51536 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[BPD–895–FNC]

RIN 0938–AL15

Medicare Program; Schedules of

Limits and Prospectively Determined

Payment Rates for Skilled Nursing

Facility Inpatient Routine Service

Costs

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Final notice with comment

period.

SUMMARY: This final notice with

comment period sets forth an updated

schedule of limits on skilled nursing

facility (SNF) routine service costs for

which payment may be made under the

Medicare program and sets forth an

updated schedule of payment rates for

low Medicare volume SNFs that elect to

receive prospectively determined

payment rates for routine service costs.

Section 1888(a) of the Social Security

Act (the Act) requires that the Secretary

update the per diem cost limits for SNF

routine service costs for cost reporting

periods beginning on or after October 1,

1995, and every 2 years thereafter. In

addition, section 1888(d)(4) of the Act

requires the Secretary to establish and

publish prospectively determined

payment rates at least 90 days prior to

the beginning of the Federal fiscal year

(FY) to which such rates are to be

applied.

DATES: Effective date: The schedule of

cost limits and the schedule of

prospectively determined payment rates

are effective for cost reporting periods

beginning on or after October 1, 1997.

Comment date: Written comments

will be considered if we receive them at

the appropriate address, as provided

below, no later than 5:00 p.m. on

December 1, 1997.

ADDRESSES: Mail written comments (an

original and three copies) to the

following address: Health Care

Financing Administration, Department

of Health and Human Services,

Attention: BPD–895–NC, P.O. Box 7517,

Baltimore, MD 21244–0517.

If you prefer, you may deliver your

written comments (one original and

three copies) to one of the following

addresses: Room 309–G, Hubert H.

Humphrey Building, 200 Independence

Avenue, SW, Washington, DC 20201, or

Room C5–09–26, 7500 Security

Boulevard, Baltimore, MD 21244–1850.

Comments may also be submitted

electronically to the following E-mail

address: BPD–895–NC@hcfa.gov. E-mail

comments must include the full name

and address of the sender and must be

submitted to the referenced address in

order to be considered. All comments

must be incorporated in the E-mail

message because we may not be able to

access attachments. Electronically

submitted comments will be available

for public inspection at the

Independence Avenue address, below.

Because of staffing and resource

limitations, we cannot accept comments

by facsimile (FAX) transmission. In

commenting, please refer to file code

BPD–895–NC. Comments received

timely will be available for public

inspection as they are received,

generally beginning approximately 3

weeks after publication of a document,

in Room 309–G of the Department’s

offices at 200 Independence Avenue,

SW, Washington, DC, on Monday

through Friday of each week from 8:30

a.m. to 5 p.m. (phone: (202) 690–7890).

Copies: To order copies of the Federal

Register containing this document, send

your request to: New Orders,

Superintendent of Documents, P.O. Box

371954, Pittsburgh, PA 15250–7954.

Specify the date of the issue requested

and enclose a check or money order

payable to the Superintendent of

Documents, or enclose your Visa or

Master Card number and expiration

date. Credit card orders can also be

placed by calling the order desk at (202)

512–1800 or by faxing to (202) 512–

2250. The cost for each copy is $8.00.

As an alternative, you can view and

photocopy the Federal Register

document at most libraries designated

as Federal Depository Libraries and at

many other public and academic

libraries throughout the country that

receive the Federal Register.

FOR FURTHER INFORMATION CONTACT:

Robert Kuhl, (410) 786–4597.

SUPPLEMENTARY INFORMATION:

I. Background

A. Authority for Establishing Cost Limits

and Prospectively Determined Payment

Rates

1. Cost Limits

Sections 1861(v)(1)(A) and 1888 of the

Act authorize the Secretary to set limits

on allowable costs incurred by a

provider of services for which payment

may be made under Medicare. These

limits are based on estimates of the costs

necessary for the efficient delivery of

needed health services. Section 1888(a)

of the Act directs the Secretary to set

limits on per diem inpatient routine

service costs for hospital-based and

freestanding SNFs by urban or rural

area. Implementing regulations appear

at 42 CFR 413.30.

2. Prospectively Determined Payment

Rates

Most SNFs are paid on a reasonable

cost basis up to the routine service per

diem cost limits described in the

previous paragraph. However, under

section 1888(d) of the Act, for cost

reporting periods beginning on or after

October 1, 1986, a SNF with fewer than

1,500 Medicare covered days in a given

cost reporting period may choose to

receive payment based on a

prospectively determined payment rate

in the subsequent cost reporting period.

Implementing regulations appear at 42

CFR Part 413, Subpart I.

The rates for the low Medicare

volume SNFs are established on a per

diem basis and include payment for the

cost of furnishing general inpatient

routine services and capital-related

costs associated with routine services.

We are required to publish annual

revisions to the rates at least 90 days

before the beginning of the Federal FY

to which the revised rates apply. In

addition, under § 413.312(a)(1)(i), we

are required to base the revised rates on

the same cost data used to develop the

cost limits that are in effect for that

Federal FY.

B. Previously Published Schedules of

and Updates to Cost Limits and Rates

1. Effective for FY 1993

We published a final notice with

comment period on October 7, 1992 (57

FR 46177) announcing a schedule of

limits for freestanding and hospitalbased SNFs effective for cost reporting

periods beginning in FY 1993. In

December 1992, we published section

2828 of the Medicare Provider

Reimbursement Manual (HCFA Pub.

15–1), Transmittal Number 370,

establishing rates effective for cost

reporting periods beginning in FY 1993.

The same cost report, wage, and

inflation data were used to develop

these cost limits and rates. The cost

reports used to develop the FY 1993

cost limits and rates covered cost

reporting periods ending on or after

June 30, 1989, through May 31, 1990, for

freestanding SNFs and on or after

October 31, 1988, through September

30, 1989, for hospital-based SNFs. The

1988 hospital wage data and

Metropolitan Statistical Area (MSA)

designations, based on pre-1990 census

data as described in the April 1, 1991,

notice (56 FR 13319), were used to

develop the wage index that was

applicable to the FY 1993 cost limits

and rates. It has been our longstanding
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices 51537

policy not to make changes in the cost

report data or recognize changes in the

wage and MSA data until we publish a

Federal Register notice announcing an

update to the SNF cost limits.

2. Effective for FY 1994 and FY 1995

Sections 13503(a)(1) and 13503(b) of

the Omnibus Budget Reconciliation Act

of 1993 (OBRA ‘93) (Public Law 103–66)

required that there be no changes in the

FY 1993 SNF routine cost limits and

rates (including adjustments for changes

in the wage index or applicable MSAs)

established under section 1888 of the

Act for cost reporting periods beginning

during Federal FY 1994 and FY 1995.

This 2-year freeze on the cost limits and

rates resulted in a savings to the

Medicare program. These provisions of

OBRA ‘93 were implemented, for cost

limits, in a final notice with comment

period on January 6, 1994 (59 FR 762)

and, for rates, in section 2828 L of the

Provider Reimbursement Manual

(Transmittal 374, December 1993).

3. Effective for FY 1996

Section 13503(a)(2) of OBRA ’93

amended section 1888(a) of the Act and

required that an update to the cost

limits be provided for cost reporting

periods beginning on or after October 1,

1995 (FY 1996), and every 2 years

thereafter. However, during the FY 1996

legislative period, reconciliation

legislation contained a provision to

preserve the savings from the 2-year

freeze by inflating the FY 1993 cost

limits and rates to cost reporting periods

beginning in FY 1996, except that

inflation for FY 1994 and FY 1995

would not have been recognized. We

did not believe that it would be

appropriate to issue the required update

to the cost limits and rates for cost

reporting periods beginning in FY 1996

until the prospect of this provision

becoming law was known. We

determined in April 1996 (7 months

into FY 1996) that the FY 1996

legislative period would not produce a

law that included this provision.

On May 3, 1996, we expedited the

issuance of the required update to the

FY 1996 cost limits and rates through a

memorandum to all Associate Regional

Administrators (ARAs) for Medicare.

We instructed the ARAs to notify the

intermediaries to implement this

update. (This memorandum also

included corrections to erroneous

projected rates of inflation used to

develop the FY 1990 and FY 1993 cost

limits.) This memorandum contained

the monthly inflation factors that were

needed to extend the FY 1993 cost

limits and rates to cost reporting periods

beginning in FY 1996.

Our policy regarding the methodology

used to provide the required update to

the limits and rates for FY 1996

conformed with the update

methodology described below Table IV

of the October 7, 1992 notice, which

extends the cost reporting periods

affected by the FY 1993 limits by

computing monthly inflation factors

beyond those shown in Table IV.

Intermediaries were using this

methodology to compute limits and

rates between October 1, 1995, and the

issuance of the aforementioned

memorandum. We explained that this

update methodology would be used

until a new schedule of limits or other

provision is issued.

4. Effective for FY 1997

Section 1888(a) of the Act did not

require us to provide an update to the

cost limits for FY 1997. Therefore, we

trended the FY 1996 cost limits and

rates to cost reporting periods beginning

in FY 1997 using the latest available

rates of inflation.

On August 22, 1996, we issued a

memorandum to all ARAs for Medicare

to notify the intermediaries of the cost

limits and monthly inflation factors for

cost reporting periods beginning in FY

1997.

On September 3, 1996, we published

a final notice with comment period (61

FR 46466) announcing the schedule of

rates effective for cost reporting periods

beginning in FY 1997. That notice

represented the first schedule of rates

published in the Federal Register after

the regulations implementing section

1888(d) were issued on July 21, 1995 (60

FR 37590).

C. Cost Limits and Rates Effective for FY

1998

This notice with comment period

announces the schedule of cost limits

and rates effective for cost reporting

periods beginning in FY 1998, as

required under section 1888(a) of the

Act. To meet the update requirement

under section 1888(a), we trended the

FY 1997 cost limits and rates to cost

reporting periods beginning in FY 1998

using the latest rates of inflation.

There is, however, increasing concern

that post-1990 census data have not

been used in determining MSA

designations and wage index values

since our last Federal Register notice

was published on October 7, 1992. We

believe that the numerous changes to

the MSA designations since we

published the FY 1993 cost limits and

rates should be recognized in

determining the appropriate wage index

values used in this notice. This notice

presents the opportunity to implement

these changes to the wage data and to

the MSA designations and conforms

with our longstanding policy to make

such changes only in a Federal Register

notice.

