## Wednesday,

May 25, 2005



# Part II



# Department of Health and Human

Services

Centers for Medicare & Medicaid Services

42 CFR Part 412 Medicare Program; Inpatient Rehabilitation Facility Prospective Payment System for FY 2006; Proposed

Rule


### 30188 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**DEPARTMENT OF HEALTH AND HUMAN SERVICES** 

**Centers for Medicare & Medicaid Services** 

**42 CFR Part 412**

**[CMS–1290–P]**

**RIN 0938–AN43**

**Medicare Program; Inpatient Rehabilitation Facility Prospective**  **Payment System for FY 2006**

**AGENCY :**  Centers for Medicare & Medicaid Services (CMS), HHS.

**ACTION :**  Proposed rule.

**SUMMARY :**  This proposed rule would update the prospective payment rates for inpatient rehabilitation facilities for Federal fiscal year 2006 as required under section 1886(j)(3)(C) of the Social Security Act (the Act). Section 1886(j)(5) of the Act requires the Secretary to publish in the Federal Register on or before August 1 before each fiscal year, the classification and weighting factors for the inpatient rehabilitation facilities case-mix groups and a description of the methodology and data used in computing the prospective payment rates for that fiscal year.

In addition, we are proposing new policies and are proposing to change existing policies regarding the prospective payment system within the authority granted under section 1886(j) of the Act.

**DATES :**  To be assured consideration, comments must be received at one of the addresses provided below, no later than 5 p.m. on July 18, 2005.

**ADDRESSES :**  In commenting, please refer to file code CMS–1290–P. Because of staff and resource limitations, we cannot accept comments by facsimile (FAX) transmission.

You may submit comments in one of three ways (no duplicates, please):

1. Electronically. You may submit electronic comments on specific issues in this regulation to http:// www.cms.hhs.gov/regulations/

ecomments. (Attachments should be in Microsoft Word, WordPerfect, or Excel; however, we prefer Microsoft Word.)

2. By mail. You may mail written comments (one original and two copies) to the following address ONLY: Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS–1290–P, P.O. Box 8010, Baltimore, MD 21244–8010.

Please allow sufficient time for mailed comments to be received before the close of the comment period.

3. By hand or courier. If you prefer, you may deliver (by hand or courier) your written comments (one original and two copies) before the close of the comment period to one of the following addresses. If you intend to deliver your comments to the Baltimore address, please call telephone number (410) 786– 7195 in advance to schedule your arrival with one of our staff members. Room 445–G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., Washington, DC 20201; or 7500 Security Boulevard, Baltimore, MD

21244–1850.

(Because access to the interior of the HHH Building is not readily available to persons without Federal Government identification, commenters are encouraged to leave their comments in the CMS drop slots located in the main lobby of the building. A stamp-in clock is available for persons wishing to retain a proof of filing by stamping in and retaining an extra copy of the comments being filed.)

Comments mailed to the addresses indicated as appropriate for hand or courier delivery may be delayed and received after the comment period.

For information on viewing public comments, see the beginning of the

**SUPPLEMENTARY INFORMATION** section.

**FOR FURTHER INFORMATION CONTACT :**  Pete Diaz, (410) 786–1235. Susanne Seagrave, (410) 786–0044. Mollie Knight, (410) 786–7984 for informationregarding the market basket and laborrelated share. August Nemec, (410) 786– 0612 for information regarding the tier comorbidities. Zinnia Ng, (410) 786– 4587 for information regarding the wage index and Core-Based Statistical Areas (CBSAs).

**SUPPLEMENTARY INFORMATION :** 

Submitting Comments: We welcome comments from the public on all issues set forth in this rule to assist us in fully considering issues and developing policies. You can assist us by referencing the file code CMS–1290–P and the specific ‘‘issue identifier’’ that precedes the section on which you choose to comment.

Inspection of Public Comments: All comments received before the close of the comment period are available for viewing by the public, including any personally identifiable or confidential business information that is included in a comment. CMS posts all electronic comments received before the close of the comment period on its public Web site as soon as possible after they have been received. Hard copy comments received timely will be available for public inspection as they are received, generally beginning approximately 3 weeks after publication of a document, at the headquarters of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view public comments, phone 1–800–

743–3951.

Table of Contents I. Background A. General Overview of the Current Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) B. Requirements for Updating the Prospective Payment Rates for IRFs C. Operational Overview of the Current IRF PPS D. Quality of Care in IRFs E. Research to Support Refinements of the Current IRF PPS F. Proposed Refinements to the IRF PPS for Fiscal Year 2006 II. Proposed Refinements to the Patient

Classification System A. Proposed Changes to the IRF Classification System 1. Development of the IRF Classification System 2. Description and Methodology Used to Develop the IRF Classification System in the August 7, 2001 Final Rule a. Rehabilitation Impairment Categories b. Functional Status Measures and Age c. Comorbidities d. Development of CMG Relative Weights e. Overview of Development of the CMG Relative Weights B. Proposed Changes to the Existing List of Tier Comorbidities 1. Proposed Changes To Remove Codes That Are Not Positively Related to Treatment Costs 2. Proposed Changes to Move Dialysis to Tier One 3. Proposed Changes to Move Comorbidity Codes Based on Their Marginal Cost C. Proposed Changes to the CMGs 1. Proposed Changes for Updating the CMGs 2. Proposed Use of a Weighted Motor Score Index and Correction to the Treatment of Unobserved Transfer to Toilet Values 3. Proposed Changes for Updating the Relative Weights III. Proposed FY 2006 Federal Prospective

Payment Rates A. Proposed Reduction of the Standard Payment Amount to Account for Coding Changes B. Proposed Adjustments to Determine the Proposed FY 2006 Standard Payment Conversion Factor 1. Proposed Market Basket Used for IRF Market Basket Index a. Overview of the Proposed RPL Market Basket b. Proposed Methodology for Operating Portion of the Proposed RPL Market Basket c. Proposed Methodology for Capital Proportion of the RPL Market Basket d. Labor-Related Share 2. Proposed Area Wage Adjustment a. Proposed Revisions of the IRF PPS Geographic Classification b. Current IRF PPS Labor Market Areas Based on MSAs


### 30189 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

c. Core-Based Statistical Areas (CBSAs) d. Proposed Revisions of the IRF PPS Labor Market Areas i. New England MSAs ii. Metropolitan Divisions iii. Micropolitan Areas e. Implementation of the Proposed Changes to Revise the Labor Market Areas f. Wage Index Data 3. Proposed Teaching Status Adjustment 4. Proposed Adjustment for Rural Location 5. Proposed Adjustment for Disproportionate Share of Low-Income Patients 6. Proposed Update to the Outlier Threshold

Amount 7. Proposed Budget Neutrality Factor Methodology for Fiscal Year 2006 8. Description of the Methodology Used to Implement the Proposed Changes in a Budget Neutral Manner 9. Description of the Proposed IRF Standard Payment Conversion Factor for Fiscal

Year 2006 10. Example of the Proposed Methodology for Adjusting the Federal Prospective Payment Rates IV. Provisions of the Proposed Regulations V. Collection of Information Requirements VI. Response to Comments VII. Regulatory Impact Analysis

Acronyms

Because of the many terms to which we refer by acronym in this propose rule, we are listing the acronyms used and their corresponding terms in alphabetical order below. ADC

—Average Daily Census AHA

—American Hospital Association AMI

—Acute Myocardial Infarction

BBA

—Balanced Budget Act of 1997 (BBA), Pub. L. 105

– 33 BBRA

—Medicare, Medicaid, and SCHIP [State Children ’ s Health Insurance Program] Balanced Budget Refinement Act of 1999, Pub. L.

