60072 Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

[HCFA–1135–N]

[RIN 0938–AK13]

Medicare Program; Hospice Wage

Index

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Notice.

SUMMARY: This notice announces the

annual update to the hospice wage

index as required by statute. This

update is effective October 1, 2000

through September 30, 2001. The wage

index is used to reflect local differences

in wage levels. The hospice wage index

methodology and values are based on

recommendations of a negotiated

rulemaking advisory committee and

were originally published in the Federal

Register on August 8, 1997.

EFFECTIVE DATE: This notice is effective

on October 1, 2000.

FOR FURTHER INFORMATION CONTACT:

Carol Blackford, (410) 786–5909.

SUPPLEMENTARY INFORMATION:

I. Background

A. Statute and Regulations

Hospice Care is an approach to

treatment that recognizes that the

impending death of an individual

warrants a change in the focus from

curative care to palliative care (relief of

pain and other uncomfortable

symptoms). The goal of hospice care is

to help terminally ill individuals

continue life with minimal disruption to

normal activities while remaining

primarily in the home environment. A

hospice uses an interdisciplinary

approach to deliver medical, social,

psychological, emotional, and spiritual

services through use of a broad

spectrum of professional and other

caregivers, with the goal of making the

individual as physically and

emotionally comfortable as possible.

Counseling and respite services are

available to the family of the hospice

patient. Hospice programs consider both

the patient and the family as a unit of

care.

Section 1861(dd) of the Social

Security Act (the Act) provides for

coverage of hospice care for terminally

ill Medicare beneficiaries who elect to

receive care from a participating

hospice. The statutory authority for

payment to hospices participating in the

Medicare program is contained in

section 1814(i) of the Act.

Our existing regulations under 42 CFR

part 418 (issued on December 16, 1983,

effective for hospice services furnished

on or after November 1, 1983) establish

eligibility requirements and payment

standards and procedures, define

covered services, and delineate the

conditions a hospice must meet to be

approved for participation in the

Medicare program. Subpart G of Part

418 provides for payment to hospices

based on one of four prospectively

determined rates for each day in which

a qualified Medicare beneficiary is

under the care of a hospice. The four

rate categories are routine home care,

continuous home care, inpatient respite

care, and general inpatient care.

Payment rates are established for each

category.

The regulations at § 418.306(c), which

require the rates to be adjusted by a

wage index, were revised in the August

8, 1997 final rule (62 FR 42860). This

rule implemented a new methodology

for calculating the hospice wage index

based on the recommendations of a

negotiated rulemaking committee. The

committee reached consensus on the

methodology. We included the resulting

committee statement, describing that

consensus, as an appendix to the August

8, 1997 final rule (62 FR 42883). The

provisions of the final hospice wage

index rule are as follows:

• The revised hospice wage index

will be calculated using the most

current available hospital wage data.

• The revised hospice wage index

was phased in over a 3-year transition

period. For the first year of the

transition period, October 1, 1997

through September 30, 1998, a blended

index was calculated by adding twothirds of the 1983 index value for an

area to one-third of the revised wage

index value for that area. During the

second year of the transition period,

October 1, 1998 through September 30,

1999, the calculation was similar,

except that the blend was one-third of

the 1983 index value and two-thirds of

the revised wage index value for that

area. We fully implemented the revised

wage index during the third transition

period, October 1, 1999 through

September 30, 2000.

• All hospice wage index values of

0.8 or greater are subject to a budgetneutrality adjustment to ensure that we

do not pay more in the aggregate than

we would have paid under the original

wage index. The budget-neutrality

adjustment is calculated by multiplying

the hospice wage index for a given area

by the budget-neutrality adjustment

factor. The budget-neutrality adjustment

is to be applied annually, both during

and after the transition period.

• All hospice wage index values

below 0.8 receive the greater of the

following adjustments: the wage index

floor, a 15-percent increase, subject to a

maximum wage index value of 0.8; or,

the budget-neutrality adjustment.

• The wage index is to be updated

annually, in the Federal Register, based

on the most current available hospital

wage data. These data will include any

changes to the definitions of

Metropolitan Statistical Areas (MSA).

Section 4441(a) of the Balanced

Budget Act of 1997 (BBA) amended

section 1814(i)(1)(C)(ii) of the Act to

establish updates to hospice rates for

fiscal years (FYs) 1998 through 2002.

Hospice rates were to be updated by a

factor equal to the market basket index,

minus 1 percentage point. However,

section 131(a) of the Balanced Budget

Refinement Act of 1999 (BBRA) changed

the payment rates for FYs 2001 and

2002 by increasing the FY 2001 rate by

0.5 percent and the FY 2002 rate by 0.75

percent. Section 131(b) of the BBRA

states that any additional payments

made under section 131(a) of the BBRA

shall not be included in updating the

hospice rates after those 2 years.

B. Update to the Hospice Wage Index

This annual update is effective

October 1, 2000 through September 30,

2001. In accordance with the agreement

signed by the Health Care Financing

Administration (HCFA) and all other

members of the Hospice Wage Index

Negotiated Rulemaking Committee, we

are using the most current HCFA

hospital data available, including any

changes to the definitions of MSAs. The

FY 2000 hospital wage index was the

most current hospital wage data

available when the FY 2001 wage index

values were calculated. We used the

pre-reclassified and pre-floor hospital

area wage index data.

All wage index values are adjusted by

a budget-neutrality factor of 1.065425

and are subject to the wage index floor

adjustment, if applicable. We have

completed all of the calculations

described above and included them in

the wage index values reflected in both

Tables A and B below. A detailed

description of the method used to

compute the hospice wage index is

contained in both the September 4, 1996

proposed rule (61 FR 46579) and the

August 8, 1997 final rule (62 FR 42860).

After the publication of the FY 2000

hospice wage index updates, we

received a number of questions about

the methodology used to calculate the

hospice wage indices. We would like to

take this opportunity to further explain

the methodology used in determining

the hospice wage indices.

Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices 60073

1. Metropolitan Statistical Areas

As explained in the September 4,

1996 hospice wage index proposed rule,

each hospice=s labor market area would

be established by the MSA definitions

issued by the Office of Management and

Budget (OMB) on December 28, 1992

based on the 1990 census, and updated

periodically by OMB. Any changes to

the MSA definitions would be effective

annually and announced in the final

rule updating the hospice wage index.

2. MSA Wage Index Values Lower Than

Rural Values

As explained above, any area not

included in an MSA is considered to be

nonurban and receives the statewide

rural rate. We are aware that in the past,

a number of MSAs have had wage index

values that were lower than their rural

statewide value. This difference is due

to variations in local wage data as

compared to national wage data. The

hospice wage index is computed by

dividing the hourly wage rate for an

MSA or nonurban area by a national

hourly wage rate. Nonurban areas could

receive a higher wage index value than

urban areas in the same state if the

hourly wage rate in the nonurban area

increased at a greater rate.