This is the first time we have

published a combined schedule of cost

limits and rates. Combining the cost

limits and rates in one notice is more

economical in that they both utilize the

same cost report data, wage index

values, and rates of inflation. In

addition, under section 1888(d) of the

Act, an individual provider’s

prospectively determined rate may not

exceed its applicable cost limit (see

Section III.D. of this notice). This notice,

containing cost limits and rates for cost

reporting periods beginning in FY 1998,

allows a provider to more conveniently

determine its individual rate than in

previous years.

II. Update of the SNF Schedule of

Limits and the Schedule of

Prospectively Determined Rates

Under the authority cited in section I.

of this notice, this final notice with

comment period sets forth for cost

reporting periods beginning in FY 1998:

(1) an updated schedule of limits on

SNF routine service costs for which

payment may be made under the

Medicare program; and (2) an updated

schedule of prospectively determined

payment rates for low Medicare volume

SNFs that have elected to receive

prospective payments for routine

service costs.

The cost limits set forth in Table I and

the rates set forth in Tables II and III of

this notice are based on the FY 1997

cost limits and rates, respectively,

trended to cost reporting periods

beginning in FY 1998, using the most

recent projections of the rates of

inflation or increase in the costs

included in the SNF market basket.

We are continuing to use the HCFA

hospital wage data to account for area

wage differences. This is necessary

because industry-specific data needed to

calculate a wage index for SNFs are not

available. Under section 106 of the

Social Security Act Amendments of

1994 (Public Law 103–432), the

Secretary was required to begin

collecting data no later than October 31,

1995, on employee compensation and

paid hours of employment in SNFs for

the purpose of constructing a SNF wage

index adjustment to the routine service

cost limits. Until this data collection

effort is completed and the data are

analyzed, we believe that hospital wage

data provide the best measure of

comparable wages that would also be

paid by SNFs, since hospitals and SNFs

generally compete in the same labor
51538 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

market for employees. We believe that

the use of the hospital wage data results

in an appropriate adjustment to the

labor-portion of the costs based on an

appropriate wage index as required

under section 1888(a) of the Act.

For the schedule of cost limits and

rates effective with this notice, we are

using wage index values that are based

on hospital wage data from cost

reporting periods beginning in FY

1993—the most recent hospital wage

data in effect before the effective date of

this notice and the most recent MSA

designations. Accordingly, with the

exception of those wage index values

that may be affected by recent

corrections to the 1993 wage data, the

wage index values used in this notice

are based on the same wage data as are

used to compute the wage index values

for the hospital prospective payment

system for discharges occurring on or

after October 1, 1996. (A detailed

description of the methodology used to

compute the hospital prospective

payment wage index is set forth in the

final rule published in the Federal

Register on August 30, 1996 (61 FR

46166).) While these wage index values

are based on the MSA designations in

effect prior to the effective date of this

notice, they do not, however, reflect

changes in geographic classification for

certain rural hospitals required under

section 1886(d)(8)(B) of the Act or

geographic reclassifications based on

decisions of the Medicare Geographic

Classification Review Board or the

Secretary under section 1886(d)(10) of

the Act. Section 1886 of the Act applies

to hospitals only. Accordingly, as in the

past, it would not be appropriate to

recognize changes in the geographic

classification of hospitals for purposes

of computing the SNF cost limits even

though an SNF may be part of a medical

complex that includes a reclassified

hospital.

III. Provisions of the SNF Schedule of

Cost Limits and Prospectively

Determined Payment Rates

The schedule of cost limits set forth

below applies to all SNFs, including

those low Medicare volume SNFs that

are eligible to receive the optional

prospectively determined payment rate

for routine services. Under § 413.314(d),

the operational portion of an SNF’s

prospectively determined payment rate,

excluding capital-related costs, cannot

exceed its actual routine service cost

limit (without regard to exceptions,

exemptions, or retroactive adjustments)

in effect at the time of the election to be

paid a prospectively determined

payment rate. The eligibility

requirements for receiving prospectively

determined payment rates are specified

in subpart I of part 413.

These schedules of cost limits and

rates provide for the following:

A. Separate Groupings for Labor-Related

and Nonlabor-Related Components of

Per Diem Routine Service Costs

We are retaining the same groupings

for the labor-related and nonlaborrelated components of per diem routine

service costs as follows:

1. As described in the October 7, 1992

notice for the FY 1993 cost limits,

separate group means were computed

for the labor-related and nonlaborrelated components for hospital-based

and freestanding SNFs in accordance

with the MSA or non-MSA designation

in effect with that notice. Each group

mean was then multiplied by 112

percent.

2. As described in the September 3,

1996 notice for the FY 1997 rates,

separate group means were computed

for labor-related, nonlabor-related, and

capital-related components in

accordance with the SNF’s census

region and MSA or non-MSA

designation in effect with that notice.

Each group mean was then multiplied

by 105 percent.

B. Adjustment of SNF Labor-Related

Data by the Wage Index

We are using a wage index based on

1993 hospital wage data and post-1990

MSA designations, as discussed in

section II of this notice, to adjust the

labor-related portion of the cost limits

and rates contained in this notice for

area wage differences.

C. Use of SNF Market Basket

We are trending the FY 1997 cost

limits and rates to FY 1998 using

projected cost increases by applying the

SNF market basket index. This market

basket index is used to adjust the SNF

cost data to reflect cost increases

occurring between the cost reporting

periods represented in the data

collection and the midpoints of the cost

reporting periods to which the cost

limits and rates apply.

The market basket index is comprised

of the most commonly used categories

of SNF routine service expenses. The

categories are based primarily on those

used by the National Center for Health

Statistics in its National Nursing Home

Surveys.

The categories of expenses are

weighted according to the estimated

proportion of SNF routine service costs

attributable to each category. A detailed

description of the market basket index

is described in the October 7, 1992

notice for cost limits and the September

3, 1996 notice for the rates.

In developing the market basket

index, we obtained historical and

projected (estimated) rates of change in

the price of goods and services in each

category. For cost limit purposes only,

estimated rates of change may be

revised, retroactively, based on actual

(final) rates of change. As described in

all previous schedules of cost limits, if

the final rate of change in the market

basket index for a calendar year differs

from the estimated rate of change by at

least 0.3 percentage points, we will

adjust the limits. Elsewhere in this issue

of the Federal Register, we are

proposing in a separate notice to

eliminate this provision to adjust the

limits.

D. Application of the Adjusted Hospital

Wage Index to the Labor-Related Costs

In developing the FY 1997 cost limits

and rates, we applied the wage index to

five categories of labor-related costs:

wages, employee benefits, health service

costs, business service costs, and

miscellaneous costs. We continue to use

this methodology in computing the FY

1998 cost limits and rates.

For purposes of applying the wage

index, employee benefits include such

items as FICA tax, health insurance, life

insurance, facility contributions to

employee retirement funds, and all

other compensation that the SNF

records in the ‘‘employee health and

welfare’’ cost center on its Medicare cost

report. Health service costs include the

costs of physician services that are

purchased under arrangement from

outside sources. Business service costs

include costs of banking, contract

laundry, telephone, and other services

that SNFs purchase at retail from

outside suppliers. Miscellaneous costs

include various types of routine

operating costs not allocated to any

other category of the market basket.

E. Per Diem Add-On to the Cost Limits

and Prospective Rates Effective for Cost

Reporting Periods Beginning in FY 1998

In the October 7, 1992 notice and the

September 3, 1996 notice, we described

a per diem add-on to the limits and

rates, respectively. This per diem addon was developed to take into account

the costs associated with the additional

requirements placed on SNFs by the

nursing home reform provisions in

section 1819 of the Act, including

conducting nurse aide training and

competency evaluation programs, and to

recognize the additional costs due to the

universal precaution requirements of

the Occupational Safety and Health

Administration (OSHA).
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices 51539

The per diem add-on effective for FY

1997 will be trended to cost reporting

periods beginning in FY 1998, using the

latest market basket index. For cost limit

purposes, the per diem add-on is $2.27

for cost reporting periods beginning on

or after October 1, 1997. For rate

purposes, the per diem add-on is $2.13

for cost reporting periods beginning on

or after October 1, 1997.

When HCFA updates the SNF cost

limits and prospective rates using a later

data base that includes the costs of

complying with these additional

requirements, a per diem add-on will no

longer be needed because those updated

limits and rates would include these

costs.

The following applies to the schedule

of cost limits only:

F. Setting of Freestanding SNF Limits

The FY 1997 cost limits for

freestanding SNFs were set at 112

percent of the average labor-related and

average nonlabor-related costs of each

group, as described in the October 7,

1992 notice. This methodology is

prescribed by section 1888(a) of the Act.

We continue to use this methodology to

set the freestanding SNF cost limits

contained in this notice.

G. Setting of Hospital-Based SNF Limits

The FY 1997 cost limits for hospitalbased SNFs were set at the freestanding

SNF limit plus 50 percent of the

difference between the freestanding SNF

limit and 112 percent of the mean per

diem routine service costs of hospitalbased SNFs. This methodology for

setting hospital-based SNF cost limits

was described in the October 7, 1992

notice and the January 6, 1994 notice.

This methodology is prescribed by

sections 1888(a) and (b) of the Act. We

continue to use this methodology to set

the hospital-based SNF cost limits

contained in this notice.

H. Cost-of-Living Adjustments to the

Limits for Alaska, Hawaii, Puerto Rico,

and the Virgin Islands

To avoid disadvantaging SNFs located

in Alaska, Hawaii, Puerto Rico, and the

Virgin Islands, we will continue to

provide a cost-of-living adjustment to

the limits for these areas. This is an

adjustment of the nonlabor-related

component of the limit that applies to

these areas, based on the amount of the

most recently determined cost-of-living

differentials developed by the Office of

Personnel Management. Since we adjust

the labor-related component by the

applicable wage index as discussed in

section III.D. of this notice, this cost-ofliving adjustment will apply only to the

nonlabor-related component.

I. Exception to Cost Limits

A SNF may request an exception to

the cost limits under the provisions of

§ 413.30(f). The SNF must make the

request to the appropriate Medicare

fiscal intermediary in accordance with

section 2530 of the Provider

Reimbursement Manual (HCFA Pub.

15–1). An adjustment may be granted if

the costs in excess of the limit are

reasonable, attributable to the

circumstances specified in § 413.30(f)(1)

through (f)(8), separately identified by

the SNF, and verified by the

intermediary.

J. Use of Classification System for the

Limits

The classification system we use is

based on whether a SNF is located

within a MSA or in a New England

County Metropolitan Area (NECMA)

based on standards published in the

Federal Register on March 30, 1990 (55

FR 12154), using Bureau of the Census

data or Bureau of Census estimates

made after 1990. The latest standards for

developing MSAs are the ones

contained in the March 30, 1990

Federal Register.