106

– 113 BIPA

—Medicare, Medicaid, and SCHIP [State Children ’ s Health Insurance Program] Benefits Improvement and Protection Act of 2000, Pub. L. 106

– 554 BLS

—Bureau of Labor Statistics CART

—Classification and Regression

Trees CBSA

—Core-Based Statistical Areas CCR

—Cost-to-charge ratio CMGs

—Case-Mix Groups CMI

—Case Mix Index CMSA

—Consolidated Metropolitan Statistical Area CPI

—Consumer Price Index DSH

—Disproportionate Share Hospital ECI

—Employment Cost Index

FI

—Fiscal Intermediary FIM

—Functional Independence

Measure FIM

–FRGs

—Functional Independence

Measures

—Function Related Groups FRG

—Function Related Group

FTE

—Full-time equivalent FY

—Federal Fiscal Year GME

—Graduate Medical Education HCRIS

—Healthcare Cost Report Information System

HIPAA

—Health Insurance Portability and Accountability Act

HHA

—Home Health Agency

IME

—Indirect Medical Education IFMC

—Iowa Foundation for Medical Care IPF

—Inpatient Psychiatric Facility IPPS

—Inpatient Prospective Payment System IRF

—Inpatient Rehabilitation Facility

IRF

–PAI

—Inpatient Rehabilitation Facility

—Patient Assessment Instrument IRF

–PPS

—Inpatient Rehabilitation Facility

—Prospective Payment System IRVEN

—Inpatient Rehabilitation Validation and Entry

LIP

—Low-income percentage MEDPAR

—Medicare Provider Analysis and Review MSA

—Metropolitan Statistical Area NECMA

—New England County Metropolitan Area NOS

—Not Otherwise Specified NTIS

—National Technical Information Service OMB

—Office of Management and Budget OSCAR

—Online Survey, Certification, and Reporting

PAI

—Patient Assessment Instrument PLI

—Professional Liability Insurance PMSA

—Primary Metropolitan Statistical Area

PPI

—Producer Price Index PPS

—Prospective Payment System RIC

—Rehabilitation Impairment Category RPL

—Rehabilitation Hospital,Psychiatric Hospital, and LongTerm Care Hospital Market Basket

TEFRA

—Tax Equity and Fiscal Responsibility Act

TEP

—Technical Expert Panel

I. Background [If you choose to comment on issues in this section, please include the caption

‘‘ Background ’’ at the beginning of your comments.]

A. General Overview of the Current Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS)

Section 4421 of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105

– 33), as amended by section 125 of the Medicare, Medicaid, and SCHIP [State Children ’ s Health Insurance Program] Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106

– 113), and by section 305 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106

– 554), provides for the implementation of a per discharge prospective payment system (PPS), through section 1886(j) of the Social Security Act (the Act), for inpatient rehabilitation hospitals and inpatient rehabilitation units of a hospital (hereinafter referred to as IRFs).

Payments under the IRF PPS encompass inpatient operating and capital costs of furnishing covered rehabilitation services (that is, routine, ancillary, and capital costs) but not costs of approved educational activities, bad debts, and other services or items outside the scope of the IRF PPS. Although a complete discussion of the IRF PPS provisions appears in the August 7, 2001 final rule, we are providing below a general description of the IRF PPS.

The IRF PPS, as described in the August 7, 2001 final rule, uses Federal prospective payment rates across 100 distinct case-mix groups (CMGs). Ninety-five CMGs were constructed using rehabilitation impairment categories, functional status (both motor and cognitive), and age (in some cases, cognitive status and age may not be a factor in defining a CMG). Five special CMGs were constructed to account for very short stays and for patients who expire in the IRF.

For each of the CMGs, we developed relative weighting factors to account for a patient ’ s clinical characteristics and expected resource needs. Thus, the weighting factors account for the relative difference in resource use across all CMGs. Within each CMG, the weighting factors were ‘‘ tiered ’’ based on the estimated effects that certain comorbidities have on resource use.

The Federal PPS rates were established using a standardized payment amount (previously referred to as the budget-neutral conversion factor). The standardized payment amount was previously called the budget neutral conversion factor because it reflected a budget neutrality adjustment for FYs 2001 and 2002, as described in § 412.624(d)(2). However, the statute requires a budget neutrality adjustment only for FYs 2001 and 2002. Accordingly, for subsequent years we believe it is more consistent with the statute to refer to the standardized payment as the standardized payment conversion factor, rather than refer to it as a budget neutral conversion factor (see 68 FR 45674, 45684 and 45685). Therefore, we will refer to the standardized payment amount in this proposed rule as the standard payment conversion factor.

For each of the tiers within a CMG, the relative weighting factors were


### 30190 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

applied to the standard payment conversion factor to compute the unadjusted Federal prospective payment rates. Under the current system, adjustments that accounted for geographic variations in wages (wage index), the percentage of low-income patients, and location in a rural area were applied to the IRF ’ s unadjusted Federal prospective payment rates. In addition, adjustments were made to account for the early transfer of a patient, interrupted stays, and high cost outliers.

Lastly, the IRF ’ s final prospective payment amount was determined under the transition methodology prescribed in section 1886(j) of the Act. Specifically, for cost reporting periods that began on or after January 1, 2002 and before October 1, 2002, section 1886(j)(1) of the Act and as specified in § 412.626 provides that IRFs transitioning into the PPS would receive

a ‘‘ blended payment. ’’ For cost reporting periods that began on or after January 1, 2002 and before October 1, 2002, these blended payments consisted of 66 2 ⁄ 3 percent of the Federal IRF PPS rate and

33 1 ⁄ 3 percent of the payment that the IRF would have been paid had the IRF PPS not been implemented. However, during the transition period, an IRF with a cost reporting period beginning on or after January 1, 2002 and before October 1, 2002 could have elected to bypass this blended payment and be paid 100 percent of the Federal IRF PPS rate. For cost reporting periods beginning on or after October 1, 2002 (FY 2003), the transition methodology expired, and payments for all IRFs consist of 100 percent of the Federal IRF PPS rate.

We established a CMS Web site that contains useful information regarding the IRF PPS. The Web site URL is www.cms.hhs.gov/providers/irfpps/ default.asp and may be accessed to download or view publications, software, and other information pertinent to the IRF PPS.

B. Requirements for Updating the Prospective Payment Rates for IRFs

On August 7, 2001, we published a final rule entitled ‘‘Medicare Program; Prospective Payment System for Inpatient Rehabilitation Facilities’’ in the Federal Register (66 FR at 41316), that established a PPS for IRFs as authorized under section 1886(j) of the Act and codified at subpart P of part 412 of the Medicare regulations. In the August 7, 2001 final rule, we set forth the per discharge Federal prospective payment rates for fiscal year (FY) 2002 that provided payment for inpatient operating and capital costs of furnishing covered rehabilitation services (that is, routine, ancillary, and capital costs) but not costs of approved educational activities, bad debts, and other services or items that are outside the scope of the IRF PPS. The provisions of the August 7, 2001 final rule were effective for cost reporting periods beginning on or after January 1, 2002. On July 1, 2002, we published a correcting amendment to the August 7, 2001 final rule in the Federal Register (67 FR at 44073). Any references to the August 7, 2001 final rule in this proposed rule include the provisions effective in the correcting amendment.

Section 1886(j)(5) of the Act and § 412.628 of the regulations require the Secretary to publish in the Federal Register , on or before August 1 of the preceding FY, the classifications and weighting factors for the IRF CMGs and a description of the methodology and data used in computing the prospective payment rates for the upcoming FY. On August 1, 2002, we published a notice in the Federal Register (67 FR at 49928) to update the IRF Federal prospective payment rates from FY 2002 to FY 2003 using the methodology as described in § 412.624. As stated in the August 1, 2002 notice, we used the same classifications and weighting factors for the IRF CMGs that were set forth in the August 7, 2001 final rule to update the IRF Federal prospective payment rates from FY 2002 to FY 2003. We have continued to update the prospective payment rates each year in accordance with the methodology set forth in the August 7, 2001 final rule.