C. Tables

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

0040 ..... Abilene, TX .................. 0.8715

Taylor, TX

0060 ..... Aguadilla, PR ............... 0.4386

Aguada, PR

Aguadilla, PR

Moca, PR

0080 ..... Akron, OH .................... 1.0829

Portage, OH

Summit, OH

0120 ..... Albany, GA ................... 1.1052

Dougherty, GA

Lee, GA

0160 ..... Albany-SchenectadyTroy, NY.0.9328

Albany, NY

Montgomery, NY

Rensselaer, NY

Saratoga, NY

Schenectady, NY

Schoharie, NY

0200 ..... Albuquerque, NM ......... 0.9056

Bernalillo, NM

Sandoval, NM

Valencia, NM

0220 ..... Alexandria, LA .............. 0.8385

Rapides, LA

0240 ..... Allentown-BethlehemEaston, PA.1.0897

Carbon, PA

Lehigh, PA

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Northampton, PA

0280 ..... Altoona, PA .................. 0.9954

Blair, PA

0320 ..... Amarillo, TX ................. 0.8929

Potter, TX

Randall, TX

0380 ..... Anchorage, AK ............. 1.3701

Anchorage, AK

0440 ..... Ann Arbor, MI ............... 1.2235

Lenawee, MI

Livingston, MI

Washtenaw, MI

0450 ..... Anniston, AL ................. 0.9017

Calhoun, AL

0460 ..... Appleton-OshkoshNeenah, WI.0.9496

Calumet, WI

Outagamie, WI

Winnebago, WI

0470 ..... Arecibo, PR .................. 0.5537

Arecibo, PR

Camuy, PR

Hatillo, PR

0480 ..... Asheville, NC ............... 0.9466

Buncombe, NC

Madison, NC

0500 ..... Athens, GA ................... 1.0340

Clarke, GA

Madison, GA

Oconee, GA

0520 ..... Atlanta, GA ................... 1.0709

Barrow, GA

Bartow, GA

Carroll, GA

Cherokee, GA

Clayton, GA

Cobb, GA

Coweta, GA

DeKalb, GA

Douglas, GA

Fayette, GA

Forsyth, GA

Fulton, GA

Gwinnett, GA

Henry, GA

Newton, GA

Paulding, GA

Pickens, GA

Rockdale, GA

Spalding, GA

Walton, GA

0560 ..... Atlantic-Cape May, NJ 1.2051

Atlantic, NJ

Cape May, NJ

0580 ..... Aubrn-Opelika, AL ........ 0.8256

Lee, AL

0600 ..... Augusta-Aiken, GA–SC 0.9603

Columbia, GA

McDuffie, GA

Richmond, GA

Aiken, SC

Edgefield, SC

0640 ..... Austin-San Marcos, TX 0.9676

Bastrop, TX

Caldwell, TX

Hays, TX

Travis, TX

Williamson, TX

0680 ..... Bakersfield, CA ............ 1.0248

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Kern, CA

0720 ..... Baltimore, MD .............. 1.0539

Anne Arundel, MD

Baltimore, MD

Baltimore City, MD

Carroll, MD

Harford, MD

Howard, MD

Queen Anne’s, MD

0733 ..... Bangor, ME .................. 1.0239

Penobscot, ME

0743 ..... Barnstable-Yarmouth,

MA.

1.4173

Barnstable, MA

0760 ..... Baton Rouge, LA ......... 0.9278

Ascension, LA

East Baton Rouge, LA

Livingston, LA

West Baton Rouge, LA

0840 ..... Beaumont-Port Arthur,

TX.

0.9129

Hardin, TX

Jefferson, TX

Orange, TX

0860 ..... Bellingham, WA ........... 1.2141

Whatcom, WA

0870 ..... Benton Harbor, MI ....... 0.9011

Berrien, MI

0875 ..... Bergen-Passaic, NJ ..... 1.2816

Bergen, NJ

Passaic, NJ

0880 ..... Billings, MT .................. 1.0696

Yellowstone, MT

0920 ..... Biloxi-GulfportPascagoula, MS.0.8383

Hancock, MS

Harrison, MS

Jackson, MS

0960 ..... Binghamton, NY ........... 0.9324

Broome, NY

Tioga, NY

1000 ..... Birmingham, AL ........... 0.9584

Blount, AL

Jefferson, AL

St. Clair, AL

Shelby, AL

1010 ..... Bismarck, ND ............... 0.8267

Burleigh, ND

Morton, ND

1020 ..... Bloomington, IN ........... 0.9155

Monroe, IN

1040 ..... Bloomington-Normal, IL 0.9582

McLean, IL

1080 ..... Boise City, ID ............... 0.9654

Ada, ID

Canyon, ID

1123 ..... Boston-Worcester-Lawrence-Lowell-Brockton, MA–NH.1.2102

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

Merrimack, NH

Rockingham, NH

60074 Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Strafford, NH

1125 ..... Boulder-Longmont, CO 1.0596

Boulder, CO

1145 ..... Brazoria, TX ................. 0.9074

Brazoria, TX

1150 ..... Bremerton, WA ............ 1.1733

Kitsap, WA

1240 ..... Brownsville-HarlingenSan Benito, TX.0.9816

Cameron, TX

1260 ..... Bryan-College Station,

TX.

0.9057

Brazos, TX

1280 ..... Buffalo-Niagara Falls,

NY.

1.0233

Erie, NY

Niagara, NY

1303 ..... Burlington, VT .............. 1.1250

Chittenden, VT

Franklin, VT

Grand Isle, VT

1310 ..... Caguas, PR .................. 0.5245

Caguas, PR

Cayey, PR

Cidra, PR

Gurabo, PR

San Lorenzo, PR

1320 ..... Canton-Massillon, OH .. 0.9346

Carroll, OH

Stark, OH

1350 ..... Casper, WY .................. 0.9802

Natrona, WY

1360 ..... Cedar Rapids, IA ......... 0.9609

Linn, IA

1400 ..... Champaign-Urbana, IL 0.9764

Champaign, IL

1440 ..... Charleston-North

Charleston, SC.

0.9577

Berkeley, SC

Charleston, SC

Dorchester, SC

1480 ..... Charleston, WV ............ 0.9691

Kanawha, WV

Putnam, WV

1520 ..... Charlotte-GastoniaRock Hill, NC–SC.1.0051

Cabarrus, NC

Gaston, NC

Lincoln, NC

Mecklenburg, NC

Rowan, NC

Stanly, NC

Union, NC

York, SC

1540 ..... Charlottesville, VA ........ 1.1267

Albemarle, VA

Charlottesville City, VA

Fluvanna, VA

Greene, VA

1560 ..... Chattanooga, TN–GA .. 1.0369

Catoosa, GA

Dade, GA

Walker, GA

Hamilton, TN

Marion, TN

1580 ..... Cheyenne, WY ............. 0.8711

Laramie, WY

1600 ..... Chicago, IL ................... 1.1585

Cook, IL

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

DeKalb, IL

Du Page, IL

Grundy, IL

Kane, IL

Kendall, IL

Lake, IL

McHenry, IL

Will, IL

1620 ..... Chico-Paradise, CA ...... 1.1071

Butte, CA

1640 ..... Cincinnati, OH–KY–IN .. 1.0035

Brown, OH

Clermont, OH

Hamilton, OH

Warren, OH

Boone, KY

Campbell, KY

Gallatin, KY

Grant, KY

Kenton, KY ...................

Pendleton, KY

Dearborn, IN

Ohio, IN

1660 ..... Clarksville-Hopkinsville,

TN–KY.

0.8619

Christian, KY

Montgomery, TN

1680 ..... Cleveland-Lorain-Elyria,

OH.

