 ................ Clay County, W Virginia ................................................................... 16620 0.8173 0.8542 4.51 

51080 ................ Doddridge County, W Virginia .......................................................... 99951 0.7809 0.7607 ¥2.59 

51090 ................ Fayette County, W Virginia .............................................................. 99951 0.7809 0.7607 ¥2.59 

51100 ................ Gilmer County, W Virginia ................................................................ 99951 0.7809 0.7607 ¥2.59 

51110 ................ Grant County, W Virginia ................................................................. 99951 0.7809 0.7607 ¥2.59 

51120 ................ Greenbrier County, W Virginia ......................................................... 99951 0.7809 0.7607 ¥2.59 

51130 ................ Hampshire County, W Virginia ......................................................... 49020 0.9057 1.0091 11.42 

51140 ................ Hancock County, W Virginia ............................................................ 48260 0.7819 0.8063 3.12 

51150 ................ Hardy County, W Virginia ................................................................. 99951 0.7809 0.7607 ¥2.59 

51160 ................ Harrison County, W Virginia ............................................................. 99951 0.7809 0.7607 ¥2.59 

51170 ................ Jackson County, W Virginia ............................................................. 99951 0.7809 0.7607 ¥2.59 

51180 ................ Jefferson County, W Virginia ........................................................... 47894 1.0951 1.1054 0.94 

51190 ................ Kanawha County, W Virginia ........................................................... 16620 0.8445 0.8542 1.15 

51200 ................ Lewis County, W Virginia ................................................................. 99951 0.7809 0.7607 ¥2.59 

51210 ................ Lincoln County, W Virginia ............................................................... 16620 0.8173 0.8542 4.51 

51220 ................ Logan County, W Virginia ................................................................ 99951 0.7809 0.7607 ¥2.59 

51230 ................ Mc Dowell County, W Virginia ......................................................... 99951 0.7809 0.7607 ¥2.59 

51240 ................ Marion County, W Virginia ............................................................... 99951 0.7809 0.7607 ¥2.59 

51250 ................ Marshall County, W Virginia ............................................................. 48540 0.7161 0.7010 ¥2.11 

51260 ................ Mason County, W Virginia ............................................................... 99951 0.7809 0.7607 ¥2.59 

51270 ................ Mercer County, W Virginia ............................................................... 99951 0.7809 0.7607 ¥2.59 

51280 ................ Mineral County, W Virginia .............................................................. 19060 0.9317 0.8446 ¥9.35 

51290 ................ Mingo County, W Virginia ................................................................ 99951 0.7809 0.7607 ¥2.59 

51300 ................ Monongalia County, W Virginia ........................................................ 34060 0.8160 0.8423 3.22 

51310 ................ Monroe County, W Virginia .............................................................. 99951 0.7809 0.7607 ¥2.59 

51320 ................ Morgan County, W Virginia .............................................................. 25180 0.8695 0.9038 3.94 

51330 ................ Nicholas County, W Virginia ............................................................ 99951 0.7809 0.7607 ¥2.59 

51340 ................ Ohio County, W Virginia ................................................................... 48540 0.7161 0.7010 ¥2.11 

51350 ................ Pendleton County, W Virginia .......................................................... 99951 0.7809 0.7607 ¥2.59 

51360 ................ Pleasants County, W Virginia .......................................................... 37620 0.8085 0.7977 ¥1.34 

51370 ................ Pocahontas County, W Virginia ....................................................... 99951 0.7809 0.7607 ¥2.59 

51380 ................ Preston County, W Virginia .............................................................. 34060 0.8160 0.8423 3.22 

51390 ................ Putnam County, W Virginia .............................................................. 16620 0.8445 0.8542 1.15 

51400 ................ Raleigh County, W Virginia .............................................................. 99951 0.7809 0.7607 ¥2.59 

51410 ................ Randolph County, W Virginia ........................................................... 99951 0.7809 0.7607 ¥2.59 

51420 ................ Ritchie County, W Virginia ............................................................... 99951 0.7809 0.7607 ¥2.59 

51430 ................ Roane County, W Virginia ................................................................ 99951 0.7809 0.7607 ¥2.59 

51440 ................ Summers County, W Virginia ........................................................... 99951 0.7809 0.7607 ¥2.59 

51450 ................ Taylor County, W Virginia ................................................................ 99951 0.7809 0.7607 ¥2.59 

51460 ................ Tucker County, W Virginia ............................................................... 99951 0.7809 0.7607 ¥2.59 

51470 ................ Tyler County, W Virginia .................................................................. 99951 0.7809 0.7607 ¥2.59 

51480 ................ Upshur County, W Virginia ............................................................... 99951 0.7809 0.7607 ¥2.59 