In this proposed rule, we are proposing to update the IRF Federal prospective payment rates from FY 2005 to FY 2006, and we are proposing revisions to the methodology described in § 412.624. The proposed changes to the methodology are described in more detail in this proposed rule. For example, we are proposing to add a new teaching status adjustment, and we are proposing to implement other changes to existing policies in a budget neutral manner, which requires applying additional budget neutrality factors to the standard payment amount to calculate the standard payment conversion factor for FY 2006. See section III of this proposed rule for further discussion of the proposed FY 2006 Federal prospective payment rates. The proposed FY 2006 Federal prospective payment rates would be effective for discharges on or after October 1, 2005 and before October 1,

2006. C. Operational Overview of the Current IRF PPS

As described in the August 7, 2001 final rule, upon the admission anddischarge of a Medicare Part A fee-forservice patient, the IRF is required to complete the appropriate sections of a patient assessment instrument, the Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF–PAI). All required data must be electronically encoded into the IRF–PAI software product. Generally, the software product includes patient grouping programming called the GROUPER software. The GROUPER software uses specific Patient Assessment Instrument (PAI) data elements to classify (or group) the patient into a distinct CMG and account for the existence of any relevant comorbidities.

The GROUPER software produces a 5- digit CMG number. The first digit is an alpha-character that indicates the comorbidity tier. The last 4 digits represent the distinct CMG number. (Free downloads of the Inpatient Rehabilitation Validation and Entry (IRVEN) software product, including the GROUPER software, are available at the CMS Web site at www.cms.hhs.gov/ providers/irfpps/default.asp ).

Once the patient is discharged, the IRF completes the Medicare claim (UB– 92 or its equivalent) using the 5-digit CMG number and sends it to the appropriate Medicare fiscal intermediary (FI). (Claims submitted to Medicare must comply with both the Administrative Simplification Compliance Act (ASCA), Pub. L. 107– 105, and the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub. L. 104–191. Section 3 of ASCA requires the Medicare Program, subject to subsection (H), to deny payment under Part A or Part B for any expenses for items or services ‘‘for which a claim is submitted other than in an electronic form specified by the Secretary.’’ Subsection (h) provides that the Secretary shall waive such denial in two types of cases and may also waive such denial ‘‘in such unusual cases as the Secretary finds appropriate.’’ See also, 68 FR at 48805 (August 15, 2003). Section 3 of ASCA operates in the context of the Administrative Simplification provisions of HIPAA, which include, among others, the transactions and code sets standards requirements codified as 45 CFR part 160 and 162, subparts A and I through R (generally known as the Transactions Rule). The Transactions Rule requires covered entities, including covered providers, to conduct covered electronic transactions according to the applicable


### 30191 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

transaction standards. See the program claim memoranda issued and published by CMS at www.cms.hhs.gov/providers/ edi/default.asp, http:// www.cms.hhs.gov/provider/edi/ default.asp and listed in the addenda to the Medicare Intermediary Manual, Part 3, section 3600. Instructions for the limited number of claims submitted to Medicare on paper are located in section 3604 of Part 3 of the Medicare Intermediary Manual.)

The Medicare Fiscal Intermediary (FI) processes the claim through its software system. This software system includes pricing programming called the PRICER software. The PRICER software uses the CMG number, along with other specificclaim data elements and providerspecific data, to adjust the IRF ’ s prospective payment for interrupted stays, transfers, short stays, and deaths and then applies the applicable adjustments to account for the IRF ’ s wage index, percentage of low-income patients, rural location, and outlier payments. D. Quality of Care in IRFs

The IRF

–PAI is the patient data collection instrument for IRFs. Currently, the IRF

–PAI contains a blend of the functional independence measures items and quality and medical needs questions. The quality and medical needs questions (which are currently collected on a voluntary basis) may need to be modified to encapsulate those data necessary for calculation of quality indicators in the future.

We awarded a contract to the Research Triangle Institute (RTI) with the primary tasks of identifying quality indicators pertinent to the inpatient rehabilitation setting and determining what information is necessary to calculate those quality indicators. These tasks included reviewing literature and other sources for existing rehabilitation quality indicators. It also involved identifying organizations involved in measuring or monitoring quality of care in the inpatient rehabilitation setting. In addition, RTI was tasked with performing independent testing of the quality indicators identified in their research.

Once RTI has issued a final report, we will determine which quality-related items should be listed on the IRF

–PAI. The revised IRF

–PAI will need to be approved by OMB before it is used in

IRFs.

We would like to take this opportunity to discuss our thinking related to broader initiatives in this area related to quality of care. We have supported the development of valid quality measures and have been engaged in a variety of quality improvement efforts focused in other post-acute care settings such as nursing homes. However, as mentioned above, any new quality-related data collected from the

IRF

–PAI would have to be analyzed to determine the feasibility of developing a payment method that accounts for the performance of the IRF in providing the necessary rehabilitative care.

Medicare beneficiaries are the primary users of IRF services. Any quality measures must be carefully constructed to address the unique characteristics of this population. Similarly, we need to consider how to design effective incentives; that is, superior performance measured against pre-established benchmarks and/or performance improvements.

In addition, while our efforts to develop the various post-acute care PPSs, including the IRF PPS, have generated substantial improvements over the preexisting cost-based systems, each of these individual systems was developed independently. As a result, we have focused on phases of a patient ’ s illness as defined by a specific site ofservice, rather than on the entire postacute episode. As the differentiation among provider types (such as SNFs and IRFs) becomes less pronounced, we need to investigate a more coordinated approach to payment and delivery of post-acute services that focuses on the overall post-acute episode.

This could entail a strategy of developing payment policy that is as neutral as possible regarding provider and patient decisions about the use of particular post-acute services. That is, Medicare should provide payments sufficient to ensure that beneficiaries receive high quality care in the most appropriate setting, so that admissions and any transfers between settings occur only when consistent with good care, rather than to generate additional revenues. In order to accomplish this objective, we need to collect and compare clinical data across different sites of service.

In fact, in the long run, our ability to compare clinical data across care settings is one of the benefits that will be realized as a basic component of the Department ’ s interest in the use of a standardized electronic health record (EHR) across all settings including IRFs. It is also important to recognize the complexity of the effort, not only in developing an integrated assessment tool that is designed using health information standards, but in examining the various provider-centric prospective payment methodologies and considering payment approaches that are based on patient characteristics and outcomes. MedPAC has recently taken a preliminary look at the challenges inimproving the coordination of our postacute care payment methods, and suggested that it may be appropriate to explore additional options for paying for post-acute services. We agree that CMS, in conjunction with MedPAC and other stakeholders, should consider a fullrange of options in analyzing our postacute care payment methods, including the IRF PPS.

We also want to encourage incremental changes that will help us build towards these longer term objectives. For example, medical records tools are now available that could allow better coordinated discharge planning procedures. These tools can be used to ensure communication of a standardized data set that then can be used to establish a comprehensive IRF care plan. Improved communications may reduce the incidence of potentially avoidable rehospitalizations and other negative impacts on quality of care that occur when patients are transferred to IRFs without a full explanation of their care needs. We are looking at ways that Medicare providers can use these tools to generate timely data across settings.

At this time, we do not offer specific proposals related to the preceding discussion. Finally, some of the ideas discussed here may exceed our current statutory authority. However, we believe that it is useful to encourage discussion of a broad range of ideas for debate of the relative advantages and disadvantages of the various policies affecting this important component of the health care sector. We welcome comments on these and other approaches.