1.0323

Ashtabula, OH

Cuyahoga, OH

Geauga, OH

Lake, OH

Lorain, OH

Medina, OH

1720 ..... Colorado Springs, CO .. 0.9821

El Paso, CO

1740 ..... Columbia, MO .............. 0.9488

Boone, MO

1760 ..... Columbia, SC ............... 0.9970

Lexington, SC

Richland, SC

1800 ..... Columbus, GA–AL ....... 0.9068

Chattahochee, GA

Harris, GA

Muscogee, GA

Russell, AL

1840 ..... Columbus, OH ............. 1.0556

Delaware, OH

Fairfield, OH

Franklin, OH

Licking, OH

Madison, OH

Pickaway, OH

1880 ..... Corpus Christi, TX ........ 0.9271

Nueces, TX

San Patricio, TX

1890 ..... Corvallis, Oregon ......... 1.1813

Benton, OR

1900 ..... Cumberland, MD–WV .. 0.9378

Allegany, MD

Mineral, WV

1920 ..... Dallas, TX .................... 1.0236

Collin, TX

Dallas, TX

Denton, TX

Ellis, TX

Henderson, TX

Hunt, TX

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Kaufman, TX

Rockwall, TX

1950 ..... Danville, VA ................. 0.9277

Danville City, VA

Pittsylvania, VA

1960 ..... Davenport-Moline-Rock

Island, IA–IL.

1.0080

Scott, IA

Henry, IL

Rock Island, IL

2000 ..... Dayton-Springfield, OH 0.9576

Clark, OH

Greene, OH

Miami, OH

Montgomery, OH

2020 ..... Daytona Beach, FL ...... 0.9248

Flagler, FL

Volusia, FL

2030 ..... Decatur, AL .................. 0.9248

Lawrence, AL

Morgan, AL

2040 ..... Decatur, IL ................... 0.8867

Macon, IL

2080 ..... Denver, CO .................. 1.0857

Adams, CO

Arapahoe, CO

Denver, CO

Douglas, CO

Jefferson, CO

2120 ..... Des Moines, IA ............ 0.9328

Dallas, IA

Polk, IA

Warren, IA

2160 ..... Detroit, MI .................... 1.1104

Lapeer, MI

Macomb, MI

Monroe, MI

Oakland, MI

St. Clair, MI

Wayne, MI

2180 ..... Dothan, AL ................... 0.8309

Dale, AL

Houston, AL

2190 ..... Dover, DE .................... 0.9947

Kent, DE

2200 ..... Dubuque, IA ................. 0.9079

Dubuque, IA

2240 ..... Duluth-Superior, MN–

WI.

1.0831

St. Louis, MN

Douglas, WI

2281 ..... Dutchess County, NY .. 1.1243

Dutchess, NY

2290 ..... Eau Claire, WI .............. 0.9544

Chippewa, WI

Eau Claire, WI

2320 ..... El Paso, TX .................. 0.9533

El Paso, TX

2330 ..... Elkhart-Goshen, IN ...... 0.9994

Elkhart, IN

2335 ..... Elmira, NY .................... 0.9092

Chemung, NY

2340 ..... Enid, OK ....................... 0.8474

Garfield, OK

2360 ..... Erie, PA ........................ 0.9614

Erie, PA

2400 ..... Eugene-Springfield, OR 1.1298

Lane, OR

Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices 60075

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

2440 ..... Evansville-Henderson,

IN–KY.

0.8847

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2520 ..... Fargo-Moorhead, ND–

MN.

0.9185

Clay, MN

Cass, ND

2560 ..... Fayetteville, NC ............ 0.9051

Cumberland, NC

2580 ..... Fayetteville-SpringdaleRogers, AR.0.8283

Benton, AR

Washington, AR

2620 ..... Flagstaff, AZ–UT .......... 1.1026

Coconino, AZ

Kane, UT

2640 ..... Flint, MI ........................ 1.1742

Genesee, MI

2650 ..... Florence, AL ................. 0.8447

Colbert, AL

Lauderdale, AL

2655 ..... Florence, SC ................ 0.9183

Florence, SC

2670 ..... Fort Collins-Loveland,

CO.

1.0977

Larimer, CO

2680 ..... Ft. Lauderdale, FL ....... 1.0839

Broward, FL

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

FL.

0.9537

Lee, FL

2710 ..... Fort Pierce-Port St.

Lucie, FL.

1.0653

Martin, FL

St. Lucie, FL

2720 ..... Fort Smith, AR–OK ...... 0.8357

Crawford, AR

Sebastian, AR

Sequoyah, OK

2750 ..... Fort Walton Beach, FL 0.9284

Okaloosa, FL

2760 ..... Fort Wayne, IN ............. 0.9692

Adams, IN

Allen, IN

De Kalb, IN

Huntington, IN

Wells, IN

Whitley, IN

2800 ..... Fort Worth-Arlington,

TX.

1.0480

Hood, TX

Johnson, TX

Parker, TX

Tarrant, TX

2840 ..... Fresno, CA ................... 1.0935

Fresno, CA

Madera, CA

2880 ..... Gadsden, AL ................ 0.9258

Etowah, AL

2900 ..... Gainesville, FL ............. 1.0764

Alachua, FL

2920 ..... Galveston-Texas City,

TX.

1.0370

Galveston, TX

2960 ..... Gary, IN ........................ 1.0005

Lake, IN

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Porter, IN

2975 ..... Glens Falls, NY ............ 0.9170

Warren, NY

Washington, NY

2980 ..... Goldsboro, NC ............. 0.8879

Wayne, NC

2985 ..... Grand Forks, ND–MN .. 0.9693

Grand Forks, ND

Polk, MN

2995 ..... Grand Junction, CO ..... 0.9790

Mesa, CO

3000 ..... Grand Rapids-Muskegon-Holland, MI.1.0799

Allegan, MI

Kent, MI

Muskegon, MI

Ottawa, MI

3040 ..... Great Falls, MT ............ 1.1144

Cascade, MT

3060 ..... Greeley, CO ................. 1.0359

Weld, CO

3080 ..... Green Bay, WI ............. 0.9731

Brown, WI

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

NC.

0.9629

Alamance, NC

Davidson, NC

Davie, NC

Forsyth, NC

Guilford, NC

Randolph, NC

Stokes, NC

Yadkin, NC

3150 ..... Greenville, NC .............. 1.0123

Pitt, NC

3160 ..... Greenville-SpartanburgAnderson, SC.0.9790

Anderson, SC

Cherokee, SC

Greenville, SC

Pickens, SC

Spartanburg, SC

3180 ..... Hagerstown, MD .......... 0.9422

Washington, MD

3200 ..... Hamilton-Middletown,

OH.

0.9532

Butler, OH

3240 ..... Harrisburg-LebanonCarlisle, PA.1.0567

Cumberland, PA

Dauphin, PA

Lebanon, PA

Perry, PA

3283 ..... Hartford, CT ................. 1.2483

Hartford, CT

Litchfield, CT

Middlesex, CT

Tolland, CT

3285 ..... Hattiesburg, MS ........... 0.8134

Forrest, MS

Lamar, MS

3290 ..... Hickory-MorgantonLenoir, NC.0.9709

Alexander, NC

Burke, NC

Caldwell, NC

Catawba, NC

3320 ..... Honolulu, HI ................. 1.2228

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Honolulu, HI

3350 ..... Houma, LA ................... 0.8350

Lafourche, LA

Terrebonne, LA

3360 ..... Houston, TX ................. 1.0002

Chambers, TX

Fort Bend, TX

Harris, TX

Liberty, TX

Montgomery, TX

Waller, TX

3400 ..... Huntington-Ashland,

WV–KY–OH.