The following applies to the schedule

of rates only:

K. Use of Classification System for the

Rates

We will retain the classification

system based on grouping SNFs by

census regions and by urban or rural

area designation within the region. As

required by sections 1883(d)(3) and

1886(d)(2)(D) of the Act, the term

‘‘region’’ means one of the 9 census

divisions, comprising the 50 States and

the District of Columbus, established by

the Bureau of Census for Statistical and

reporting purposes. The term ‘‘urban

rate’’ means an area within a MSA (as

defined by the Office of Management

and Budget (OMB), with exceptions for

certain NECMAs, as described in a

notice published in the Federal Register

on April 1, 1991 (56 FR 13319)). The

term ‘‘rural area’’ means an area outside

such an area (MSA).

IV. Methodology for Determining Per

Diem Routine Service Cost Limits and

Low Volume Prospective Payment

Rates

A. Development of Base Cost Limits and

Rates

As discussed in section I of this

notice, we trended the FY 1997 cost

limits and rates using the latest market

basket index, as discussed in section

III.C. of this notice. The annual

percentage increases in the market

basket over the previous year that we

used for this projection in this notice

are:

1993 ..............................................................3.7

1994 ..............................................................3.4

1995 ..............................................................2.9

1996 ............................................................1 2.7

1997 ............................................................1 3.2

1998 ............................................................1 3.4

1999 ............................................................1 3.6

1Forecasted increase.

B. Calculation of SNF Limit

1. Components of Limit

For each freestanding group, the

freestanding limits for FY 1998 are

shown in Table I of this notice. We used

the computation below to determine the

hospital-based cost limits shown in

Table I.

COST LIMIT DATA—HOSPITAL-BASED SNFS FOR COST REPORTING PERIODS BEGINNING ON OR AFTER OCTOBER 1, 1997

112 percent of hospital-based mean cost Urban

(MSA)

Rural (nonMSA)

Labor ................................................................................................................................................................................ $166.13 $143.18

Nonlabor ........................................................................................................................................................................... 34.97 23.58

Total .......................................................................................................................................................................... 201.10 166.76
51540 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

CALCULATION OF 50 PERCENT OF DIFFERENCE BETWEEN 112 PERCENT OF HOSPITAL-BASED MEAN COST AND

FREESTANDING LIMIT

Labor Nonlabor

Urban (MSA)

112 Percent of Hospital-Based Mean Cost ..................................................................................................................... $166.13 $34.97

Freestanding Limit (Table I) ............................................................................................................................................. ¥91.23 ¥19.59

Difference .................................................................................................................................................................. 74.90 15.38

50 Percent of Difference ........................................................................................................................................... 37.45 7.69

Plus Freestanding Limit ............................................................................................................................................ +91.23 +19.59

Hospital-Based Limit (MSA) ............................................................................................................................................. 128.68 27.28

Rural (Non-MSA)

112 Percent of Hospital-Based Mean Cost ..................................................................................................................... $143.18 $23.58

Freestanding Limit (Table I) ............................................................................................................................................. ¥92.64 ¥15.64

Difference .................................................................................................................................................................. 50.54 7.94

50 Percent of Difference ........................................................................................................................................... 25.27 3.97

Plus Freestanding Limit ............................................................................................................................................ +92.64 +15.64

Hospital-Based Limit (Non-MSA) ..................................................................................................................................... 117.91 19.61

2. Adjustment of Labor-Related

Component by Wage Index

To arrive at a labor-adjusted limit for

each SNF, we multiply the labor-related

component of the limit for the SNF’s

group by the wage index developed

from wage levels for hospital workers in

the area in which the SNF is located

(see Tables IV and V of this notice). The

adjusted limit that applies to a SNF is

the sum of the nonlabor-related

component, plus the adjusted laborrelated component, plus the OBRA/

OSHA per diem add-on discussed in

section III.E. of this notice.

Example—Calculation of Adjusted

Limit for a Freestanding SNF Located in

Dallas, Texas:

Labor-Related Component ........................................................................................................................................... $ 91.23 (Table I).

Wage Index ................................................................................................................................................................... ×0.9729 (Table IV).

Adjusted Labor Component ......................................................................................................................................... 88.76

Nonlabor-Related Component ..................................................................................................................................... +19.59 (Table I).

OBRA/OSHA Per Diem Add-On ................................................................................................................................. +2.27 (Sec. III.E.).

Adjusted Limit ............................................................................................................................................................. 110.62

3. Adjustment for Cost Reporting Period

If a facility has a cost reporting period

beginning in a month after October 1,

1997, the intermediary increases the

limit that otherwise would apply to the

SNF by the factor from Table VI of this

notice that corresponds to the month

and year in which the cost reporting

period begins. Each factor represents the

compounded monthly increase derived

from the projected annual increase in

the market basket index and is used to

account for inflation in costs that occur

after the date on which the limits are

effective.

Example: The following is a

computation of a revised limit for the

previously cited SNF that has a cost

reporting period that begins January 1,

1998. The base adjusted limit for the

SNF is $110.62. The revised limit

applicable to its cost reporting period

$111.56, is computed as follows:

Individual SNF Adjusted Base Limit ........................................................................................................................................................ $110.62

Adjustment Factor from Table V ............................................................................................................................................................... ×1.00846

Revised Limit .............................................................................................................................................................................................. 111.56

If a facility uses a cost reporting

period that is not 12 months in

duration, a special adjustment factor

will be calculated. This is necessary

because projections are computed to the

midpoint of a cost reporting period and

the adjustment factors in Table VI of

this notice are based on an assumed 12-

month reporting period. For cost

reporting periods of other than 12

months, the calculation is done for the

midpoint of the specific cost reporting

period. The SNF’s intermediary will

obtain this adjustment factor from

HCFA Central Office.

C. Calculation of the Routine Operating

Portion of the Rates.

1. Adjustment of Labor-Related

Component by Wage Index

a. Urban SNFs. To arrive at a labor

adjusted component for the rates, we

multiply the labor-related component of

the rate for the SNF’s region (Table II of

this notice) by the wage index

developed from wage levels for hospital

workers in the area in which the SNF is

located (Table IV of this notice).

b. Rural SNFs. To arrive at a labor

adjusted component for the rates, we

multiply the labor-related rate for the

SNF’s region (Table III of this notice) by

the wage index developed from wage

levels for hospital workers in the state

in which the SNF is located (Table V of

this notice).

2. Non-Labor-Related and OBRA/OSHA

Per Diem Add-on

The adjusted routine operating

portion of the rate that applies to a SNF

is the sum of the nonlabor-related

component, plus the labor adjusted

component, plus the OBRA/OSHA per

diem add-on discussed in section III.E.

of this notice.
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices 51541

3. Adjustment for Cost Reporting Period

If a facility has a cost reporting period

beginning in a month after October 1,

1997, the intermediary increases the

adjusted routine operating portion of the

rate that otherwise apply to the SNF by

the factor from Table VI of this notice

that corresponds to the month and year

in which the cost reporting period

begins. Each factor represents the

compounded monthly increase derived

from the annual increase in the market

basket index and is used to account for

inflation in costs that occur after the

date on which the prospective payment

rates are effective.

If a facility uses a cost reporting

period that is not 12 months in

duration, a special adjustment factor is

calculated. This is necessary because

market basket increases are computed to

the midpoint of a cost reporting period

and the adjustment factors in Table VI

of this notice are based on an assumed

12-month cost reporting period. For cost

reporting periods of other than 12

months, the calculation is done for the

midpoint of the specific cost reporting

period. The SNF’s intermediary obtains

this adjustment factor from the HCFA

Central Office.

D. Comparison of Provider’s Prospective

Payment Rate With Provider’s Cost Limit

Below is an example of the

calculation of the prospectively

determined payment rate for a provider,

including a comparison of the adjusted

routine operating portion of the rate

with the applicable routine operating

cost limit applicable to the specific

provider. The capital-related component

of the rate is added to the lower of the

SNF’s specific cost limit or its adjusted

routine operating portion of the rate to

arrive at the provider’s actual

prospectively determined payment rate.

Example: In this case, the adjusted

cost limit is less than the adjusted rate

for a freestanding SNF located in

Providence, Rhode Island (MSA Region

1), with a cost reporting period

beginning January 1, 1998. Therefore,

the prospectively determined payment

rate for this SNF is the adjusted limit

plus the capital-related component of

the rate ($134.93).

Labor-related componentNon-labor

related

component

Capital-related component

Limit (Table I) ........................................................................................................................................... $91.23 $19.59 ....................

Rate (Table II) .......................................................................................................................................... 120.13 22.91 $10.00

CALCULATION OF PROSPECTIVE PAYMENT RATE

Limit Rate Rate source

Labor-Related Component ............................................................................................................ $91.23 $120.13 (Chart above).

Wage Index ................................................................................................................................... ×1.1092 ×1.1092 (Table IV).

Adjusted Labor Component .......................................................................................................... 101.19 133.25

Non-Labor Component .................................................................................................................. 19.59 22.91 (Chart above).

OBRA/OSHA Add-on .................................................................................................................... +2.27 +2.13 (Sec III.E.).

Adjusted Limit/Rate ....................................................................................................................... 123.05 $158.29

Cost Reporting Year Adjustment Factor ....................................................................................... ×1.00846 ×1.00846 (Table VI).

Revised Limit/Rate ........................................................................................................................ 124.09 159.63

Capital-Related Component .......................................................................................................... +10.00 (Chart above).

Prospectively Determined Payment Rate ..................................................................................... 134.09

V. Schedule of Limits

Under the authority of sections

1861(v)(1)(A) and 1888 of the Act, the

following group per diem limits will

apply to the adjusted SNF inpatient

routine service costs paid for under

Medicare for cost reporting periods

beginning on or after October 1, 1997.

Medicare fiscal intermediaries will

compute the adjusted limits for SNFs

using the methodology set forth in this

notice and will notify each SNF of its

applicable limit. These limits, as

adjusted by the applicable wage

indexes, cost reporting year

adjustments, and adjusted by the OBRA/

OSHA per diem add-on, will remain in

effect for cost reporting periods

beginning on or after October 1, 1997,

until a new schedule of cost limits or

other provision is issued.