E. Research To Support Refinements of the Current IRF PPS

As described in the August 7, 2001 final rule, we contracted with the RAND Corporation (RAND) to analyze IRF data to support our efforts in developing the CMG patient classification system and the IRF PPS. Since then, we have continued our contract with RAND to support us in developing potential refinements to the classification system and the PPS. RAND has also developed a system to monitor the effects of the IRF PPS on patients ’ access to IRF care and other post-acute care services.

In 1995, RAND began extensive research, sponsored by us, on the development of a per-discharge based PPS using a patient classification system known as Functional Independence Measures-Function Related Groups (FIM

–FRGs) for IRFs. The results of

RAND ’ s earliest research, using 1994


### 30192 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

data, were released in September 1997 and are contained in two reports available through the National Technical Information Service (NTIS). The reports are: Classification System for Inpatient Rehabilitation Patients

—A Review and Proposed Revisions to theFunction Independence MeasureFunction Related Groups, NTIS order number PB98

– 105992INZ, and Prospective Payment System for Inpatient Rehabilitation, NTIS order number PB98

– 106024INZ.

In July 1999, we contracted with RAND to update its earlier research. The update included an analysis of Functional Independence Measure (FIM) data, the Function Related Groups (FRGs), and the model rehabilitation PPS using 1996 and 1997 data. The purpose of updating the earlier research was to develop the underlying data necessary to support the Medicare IRF PPS based on CMGs for the November 3, 2000 proposed rule (65 FR at 66313). RAND expanded the scope of its earlier research to include the examination of several payment elements, such as comorbidities, facility-level adjustments, and implementation issues, including evaluation and monitoring. Then, to develop the provisions of the August 7, 2001 final rule (66 FR 41316, 41323), RAND did similar analysis on calendar year 1998 and 1999 Medicare Provider Analysis and Review (MedPAR) files and patient assessment data.

We have continued to contract with RAND to help us identify potential refinements to the IRF PPS. RAND conducted updated analyses of the patient classification system, case mix and coding changes, and facility-level adjustments for the IRF PPS using data from calendar year 2002 and FY 2003. This is the first time CMS or RAND has had data generated by IRFs after the implementation of the IRF PPS that are available for data analysis. The refinements we are proposing to make to the IRF PPS are based on the analyses and recommendations from RAND. In addition, RAND sought advice from a technical expert panel (TEP), which reviewed their methodology and findings.

F. Proposed Refinements to the IRF PPS for Fiscal Year 2006 Based on analyses by RAND using calendar year 2002 and FY 2003 data, we are proposing refinements to the IRF PPS case-mix classification system (the CMGs and the corresponding relativeweights) and the case-level and facilitylevel adjustments. Several new developments warrant these proposed refinements, including

— (1) the availability of more recent 2002 and 2003 data; (2) better coding of comorbidities and patient severity; (3) more complete data; (4) new data sources for imputing missing values; and (5) improved statistical approaches.

In this proposed rule, we are proposing to make the following revisions:

• Reduce the standard payment amount by 1.9 percent.

In the August 7, 2001 final rule, we used cost report data from FYs 1998, 1997, and/or 1996 and calendar year 1999 Medicare bill data in calculating the initial PPS payment rates. As discussed in detail in section III.A of this proposed rule, analysis of calendar year 2002 data indicates that the standard payment conversion factor is now at least 1.9 percent higher than it should be to reflect the actual costs of caring for Medicare patients in IRFs. The data demonstrate that this is largely because the implementation of the IRF PPS caused important changes in IRFs ’ coding practices, including increased accuracy and consistency in coding.

• Make revisions to the comorbidity tiers and the CMGs.

In the August 7, 2001 final rule, we used FIM and Medicare data from 1998 and 1999 to construct the CMGs and to assign the comorbidity tiers. As discussed in detail in section II of this proposed rule, analysis of calendar year 2002 and FY 2003 data indicates the need to refine the comorbidity tiers and the CMGs to better reflect the costs of Medicare cases in IRFs.

• Adopt the new geographic labor market area definitions based on the definitions created by the Office of Management and Budget (OMB), known as Core-Based Statistical Areas (CBSAs), for purposes of computing the proposed wage index adjustment to IRF payments.

Historically, Medicare PPSs have used market area definitions developed by OMB. We are proposing to adopt new market area definitions which are based on OMB definitions. As discussed in detail in section III.B.2 of this proposed rule, we believe that these designations more accurately reflect the local economies and wage levels of the areas in which hospitals are located. These are the same labor market area definitions implemented for acute care inpatient hospitals under the hospital inpatient prospective payment system (IPPS) as specified in § 412.64(b)(1)(ii)(A) through (C), which were effective for those hospitals beginning October 1, 2004 as discussed in the August 11, 2004 IPPS final rule (69 FR at 49026 through 49032).

• Implement a teaching status adjustment to payments for services provided in IRFs that are, or are part of, teaching hospitals.

In previous rules, including the August 7, 2001 final rule, we noted that analyses of the data did not support a teaching adjustment. However, analysis of the more recent calendar year 2002 and fiscal year 2003 data supports a teaching status adjustment. For the first time, as discussed in detail in section III.B.3 of this proposed rule, the data analysis has demonstrated a statistically significant relationship between an

IRF ’ s teaching status and the costs of caring for patients in that IRF. We believe this may suggest the need to account for the higher costs associated with major teaching programs. For reasons discussed in detail in section III.B.3 of this proposed rule, we are proposing to implement the new teaching status adjustment in a budget neutral manner. However, we have some concerns about proposing a teaching status adjustment for IRFs at this time (as discussed in detail in section III.B.3 of this proposed rule). Because of these concerns, we are specifically soliciting comments on our consideration of an IRF teaching status adjustment.

• Update the formulas used to compute the rural and the low-income patient (LIP) adjustments to IRF payments.

In the August 7, 2001 final rule, we implemented an adjustment to account for the higher costs in rural IRFs by multiplying their payments by 1.1914. As discussed in detail in section III.B.4 of this proposed rule, the regression analysis RAND performed on fiscal year 2003 data suggests that this rural adjustment should be updated to 1.241 to account for the differences in costs between rural and urban IRFs.

Similarly, in the August 7, 2001 final rule, we implemented an adjustment to payments to reflect facilities ’ lowincome patient percentage calculated as (1+ the disproportionate share hospital (DSH) patient percentage) raised to the power of 0.4838. As discussed in detail in section III.B.5 of this proposed rule, the regression analysis RAND performed on fiscal year 2003 data indicates that the LIP adjustment should now be calculated as (1 + DSH patient percentage) raised to the power of 0.636. For reasons discussed in detail in section III.B.5 of this proposed rule, we are proposing to implement the changes to these adjustments in a budget neutral

manner.

• Update the outlier threshold amount from $11,211 (FY 2005) to $4,911 (FY 2006) to maintain total estimated outlier payments at 3 percent of total estimated payments.


### 30193 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

In the August 7, 2001 final rule, we describe the process by which we calculate the outlier threshold, which involves simulating payments and then determining a threshold that would result in outlier payments being equal to 3 percent of total payments under the simulation. As discussed in detail in section III.B.6 of this proposed rule, we believe based on RAND ’ s regression analysis that all of the other proposed updates to the IRF PPS, including the structure of the CMGs and the tiers, the relative weights, and the facility-level adjustments (such as the rural adjustment, the LIP adjustment, and the proposed teaching status adjustment) make it necessary to propose to adjust the outlier threshold amount.

II. Proposed Refinements to the Patient Classification System [If you choose to comment on issues in this section, please include the caption

‘‘ Proposed Refinements to the Patient Classification System ’’ at the beginning of your comments.]

A. Proposed Changes to the IRF Classification System

1. Development of the IRF Classification System

Section 1886(j)(2)(A)(i) of the Act, as amended by section 125 of the Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 1999 requires the Secretary to establish

‘‘ classes of patient discharges ofrehabilitation facilities by functionalrelated groups (each referred to as a case-mix group or CMG), based on impairment, age, comorbidities, and functional capability of the patients, and such other factors as the Secretary deems appropriate to improve the explanatory power of functional independence measure-function related

groups. ’’ In addition, the Secretary is required to establish a method of classifying specific patients in IRFs within these groups as specified in § 412.620.