1.0396

Boyd, KY

Carter, KY

Greenup, KY

Lawrence, OH

Cabell, WV

Wayne, WV

3440 ..... Huntsville, AL ............... 0.9400

Limestone, AL

Madison, AL

3480 ..... Indianapolis, IN ............ 1.0434

Boone, IN

Hamilton, IN

Hancock, IN

Hendricks, IN

Johnson, IN

Madison, IN

Marion, IN

Morgan, IN

Shelby, IN

3500 ..... Iowa City, IA ................. 1.0237

Johnson, IA

3520 ..... Jackson, MI .................. 0.9419

Jackson, MI

3560 ..... Jackson, MS ................ 0.8936

Hinds, MS

Madison, MS

Rankin, MS

3580 ..... Jackson, TN ................. 0.9164

Madison, TN

Chester, TN

3600 ..... Jacksonville, FL ........... 0.9544

Clay, FL

Duval, FL

Nassau, FL

St. Johns, FL

3605 ..... Jacksonville, NC ........... 0.8367

Onslow, NC

3610 ..... Jamestown, NY ............ 0.8372

Chautauqua, NY

3620 ..... Janesville-Beloit, WI ..... 1.0289

Rock, WI

3640 ..... Jersey City, NJ ............. 1.2440

Hudson, NJ

3660 ..... Johnson City-KingsportBristol, TN–VA.0.9433

Carter, TN

Hawkins, TN

Sullivan, TN

Unicoi, TN

Washington, TN

Bristol City, VA

Scott, VA

Washington, VA

3680 ..... Johnstown, PA ............. 0.9206

Cambria, PA

Somerset, PA

60076 Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

3700 ..... Jonesboro, AR ............. 0.8000

Craighead, AR

3710 ..... Joplin, MO .................... 0.8181

Jasper, MO

Newton, MO

3720 ..... Kalamazoo-Battlecreek,

MI.

1.0635

Calhoun, MI

Kalamazoo, MI

Van Buren, MI

3740 ..... Kankakee, IL ................ 0.9162

Kankakee, IL

3760 ..... Kansas City, KS–MO ... 0.9932

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 ................ 0.9625

Kenosha, WI

3810 ..... Killeen-Temple, TX ...... 1.0583

Bell, TX

Coryell, TX

3840 ..... Knoxville, TN ................ 0.9802

Anderson, TN

Blount, TN

Knox, TN

Loudon, TN

Sevier, TN

Union, TN

3850 ..... Kokomo, IN .................. 0.9503

Howard, IN

Tipton, IN

3870 ..... La Crosse, WI–MN ...... 0.9519

Houston, MN

La Crosse, WI

3880 ..... Lafayette, LA ................ 0.8886

Acadia, LA

Lafayette, LA

St. Landry, LA

St. Martin, LA

3920 ..... Lafayette, IN ................. 0.9386

Clinton, IN

Tippecanoe, IN

3960 ..... Lake Charles, LA ......... 0.8488

Calcasieu, LA

3980 ..... Lakeland-Winter Haven,

FL.

0.9393

Polk, FL

4000 ..... Lancaster, PA .............. 0.9862

Lancaster, PA

4040 ..... Lansing-East Lansing,

MI.

1.0631

Clinton, MI

Eaton, MI

Ingham, MI

4080 ..... Laredo, TX ................... 0.8868

Webb, TX

4100 ..... Las Cruces, NM ........... 0.9153

Dona Ana, NM

4120 ..... Las Vegas, NV–AZ ...... 1.1996

Mohave, AZ

Clarke, NV

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Nye, NV

4150 ..... Lawrence, KS ............... 0.8761

Douglas, KS

4200 ..... Lawton, OK .................. 1.0157

Comanche, OK

4243 ..... Lewiston-Auburn, ME ... 0.9482

Androscoggin, ME

4280 ..... Lexington, KY ............... 0.9090

Bourbon, KY

Clark, KY

Fayette, KY

Jessamine, KY

Madison, KY

Scott, KY

Woodford, KY

4320 ..... Lima, OH ...................... 0.9489

Allen, OH

Auglaize, OH

4360 ..... Lincoln, NE ................... 1.0304

Lancaster, NE

4400 ..... Little Rock-North Little

Rock, AR.

0.9179

Faulkner, AR

Lonoke, AR

Pulaski, AR

Saline, AR

4420 ..... Longview-Marshall, TX 0.9311

Gregg, TX

Harrison, TX ..............

Upshur, TX

4480 ..... Los Angeles-Long

Beach, CA.

1.2841

Los Angeles, CA

4520 ..... Louisville, KY–IN .......... 0.9996

Clark, IN

Floyd, IN ..............

Harrison, IN

Scott, IN

Bullitt, KY

Jefferson, KY

Oldham, KY

4600 ..... Lubbock, TX ................. 0.8962

Lubbock, TX

4640 ..... Lynchburg, VA ............. 0.9392

Amherst, VA

Bedford, VA

Bedford City, VA

Campbell, VA

Lynchburg City, VA

4680 ..... Macon, GA ................... 0.9089

Bibb, GA

Houston, GA

Jones, GA

Peach, GA

Twiggs, GA

4720 ..... Madison, WI ................. 1.0367

Dane, WI

4800 ..... Mansfield, OH .............. 0.9031

Crawford, OH ..............

Richland, OH

4840 ..... Mayaguez, PR ............. 0.5376

Anasco, PR

Cabo Rojo, PR

Hormigueros, PR

Mayaguez, PR

Sabana Grande, PR ..............

San German, PR ..............

4880 ..... McAllen-Edinburg-Mission, TX.0.8652

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Hidalgo, TX

4890 ..... Medford-Ashland, OR .. 1.1180

Jackson, OR

4900 ..... Melbourne-TitusvillePalm Bay, FL.0.9905

Brevard, Fl

4920 ..... Memphis, TN–AR–MS 0.8784

Crittenden, AR

DeSoto, MS

Fayette, TN

Shelby, TN

Tipton, TN

4940 ..... Merced, CA .................. 1.0950

Merced, CA

5000 ..... Miami, FL ..................... 1.0904

Dade, FL

5015 ..... Middlesex-SomersetHunterdon, NJ.1.1851

Hunterdon, NJ

Middlesex, NJ

Somerset, NJ

5080 ..... Milwaukee-Waukesha,

WI.

1.0490

Milwaukee, WI

Ozaukee, WI

Washington, WI

Waukesha, WI

5120 ..... Minneapolis-St. Paul,

MN–WI.

1.1645

Anoka, MN

Carver, MN

Chisago, MN Dakota,

MN

Hennepin, MN

Isanti, MN

Ramsey, MN

Scott, MN

Sherbune, MN

Washington, MN

Wright, MN

Pierce, WI

St. Croix, WI

5140 ..... Missoula, MT ................ 0.9681

Missoula, MT

5160 ..... Mobile, AL .................... 0.8809

Baldwin, AL

Mobile, AL

5170 ..... Modesto, CA ................ 1.0774

Stanislaus, CA

5190 ..... Monmouth-Ocean, NJ .. 1.1996

Monmouth, NJ

Ocean, NJ

5200 ..... Monroe, LA .................. 0.8760

Ouachita, LA

5240 ..... Montgomery, AL ........... 0.8208

Autauga, AL

Elmore, AL

Montgomery, AL

5280 ..... Muncie, IN .................... 1.1544

Delaware, IN

5330 ..... Myrtle Beach, SC ......... 0.9088

Horry, SC

5345 ..... Naples, FL .................... 1.0484

Collier, FL

5360 ..... Nashville, TN ................ 1.0068

Cheatham, TN

Davidson, TN

Dickson, TN

Robertson, TN

Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices 60077

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Rutherford TN

Sumner, TN

Williamson, TN

Wilson, TN

5380 ..... Nassau-Suffolk, NY ...... 1.4997

Nassau, NY

Suffolk, NY

5483 ..... New Haven-BridgeportStamford-WaterburyDanbury, CT.1.3166

Fairfield, CT

New Haven, CT

5523 ..... New London-Norwich,

CT.