TABLE I.—SNF GROUP LIMITS

[Cost Reporting Periods Beginning On or After 10/1/97]

Location

Labor-related componentNon-labor*

related

component

Freestanding:

MSA Limit .................................................................................................................................................................. $91.23 $19.59

Non-MSA Limit .......................................................................................................................................................... 92.64 15.64

Hospital-Based:

MSA Limit .................................................................................................................................................................. 128.68 27.28

Non-MSA Limit .......................................................................................................................................................... 117.91 19.61

* The nonlabor portion of the limits for SNFs located in the States of Alaska and Hawaii, the Commonwealth of Puerto Rico, and the Virgin Islands will be increased by the following cost-of-living adjustments:
51542 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

Area Adjustment

factor

Alaska ...................................................................................................................................................................................................... 1.250

Hawaii:

Oahu ................................................................................................................................................................................................. 1.225

Kauai ................................................................................................................................................................................................. 1.175

Maui, Lanai and Molokai .................................................................................................................................................................. 1.200

Hawaii (island) .................................................................................................................................................................................. 1.150

Puerto Rico .............................................................................................................................................................................................. 1.100

Virgin Islands ........................................................................................................................................................................................... 1.125

TABLE II.—PROSPECTIVE RATES—MSA LOCATIONS EFFECTIVE OCTOBER 1, 1997

Region 1 Laborrelated

NonlaborrelatedCapitalrelated

1. New England (CT, ME, MA, NH, RI, VT) ............................................................................................ $120.13 $22.91 $10.00

2. Middle Atlantic (PA, NJ, NY) ................................................................................................................ 115.86 20.94 9.79

3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) .................................................................... 103.86 16.70 9.81

4. East North Central (IL, IN, MI, OH, WI) ............................................................................................... 98.70 16.40 9.18

5. East South Central (AL, KY, MS, TN) ................................................................................................. 99.28 14.61 7.32

6. West North Central (IA, KS, MN, MO, NE, ND, SD) ........................................................................... 105.87 17.59 10.23

7. West South Central (AR, LA, OK, TX) ................................................................................................ 92.64 14.47 10.06

8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) .................................................................................... 110.22 18.83 13.04

9. Pacific (AK, CA, HI, OR, WA) .............................................................................................................. 100.30 20.56 8.40

1There are 17 MSAs that have counties in two or more regions. For each of these MSAs, the region in which a majority of the SNFs are located determines the regional rate that is paid as shown below. This is the same methodology as that used to implement the requirements of

section 1886(d)(2)(D) of the Act as they apply to the hospital prospective payment system.

The MSAs are as follows:

MSA Region

Chattanooga, TN–GA .............................................................................................................................................................................. 5

Cincinnati, OH–KY–IN ............................................................................................................................................................................. 4

Columbus, GA–AL ................................................................................................................................................................................... 3

Davenport-Rock Island-Moline, IA–IL ...................................................................................................................................................... 4

Duluth-Superior, MN–WI .......................................................................................................................................................................... 6

Evansville-Henderson, IN–KY .................................................................................................................................................................. 4

Huntington-Ashland, WV–KY–OH ........................................................................................................................................................... 3

Johnson City-Kingsport-Bristol, TN–VA ................................................................................................................................................... 5

La Crosse, WI–MN .................................................................................................................................................................................. 4

Louisville, KY–IN ...................................................................................................................................................................................... 5

Memphis, TN–AR–MS ............................................................................................................................................................................. 5

Minneapolis-St. Paul, MN–WI .................................................................................................................................................................. 6

Parkersburg-Marietta, WV–OH ................................................................................................................................................................ 3

St. Louis, MO–IL ...................................................................................................................................................................................... 6

Steubenville-Weirton, OH–WV ................................................................................................................................................................. 4

Wheeling, WV–OH ................................................................................................................................................................................... 3

Wilmington-Newark, DE–NJ–MD ............................................................................................................................................................. 3

TABLE III.—PROSPECTIVE RATES—NON-MSA LOCATIONS EFFECTIVE OCTOBER 1, 1997

Region Laborrelated

NonlaborrelatedCapitalrelated

1. New England (CT, ME, MA, NH, RI, VT) ............................................................................................ $129.68 $21.62 $10.58

2. Middle Atlantic (PA, NJ, NY) ................................................................................................................ 121.14 17.40 7.94

3. South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV) .................................................................... 114.52 15.56 9.19

4. East North Central (IL, IN, MI, OH, WI) ............................................................................................... 108.02 15.08 8.28

5. East South Central (AL, KY, MS, TN) ................................................................................................. 108.81 13.70 6.77

6. West North Central (IA, KS, MN, MO, NE, ND, SD) ........................................................................... 111.41 14.83 6.66

7. West South Central (AR, LA, OK, TX) ................................................................................................ 105.74 13.44 9.22

8. Mountain (AZ, CO, ID, MT, NV, NM, UT, WY) .................................................................................... 110.40 16.18 8.36

9. Pacific (AK, CA, HI, OR, WA) .............................................................................................................. 123.54 20.74 10.16
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices 51543

TABLE IV.—WAGE INDEX FOR URBAN

AREAS

Urban area (constituent counties

or county equivalents)

Wage

index

0040 Abilene, TX ........................ 0.8048

Taylor, TX

0060 Aguadilla, PR .................... 0.4237

Aguada, PR

Aguadilla, PR

Moca, PR

0080 Akron, OH ......................... 0.9853

Portage, OH

Summit, OH

0120 Albany, GA ........................ 0.8597

Dougherty, GA

Lee, GA

0160 Albany-Schenectady-Troy,

NY ............................................. 0.8624

Albany, NY

Montgomery, NY

Rensselaer, NY

Saratoga, NY

Schenectady, NY

Schoharie, NY

0200 Albuquerque, NM .............. 0.9344

Bernalillo, NM

Sandoval, NM

Valencia, NM

0220 Alexandria, LA ................... 0.8119

Rapides, LA

0240 Allentown-Bethlehem-Easton, PA ...................................... 0.9992

Carbon, PA

Lehigh, PA

Northampton, PA

0280 Altoona, PA ....................... 0.9510

Blair, PA

0320 Amarillo, TX ....................... 0.8730

Potter, TX

Randall, TX

0380 AK Anchorage, AK ............ 1.3224

Anchorage,

0440 Ann Arbor, MI ...................... 1.1662

Lenawee, MI

Livingston, MI

Washtenaw, MI

0450 Anniston, AL ...................... 0.8023

Calhoun, AL

0460 Appleton-OshkoshNeenah, WI ............................... 0.8890

Calumet, WI

Outagamie, WI

Winnebago, WI

0470 Arecibo, PR ....................... 0.4397

Arecibo, PR

Camuy, PR

Hatillo, PR

0480 Asheville, NC ..................... 0.9334

Buncombe, NC

Madison, NC

0500 Athens, GA ........................ 0.9408

Clarke, GA

Madison, GA

Oconee, GA

0520 Atlanta, GA ........................ 1.0033

Barrow, GA

Bartow, GA

Carroll, GA

Cherokee, GA

Clayton, GA

Cobb, GA

Coweta, GA

DeKalb, GA

Douglas, GA

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Fayette, GA

Forsyth, GA

Fulton, GA

Gwinnett, GA

Henry, GA

Newton, GA

Paulding, GA

Pickens, GA

Rockdale, GA

Spalding, GA

Walton, GA

0560 Atlantic City-Cape May, NJ 1.1077

Atlantic City, NJ

Cape May, NJ

0600 Augusta-Aiken, GA–SC ..... 0.8836

Columbia, GA

McDuffie, GA

Richmond, GA

Aiken, SC

Edgefield, SC

0640 Austin-San Marcos, TX ..... 0.9254

Bastrop, TX

Caldwell, TX

Hays, TX

Travis, TX Williamson, TX

0680 Bakersfield, CA ................. 1.0189

Kern, CA

0720 Baltimore, MD ................... 0.9798

Anne Arundel, MD

Baltimore, MD

Baltimore City, MD

Carroll, MD

Harford, MD

Howard, MD

Queen Annes, MD

0733 Bangor, ME ....................... 0.9391

Penobscot, ME

0743 Barnstable-Yarmouth, MA 1.3651

Barnstable, MA

0760 Baton Rouge, LA ............... 0.8433

Ascension, LA

East Baton Rouge, LA

Livingston, LA

West Baton Rouge, LA

0840 Beaumont-Port Arthur, TX 0.8576

Hardin, TX

Jefferson, TX

Orange, TX

0860 Bellingham, WA ................. 1.1317

Whatcom, WA

0870 Benton Harbor, MI ............. 0.8506

Berrien, MI

0875 Bergen-Passaic, NJ .......... 1.1785

Bergen, NJ

Passaic, NJ

0880 Billings, MT ........................ 0.9086

Yellowstone, MT

0920 Biloxi-Gulfport-Pascagoula,

MS ............................................. 0.8554

Hancock, MS

Harrison, MS

Jackson, MS

0960 Binghamton, NY ................ 0.8822

Broome, NY

Tioga, NY

1000 Birmingham, AL ................. 0.9036

Blount, AL

Jefferson, AL

St. Clair, AL

Shelby, AL

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

1010 Bismarck, ND .................... 0.7923

Burleigh, ND

Morton, ND

1020 Bloomington, IN ................. 0.8652

Monroe, IN

1040 Bloomington-Normal, IL .... 0.8990

McLean, IL

1080 Boise City, ID .................... 0.9383

Ada, ID

Canyon, ID

1123 Boston-Worcester Lawrence-Lowell- ............................. 1.1613

Brockton,MA–NH

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

Merrimack, NH

Rockingham, NH

Strafford, NH

1125 Boulder-Longmont, CO ..... 0.9522

Boulder, CO

1145 Brazoria, TX ...................... 0.9201

Brazoria, TX

1150 Bremerton, WA .................. 1.0901

Kitsap, WA

1240 Brownsville-Harlingen-San

Benito, TX ................................. 0.8542

Cameron, TX

1260 Bryan-College Station, TX 0.8851

Brazos, TX

1280 Buffalo-Niagara Falls, NY 0.9107

Erie, NY

Niagara, NY

1303 Burlington, VT ................... 1.0068

Chittenden, VT

Franklin, VT

Grand Isle, VT

1310 Caguas, PR ....................... 0.4573

Caguas, PR

Cayey, PR

Cidra, PR

Gurabo, PR

San Lorenzo, PR

1320 Canton-Massillon, OH ....... 0.8648

Carroll, OH

Stark, OH

1350 Casper, WY ....................... 0.8821

Natrona, WY

1360 Cedar Rapids, IA ............... 0.8458

Linn, IA

1400 Champaign-Urbana, IL ...... 0.9391

Champaign, IL

1440 Charleston-North Charleston, SC ...................................... 0.8963

Berkeley, SC

Charleston, SC

Dorchester, SC

1480 Charleston, WV ................. 0.9526

Kanawha, WV

Putnam, WV

1520 Charlotte-Gastonia-Rock

Hill, NC–SC ............................... 0.9620

Cabarrus, NC

Gaston, NC

Lincoln, NC
51544 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Mecklenburg, NC