51490 ................ Wayne County, W Virginia ............................................................... 26580 0.9477 0.8997 ¥5.06 

51500 ................ Webster County, W Virginia ............................................................. 99951 0.7809 0.7607 ¥2.59 

51510 ................ Wetzel County, W Virginia ............................................................... 99951 0.7809 0.7607 ¥2.59 

51520 ................ Wirt County, W Virginia .................................................................... 37620 0.8085 0.7977 ¥1.34 

51530 ................ Wood County, W Virginia ................................................................. 37620 0.8270 0.7977 ¥3.54 

51540 ................ Wyoming County, W Virginia ........................................................... 99951 0.7809 0.7607 ¥2.59 

52000 ................ Adams County, Wisconsin ............................................................... 99952 0.9494 0.9553 0.62 


rmajette on PROD1PC67 with RULES2
Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 66005 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

52010 ................ Ashland County, Wisconsin ............................................................. 99952 0.9494 0.9553 0.62 

52020 ................ Barron County, Wisconsin ................................................................ 99952 0.9494 0.9553 0.62 

52030 ................ Bayfield County, Wisconsin .............................................................. 99952 0.9494 0.9553 0.62 

52040 ................ Brown County, Wisconsin ................................................................ 24580 0.9483 0.9787 3.21 

52050 ................ Buffalo County, Wisconsin ............................................................... 99952 0.9494 0.9553 0.62 

52060 ................ Burnett County, Wisconsin ............................................................... 99952 0.9494 0.9553 0.62 

52070 ................ Calumet County, Wisconsin ............................................................. 11540 0.9264 0.9455 2.06 

52080 ................ Chippewa County, Wisconsin .......................................................... 20740 0.9201 0.9630 4.66 

52090 ................ Clark County, Wisconsin .................................................................. 99952 0.9494 0.9553 0.62 

52100 ................ Columbia County, Wisconsin ........................................................... 31540 1.0069 1.0840 7.66 

52110 ................ Crawford County, Wisconsin ............................................................ 99952 0.9494 0.9553 0.62 

52120 ................ Dane County, Wisconsin .................................................................. 31540 1.0707 1.0840 1.24 

52130 ................ Dodge County, Wisconsin ................................................................ 99952 0.9494 0.9553 0.62 

52140 ................ Door County, Wisconsin ................................................................... 99952 0.9494 0.9553 0.62 

52150 ................ Douglas County, Wisconsin ............................................................. 20260 1.0213 1.0042 ¥1.67 

52160 ................ Dunn County, Wisconsin .................................................................. 99952 0.9494 0.9553 0.62 

52170 ................ Eau Claire County, Wisconsin ......................................................... 20740 0.9201 0.9630 4.66 

52180 ................ Florence County, Wisconsin ............................................................ 99952 0.9494 0.9553 0.62 

52190 ................ Fond Du Lac County, Wisconsin ..................................................... 22540 0.9559 1.0063 5.27

52200 ................ Forest County, Wisconsin ................................................................ 99952 0.9494 0.9553 0.62 

52210 ................ Grant County, Wisconsin ................................................................. 99952 0.9494 0.9553 0.62 

52220 ................ Green County, Wisconsin ................................................................ 99952 0.9494 0.9553 0.62 

52230 ................ Green Lake County, Wisconsin ....................................................... 99952 0.9494 0.9553 0.62 

52240 ................ Iowa County, Wisconsin ................................................................... 31540 1.0069 1.0840 7.66 

52250 ................ Iron County, Wisconsin .................................................................... 99952 0.9494 0.9553 0.62 

52260 ................ Jackson County, Wisconsin ............................................................. 99952 0.9494 0.9553 0.62 

52270 ................ Jefferson County, Wisconsin ............................................................ 99952 0.9494 0.9553 0.62 

52280 ................ Juneau County, Wisconsin ............................................................... 99952 0.9494 0.9553 0.62 

52290 ................ Kenosha County, Wisconsin ............................................................ 29404 1.0095 1.0570 4.71 

52300 ................ Kewaunee County, Wisconsin ......................................................... 24580 0.9481 0.9787 3.23 

52310 ................ La Crosse County, Wisconsin .......................................................... 29100 0.9564 0.9426 ¥1.44 

52320 ................ Lafayette County, Wisconsin ............................................................ 99952 0.9494 0.9553 0.62 

52330 ................ Langlade County, Wisconsin ............................................................ 99952 0.9494 0.9553 0.62 

52340 ................ Lincoln County, Wisconsin ............................................................... 99952 0.9494 0.9553 0.62 

52350 ................ Manitowoc County, Wisconsin ......................................................... 99952 0.9494 0.9553 0.62 