1.3242

New London, CT

5560 ..... New Orleans, LA .......... 0.9685

Jefferson, LA

Orleans, LA

Plaquemines, LA

St. Bernard, LA

St. Charles, LA

St. James, LA

St. John The Baptist,

LA

St. Tammany, LA

5600 ..... New York, NY .............. 1.5469

Bronx, NY

Kings, NY

New York, NY

Putnam, NY

Queens, NY

Richmond, NY

Rockland, NY

Westchester, NY

5640 ..... Newark, NJ .................. 1.2409

Essex, NJ

Morris, NJ

Sussex, NJ

Union, NJ

Warren, NJ

5660 ..... Newburgh, NY–PA ....... 1.1624

Orange, NY

Pike, PA

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

NC.

0.8993

Currituck, NC

Chesapeake City, VA

Gloucester, VA

Hampton City, VA

James City, VA

Isle of Wight, 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 ................. 1.6044

Alameda, CA

Contra Costa, CA

5790 ..... Ocala, FL ..................... 1.0245

Marion, FL

5800 ..... Odessa-Midland, TX .... 0.9455

Ector, TX

Midland, TX

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

5880 ..... Oklahoma City, OK ...... 0.9150

Canadian, OK

Cleveland, OK

Logan, OK

McClain, OK

Oklahoma, OK

Pottawatomie, OK

5910 ..... Olympia, WA ................ 1.1648

Thurston, WA

5920 ..... Omaha, NE–IA ............. 1.1140

Pottawattamie, IA

Cass, NE

Douglas, NE

Sarpy, NE

Washington, NE

5945 ..... Orange County, CA ..... 1.2349

Orange, CA

5960 ..... Orlando, FL .................. 1.0437

Lake, FL

Orange, FL

Osceola, FL

Seminole, FL

5990 ..... Owensboro, KY ............ 0.8635

Daviess, KY

6015 ..... Panama City, FL .......... 0.9770

Bay, FL

6020 ..... Parkersburg-Marietta,

WV–OH.

0.8896

Washington, OH

Wood, WV

6080 ..... Pensacola, FL .............. 0.8995

Escambia, FL

Santa Rosa, FL

6120 ..... Peoria-Pekin, IL ........... 0.8896

Peoria, IL

Tazewell, IL

Woodford, IL

6160 ..... Philadelphia, PA–NJ .... 1.1891

Burlington, NJ

Camden, NJ

Gloucester, NJ

Salem, NJ

Bucks, PA

Chester, PA

Delaware, PA

Montgomery, PA

Philadelphia, PA

6200 ..... Phoenix-Mesa, AZ ....... 1.0084

Maricopa, AZ

Pinal, AZ

6240 ..... Pine Bluff, AR .............. 0.8202

Jefferson, AR

6280 ..... Pittsburgh, PA .............. 1.0265

Allegheny, PA

Beaver,PA

Butler, PA

Fayette, PA

Washington, PA

Westmoreland, PA

6323 ..... Pittsfield, MA ................ 1.0927

Berkshire, MA

6340 ..... Pocatello, ID ................. 0.9561

Bannock, ID

6360 ..... Ponce, PR .................... 0.5717

Guayanilla, PR

Juana Diaz, PR

Penuelas, PR

Ponce, PR

Villalba, PR

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Yauco, PR

6403 ..... Portland, ME ................ 1.0096

Cumberland, ME

Sagadahoc, ME

York, ME

6440 ..... Portland-Vancouver,

OR–WA.

1.1694

Clackamas, OR

Columbia, OR

Multnomah, OR

Washington, OR

Yamhill, OR

Clark, WA

6483 ..... Providence-WarwickPawtucket, RI.1.1391

Bristol, RI

Kent, RI

Newport, RI

Providence, RI

Washington, RI

6520 ..... Provo-Orem, UT ........... 1.0461

Utah, UT

6560 ..... Pueblo, CO .................. 0.9433

Pueblo, CO

6580 ..... Punta Gorda, FL .......... 0.9509

Charlotte, FL

6600 ..... Racine, WI ................... 0.9820

Racine, WI

6640 ..... Raleigh-Durham-Chapel

Hill, NC.

1.0170

Chatham, NC

Durham, NC ..............

Franklin, NC

Johnston, NC

Orange, NC

Wake, NC

6660 ..... Rapid City, SD ............. 0.8911

Pennington, SD

6680 ..... Reading, PA ................. 1.0054

Berks, PA

6690 ..... Redding, CA ................. 1.2002

Shasta, CA

6720 ..... Reno, NV ..................... 1.1353

Washoe, NV

6740 ..... Richland-KennewickPasco, WA.1.1959

Benton, WA

Franklin, WA

6760 ..... Richmond-Petersburg,

VA.

1.0171

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.

1.1945

Riverside, CA

San Bernardino, CA

60078 Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

6800 ..... Roanoke, VA ................ 0.8672

Botetourt, VA

Roanoke, VA

Roanoke City, VA

Salem City, VA

6820 ..... Rochester, MN ............. 1.2178

Olmsted, MN

6840 ..... Rochester, NY .............. 0.9786

Genesee, NY

Livingston, NY

Monroe, NY

Ontario, NY

Orleans, NY

Wayne, NY

6880 ..... Rockford, IL .................. 0.9359

Boone, IL

Ogle, IL

Winnebago, IL

6895 ..... Rocky Mount, NC ......... 0.9307

Edgecombe, NC

Nash, NC

6920 ..... Sacramento, CA ........... 1.3089

El Dorado, CA

Placer, CA

Sacramento, CA

6960 ..... Saginaw-Bay City-Midland, MI.0.9895

Bay, MI

Midland, MI

Saginaw, MI

6980 ..... St. Cloud, MN .............. 1.0038

Benton, MN

Stearns, MN

7000 ..... St. Joseph, MO ............ 0.9529

Andrew, MO

Buchanan, MO

7040 ..... St. Louis, MO–IL .......... 0.9645

Franklin, MO

Jefferson, MO

Lincoln, MO

St. Charles, MO

St. Louis, MO

St. Louis City, MO

Warren, MO

Clinton, IL

Jersey, IL

Madison, IL

Monroe, IL

St. Clair, IL

7080 ..... Salem, OR ................... 1.0601

Marion, OR

Polk, OR

7120 ..... Salinas, CA .................. 1.5674

Monterey, CA

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

UT.

1.0500

Davis, UT

Salt Lake, UT

Weber, UT

7200 ..... San Angelo, TX ............ 0.8359

Tom Green, TX

7240 ..... San Antonio, TX ........... 0.8862

Bexar, TX

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Comal, TX

Guadalupe, TX

Wilson, TX

7320 ..... San Diego, CA ............. 1.2712

7360 ..... San Francisco, CA ....... 1.4918

Marin, CA

San Francisco, CA

San Mateo, CA

7400 ..... San Jose, CA ............... 1.4500

Santa Clara, CA

7440 ..... San Juan-Bayamon, PR 0.5357

Aguas Buenas, PR

Barceloneta, PR

Bayamon, PR

Canovanas, PR

Carolina, PR

Catano, PR

Ceiba, PR

Comerio, PR

Corozal, PR

Dorado, PR

Fajardo, PR

Florida, PR

Guaynabo, PR

Humacao, PR

Juncos, PR

Los Piedras, PR

Loiza, PR

Luguillo, PR

Manati, PR

Morovis, PR

Naguabo, PR

Naranjito, PR

Rio Grande, PR

San Juan, PR

Toa Alta, PR

Toa Baja, PR

Trujillo Alto, PR

Vega Alta, PR

Vega Baja, PR

Yabucoa, PR

7460 ..... San Luis ObispoAtascadero-Paso

Robles, CA.