In the August 7, 2001 final rule (66 FR at 41342), we implemented a methodology to establish a patient classification system using CMGs. The CMGs are based on the FIM

–FRG methodology and reflect refinements to that methodology.

In general, a patient is first placed in a major group called a rehabilitation impairment category (RIC) based on the patient ’ s primary reason for inpatient rehabilitation, (for example, a stroke). The patient is then placed into a CMG within the RIC, based on the patient ’ s ability to perform specific activities of daily living, and sometimes the patient ’ s cognitive ability and/or age. Other special circumstances, such as the occurrence of very short stays, or cases where the patient expired, are also considered in determining the appropriate CMG.

We explained in the August 7, 2001 final rule that further analysis of FIM and Medicare data may result in refinements to CMGs. In the August 7, 2001 final rule, we used the most recent FIM and Medicare data available at that time (that is 1998 and 1999 data). Developing the CMGs with the 1998 and 1999 data resulted in 95 CMGs based on the FIM

–FRG methodology. The data also supported the establishment of five additional special CMGs that improved the explanatory power of the FIM

–FRGs. We established one additional special CMG to account for very short stays and four additional special CMGs to account for cases where the patient expired. In addition, we established a payment of an additional amount for patients with at least one relevant comorbidity in certain CMGs.

2. Description and Methodology Used to Develop the IRF Classification System in the August 7, 2001 Final Rule a. Rehabilitation Impairment Categories

In the first step to develop the CMGs, the FIM data from 1998 and 1999 were used to group patients into RICs. Specifically, the impairment code from the assessment instrument used by clients of UDSmr and Healthsouth indicates the primary reason for the inpatient rehabilitation admission. This impairment code is used to group the patient into a RIC. Currently, we use 21 RICs for the IRF PPS.

b. Functional Status Measures and Age

After using the RIC to define the first division among the inpatient rehabilitation groups, we used functional status measures and age to partition the cases further. In the August 7, 2001 final rule, we used 1998 and 1999 Medicare bills with corresponding FIM data to create the CMGs and more thoroughly examine each item of the motor and cognitive measures. Based on the data used for the August 7, 2001 final rule, we found that we could improve upon the CMGs by making a slight modification to the motor measure. We modified the motor measure by removing the transfer to tub/ shower item because we found that an increase in a patient ’ s ability to perform functional tasks with less assistance for this item was associated with an increase in cost, whereas an increase in other functional items decreased costs. We describe below the statistical methodology (Classification and Regression Trees (CART)) that we used to incorporate a patient ’ s functional status measures (modified motor score and cognitive score) and age into the construction of the CMGs in the August 7, 2001 final rule.

We used the CART methodology to divide the rehabilitation cases further within each RIC. (Further information regarding the CART methodology can be found in the seminal literature on CART (Classification and Regression Trees, Leo Breiman, Jerome Friedman, Richard Olshen, Charles Stone, Wadsworth Inc., Belmont CA, 1984: pp. 78

– 80).) We chose to use the CART method because it is useful in identifying statistical relationships among data and, using these relationships, constructing a predictive model for organizing and separating a large set of data into smaller, similar groups. Further, in constructing the CMGs, we analyzed the extent to which the independent variables (motor score, cognitive score, and age) helped predict the value of the dependent variable (the log of the cost per case). The CART methodology creates the CMGs that classify patients with clinically distinct resource needs into groups. CART is an iterative process that creates initial groups of patients and then searches for ways to divide the initial groups to decrease the clinical and cost variances further and to increase the explanatory power of the CMGs. Our current CMGs are based on historical data. In order to develop a separate CMG, we need to have data on a sufficient number of cases to develop coherent groups. Currently, we use 95 CMGs as well as 5 special CMGs for scenarios involving short stays or the expiration of the patient.

c. Comorbidities

Under the statutory authority of section 1886(j)(2)(C)(i) of the Act, we are proposing to make several changes to the comorbidity tiers associated with the CMGs for comorbidities that are not positively related to treatment costs, or their excessive use is questionable, or their condition could not be differentiated from another condition. Specifically, section 1886(j)(2)(C)(i) of the Act provides the following: The Secretary shall from time to time adjust the classifications and weighting factors established under this paragraph as appropriate to reflect changes in treatment patterns, technology, case mix, number of payment units for which payment is made under this title and other factors that may affect the relative use of resources. The adjustments shall be made in a manner so that changes in aggregate payments under the


### 30194 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

classification system are a result of real changes and are not a result of changes in coding that are unrelated to real changes in case mix.

A comorbidity is a specific patient condition that is secondary to the patient ’ s principal diagnosis or impairment that is used to place a patient into a RIC. A patient could have one or more comorbidities present during the inpatient rehabilitation stay. Our analysis for the August 7, 2001 final rule found that the presence of a comorbidity could have a major effect on the cost of furnishing inpatient rehabilitation care. We also stated that the effect of comorbidities varied across RICs, significantly increasing the costs of patients in some RICs, while having no effect in others. Therefore, for the August 7, 2001 final rule, we linked frequently occurring comorbidities to impairment categories in order to ensure that all of the chosen comorbidities were not an inherent part of the diagnosis that assigns the patient to the RIC.

Furthermore, in the August 7, 2001 final rule, we indicated that comorbidities can affect cost per case for some of the CMGs, but not all. When comorbidities substantially increased the average cost of the CMG and were determined to be clinically relevant (not inherent in the diagnosis in the RIC), we developed CMG relative weights adjusted for comorbidities ( § 412.620(b)).

d. Development of CMG Relative Weights

Section 1886(j)(2)(B) of the Act requires that an appropriate relative weight be assigned to each CMG. Relative weights account for the variance in cost per discharge and resource utilization among the payment groups and are a primary element of a case-mix adjusted PPS. The establishment of relative weights helps ensure that beneficiaries have access to care and receive the appropriate services that are commensurate to other beneficiaries that are classified in the same CMG. In addition, prospective payments that are based on relative weights encourage provider efficiency and, hence, help ensure a fair distribution of Medicare payments. Accordingly, as specified in § 412.620(b)(1), we calculate a relative weight for each CMG that is proportional to the resources needed by an average inpatient rehabilitation case in that CMG. For example, cases in a CMG with a relative weight of 2, on average, will cost twice as much as cases in a CMG with a relative weight of 1. We discuss the details of developing the relative weights below.

As indicated in the August 7, 2001 final rule, we believe that the RAND analysis has shown that CMGs based on function-related groups (adjusted for comorbidities) are effective predictors of resource use as measured by proxies such as length of stay and costs. The use of these proxies is necessary in developing the relative weights because data that measure actual nursing and therapy time spent on patient care, and other resource use data, are not available.