Rowan, NC

Union, NC

York, SC

1540 Charlottesville, VA ............. 0.9155

Albemarle, VA

Charlottesville City, VA

Fluvanna, VA

Greene, VA

1560 Chattanooga, TN–GA ........ 0.8847

Catoosa, GA

Dade, GA

Walker, GA

Hamilton, TN

Marion, TN

1580 Cheyenne, WY .................. 0.7678

Laramie, WY

1600 Chicago, IL ........................ 1.0760

Cook, IL

DeKalb, IL

DuPage, IL

Grundy, IL

Kane, IL

Kendall, IL

Lake, IL

McHenry, IL

Will, IL

1620 Chico-Paradise, CA ........... 1.0417

Butte, CA

1640 Cincinnati, OH–KY–IN ....... 0.9570

Dearborn, IN

Ohio, IN

Boone, KY

Campbell, KY

Gallatin, KY

Grant, KY

Kenton, KY

Pendleton, KY

Brown, OH

Clermont, OH

Hamilton, OH

Warren, OH

1660 Clarksville-Hopkinsville,

TN–KY ....................................... 0.7716

Christian, KY

Montgomery, TN

1680 Cleveland-Lorain-Elyria,

OH ............................................. 0.9886

Ashtabula, OH

Cuyahoga, OH

Geauga, OH

Lake, OH

Lorain, OH

Medina, OH

1720 Colorado Springs, CO ....... 0.9341

El Paso, CO

1740 Columbia, MO ................... 0.8899

Boone, MO

1760 Columbia, SC .................... 0.9160

Lexington, SC

Richland, SC

1800 Columbus, GA–AL Russell,

AL .............................................. 0.7779

Chattanoochee, GA

Harris, GA

Muscogee, GA

1840 Columbus, OH ................... 0.9681

Delaware, OH

Fairfield, OH

Franklin, OH

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Licking, OH

Madison, OH

Pickaway, OH

1880 Corpus Christi, TX ............. 0.8881

Nueces, TX

San Patricio, TX

1900 Cumberland, MD–WV ....... 0.8671

Allegany, MD

Mineral, WV

1920 Dallas, TX .......................... 0.9729

Collin, TX

Dallas, TX

Denton, TX

Ellis, TX

Henderson, TX

Hunt, TX

Kaufman, TX

Rockwall, TX

1950 Danville, VA ....................... 0.8497

Danville City, VA

Pittsylvania, VA

1960 Davenport-Rock IslandMoline, IA–IL ............................. 0.8388

Scott, IA

Henry, IL

Rock Island, IL

2000 Dayton-Springfield, OH ..... 0.9559

Clark, OH

Greene, OH

Miami, OH

Montgomery, OH

2020 Daytona Beach, FL ........... 0.8871

Flagler, FL

Volusia, FL

2030 Decatur, AL ....................... 0.8384

Lawrence, AL

Morgan, AL

2040 Decatur, IL ......................... 0.7848

Macon, IL

2080 Denver, CO ....................... 1.0166

Adams, CO

Arapahoe, CO

Denver, CO

Douglas, CO

Jefferson, CO

2120 Des Moines, IA .................. 0.8815

Dallas, IA

Polk, IA

Warren, IA

2160 Detroit, MI .......................... 1.0724

Lapeer, MI

Macomb, MI

Monroe, MI

Oakland, MI

St. Clair, MI

Wayne, MI

2180 Dothan, AL ........................ 0.7740

Dale, AL

Houston, AL

2190 Dover, DE .......................... 0.8997

Kent, DE

2200 Dubuque, IA ...................... 0.8112

Dubuque, IA

2240 Duluth-Superior, MN–WI ... 0.9416

St. Louis, MN

Douglas, WI

2281 Dutchess County, NY ........ 1.0589

Dutchess, NY

2290 Eau Claire, WI ................... 0.8678

Chippewa, WI

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Eau Claire, WI

2320 El Paso, TX ....................... 0.9464

El Paso, TX

2330 Elkhart-Goshen, IN ............ 0.8801

Elkhart, IN

2335 Elmira, NY ......................... 0.8417

Chemung, NY

2340 Enid, OK ............................ 0.7862

Garfield, OK

2360 Erie, PA ............................. 0.9159

Erie, PA

2400 Eugene-Springfield, OR .... 1.1271

Lane, OR

2440 Evansville-Henderson, IN–

KY .............................................. 0.8983

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2520 Fargo-Moorhead, ND–MN 0.9045