1.1156

San Luis Obispo, CA

7480 ..... Santa Barbara-Santa

Maria-Lompoc, CA.

1.1528

Santa Barbara, CA

7485 ..... Santa Cruz-Watsonville,

CA.

1.4840

Santa Cruz, CA

7490 ..... Santa Fe, NM ............... 1.1121

Los Alamos, NM

Santa Fe, NM

7500 ..... Santa Rosa, CA ........... 1.3852

Sonoma, CA

7510 ..... Sarasota-Bradenton, FL 1.0554

Manatee, FL

Sarasota, FL

7520 ..... Savannah, GA .............. 1.0605

Bryan, GA

Chatham, GA

Effingham, GA

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

7560 ..... Scranton—WilkesBarre—Hazleton, PA.0.8921

Columbia, PA

Lackawanna, PA

Luzerne, PA

Wyoming, PA

7600 ..... Seattle-Bellevue-Everett, WA.1.2030

Island, WA

King, WA

Snohomish, WA

7610 ..... Sharon, PA ................... 0.8826

Mercer, PA

7620 ..... Sheboygan, WI ............ 0.8740

Sheboygan, WI

7640 ..... Sherman-Denison, TX .. 0.9940

Grayson, TX

7680 ..... Shreveport-Bossier

City, LA.

0.9642

Bossier, LA

Caddo, LA

Webster, LA

7720 ..... Sioux City, IA–NE ........ 0.9108

Woodbury, IA

Dakota, NE

7760 ..... Sioux Falls, SD ............ 0.9351

Lincoln, SD

Minnehaha, SD

7800 ..... South Bend, IN ............ 1.0435

St. Joseph, IN

7840 ..... Spokane, WA ............... 1.1507

Spokane, WA

7880 ..... Springfield, IL ............... 0.9252

Menard, IL

Sangamon, IL

7920 ..... Springfield, MO ............ 0.8515

Christian, MO

Greene, MO

Webster, MO

8003 ..... Springfield, MA ............. 1.1377

Hampden, MA

Hampshire, MA

8840 ..... Washington, DC–MD–

VA–WV.

1.1778

District of Columbia, DC

Calvert, MD

Charles, MD

Frederick, MD

Montgomery, MD

Prince Georges, MD

Alexandria City, VA

Arlington, VA

Clarke, VA

Culpeper, VA

Fairfax, VA

Fairfax City, VA

Falls Church City, VA

Fauquier, VA

Fredericksburg City, VA

King George, VA

Loudoun, VA

Manassas City, VA

Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices 60079

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Manassas Park City,

VA

Prince William, VA

Spotsylvania, VA

Stafford, VA

Warren, VA

Berkeley, WV

Jefferson, WV

8920 ..... Waterloo-Cedar Falls,

IA.

0.9075

Black Hawk, IA

8940 ..... Wausau, WI ................. 1.0064

Marathon, WI

8960 ..... West Palm Beach-Boca

Raton, FL.

1.0668

Palm Beach, FL

9000 ..... Wheeling, WV–OH ....... 0.8144

Belmont, OH

Marshall, WV

Ohio, WV

9040 ..... Wichita, KS .................. 1.0038

Butler, KS

Harvey, KS

Sedgwick, KS

9080 ..... Wichita Falls, TX .......... 0.8154

Archer, TX

Wichita, TX

8050 ..... State College, PA ........ 0.9737

Centre, PA

8080 ..... Steubenville-Weirton,

OH–WV.

0.9179

Jefferson, OH

Brooke, WV

Hancock, WV

8120 ..... Stockton-Lodi, CA ........ 1.1207

San Joaquin, CA

8140 ..... Sumter, SC .................. 0.8778

Sumter, SC

8160 ..... Syracuse, NY ............... 1.1377

Cayuga, NY

Madison, NY

Onondaga, NY

Oswego, NY

8200 ..... Tacoma, WA ................ 1.2230

Pierce, WA

8240 ..... Tallahassee, FL ........... 0.9040

Gadsden, FL

Leon, FL

8280 ..... Tampa-St. PetersburgClearwater, FL.0.9637

Hernando, FL

Hillsborough, FL

Pasco, FL

Pinellas, FL

8320 ..... Terre Haute, IN ............ 0.9132

Clay, IN

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

Vermillion, IN

Vigo, IN

8360 ..... Texarkana, AR–Texarkana, TX.0.8668

Miller, AR

Bowie, TX

8400 ..... Toledo, OH ................... 1.0458

Fulton, OH

Lucas, OH

Wood, OH

8440 ..... Topeka, KS .................. 0.9937

Shawnee, KS

8480 ..... Trenton, NJ .................. 1.0764

Mercer, NJ

8520 ..... Tucson, AZ ................... 0.9315

Pima, AZ

8560 ..... Tulsa, OK ..................... 0.8616

Creek, OK

Osage, OK

Rogers, OK

Tulsa, OK

Wagoner, OK

8600 ..... Tuscaloosa, AL ............ 0.8593

Tuscaloosa, AL

8640 ..... Tyler, TX ...................... 0.9983

Smith

8680 ..... Utica-Rome, NY ........... 0.8842

Herkimer, NY

Oneida, NY

8720 ..... Vallejo-Fairfield-Napa,

CA.

1.4220

Napa, CA

Solano, CA

8735 ..... Ventura, CA ................. 1.2206

8750 ..... Victoria, TX .................. 0.8927

8760 ..... Vineland-MillvilleBridgeton, NJ.1.1206

Cumberland, NJ

8780 ..... Visalia-Turlare-Porterville, CA.1.1093

Tulare, CA

8800 ..... Waco, TX ..................... 0.8604

McLennan, TX

9140 ..... Williamsport, PA ........... 0.9003

Lycoming, PA

9160 ..... Wilmington-Newark,

DE–MD.

1.2013

New Castle, DE

Cecil, MD

9200 ..... Wilmington, NC ............ 1.0343

Brunswick, NC

New Hanover, NC

9260 ..... Yakima, WA ................. 1.1009

Yakima, WA

9270 ..... Yolo, CA ....................... 1.0356

Yolo, CA

TABLE A.—HOSPICE WAGE INDEX FOR

URBAN AREAS—Continued

MSA

code No.

Urban area (constituent

counties or county

equivalents) 1

Wage

index 2

9280 ..... York, PA ....................... 0.9919

York, PA

9320 ..... Youngstown-Warren,

OH.

1.0651

Columbiana, OH

Mahoning, OH

Trumbull, OH

9340 ..... Yuba City, CA .............. 1.1361

Sutter, CA

Yuba, CA

9360 ..... Yuma, AZ ..................... 1.0574

Yuma, AZ

1This column lists each MSA area name (in

italics) and each county, or county equivalent,

in the MSA area. Counties not listed in this

Table are considered to be Rural Areas. Wage

Index values for these areas are found in

Table B. 2Wage index values are based on FY 1996

hospital cost report data before reclassification. This wage index is further adjusted.

Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of

1.065425. Wage index values below 0.8 are

adjusted to be the greater of a 15-percent increase, subject to a maximum wage index

value of 0.8, or an adjustment by multiplying

the hospital wage index value for a given area

by the budget-neutrality adjustment. We have

completed all of these adjustments and included them in the wage index values reflected in this table.