e. Overview of Development of the CMG Relative Weights

As indicated in the August 7, 2001 final rule, to calculate the relative weights, we estimate operating (routine and ancillary services) and capital costs of IRFs. For this proposed rule, we use the same method for calculating the cost of a case that we outlined in the August 7, 2001 final (66 FR at 41351 through 43153). We obtained cost-to-charge ratios for ancillary services and per diem costs for routine services from the most recent available cost report data. We then obtain charges from Medicare bill data and derived corresponding functional measures from the FIM data. We omit data from rehabilitationfacilities that are classified as allinclusive providers from the calculation of the relative weights, as well as from the parameters that we use to define transfer cases, because these facilities are paid a single, negotiated rate per discharge and therefore do not maintain a charge structure. For ancillary services, we calculate both operating and capital costs by converting charges from Medicare claims into costs using facility-specific, cost-center specific cost-to-charge ratios obtained from cost reports. Our data analysis for the August 7, 2001 final rule showed that some departmental cost-to-charge ratios were missing or found to be outside a range of statistically valid values. For anesthesiology, a value greater than 10, or less than 0.01, is found not to be statistically valid. For all other cost centers, values greater than 10 or less than 0.5 are found not to be statistically valid. In the August 7, 2001 final rule, we replaced individual cost-to-charge ratios outside of these thresholds. The replacement value that we used for these aberrant cost-to-charge ratios was the mean value of the cost-to-charge ratio for the cost-center within the same type of hospital (either freestanding or unit). For routine services, per diem operating and capital costs are used to develop the relative weights. In addition, per diem operating and capital costs for special care services are used to develop the relative weights. (Special care services are furnished in intensive care units. We note that fewer than 1 percent of rehabilitation days are spent in intensive care units.) Per diem costs are obtained from each facility ’ s Medicare cost report data. We use per diem costs for routine and special care services because, unlike for ancillaryservices, we could not obtain cost-tocharge ratios for these services from the cost report data. To estimate the costs for routine and special care services included in developing the relative weights, we sum the product of routine cost per diem and Medicare inpatient days and the product of the special care per diem and the number of Medicare special care days.

In the August 7, 2001 final rule, we used a hospital specific relative value method to calculate relative weights. We used the following basic steps to calculate the relative weights as indicated in the August 7, 2001 final rule (at 66 FR 41316, 41351 through 41352).

The first step in calculating the CMG weights is to estimate the effect that comorbidities have on costs. The second step required us to adjust the cost of each Medicare discharge (case) to reflect the effects found in the first step. In the third step, the adjusted costs from the second step were used to calculate

‘‘ relative adjusted weights ’’ in each CMG using the hospital-specific relative value method. The final steps are to calculate the CMG relative weights by modifying the ‘‘ relative adjusted weight ’’ with the effects of the existence of the comorbidity tiers (explained below) and normalizing the weights to

1. B. Proposed Changes to the Existing List of Tier Comorbidities

1. Proposed Changes to Remove Codes That Are Not Positively Related to Treatment Costs

While our methodology for this proposed rule for determining the tiers remains unchanged from the August 7, 2001 final rule, RAND ’ s analysis indicates that 1.6 percent of FY 2003 cases received a tier payment (often in tier one) that was not justified by any higher cost for the case. Therefore, under statutory authority section 1886(j)(2)(C)(i) of the Act, we are proposing several technical changes to the comorbidity tiers associated with the CMGs. Specifically, the RAND analysis found that the first 17 diagnoses shown in Table 1 below are no longer positively related to treatment cost after controlling for CMG. The


### 30195 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

additional two codes were also problematic. According to RAND, code 410.91 (AMI, NOS, Initial) was too unspecific to be differentiated from other related codes and code 260, Kwashiorkor, was found to be unrealistically represented in the data according to a RAND technical expert panel.

With respect to the eighteenth code in Table One, (410.X1) Specific AMI, initial), we note that RAND found there is not clinical reason to believe that this code differs in a rehabilitation environment from all of the specific codes for initial AMI of the form 410.X, where X is an numeric digit. In other words, this code is indistinguishable from the seventeenth code in Table One (410.91 AMI, NOS, initial). Following this observation, RAND tested the other initial AMI codes as a single group and found that they have no positive effect on case cost. Since we are proposing to

remove ‘‘ AMI, NOS, initial ’’ from the tier list because it is not positively related to treatment cost after controlling for the CMG, we believe that

‘‘ Specific AMI, initial ’’ similarly should be removed from the tier list since it is indistinguishable from ‘‘ AMI, NOS, initial. ’’

With respect to the last code in Table One (Kwashiorkor), we are proposing to remove this code from the tier list as well. This comorbidity is positively related to cost in our data. However,

RAND ’ s technical expert panel (TEP) found the large number of cases coded with this rare disease to be unrealistic and recommended that it be removed from the tier list.

Table 1 contains two malnutrition codes, and removing these two malnutrition codes where use is concentrated in specific hospitals is particularly important because these hospitals are likely receiving unwarrantedly high payments due to the tier one assignment of these cases. Thus, because we believe the excess use of these two comorbid conditions is inappropriate based on the findings of

RAND ’ s TEP, we are proposing their removal.

The data indicate large variation in the rate of increase from the 1999 data to the 2003 data across the conditions that make up the tiers. The greatest increases were for miscellaneous throat conditions and malnutrition, each of which were more than 10 times as frequent in 2003 as in 1999. The growth in these two conditions was far larger than for any other condition. Many conditions, however, more than doubled in frequency, including dialysis, cachexia, obesity, and the non-renal complications of diabetes. The condition with the least growth, renal complications of diabetes, may have been affected by improved coding of dialysis.

The remaining proposed changes to our initial list of diagnoses in Table 1 deal with tracheostomy cases. These rare cases were excluded from the pulmonary RIC 15 in the August 7, 2001 final rule. The new data indicate that they are more expensive than other cases in the same CMG in RIC 15, as well as in other RICs. Therefore, we believe the data demonstrate that tracheostomy cases should be added to the tier list for RIC 15. Finally, DX V55.0, ‘‘ attention to tracheostomy ’’ should initially have been part of this condition as these cases were and are as expensive as other tracheostomy cases. Thus, since ‘‘ attention to tracheostomy ’’ is as expensive as other tracheostomy cases, it is logical to group such similar cases together.

We believe that the data provided by RAND support the removal of the codes in Table 1 below because they either have no impact on cost after controlling for their CMG or are indistinguishable from other codes or are unrealistically overrepresented. Therefore, we are proposing to remove these codes from the tier list.



### TABLE 

### 1.—P ROPOSED 

### L IST OF 

### C ODES 

### T O 

### B E 

### R EMOVED 

### F ROM THE 

### T IER 

### L IST

ICD–9–CM code Abbreviated code title Condition

235.1 ............. Unc behav neo oral/phar ...................................................................................... ............. Miscellaneous throat conditions. 933.1 ............. Foreign body in larynx ....................................................................................... ................ Miscellaneous throat conditions. 934.1 ............. Foreign body bronchus ........................................................................................ .............. Miscellaneous throat conditions. 530.0 ............. Achalasia & cardiospasm ...................................................................................... ............ Esophegeal conditions. 530.3 ............. Esophageal stricture ......................................................................................... ................. Esophegeal conditions. 530.6 ............. Acquired esophag diverticulum ................................................................................ ......... Esophegeal conditions. V46.1 ............ Dependence on respirator ...................................................................................... ........... Ventilator status. 799.4 ............. Cachexia ..................................................................................................... ....................... Cachexia. V49.75 .......... Status amputation below knee ................................................................................... ....... Amputation of LE. V49.76 .......... Status amputation above knee ................................................................................... ....... Amputation of LE. V497.7 .......... Status amputation hip .......................................................................................... .............. Amputation of LE. 356.4 ............. Idiopathic progressive polyneuropathy ........................................................................ ...... Meningitis and encephalitis. 250.90 ........... Diabetes II, w unspecified complications, not stated as uncontrolled .............................. Non-renal Co mplications of Diabetes. 250.93 ........... Diabetes I, w unspecified complications, uncontrolled ..................................................... Non- renal Complications of Diabetes. 261 ................ Nutritional Marasmus ........................................................................................ ................. Malnutrition. 262 ................ Other severe protein calorie deficiency ..................................................................... ........ Malnutrition. 410.91 ........... AMI, NOS, initial ............................................................................................. ................... Major comorbidities. 410.X1 .......... Specific AMI, initial .......................................................................................... .................. Major comorbidities. 260 ................ Kwashiorkor ................................................................................................. ...................... Malnutrition.