Clay, MN

Cass, ND

2560 Fayetteville, NC ................. 0.9007

Cumberland, NC

2580 Fayetteville-SpringdaleRogers, AR ................................ 0.7220

Benton, AR

Washington, AR

2620 Flagstaff, AZ–UT ............... 0.9019

Coconino, AZ

Kane, UT

2640 Flint, MI ................................ 1.1248

Genesee, MI

2650 Florence, AL ...................... 0.7938

Colbert, AL

Lauderdale, AL

2655 Florence, SC ..................... 0.8594

Florence, SC

2670 Fort Collins-Loveland, CO 1.0562

Larimer, CO

2680 Ft. Lauderdale, FL ............. 1.0548

Broward, FL

2700 Fort Myers-Cape Coral, FL 0.9032

Lee, FL

2710 Fort Pierce-Port St. Lucie,

FL .............................................. 1.0169

Martin, FL

St. Lucie, FL

2720 Fort Smith, AR–OK ........... 0.7864

Crawford, AR

Sebastian, AR

Sequoyah, OK

2750 Fort Walton Beach, FL ...... 0.9192

Okaloosa, FL

2760 Fort Wayne, IN .................. 0.8800

Adams, IN

Allen, IN

DeKalb, IN

Huntington, IN

Wells, IN

Whitley, IN

2800 Forth Worth-Arlington, TX 1.0153

Hood, TX

Johnson, TX

Parker, TX

Tarrant, TX

2840 Fresno, CA ........................ 1.1183

Fresno, CA

Madera, CA

2880 Gadsden, AL ..................... 0.8881
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices 51545

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Etowah, AL

2900 Gainesville, FL .................. 0.9434

Alachua, FL

2920 Galveston-Texas City, TX 1.0997

Galveston, TX

2960 Gary, IN ............................. 0.9641

Lake, IN

Porter, IN

2975 Glens Falls, NY ................. 0.8562

Warren, NY

Washington, NY

2980 Goldsboro, NC .................. 0.8393

Wayne, NC

2985 Grand Forks, ND–MN ....... 0.9011

Polk, MN

Grand Forks, ND

2995 Grand Junction, CO .......... 0.8336

Mesa, CO

3000 Grand Rapids-MuskegonHolland, MI ................................ 1.0119

Allegan, MI

Kent, MI

Muskegon, MI

Ottawa, MI

3040 Great Falls, MT ................. 0.8681

Cascade, MT

3060 Greeley, CO ...................... 0.9690

Weld, CO

3080 Green Bay, WI .................. 0.9038

Brown, WI

3120 Greensboro-WinstonSalem-High Point, NC ............... 0.9332

Alamance, NC

Davidson, NC

Davie, NC

Forsyth, NC

Guilford, NC

Randolph, NC

Stokes, NC

Yadkin, NC

3150 Greenville, NC ................... 0.9078

Pitt, NC

3160 Greenville-Spartanburg-Anderson, SC ................................ 0.8927

Anderson, SC

Cherokee, SC

Greenville, SC

Pickens, SC

Spartanburg, SC

3180 Hagerstown, MD .................. 0.9175

Washington, MD

3200 Hamilton-Middletown, OH 0.9490

Butler, OH

3240 Harrisburg-Lebanon-Carlisle, PA ..................................... 1.0158

Cumberland, PA

Dauphin, PA

Lebanon, PA

Perry, PA

3283 Hartford, CT ...................... 1.2367

Hartford, CT

Litchfield, CT

Middlesex, CT

Tolland, CT

3285 Hattiesburg, MS ................ 0.7252

Forrest, MS

Lamar, MS

3290 Hickory-Morganton-Lenoir,

NC ............................................. 0.8626

Alexander, NC

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Burke, NC

Caldwell, NC

Catawba, NC

3320 Honolulu, HI ...................... 1.1461

Honolulu, HI

3350 Houma, LA ........................ 0.7853

Lafourche, LA

Terrebonne, LA

3360 Houston, TX ...................... 1.0000

Chambers, TX

Fort Bend, TX

Harris, TX

Liberty, TX

Montgomery, TX

Waller, TX

3400 Huntington-Ashland, WV–

KY–OH ...................................... 0.9174

Boyd, KY

Carter, KY

Greenup, KY

Lawrence, OH

Cabell, WV

Wayne, WV

3440 Huntsville, AL .................... 0.8206

Limestone, AL

Madison, AL

3480 Indianapolis, IN ................. 0.9903

Boone, IN

Hamilton, IN

Hancock, IN

Hendricks, IN

Johnson, IN

Madison, IN

Marion, IN

Morgan, IN

Shelby, IN

3500 Iowa City, IA ...................... 0.9361

Johnson, IA

3520 Jackson, MI ....................... 0.9045

Jackson, MI

3560 Jackson, MS ...................... 0.7884

Hinds, MS

Madison, MS

Rankin, MS

3580 Jackson, TN ...................... 0.8288

Chester, TN

Madison, TN

3600 Jacksonville, FL ................. 0.9086

Clay, FL

Duval, FL

Nassau, FL

St. Johns, FL

3605 Jacksonville, NC ................ 0.7055

Onslow, NC

3610 Jamestown, NY ................. 0.7670

Chautaqua, NY

3620 Janesville-Beloit, WI .......... 0.8645

Rock, WI

3640 Jersey City, NJ .................. 1.1382

Hudson, NJ

3660 Johnson City-KingsportBristol, TN–VA ........................... 0.8884

Carter, TN

Hawkins, TN

Sullivan, TN

Unicoi, TN

Washington, TN

Bristol City, VA

Scott, VA

Washington, VA

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

3680 Johnstown, PA .................. 0.8398

Cambria, PA

Somerset, PA

3700 Jonesboro, AR .................. 0.7220

Craighead, AR

3710 Joplin, MO ......................... 0.7638

Jasper, MO

Newton, MO

3720 Kalamazoo-Battlecreek, MI 1.0542

Calhoun, MI

Kalamazoo, MI

Van Buren, MI

3740 Kankakee, IL ..................... 0.9115

Kankakee, IL

3760 Kansas City, KS–MO ........ 0.9478

Johnson, KS

Leavenworth, KS

Miami, KS

Wyandotte, KS

Cass, MO

Clay, MO

Clinton, MO

Jackson, MO

Lafayette, MO

Platte, MO

Ray, MO

3800 Kenosha, WI ...................... 0.9145

Kenosha, WI

3810 Killeen-Temple, TX ............ 1.0392

Bell, TX

Coryell, TX

3840 Knoxville, TN ..................... 0.8502

Anderson, TN

Blount, TN

Knox, TN

Loudon, TN

Sevier, TN

Union, TN

3850 Kokomo, IN ....................... 0.8590

Howard, IN

Tipton, IN

3870 La Crosse, WI–MN ............ 0.8618

Houston, MN

La Crosse, WI

3880 Lafayette, LA ..................... 0.8163

Acadia, LA

Lafayette, LA

St. Landry, LA

St. Martin, LA

3920 Lafayette, IN ...................... 0.8781

Clinton, IN

Tippecanoe, IN

3960 Lake Charles, LA .............. 0.8034

Calcasieu, LA

3980 Lakeland-Winter Haven,

FL .............................................. 0.8774

Polk, FL

4000 Lancaster, PA .................... 0.9583

Lancaster, PA

4040 Lansing-East Lansing, MI 1.0010

Clinton, MI

Eaton, MI

Ingham, MI

4080 Laredo, TX ........................ 0.7073

Webb, TX

4100 Las Cruces, NM ................ 0.8497

Dona Ana, NM

4120 Las Vegas, NV–AZ ........... 1.0870

Mohave, AZ

Clark, NV
51546 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Nye, NV

4150 Lawrence, KS .................... 0.8597

Douglas, KS

4200 Lawton, OK ....................... 0.8365

Comanche, OK

4243 Lewiston-Auburn, ME ........ 0.9410

Androscoggin, ME

4280 Lexington, KY .................... 0.8293

Bourbon, KY

Clark, KY

Fayette, KY

Jessamine, KY

Madison, KY

Scott, KY

Woodford, KY

4320 Lima, OH ........................... 0.8732

Allen, OH

Auglaize, OH

4360 Lincoln, NE ........................ 0.9161

Lancaster, NE

4400 Little Rock-North Little

Rock, AR ................................... 0.8597

Faulkner, AR

Lonoke, AR

Pulaski, AR

Saline, AR

4420 Longview-Marshall, TX ...... 0.8645

Gregg, TX

Harrison, TX

Upshur, TX

4480 Los Angeles-Long Beach,

CA ............................................. 1.2343

Los Angeles, CA

4520 Louisville, KY–IN ............... 0.9447

Clark, IN

Floyd, IN

Harrison, IN

Scott, IN

Bullitt, KY

Jefferson, KY

Oldham, KY

4600 Lubbock, TX ...................... 0.8510

Lubbock, TX

4640 Lynchburg, VA ................... 0.8052

Amherst, VA

Bedford City, VA

Bedford, VA

Campbell, VA

Lynchburg City, VA

4680 Macon, GA ........................ 0.8824

Bibb, GA

Houston, GA

Jones, GA

Peach, GA

Twiggs, GA

4720 Madison, WI ...................... 1.0021

Dane, WI

4800 Mansfield, OH ................... 0.8524

Crawford, OH

Richland, OH

4840 Mayaguez, PR ................... 0.4215

Anasco, PR

Cabo Rojo, PR

Hormigueros, PR

Mayaguez, PR

Sabana Grande, PR

San German, PR

4880 McAllen-Edinburg-Mission,

TX .............................................. 0.8485

Hidalgo, TX

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

4890 Medford-Ashland, OR ....... 1.0068

Jackson, OR

4900 Melbourne-Titusville-Palm

Bay, FL ...................................... 0.9068

Brevard, Fl

4920 Memphis, TN–AR–MS ...... 0.8166

Crittenden, AR

DeSoto, MS

Fayette, TN

Shelby, TN

Tipton, TN

4940 Merced, CA ....................... 1.0660

Merced, CA

5000 Miami, FL .......................... 0.9938

Dade, FL

5015 Middlesex-SomersetHunterdon, NJ ........................... 1.0883

Hunterdon, NJ

Middlesex, NJ

Somerset, NJ

5080 Milwaukee-Waukesha, WI 0.9645

Milwaukee, WI

Ozaukee, WI

Washington, WI

Waukesha, WI

5120 Minneapolis-St. Paul, MN–

WI .............................................. 1.0777

Anoka, MN

Carver, MN

Chicago, MN

Dakota, MN

Hennepin, MN

Isanti, MN

Ramsey, MN

Scott, MN

Sherburne, MN

Washington, MN

Wright, MN

Pierce, WI

St. Croix, WI

5160 Mobile, AL ......................... 0.7981

Baldwin, AL

Mobile, AL

5170 Modesto, CA ..................... 1.0600

Stanislaus, CA

5190 Monmouth-Ocean, NJ ....... 1.0833

Monmouth, NJ

Ocean, NJ

5200 Monroe, LA ........................ 0.8211

Ouachita, LA

5240 Montgomery, AL ................ 0.7876

Autauga, AL

Elmore, AL

Montgomery, AL

5280 Muncie, IN ......................... 0.9714

Delaware, IN

5330 Myrtle Beach, SC .............. 0.7790

Horry, SC

5345 Naples, FL ......................... 1.0199

Collier, FL

5360 Nashville, TN ..................... 0.9081

Cheatham, TN

Davidson, TN

Dickson, TN

Robertson, TN

Rutherford, TN

Sumner, TN

Williamson, TN

Wilson, TN

5380 Nassau-Suffolk, NY ........... 1.3547

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Nassau, NY

Suffolk, NY

5483 New Haven-BridgeportStamford-Danbury- .................... 1.2704

Waterbury,CT

Fairfield, CT

New Haven, CT

5523 New London-Norwich, CT 1.2262

New London, CT

5560 New Orleans, LA ............... 0.9294

Jefferson, LA

Orleans, LA

Plaquemines, LA

St. Bernard, LA

St. Charles, LA

St. James, LA

St. John Baptist, LA

St. Tammany, LA

5600 New York, NY ................... 1.4154

Bronx, NY

Kings, NY

New York, NY

Putnam, NY

Queens, NY

Richmond, NY

Rockland, NY

Westchester, NY

5640 Newark, NJ ........................ 1.1762

Essex, NJ

Morris, NJ

Sussex, NJ

Union, NJ

Warren, NJ

5660 Newburgh, NY–PA ............ 1.0803

Orange, NY

Pike, PA

5720 Norfolk-Virginia BeachNewport News, VA–NC ............. 0.8348

Currituck, NC

Chesapeake City, VA

Gloucester, VA

Hampton City, VA

Isle of Wight, VA

James City, VA

Mathews, VA

Newport News City, VA

Norfolk City, VA

Poquoson City, VA

Portsmouth City, VA

Suffolk City, VA

Virginia Beach City, VA

Williamsburg City, VA

York, VA

5775 Oakland, CA ...................... 1.4991

Alameda, CA

Contra Costa, CA

5790 Ocala, FL ........................... 0.9105

Marion, FL

5800 Odessa-Midland, TX ......... 0.8482

Ector, TX

Midland, TX

5880 Oklahoma City, OK ........... 0.8371

Canadian, OK

Cleveland, OK

Logan, OK

McClain, OK

Oklahoma, OK

Pottawatomie, OK

5910 Olympia, WA ..................... 1.0689

Thurston, WA
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices 51547

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

5920 Omaha, NE–IA .................. 0.9480

Pottawattamie, IA

Cass, NE

Douglas, NE

Sarpy, NE

Washington, NE

5945 Orange County, CA ........... 1.1966

Orange, CA

5960 Orlando, FL ....................... 0.9470

Lake, FL

Orange, FL

Osceola, FL

Seminole, FL

5990 Owensboro, KY ................. 0.7575

Daviess, KY

6015 Panama City, FL ............... 0.8061

Bay, FL

6020 Parkersburg-Marietta, WV–

OH ............................................. 0.7877

Washington, OH

Wood, WV

6080 Pensacola, FL ................... 0.8202

Escambia, FL

Santa Rosa, FL

6120 Peoria-Pekin, IL ................. 0.8905

Peoria, IL

Tazewell, IL

Woodford, IL

6160 Philadelphia, PA–NJ ......... 1.1237

Burlington, NJ

Camden, NJ

Gloucester, NJ

Salem, NJ

Bucks, PA

Chester, PA

Delaware, PA

Montgomery, PA

Philadelphia, PA

6200 Phoenix-Mesa, AZ ............. 0.9810

Maricopa, AZ

Pinal, AZ