TABLE B.—WAGE INDEX FOR RURAL

AREAS

MSA code

No. Nonurban area Wageindex 1

9901 ....... Alabama ....................... 0.8000

9902 ....... Alaska .......................... 1.2847

9903 ....... Arizona ......................... 0.9104

9904 ....... Arkansas ...................... 0.8000

9905 ....... California ...................... 1.0603

9906 ....... Colorado ....................... 0.9391

9907 ....... Connecticut .................. 1.3226

9908 ....... Delaware ...................... 0.9767

9910 ....... Florida .......................... 0.9575

9911 ....... Georgia ........................ 0.8625

9912 ....... Hawaii .......................... 1.1430

9913 ....... Idaho ............................ 0.9218

9914 ....... Illinois ........................... 0.8575

9915 ....... Indiana ......................... 0.8946

9916 ....... Iowa .............................. 0.8446

60080 Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices

TABLE B.—WAGE INDEX FOR RURAL

AREAS—Continued

MSA code

No. Nonurban area Wageindex 1

9917 ....... Kansas ......................... 0.8000

9918 ....... Kentucky ...................... 0.8569

9919 ....... Louisiana ...................... 0.8000

9920 ....... Maine ........................... 0.9205

9921 ....... Maryland ...................... 0.9197

9922 ....... Massachusetts ............. 1.2114

9923 ....... Michigan ....................... 0.9392

9924 ....... Minnesota ..................... 0.9237

9925 ....... Mississippi .................... 0.8000

9926 ....... Missouri ........................ 0.8229

9927 ....... Montana ....................... 0.8945

9928 ....... Nebraska ...................... 0.8532

9929 ....... Nevada ......................... 0.9693

9930 ....... New Hampshire ........... 1.0554

9931 ....... New Jersey 2 ................ ............

9932 ....... New Mexico ................. 0.8927

9933 ....... New York ..................... 0.9202

9934 ....... North Carolina .............. 0.8832

9935 ....... North Dakota ................ 0.8148

9936 ....... Ohio .............................. 0.9216

9937 ....... Oklahoma ..................... 0.8000

9938 ....... Oregon ......................... 1.0514

9939 ....... Pennsylvania ................ 0.9083

9940 ....... Puerto Rico .................. 0.4886

9941 ....... Rhode Island 2 .............. ............

9942 ....... South Carolina ............. 0.8805

9943 ....... South Dakota ............... 0.8073

9944 ....... Tennessee ................... 0.8152

9945 ....... Texas ........................... 0.8000

9946 ....... Utah .............................. 0.9490

9947 ....... Vermont ........................ 1.0024

9948 ....... Virgin Islands ............... 0.7252

9949 ....... Virginia ......................... 0.8421

9950 ....... Washington .................. 1.1131

9951 ....... West Virginia ................ 0.8597

9952 ....... Wisconsin ..................... 0.9333

9953 ....... Wyoming ...................... 0.9440

9965 ....... Guam ........................... 1.0240

1Wage index values are based on FY 1996

hospital cost report data before reclassification. This wage index is further adjusted.

Wage index values greater than 0.8 are subject to a budget-neutrality adjustment of

1.065425. Wage index values below 0.8 are

adjusted to be the greater of a 15-percent increase, subject to a maximum wage index

value of 0.8, or an adjustment by multiplying

the hospital wage index value for a given area

by the budget-neutrality adjustment. We have

completed all of these adjustments and have

included them in the wage index values reflected in this table. 2All counties within the State are classified

as urban.

II. Regulatory Impact Statement

We have examined the impacts of this

notice as required by Executive Order

12866, the Unfunded Mandate Reform

Act, and the Regulatory Flexibility Act

(RFA) (Pub. L. 96–354). In this notice,

we identified an impact on hospices as

a result of changes in the way we

compute the hospice wage index. The

change in the methodology for

computing the wage index was

determined through a negotiated

rulemaking committee and

implemented in the August 8, 1997 final

rule (62 FR 42860). We recognize that

the BBRA adjusted hospice payments

upward by 0.5 percent; however, we did

not do a separate analysis of the impact

of this payment adjustment. We used

the new rates adjusted by the BBRA

when estimating the payments to be

made under the new wage index and

when calculating the budget-neutrality

adjustment factor. Overall, we believe

the changes included in this notice to be

insignificant.

1. Executive Order 12866 and RFA

Executive Order 12866 directs

agencies to assess all costs and benefits

of available regulatory alternatives and,

when regulation is necessary, to select

regulatory approaches that maximize

net benefits (including potential

economic, environmental, public health

and safety effects; distributive impacts;

and equity). We have determined that

this notice is not an economically

significant rule under this Executive

Order. The RFA requires agencies to

analyze options for regulatory relief for

small businesses. For purposes of the

RFA, States and individuals are not

considered small entities. However,

most providers, physicians, and health

care suppliers are small entities, either

by nonprofit status or by having

revenues of $5 million or less annually.

Approximately 73 percent of Medicare

certified hospices are identified as

voluntary, government, or other

agencies, and, therefore, are considered

small entities. Because the National

Hospice Organization estimates that

approximately 70 percent of hospice

patients are Medicare beneficiaries, we

have not considered other sources of

revenue in this analysis.

As discussed below, the estimated

decreases in payment to hospices

overall are very slight. The most

significant change is an increase in

estimated payments to rural areas in

East and West South Central, at 4.8 and

9.1 percent, respectively. The effects of

this notice on West South Central alone,

indicate that 54 of the 85 hospices in

urban West South Central can be

considered small entities that will

experience an 9.1-percent increase in

Medicare payments. Therefore, we

anticipate this notice will have a

significant, albeit positive, impact on a

substantial number of small entities.

However, the methodology for the

hospice wage index was previously

determined by consensus through a

negotiated rulemaking committee that

included representatives of national

hospice associations; rural, urban, large

and small hospices; multi-site hospices;

and consumer groups. Based on the

options considered, the committee

determined that the methodology

described in the committee statement,

and adopted into regulation in the

August 8, 1997 final rule, was favorable

for the hospice community as well as for

beneficiaries. Therefore, we believe that

mitigating any negative effects on small

entities has been taken into

consideration.

2. Congressional Review

Section 804(2) of Title 5, United

States Code (U.S.C.) (as added by

section 251 of Pub. L. 104–121),

specifies that a ‘‘major rule’’ is any rule

that the Office of Management and

Budget finds is likely to result in—

• An annual effect on the economy of

$100 million or more;

• A major increase in costs or prices

for consumers, individual industries,

Federal, State, or local government

agencies, or geographic regions; or

• Significant adverse effects on

competition, employment, investment,

productivity, innovation, or on the

ability of United States-based

enterprises to compete with foreignbased enterprises in domestic and

export markets.

We estimate that the impact of this

notice will not be $100 million or more;

therefore, this notice is not a major rule

as defined in Title 5, United States

Code, section 804(2) and is not being

forwarded to the Congress for a 60-day

review period.

3. Unfunded Mandate

The Unfunded Mandate Reform Act of

1995 also requires (in section 202) that

agencies prepare an assessment of

anticipated costs and benefits for any

rule that may result in an expenditure

by State, local, and tribal governments,

in the aggregate, or by the private sector,

of $100 million or more in any one year.

The notice has no consequential effect

on State, local, or tribal governments.

We believe the private sector costs of

this notice fall below the threshold as

well.

4. Rural Hospital Impact

Section 1102(b) of the Act requires us

to prepare a regulatory impact analysis

for any notice that 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 an MSA and has fewer

than 50 beds.