2. Proposed Changes To Move Dialysis To Tier One

We are proposing the movement of dialysis to tier one, which is the tier associated with the highest payment. The data from the RAND analysis show that patients on dialysis cost substantially more than current payments for these patients and should be moved into the highest paid tier because this tier would more closely align payment with the cost of a case. Based on RAND ’ s analysis using 2003 data, a patient with dialysis costs 31 percent more than a non-dialysis patient in the same CMG and with the same other accompanying comorbidities. Overall, the largest increase in the cost of a condition occurs among patients on dialysis, where the coefficient in the cost regression increases by 93 percent, from 0.1400 to 0.2697. Part of the explanation for the increased coefficient could be that some IRFs had not borne all dialysis costs for their patients in the pre-PPS period


### 30196 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

(because providers were previously permitted to bill for dialysis separately). Dialysis is currently in tier two. However, it is likely that, in the 1999 data, some IRFs had not borne all dialysis costs for their patients. Because the fraction of cases coded with dialysis increased by 170 percent, it is also likely that improved coding was part of the explanation for the increased coefficient. We believe a 170 percent increase is such a dramatic increase that it would be highly unlikely that in one short time, 170 percent more patients need dialysis than they did before the implementation of the IRF PPS. We also believe that the improved coding is likely due to the fact that higher costs are associated with dialysis patients and therefore IRFs, in an effort to ensure that their payments cover these higher expenses will better and more carefully code comorbidities whose presence will result in higher PPS payments.

Moving dialysis patients to tier one will more adequately compensate hospitals for the extra cost of those patients and thereby maintain or increase access to these services.

3. Proposed Changes To Move Comorbidity Codes Based on Their Marginal Cost

Under statutory authority section 1886(j)(2)(C)(i) of the Act, we are proposing to move comorbidity codes based on their marginal cost. Another limitation with the existing tiers is that costs for several conditions would be more accurately predicted if their tier assignments were changed. After examining RAND ’ s data, we believe that a full 4 percent of FY 2003 cases should be moved down to tiers with lower payment.

We propose that tier assignments be based on the results of statistical analyses RAND has performed under contract with CMS, using as independent variables only the proposed CMGs and conditions that we are proposing for tiers (for example, the CMGs and conditions that remain after the proposed changes have been made). We are proposing that the tier assignments of each of these conditions be decided based on the magnitude of their coefficients in RAND ’ s statistical analysis.

We believe the IRF PPS led to substantial changes in coding ofcomorbidities between 1999 (preimplementation of the IRF PPS) and 2003 (post-implementation of the IRF PPS). The percentage of cases with one or more comorbidities increased from 16.79 percent in the data in which tiers were defined (1998 through 1999) to 25.51 percent in FY 2003. This is an increase of 52 percent in tier incidence (52 = 100 × (25.51

¥ 16.79)/16.79). The presence of a tier one comorbidity, the highest paid of the tiers, almost quadrupled during this same time period. Although, coding likely improved, the presence of upcoding for a higher payment may play a factor as well.

The 2003 data provide a more accurate explanation of the costs that are associated with each of the comorbidities, largely due to having 100 percent of the Medicare-covered IRF cases in the later data versus slightly more than half of the cases in 1999 data. Therefore, using the 2003 data to propose to assign each diagnosis or condition will considerably improve the matching of payments to their relative

costs. C. Proposed Changes to the CMGs

Section 1886(j)(2)(C)(i) of the Act requires the Secretary from time to time to adjust the classifications and weighting factors of patients under the IRF PPS to reflect changes in treatment patterns, technology, case mix, number of payment units for which payment is made, and other factors that may affect the relative use of resources. These adjustments shall be made in a manner so that changes in aggregate payments under the classification system are the result of real changes and not the result of changes in coding that are unrelated to real changes in case mix.

In accordance with section 1886(j)(2)(C)(i) of the Act and as specified in § 412.620(c) and based on the research conducted by RAND, we are proposing to update the CMGs used to classify IRF patients for purposes of establishing payment amounts. We are also proposing to update the relative weights associated with the payment groups based on FY 2003 Medicare bill and patient assessment data. We are proposing to replace the current unweighted motor score index used to assign patients to CMGs with a weighted motor score index that would improve our ability to accurately predict the costs of caring for IRF patients, as described in detail below. However, we are not proposing to change the methodology for computing the cognitive score index.

As described in the August 7, 2001 final rule, we contracted with RAND to analyze IRF data to support our efforts in developing our patient classification system and the IRF PPS. We have continued our contract with RAND to support us in developing potential refinements to the classification system and the PPS. As part of this research, we asked RAND to examine possible refinements to the CMGs to identify potential improvements in the alignment between Medicare payments and actual IRF costs. In conducting its research, RAND used a technical expert panel (TEP) made up of experts from industry groups, other government entities, academia, and other interested parties. The technical expert panel reviewed RAND ’ s methodologies and advised RAND on many technical issues.

Several recent developments make significant improvements in the alignment between Medicare payments and actual IRF costs possible. First, when the IRF PPS was implemented in 2002, a new recording instrument was used to collect patient data, the IRF Patient Assessment Instrument (or the IRF PAI). The new instrument contained questions that improved the quality of the patient-level information available to researchers.

Second, more recent data are available on a larger patient population. Until now, the design of the IRF PPS was based entirely on 1999 data on Medicare rehabilitation patients from just asample of hospitals. Now, we have postPPS data from 2002 and 2003 that describe the entire universe of Medicare-covered rehabilitation patients.

Finally, we believe that proposed improvements in the algorithms that produced the initial CMGs, as described below, should lead to new CMGs that better predict treatment costs in the IRF PPS.

Using FIM (the inpatient rehabilitation facility assessment instrument before the PPS) and Medicare data from 1998 and 1999, RAND helped us develop the original structure of the IRF PPS. IRFs became subject to the PPS beginning with cost reporting periods on or after January 1, 2002. The PPS is based on assigning patients to particular CMGs that are designed to predict the costs of treating particular Medicare patients according to how well they function in four general categories: transfers, sphincter control, self-care (for example, grooming, eating), and locomotion. Patient functioning is measured according to 18 categories of activity: 13 motor tasks, such as climbing stairs, and 5 cognitive tasks, such as recall. The PPS is intended to align payments to IRFs as closely as possible with the actual costs of treating patients. If the PPS ‘‘ underpays ’’ for some kinds of care, IRFs have incentives to limit access for patients requiring that kind of care because payments would be less than the costs of providing care for a particular case so an IRF may try to


### 30197 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

limit its financial ‘‘ losses ’’ ; conversely, if the PPS overpays, resources are wasted because IRFs ’ payments exceed the costs of providing care for a particular case.

The fiscal year 2003 data file currently available for refining the CMGs is better than the 1999 data RAND originally used to construct the IRF PPS because it contains many more IRF cases and represents the universe of Medicare-covered IRF cases, rather than a sample. The best available data that CMS and RAND had for analysis in 1999 contained 390,048 IRF cases,representing 64 percent of all Medicarecovered patients in participating IRF hospitals. The more recent data contain 523,338 IRF cases (fiscal year 2003), representing all Medicare-covered patients in participating IRF hospitals. The larger file enables RAND to obtain greater precision in the analysis and ensures a more balanced and complete picture of patients under the IRF PPS. Also, the fiscal year 2003 data are better than the 1999 data used to design the IRF PPS because they include more detailed information about patients ’ level of functioning. For example, new variables are included in the more recent data that provide further details on patient functioning. Standard bowel and bladder scores on the FIM instrument (used to assess patients before the IRF PPS), for example, measured some combination of the level of assistance required and the frequency of accidents (that is, soiling of clothes and surroundings). New variables on the

IRF

–PAI instrument measure the level and the frequency separately. Since measures of the level of assistance required and the frequency of accidents contain slightly different information about the expected costliness of an IRF patient, having measures for these two variables separately provides additional information to researchers. Furthermore, additional optional information is recorded on the health status of patients in the more recent data (for example, shortness of breath, presence of ulcers, inability to balance).