6240 Pine Bluff, AR .................... 0.7886

Jefferson, AR

6280 Pittsburgh, PA ................... 0.9701

Allegheny, PA

Beaver, PA

Butler, PA

Fayette, PA

Washington, PA

Westmoreland, PA

6323 Pittsfield, MA ..................... 1.0552

Berkshire, MA

6340 Pocatelo, ID ....................... 0.8784

Bannock ID

6360 Ponce, PR ......................... 0.4685

Guayanilla, PR

Juana Diaz, PR

Penuelas, PR

Ponce, PR

Villalba, PR

Yauco, PR

6403 Portland, ME ..................... 0.9619

Cumberland, ME

Sagadahoc, ME

York, ME

6440 Portland-Vancouver, OR–

WA ............................................. 1.1235

Clackamas, OR

Columbia, OR

Multnomah, OR

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Washington, OR

Yamhill, OR

Clark, WA

6483 Providence-Warwick-Pawtucket, RI ................................... 1.1092

Bristol, RI

Kent, RI

Newport, RI

Providence, RI

Washington, RI

6520 Provo-Orem, UT ................ 1.0116

Utah, UT

6560 Pueblo, CO ........................ 0.8284

Pueblo, CO

6580 Punta Gorda, FL ............... 0.8999

Charlotte, FL

6600 Racine, WI ......................... 0.8835

Racine, WI

6640 Raleigh-Durham-Chapel

Hill, NC ...................................... 0.9728

Chatham, NC

Durham, NC

Franklin, NC

Johnston, NC

Orange, NC

Wake, NC

6660 Rapid City, SD .................. 0.8455

Pennington, SD

6680 Reading, PA ...................... 0.9445

Berks, PA

6690 Redding, CA ...................... 1.1605

Shasta, CA

6720 Reno, NV ........................... 1.1018

Washoe, NV

6740 Richland-KennewickPasco, WA ................................ 0.9970

Benton, WA

Franklin, WA

6760 Richmond-Petersburg, VA 0.9194

Charles City County, VA

Chesterfield, VA

Colonial Heights City, VA

Dinwiddie, VA

Goochland, VA

Hanover, VA

Henrico, VA

Hopewell City, VA

New Kent, VA

Petersburg City, VA

Powhatan, VA

Prince George, VA

Richmond City, VA

6780 Riverside-San Bernardino,

CA ............................................. 1.1379

Riverside, CA

San Bernardino, CA

6800 Roanoke, VA ..................... 0.8702

Botetourt, VA

Roanoke, VA

Roanoke City, VA

Salem City, VA

6820 Rochester, MN .................. 1.0428

Olmsted, MN

6840 Rochester, NY ................... 0.9649

Genesee, NY

Livingston, NY

Monroe, NY

Ontario, NY

Orleans, NY

Wayne, NY

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

6880 Rockford, IL ....................... 0.8994

Boone, IL

Ogle, IL

Winnebago, IL

6895 Rocky Mount, NC .............. 0.8955

Edgecombe, NC

Nash, NC

6920 Sacramento, CA ................ 1.2351

El Dorado, CA

Placer, CA

Sacramento, CA

6960 Saginaw-Bay City-Midland,

MI .............................................. 0.9612

Bay, MI

Midland, MI

Saginaw, MI

6980 St. Cloud, MN .................... 0.9457

Benton, MN

Stearns, MN

7000 St. Joseph, MO ................. 0.8551

Andrews, MO

Buchanan, MO

7040 St. Louis, MO–IL ............... 0.9022

Clinton, IL

Jersey, IL

Madison, IL

Monroe, IL

St. Clair, IL

Franklin, MO

Jefferson, MO

Lincoln, MO

St. Charles, MO

St. Louis, MO

St. Louis City, MO

Warren, MO

7080 Salem, OR ......................... 0.9728

Marion, OR

Polk, OR

7120 Salinas, CA ....................... 1.3803

Monterey, CA

7160 Salt Lake City-Ogden, UT 0.9677

Davis, UT

Salt Lake, UT

Weber, UT

7200 San Angelo, TX ................. 0.7577

Tom Green, TX

7240 San Antonio, TX ................ 0.8390

Bexar, TX

Comal, TX

Guadalupe, TX

Wilson, TX

7320 San Diego, CA .................. 1.2134

San Diego, CA

7360 San Francisco, CA ............ 1.4260

Marin, CA

San Francisco, CA

San Mateo, CA

7400 San Jose, CA .................... 1.4519

Santa Clara, CA

7440 San Juan-Bayamon, PR ... 0.4506

Aguas Buenas, PR

Barceloneta, PR

Bayamon, PR

Canovanas, PR

Carolina, PR

Catano, PR

Ceiba, PR

Comerio, PR

Corozal, PR

Dorado, PR
51548 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Fajardo, PR

Florida, PR

Guaynabo, PR

Humacao, PR

Juncos, PR

Los Piedras, PR

Loiza, PR

Luguillo, PR

Manati, PR

Morovis, PR

Naguabo, PR

Naranjito, PR

Rio Grande, PR

San Juan, PR

Toa Alta, PR

Toa Baja, PR

Trujillo Alto, PR

Vega Alta, PR

Vega Baja, PR

Yabucoa, PR

7460 San Luis ObispoAtascadero-Paso Robles, CA ... 1.1561

San Luis Obispo, CA

7480 Santa Barbara-Santa

Maria-Lompoc, CA .................... 1.1242

Santa Barbara, CA

7485 Santa Cruz-Watsonville,

CA ............................................. 1.3520

Santa Cruz, CA

7490 Santa Fe, NM .................... 1.0823

Los Alamos, NM

Santa Fe, NM

7500 Santa Rosa, CA ................ 1.2526

Sonoma, CA

7510 Sarasota-Bradenton, FL .... 0.9789

Manatee, FL

Sarasota, FL

7520 Savannah, GA ................... 0.9649

Bryan, GA

Chatham, GA

Effingham, GA

7560 Scranton—Wilkes-Barre—

Hazleton, PA ............................. 0.8752

Columbia, PA

Lackawanna, PA

Luzerne, PA

Wyoming, PA

7600 Seattle-Bellevue-Everett,

WA ............................................. 1.1384

Island, WA

King, WA

Snohomish, WA

7610 Sharon, PA ........................ 0.8885

Mercer, PA

7620 Sheboygan, WI .................. 0.7764

Sheboygan, WI

7640 Sherman-Denison, TX ....... 0.8614

Grayson, TX

7680 Shreveport-Bossier City,

LA .............................................. 0.9359

Bossier, LA

Caddo, LA

Webster, LA

7720 Sioux City, IA–NE ............. 0.8313

Woodbury, IA

Dakota, NE

7760 Sioux Falls, SD ................. 0.8620

Lincoln, SD

Minnehaha, SD

7800 South Bend, IN .................. 0.9934

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

St. Joseph, IN

7840 Spokane, WA .................... 1.0524

Spokane, WA

7880 Springfield, IL .................... 0.8671

Menard, IL

Sangamon, IL

7920 Springfield, MO ................. 0.7823

Christian, MO

Greene, MO

Webster, MO

8003 Springfield, MA .................. 1.0586

Hampden, MA

Hampshire, MA

8050 State College, PA .............. 0.9538

Centre, PA

8080 Steubenville-Weirton, OH–

WV ............................................. 0.8266

Jefferson, OH

Brooke, WV

Hancock, WV

8120 Stockton-Lodi, CA ............. 1.1330

San Joaquin, CA

8140 Sumter, SC ........................ 0.7699

Sumter, SC

8160 Syracuse, NY .................... 0.9395

Cayuga, NY

Madison, NY

Onondaga, NY

Oswego, NY

8200 Tacoma, WA ..................... 1.0860

Pierce, WA

8240 Tallahassee, FL ................. 0.8313

Gadsden, FL

Leon, FL

8280 Tampa-St. PetersburgClearwater, FL ........................... 0.9250

Hernando, FL

Hillsborough, FL

Pasco, FL

Pinellas, FL

8320 Terre Haute, IN ................. 0.8591

Clay, IN

Vermillion, IN

Vigo, IN

8360 Texarkana, AR-Texarkana,

TX .............................................. 0.8503

Miller, AR

Bowie, TX

8400 Toledo, OH ........................ 1.0361

Fulton, OH

Lucas, OH

Wood, OH

8440 Topeka, KS ....................... 1.0086

Shawnee, KS

8480 Trenton, NJ ....................... 1.0549

Mercer, NJ

8520 Tucson, AZ ........................ 0.9068

Pima, AZ

8560 Tulsa, OK .......................... 0.8095

Creek, OK

Osage, OK

Rogers, OK

Tulsa, OK

Wagoner, OK

8600 Tuscaloosa, AL ................. 0.7784

Tuscaloosa, AL

8640 Tyler, TX ............................ 0.9996

Smith, TX

8680 Utica-Rome, NY ................ 0.8413

Herkimer, NY

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

Oneida, NY

8720 Vallejo-Fairfield-Napa, CA 1.3947

Napa, CA

Solano, CA

8735 Ventura, CA ....................... 1.1454

Ventura, CA

8750 Victoria, TX ........................ 0.8393

Victoria, TX

8760 Vineland-Millville-Bridgeton, NJ ....................................... 0.9993

Cumberland, NJ

8780 Visalia-Tulare-Porterville,

CA ............................................. 1.0151

Tulare, CA

8800 Waco, TX .......................... 0.7772

McLennan, TX

8840 Washington, DC–MD–VA–

WV ............................................. 1.0823

District of Columbia, DC

Calvert, MD

Charles, MD

Frederick, MD

Montgomery, MD

Prince Georges, MD

Alexandria City, VA

Arlington, VA

Clarke, VA

Culpepper, VA

Fairfax, VA

Fairfax City, VA

Falls Church City, VA

Fauquier, VA

Fredericksburg City, VA

King George, VA

Loudoun, VA

Manassas City, VA

Manassas Park City, VA

Prince William, VA

Spotsylvania, VA

Stafford, VA

Warren, VA

Berkeley, WV

Jefferson, WV

8920 Waterloo-Cedar Falls, IA ... 0.8705

Black Hawk, IA

8940 Wausau, WI ....................... 1.0323

Marathon, WI

8960 West Palm Beach-Boca

Raton, FL .................................. 1.0202

Palm Beach, FL

9000 Wheeling, OH–WV ............ 0.7563

Belmont, OH

Marshall, WV

Ohio, WV

9040 Wichita, KS ........................ 0.9369

Butler, KS

Harvey, KS

Sedgwick, KS

9080 Wichita Falls, TX ............... 0.8041

Archer, TX

Wichita, TX

9140 Williamsport, PA ................ 0.8467

Lycoming, PA

9160 Wilmington-Newark, DE–

MD ............................................. 1.1315

New Castle, DE

Cecil, MD

9200 Wilmington, NC ................. 0.9046

New Hanover, NC

Brunswick, NC
Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices 51549

TABLE IV.—WAGE INDEX FOR URBAN

AREAS—Continued

Urban area (constituent counties

or county equivalents)

Wage

index

9260 Yakima, WA ...................... 1.0026

Yakima, WA

9270 Yolo, CA ............................ 1.1444

Yolo, CA

9280 York, PA ............................ 0.9104

York, PA

9320 Youngstown-Warren, OH .. 0.9742

Columbiana, OH

Mahoning, OH

Trumbull, OH

9340 Yuba City, CA ................... 1.0414

Sutter, CA

Yuba, CA

9360 Yuma, AZ .......................... 0.9497

Yuma, AZ

TABLE V.—WAGE INDEX FOR RURAL

AREAS

Nonurban area Wage

index

Alabama ........................................ 0.7122

Alaska ........................................... 1.2444

Arizona .......................................... 0.7928

Arkansas ....................................... 0.6954

California ....................................... 1.0002

Colorado ....................................... 0.8092

Connecticut ................................... 1.2759

Delaware ....................................... 0.9447

Florida ........................................... 0.8668

Georgia ......................................... 0.7653

Hawaii ........................................... 1.0245

Idaho ............................................. 0.8277

Illinois ............................................ 0.7553

Indiana .......................................... 0.8124

Iowa .............................................. 0.7373

Kansas .......................................... 0.7107

Kentucky ....................................... 0.7753

Louisiana ....................................... 0.7232

Maine ............................................ 0.8317

Maryland ....................................... 0.8427

Massachusetts .............................. 1.0070

Michigan ........................................ 0.8830

Minnesota ..................................... 0.8144

Mississippi ..................................... 0.6793

Missouri ......................................... 0.7261

Montana ........................................ 0.8128

Nebraska ....................................... 0.7214

Nevada .......................................... 0.8775

New Hampshire ............................ 0.9745

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

New Mexico .................................. 0.8000

New York ...................................... 0.8558

North Carolina ............................... 0.7950

North Dakota ................................. 0.7358

Ohio .............................................. 0.8332

Oklahoma ...................................... 0.6942

Oregon .......................................... 0.9664

Pennsylvania ................................. 0.8453

Puerto Rico ................................... 0.4026

Rhode Island1 ............................... ................