Because this notice has no direct

impact on small hospitals, in

accordance with 5 U.S.C. 604, the

Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices 60081

Secretary certifies that this notice will

not have a significant impact on the

operations of a substantial number of

small rural hospitals.

5. Federalism

We have reviewed this notice under

the threshold criteria of Executive Order

13132, Federalism, and have

determined that this notice will not

have any negative impact on the rights,

roles, and responsibilities of State, local,

or tribal governments.

A. Anticipated Effects

We have compared estimated

payments using the FY 1983 hospice

wage index to estimated payments using

the FY 2001 wage index and determined

the current hospice rates to be budgetneutral. As mentioned above, the

negotiated rulemaking committee

agreement required that we not pay

more under the new wage index in the

aggregate than we would have paid

under the original wage index.

This impact analysis compares

hospice payments under the FY 2000

hospice wage index to the estimated

payments using the FY 2001 wage

index. The data used in developing the

quantitative analysis for this notice were

obtained from the March 2000 update of

the national claims history file of all

bills submitted during FY 1999. We

deleted bills from hospices that have

since closed.

Table C demonstrates the results of

our analysis. In Column 2 of Table C, we

indicate the number of routine home

care days that were included in our

analysis, although the analysis was

performed on all types of hospice care.

Column 3 of Table C indicates payments

that were made using the FY 2000 wage

index. Column 4 of Table C is based on

FY 1999 claims and estimates payments

to be made to hospices using the FY

2001 wage index. The final column,

which compares Columns 3 and 4,

shows the percent change in estimated

hospice payments made based on the

category of the hospice.

Table C categorizes hospices by

various geographic and provider

characteristics. The first row displays

the results of the impact analysis for all

Medicare certified hospices. The second

and third rows of the table categorize

hospices according to their geographic

location (urban and rural). Our analysis

indicated that there are 1,351 hospices

located in urban areas and 798 hospices

located in rural areas. The next two

groupings in the table indicate the

number of hospices by census region,

also broken down by urban and rural

hospices. The sixth grouping shows the

impact on hospices based on the size of

the hospice’s program. We determined

that the majority of hospice payments

are made at the routine home care rate.

Therefore, we based the size of each

individual hospice’s program on the

number of routine home care days

provided in 1999. The next grouping

shows the impact on hospices by type

of ownership. The final grouping shows

the impact on hospices defined by

whether they are provider-based or

freestanding.

The results of our analysis shows that

the greatest increases in payment are for

rural areas in the West and East South

Central Regions, with a 9.1 percent and

4.8 percent increase, respectively. The

greatest decreases in payment are for

urban areas in the New England and

Mountain regions, each with a 0.4

percent decrease, and for rural areas in

the Middle Atlantic and Pacific regions,

each with a 0.4 percent decrease.

The breakdown by size, type of

ownership, and facility base showed an

increase in payments to all hospice

programs. Small hospice programs

showed significant increases of about 10

percent, while larger programs

experienced only a negligible increase.

Government-owned hospices showed

the greatest estimated increase of 2.7

percent, while payments to voluntary

hospices are expected to increase by 0.4

percent. In terms of hospice base,

freestanding hospices showed the

greatest estimated payment increase

while home health agencies showed the

smallest amount of payment increase.

TABLE C.—IMPACT OF HOSPICE WAGE INDEX CHANGE

Number of

hospices

(1)

Number of

routine

home care

days in

thousands

(2)

Payments

using FY

2000 wage

index in

thousands

(3)

Estimated

payments

using FY

2001 wage

index in

thousands

(4)

Percent

change in

Hospice

payments

(5)

(By geographic location):

All Hospices ................................................................................................ 2,149 21,354 2,490,702 2,504,439 0.6

Urban Hospices ................................................................................... 1,351 18,120 2,185,780 2,190,590 0.2

Rural Hospices .................................................................................... 798 3,234 304,922 313,849 2.9

By Region—Urban:

New England ....................................................................................... 94 642 89,447 89,051 ¥0.4

Middle Atlantic ..................................................................................... 170 2,245 290,927 291,894 0.3

South Atlantic ...................................................................................... 185 4,030 509,079 511,583 0.5

East North Central ............................................................................... 224 2,862 334,861 336,694 0.5

East South Central .............................................................................. 94 1,169 123,023 123,530 0.4

West North Central .............................................................................. 96 1,061 113,167 113,498 0.3

West South Central ............................................................................. 188 2,408 261,632 261,287 ¥0.1

Mountain .............................................................................................. 88 1,135 149,035 148,443 ¥0.4

Pacific .................................................................................................. 183 2,325 298,138 298,086 0

Puerto Rico .......................................................................................... 29 243 16,470 16,524 0.3

By Region—Rural:

New England ....................................................................................... 26 72 7,666 7,811 1.9

Middle Atlantic ..................................................................................... 35 168 17,282 17,214 ¥0.4

South Atlantic ...................................................................................... 117 681 63,904 65,005 1.7

East North Central ............................................................................... 136 561 53,801 54,541 1.4

East South Central .............................................................................. 81 524 48,159 50,481 4.8

West North Central .............................................................................. 174 409 37,622 38,969 3.6

West South Central ............................................................................. 85 362 29.640 32.351 9.1

Mountain .............................................................................................. 87 217 21.359 22,048 3.2

Pacific .................................................................................................. 54 217 24,012 23,922 ¥0.4

60082 Federal Register / Vol. 65, No. 195 / Friday, October 6, 2000 / Notices

TABLE C.—IMPACT OF HOSPICE WAGE INDEX CHANGE—Continued

Number of

hospices

(1)

Number of

routine

home care

days in

thousands

(2)

Payments

using FY

2000 wage

index in

thousands

(3)

Estimated

payments

using FY

2001 wage

index in

thousands

(4)

Percent

change in

Hospice

payments

(5)

Puerto Rico .......................................................................................... 3 23 1,476 1,507 2.1

(Skilled)

Routine home care days:

0–1,754 days ....................................................................................... 437 390 36,700 40,609 10.6

1,754–4,373 days ................................................................................ 502 1,504 150,829 154,399 2.4

4,373–9,681 days ................................................................................ 556 3,669 388,427 390,269 0.5

9,681 + days ........................................................................................ 653 15,449 1,875,339 1,879,969 0.2

Type of ownership:

Voluntary .............................................................................................. 1,351 13,975 1,638,339 1,644,677 0.4

Proprietary ........................................................................................... 573 6,714 784,488 790,194 0.7

Government ......................................................................................... 192 568 58,174 59,770 2.7

Other .................................................................................................... 33 97 9,701 9,797 1.0

Hospice base:

Freestanding ........................................................................................ 874 12,368 1,451,898 1,461,421 0.7

Home health agency ........................................................................... 716 5,357 625,165 627,440 0.4

Hospital ................................................................................................ 538 3,503 395,997 397,830 0.5

Skilled nursing facility .......................................................................... 21 126 17,642 17,748 0.6

In accordance with the provisions of

Executive Order 12866, this regulation

was reviewed by the Office of

Management and Budget.

Authority: Section 1814(i) of the Social

Security Act (42 U.S.C. 1395f (i)(1)).

(Catalog of Federal Domestic Assistance

Program No. 93.773 Medicare—Hospital

Insurance Program; and No. 93.774,

Medicare—Supplementary Medical

Insurance Program)

Dated: August 21, 2000.

Nancy-Ann Min DeParle,

Administrator, Health Care Financing

Administration.

Dated: September 22, 2000.

Donna E. Shalala,

Secretary.

[FR Doc. 00–25547 Filed 10–2–00; 12:23 pm]

BILLING CODE 4120–01–P