52360 ................ Marathon County, Wisconsin ........................................................... 48140 0.9590 0.9722 1.38 

52370 ................ Marinette County, Wisconsin ........................................................... 99952 0.9494 0.9553 0.62 

52380 ................ Marquette County, Wisconsin .......................................................... 99952 0.9494 0.9553 0.62 

52381 ................ Menominee County, Wisconsin ........................................................ 99952 0.9494 0.9553 0.62 

52390 ................ Milwaukee County, Wisconsin ......................................................... 33340 1.0146 1.0218 0.71 

52400 ................ Monroe County, Wisconsin .............................................................. 99952 0.9494 0.9553 0.62 

52410 ................ Oconto County, Wisconsin ............................................................... 24580 0.9481 0.9787 3.23 

52420 ................ Oneida County, Wisconsin ............................................................... 99952 0.9494 0.9553 0.62 

52430 ................ Outagamie County, Wisconsin ......................................................... 11540 0.9264 0.9455 2.06 

52440 ................ Ozaukee County, Wisconsin ............................................................ 33340 1.0146 1.0218 0.71 

52450 ................ Pepin County, Wisconsin ................................................................. 99952 0.9494 0.9553 0.62 

52460 ................ Pierce County, Wisconsin ................................................................ 33460 1.1075 1.0946 ¥1.16 

52470 ................ Polk County, Wisconsin ................................................................... 99952 0.9494 0.9553 0.62 

52480 ................ Portage County, Wisconsin .............................................................. 99952 0.9494 0.9553 0.62 

52490 ................ Price County, Wisconsin .................................................................. 99952 0.9494 0.9553 0.62 

52500 ................ Racine County, Wisconsin ............................................................... 39540 0.8997 0.9356 3.99 

52510 ................ Richland County, Wisconsin ............................................................ 99952 0.9494 0.9553 0.62 

52520 ................ Rock County, Wisconsin .................................................................. 27500 0.9538 0.9655 1.23 

52530 ................ Rusk County, Wisconsin .................................................................. 99952 0.9494 0.9553 0.62 

52540 ................ St Croix County, Wisconsin ............................................................. 33460 1.1075 1.0946 ¥1.16 

52550 ................ Sauk County, Wisconsin .................................................................. 99952 0.9494 0.9553 0.62 

52560 ................ Sawyer County, Wisconsin .............................................................. 99952 0.9494 0.9553 0.62 

52570 ................ Shawano County, Wisconsin ........................................................... 99952 0.9494 0.9553 0.62 

52580 ................ Sheboygan County, Wisconsin ........................................................ 43100 0.8911 0.9026 1.29 

52590 ................ Taylor County, Wisconsin ................................................................ 99952 0.9494 0.9553 0.62 

52600 ................ Trempealeau County, Wisconsin ..................................................... 99952 0.9494 0.9553 0.62

52610 ................ Vernon County, Wisconsin ............................................................... 99952 0.9494 0.9553 0.62 

52620 ................ Vilas County, Wisconsin ................................................................... 99952 0.9494 0.9553 0.62 

52630 ................ Walworth County, Wisconsin ........................................................... 99952 0.9494 0.9553 0.62 

52640 ................ Washburn County, Wisconsin .......................................................... 99952 0.9494 0.9553 0.62 

52650 ................ Washington County, Wisconsin ....................................................... 33340 1.0146 1.0218 0.71 

52660 ................ Waukesha County, Wisconsin ......................................................... 33340 1.0146 1.0218 0.71 

52670 ................ Waupaca County, Wisconsin ........................................................... 99952 0.9494 0.9553 0.62 


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66006 Federal Register / Vol. 71, No. 217 / Thursday, November 9, 2006 / Rules and Regulations 

ADDENDUM C.—COMPARISON OF HH PPS TRANSITION WAGE INDEX FOR CY 2006 AND PRE-FLOOR AND PRERECLASSIFIED HOSPITAL WAGE INDEX FOR CY 2007—Continued 

SSA state/county 

code County name CBSA No. 