South Carolina .............................. 0.7668

South Dakota ................................ 0.7063

Tennessee .................................... 0.7341

Texas ............................................ 0.7462

Utah .............................................. 0.8848

Vermont ........................................ 0.8921

TABLE V.—WAGE INDEX FOR RURAL

AREAS—Continued

Nonurban area Wage

index

Virginia .......................................... 0.7713

Virgin Islands ................................ 0.5660

Washington ................................... 0.9933

West Virginia ................................. 0.7904

Wisconsin ...................................... 0.8430

Wyoming ....................................... 0.8177

1All counties within the State are classified

urban.

TABLE VI.—COST REPORTING YEAR

ADJUSTMENT FACTORS 1

[Effective October 1, 1997]

If a SNF cost reporting period begins:

The adjustment

factor is:

Nov. 1, 1997 ................................. 1.00285

Dec. 1, 1997 ................................. 1.00560

Jan. 1, 1998 .................................. 1.00846

Feb. 1, 1998 ................................. 1.01149

Mar. 1, 1998 ................................. 1.01424

Apr. 1, 1998 .................................. 1.01729

May 1, 1998 .................................. 1.02025

June 1, 1998 ................................. 1.02332

July 1, 1998 .................................. 1.02630

Aug. 1, 1998 ................................. 1.02939

Sept. 1, 1998 ................................ 1.03249

1Based on compounded projected market

basket inflation rates of 3.4 percent for 1998

and 3.6 percent for 1999.

VI. Impact Statement

For notices such as this, we generally

prepare a regulatory flexibility analysis

that is consistent with the Regulatory

Flexibility Act (RFA) (5 U.S.C. 601

through 612) unless we certify that a

notice will not have a significant

economic impact on a substantial

number of small entities. For purposes

of the RFA, all SNFs are considered to

be small entities. Individuals and States

are not included in the definition of a

small entity.

This final notice with comment

period sets forth an updated schedule of

limits on SNF routine service costs for

which payment may be made under the

Medicare program and sets forth an

updated schedule of payment rates for

low Medicare volume skilled nursing

facilities that elect to receive

prospectively determined payment rates

for routine service costs. Section 1888(a)

of the Act requires that the Secretary

update the per diem cost limits for SNF

routine service costs for cost reporting

periods beginning on or after October 1,

1995, and every 2 years thereafter. In

addition, section 1888(d)(4) of the Act

requires the Secretary to establish and

publish prospectively determined

payment rates at least 90 days prior to

the beginning of the Federal fiscal year

to which such rates are to be applied.

This final notice with comment

period is the first time we are

publishing a combined schedule of cost

limits and rates. Combining the cost

limits and rates in one notice is more

economical in that they both utilize the

same cost report data, wage index

values, and rates of inflation. In

addition, under section 1888(d) of the

Act, an individual provider’s

prospectively determined rate may not

exceed its applicable cost limit (see

Section III.D. of this notice). This final

notice with comment period, by

containing both cost limits and rates for

cost reporting periods beginning FY

1998, allows a provider to more

conveniently determine its individual

rate than in previous years.

As required under section 1888(a) and

1888(d) of the Act respectively, this

final notice with comment period sets

forth a revised schedule of SNF per

diem cost limits and prospectively

determined payment rates for

freestanding and hospital-based SNFs

for cost reporting periods beginning in

FY 1998. As explained in this notice, we

have retained the same basic

methodology used to compute the limits

and rates effective for cost reporting

periods beginning in FY 1997, but we

are revising the schedule of limits and

rates to reflect more recent wage data,

MSA designations, and inflation data.

The estimated effects of this notice are

that (1) the updated cost limits will

result in a loss of savings to the

Medicare program of $20 million in FY

1998, and (2) the updated rates will

have a negligible effect. These estimates

are the effect of the updating the cost

limits and rates to reflect more recent

wage data, MSA designations, and

inflation data compared to just updating

the previous (FY 1997) cost limits or

rates only for inflation.

The table below shows the effect of

updating the cost limits contained in

this notice in comparison with updating

the cost limits effective for FY 1997 by

inflation (the market basket).

Specifically, column (A) of the table

shows the estimated total number of

SNFs to which the cost limits effective

for FY 1998 will apply. Column (B)

shows the number of SNFs that would

exceed the cost limits effective for FY

1997 updated only for inflation. Column

(C) shows the number of SNFs that

would exceed the cost limits contained

in this notice. Implementing the cost

limits contained in this notice, as
51550 Federal Register / Vol. 62, No. 190 / Wednesday, October 1, 1997 / Notices

compared with maintaining the FY 1997

cost limits updated for inflation, will

result in a small decrease in the number

of SNFs with costs in excess of the

limits.

Total SNFs

to which

limits effective for FY

1998 will

apply

(column A)

Number of

SNFs over

FY 1997

limits updated for inflation

(column B)

Number of

SNFs over

FY 1998

limits contained in

this notice

(column C)

Freestanding SNFs:

Urban (MSA) ..................................................................................................................................... 4873 2353 2331

Rural (non-MSA) ............................................................................................................................... 1638 900 878

Hospital-Based SNFs: .................... .................... ....................

Urban (MSA) ..................................................................................................................................... 367 301 283

Rural (non-MSA) ............................................................................................................................... 348 224 217

We are unable to identify the effects

of these provisions on individual SNFs,

but we expect that decreases in the

number of SNFs exceeding the limits

generally would result in increases in

payments to those SNFs whose costs

would previously have exceeded the

limits but now fall under the limits. The

effects of the increase in the limits on

the total revenues of individual SNFs

will depend on the SNF’s ability to

operate within the cost limits and on the

proportion of its revenues that come

from the Medicare program.

For purposes of the RFA, it is our

practice not to consider an economic

impact to be significant unless the

annual total costs or revenues of a

substantial number of entities will be

increased or decreased by at least 3

percent. Because Medicare payments

generally do not account for a high

proportion of SNF revenue, we believe

that the updated SNF limits and rates

will not result in a substantial number

of SNFs experiencing significant

increases in their total revenues.

Therefore, we have determined, and we

certify, that a regulatory flexibility

analysis under the RFA is not required.

Section 1102(b) of the Act requires us

to prepare a regulatory impact analysis

if a notice such as this may have a

significant impact on the operations of

a substantial number of small rural

hospitals. Such an 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 50

beds.

We have not prepared a rural impact

statement since we have determined

that this final notice with comment

period will not have a significant

economic impact on the operations of a

substantial number of small rural

hospitals.

In accordance with the provisions of

Executive Order 12866, this notice was

reviewed by the Office of Management

and Budget.

VII. Waiver of Proposed Notice

In adopting notices such as this, we

ordinarily publish a proposed notice in

the Federal Register with a 60-day

period for public comment as required

under section 1871(b)(1) of the Act.

However, we may waive these

procedures if we find good cause that

prior notice and comment is

impractical, unnecessary, or contrary to

the public interest.

As discussed in section II. of this

notice, we have used the same

methodology to develop this schedule of

limits that was used in setting the limits

published for public comment on

October 7, 1992. As discussed above,

section 13503(a)(2) of OBRA’ 93 delayed

the update to the schedule of limits

until October 1, 1995 and then every 2

years. We have also used the same

methodology to develop this schedule of

rates that was used in setting the rates

published for public comment on

September 3, 1996. Section 13503(b) of

OBRA’ 93 delayed the update to the

schedule of prospectively determined

payment rates until October 1, 1995.

Thus, in conformance with the clear

direction provided in sections

1861(v)(1) and 1888 of the Act and

regulations at §§ 413.30 and 413.320,

this notice announces the update to the

schedule of limits for SNF routine

service costs and the update to the

schedule of prospectively determined

payment rates for SNF inpatient cost, for

cost reporting periods beginning on or

after October 1, 1997. Because the

statute directs that this schedule of

limits and this schedule of rates are

effective for cost reporting periods

beginning October 1, 1997, and given

that we are making no changes in the

methodology used to develop these

limits, we believe it is unnecessary to

publish a proposed notice. Therefore,

we find good cause to waive publication

of a proposed notice. However, we are

providing a 60-day period for public

comment, as indicated at the beginning

of this notice.

VIII. Response to Comments

Because of the large number of items

of correspondence we normally receive

on Federal Register documents

published for comment, we are not able

to acknowledge or respond to them

individually. We will consider all

comments we receive by the date and

time specified in the DATES section of

this notice, and, if we proceed with a

subsequent document, we will respond

to the comments in that document.

Authority: (Secs. 1102, 1814(b), 1861(v)(1),

1866(a), 1871, and 1888 of the Social

Security Act (42 U.S.C. 1302, 1395f(b),

1395x(v)(1), 1395cc(a), 1395hh, and 1395yy);

section 13503 of Pub. L. 103–66 (42 U.S.C.

1395x(v)(1)(B) and 1395yy (note)) and 42

CFR 413.1, 413.24, 413.300 through 413.321).

(Catalog of Federal Domestic Assistance

Program No. 93.773, Medicare—Hospital

Insurance)

Dated: September 25, 1997.

Nancy-Ann Min DeParle,

Deputy Administrator, Health Care Financing

Administration.

Dated: September 25, 1997.

Donna E. Shalala,

Secretary.

[FR Doc. 97–25983 Filed 9–30–97; 8:45 am]

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