CY 2006 

HH PPS 

transition 

wage index 

CY2007 

CBSAbased wage 

index 

Percent 

change 

CY2006–

CY2007 

52680 ................ Waushara County, Wisconsin .......................................................... 99952 0.9494 0.9553 0.62 

52690 ................ Winnebago County, Wisconsin ........................................................ 36780 0.9211 0.9315 1.13 

52700 ................ Wood County, Wisconsin ................................................................. 99952 0.9494 0.9553 0.62 

53000 ................ Albany County, Wyoming ................................................................. 99953 0.9257 0.9295 0.41 

53010 ................ Big Horn County, Wyoming .............................................................. 99953 0.9257 0.9295 0.41 

53020 ................ Campbell County, Wyoming ............................................................. 99953 0.9257 0.9295 0.41 

53030 ................ Carbon County, Wyoming ................................................................ 99953 0.9257 0.9295 0.41 

53040 ................ Converse County, Wyoming ............................................................ 99953 0.9257 0.9295 0.41 

53050 ................ Crook County, Wyoming .................................................................. 99953 0.9257 0.9295 0.41 

53060 ................ Fremont County, Wyoming .............................................................. 99953 0.9257 0.9295 0.41 

53070 ................ Goshen County, Wyoming ............................................................... 99953 0.9257 0.9295 0.41 

53080 ................ Hot Springs County, Wyoming ......................................................... 99953 0.9257 0.9295 0.41 

53090 ................ Johnson County, Wyoming .............................................................. 99953 0.9257 0.9295 0.41 

53100 ................ Laramie County, Wyoming ............................................................... 16940 0.8775 0.9060 3.25 

53110 ................ Lincoln County, Wyoming ................................................................ 99953 0.9257 0.9295 0.41 

53120 ................ Natrona County, Wyoming ............................................................... 16220 0.9026 0.9145 1.32 

53130 ................ Niobrara County, Wyoming .............................................................. 99953 0.9257 0.9295 0.41 

53140 ................ Park County, Wyoming .................................................................... 99953 0.9257 0.9295 0.41 

53150 ................ Platte County, Wyoming ................................................................... 99953 0.9257 0.9295 0.41 

53160 ................ Sheridan County, Wyoming ............................................................. 99953 0.9257 0.9295 0.41 

53170 ................ Sublette County, Wyoming ............................................................... 99953 0.9257 0.9295 0.41 

53180 ................ Sweetwater County, Wyoming ......................................................... 99953 0.9257 0.9295 0.41 

53190 ................ Teton County, Wyoming ................................................................... 99953 0.9257 0.9295 0.41 

53200 ................ Uinta County, Wyoming ................................................................... 99953 0.9257 0.9295 0.41 

53210 ................ Washakie County, Wyoming ............................................................ 99953 0.9257 0.9295 0.41 

53220 ................ Weston County, Wyoming ................................................................ 99953 0.9257 0.9295 0.41 

65010 ................ Agana County, Guam ....................................................................... 99965 0.9611 0.9611 0.00 

65020 ................ Agana Heights County, Guam ......................................................... 99965 0.9611 0.9611 0.00 

65030 ................ Agat County, Guam .......................................................................... 99965 0.9611 0.9611 0.00 

65040 ................ Asan County, Guam ......................................................................... 99965 0.9611 0.9611 0.00 

65050 ................ Barrigada County, Guam ................................................................. 99965 0.9611 0.9611 0.00 

65060 ................ Chalan Pago County, Guam ............................................................ 99965 0.9611 0.9611 0.00 

65070 ................ Dededo County, Guam .................................................................... 99965 0.9611 0.9611 0.00 

65080 ................ Inarajan County, Guam .................................................................... 99965 0.9611 0.9611 0.00 

65090 ................ Maite County, Guam ........................................................................ 99965 0.9611 0.9611 0.00 

65100 ................ Mangilao County, Guam .................................................................. 99965 0.9611 0.9611 0.00 

65110 ................ Merizo County, Guam ...................................................................... 99965 0.9611 0.9611 0.00 

65120 ................ Mongmong County, Guam ............................................................... 99965 0.9611 0.9611 0.00 

65130 ................ Ordot County, Guam ........................................................................ 99965 0.9611 0.9611 0.00 

65140 ................ Piti County, Guam ............................................................................ 99965 0.9611 0.9611 0.00 

65150 ................ Santa Rita County, Guam ................................................................ 99965 0.9611 0.9611 0.00 

65160 ................ Sinajana County, Guam ................................................................... 99965 0.9611 0.9611 0.00 

65170 ................ Talofofo County, Guam .................................................................... 99965 0.9611 0.9611 0.00 

65180 ................ Tamuning County, Guam ................................................................. 99965 0.9611 0.9611 0.00 

65190 ................ Toto County, Guam .......................................................................... 99965 0.9611 0.9611 0.00 

65200 ................ Umatac County, Guam ..................................................................... 99965 0.9611 0.9611 0.00 

65210 ................ Yigo County, Guam .......................................................................... 99965 0.9611 0.9611 0.00 

65220 ................ Yona County, Guam ......................................................................... 99965 0.9611 0.9611 0.00 

[FR Doc. 06–9068 Filed 11–1–06; 4:00 pm] 

BILLING CODE 4120–01–P 


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