1. Proposed Changes for Updating the CMGs

As described in the August 7, 2001 final rule, RAND developed the original list of CMGs using FIM data from 1998 and 1999 to group patients into RICs. Table 2 below shows the final set of 95 CMGs based on the FIM

–FRG methodology, the 5 special CMGs, and their descriptions. Impairment codes from the assessment instrument used by UDSmr and Healthsouth indicated the primary reasons for inpatient rehabilitation admissions. The impairment codes were used to group patients into RICs. Table 3 below shows each RIC and its associated impairment code.

**BILLING CODE 4120**

**– 01** 

**– P** 


### 30198 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30199 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30200 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30201 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30202 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30203 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30204 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30205 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**BILLING CODE 4120**

**– 01** 

**– C**  Given the availability of more recent, post-PPS data, we asked RAND to examine possible refinements to the CMGs to identify potential


### 30206 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

improvements in the alignment between Medicare payments and actual IRF costs. In addition to analyzing fiscal year 2003 data, RAND also convened a TEP, made up of researchers from industry, provider organizations, government, and academia, to provide support and guidance through the process of developing possible refinements to the PPS. Members of the TEP reviewed drafts of RAND ’ s reports, offered suggestions for additional analyses, and provided clinicians ’ views of the importance and significance of various findings.

RAND ’ s analysis of the FY 2003 data, along with the support and guidance of the TEP, strongly suggest the need to update the CMGs to better align payments with costs under the IRF PPS. The other option we considered before deciding to propose to update the CMGs with the fiscal year 2003 data was to maintain the same CMG structure but recalculate the relative weights for the current CMGs using the 2003 data. After carefully reviewing the results of

RAND ’ s regression analysis, which compared the predictive ability of the CMGs under 3 scenarios (not updating the CMGs or the relative weights, updating only the relative weights and not the CMGs, and updating both the relative weights and the CMGs), we believe (based on RAND ’ s analysis) that updating both the relative weights and the CMGs will allow the classification system to do a much better job of reflecting changes in treatment patterns, technology, case mix, and other factors which may affect the relative use of

resources.

We believe it is appropriate to update the CMGs and the relative weights at this time because the 2003 data we now have represent a substantial improvement over the 1999 data. Themore recent data include all Medicarecovered IRF cases rather than a subset, allowing us to base the proposed CMG changes on a complete picture of the types of patients in IRFs. In designing the IRF PPS, we used the best available data, but those data did not allow us to have a complete picture of the types of patients in IRFs. Also, the clinical coding of patient conditions in IRFs is vastly improved in the more recent data than it was in the best available data we had to design the IRF PPS. In addition, changes in treatment patterns, technology, case mix, and other factors affecting the relative use of resources in IRFs since the IRF PPS was implemented likely require an update to the classification system.

We are currently paying IRFs based on 95 CMGs and 5 special CMGs developed using the CART algorithm applied to 1999 data. The CART algorithm that was used in designing the IRF PPS assigned patients to RICs according to their age and their motor and cognitive FIM scores. CART produced the partitions so that the reported wage-adjusted rehabilitation cost of the patients was relatively constant within partitions. Then, a subjective decision-making process was used to decrease the number of CMGs (to ensure that the payment system did not become unduly complicated), to enforce certain constraints on the CMGs (to ensure that, for instance, IRFs were not paid more for patients who had fewer comorbidities than for patients with more comorbidities), and to fit the comorbidity tiers. Although the use of a subjective decision-making process (rather than a computer algorithm) was very useful, there were limitations. For example, it made it difficult to explore the implications of variations to the CART models because a computer program can examine many more variations of a model in a much shorter time than an individual person. Furthermore, the computer is more efficient at accounting for all of the possible combinations and interactions between important variables that affect patient costs.

In analyzing potential refinements to the IRF PPS, RAND created a new algorithm that would be very useful in constructing the proposed CMGs (the new algorithm would be based on the CART methodology described in detail earlier in this section of the proposed rule). RAND applied the new algorithm to the fiscal year 2003 IRF data. We are proposing to use RAND ’ s new algorithm for refinements to the CMGs. The proposed algorithm would be based entirely on an iterative computerized process to decrease the number of CMGs, enforce constraints on the CMGs, and assign the comorbidity tiers. At each step in the process, the proposed new CART algorithm would produce all of the possible combinations of CMGs using all available variables. It would then select the variables and the CMG constructions that offer the best predictive ability, as measured by the greatest decrease in the mean-squared error. We propose that the following constraints be placed on the algorithm, based on RAND ’ s analysis: (1) Neighboring CMGs would have to differ by at least $1,500, unless eliminating the CMG would change the estimated costs of patients in that CMG by more than $1,000; (2) estimated costs for patients with lower motor or cognitive index scores (more functionally dependent) would always have to be higher than estimated costs for patients with higher motor or cognitive index scores (less functionally dependent). We believe that the PPS should not pay more for a patient who is less functionally dependent than for one who is more functionally dependent; and (3) each CMG must contain at least 50 observations (for statistical validity).

RAND ’ s technical expert panel, which included representatives from industry groups, other government entities, academia, and other researchers, reviewed and commented on these constraints and the rest of RAND ’ s proposed methodology (developed based on RAND ’ s analysis of the data) for updating the CMGs as RAND developed the improvements to the CART methodology.

The following would be the most substantial differences between the existing CMGs and the proposed new CMGs:

• Fewer CMGs than before (87 compared with 95 in the current system).

• The number of CMGs under the RIC for stroke patients (RIC 1) would decrease from 14 to 10.

• The cognitive index score would affect patient classification in two of the RICs (RICs 1 and 2), whereas it currently affects RICs 1, 2, 5, 8, 12, and 18.

• A patient ’ s age would now affect assignment for CMGs in RICs 1, 4 and 8, whereas it currently affects assignment for CMGs in RICs 1 and 4.

In Table 2 above, we provided the CMGs that are currently being used to pay IRFs. Table 4 below shows the proposed new CMGs.

**BILLING CODE 4120**

**– 01** 

**– P** 


### 30207 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30208 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30209 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30210 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**BILLING CODE 4120**

**– 01** 

**– C** 

Note: CMG definitions use proposed weighted motor scores, as defined below.

The primary objective in updating the CMGs is to better align IRF payments with the costs of caring for IRF patients, given better, more recent information. This requires that we improve the ability of the system to predict patient

costs. RAND ’ s analysis suggests that the proposed new CMGs clearly improve the ability of the payment system to predict patient costs. The proposed new CMGs would greatly improve the explanation of the variance in the system. 2. Proposed Use of a Weighted Motor Score Index and Correction to the Treatment of Unobserved Transfer to Toilet Values

As described in detail below, we are proposing to use a weighted motor score index in assigning patients to CMGs, instead of the current motor score index that treats all components equally. We are also proposing to change the motor score value for the transfer to toilet variable to 2 rather than 1 when it is unobserved. However, we are not proposing changes to the cognitive score index. As described in detail below, we believe that a weighted motor score index, with the correction to the treatment of unobserved transfer to toilet values would improve the classification of patients into CMGs, which in turn would improve the accuracy of payments to IRFs.

In order to classify a patient into a CMG, IRFs use the admission assessment data from the IRF

–PAI to score a patient ’ s functional independence measures. The functional independence measures consist of what are termed ‘‘ motor ’’ items and

‘‘ cognitive ’’ items. In addition to the functional independence measures, the patient ’ s age may also influence the patient ’ s CMG classification. The motor items are generally indications of the patient ’ s physical functioning level. The cognitive items are generally indications of the patient ’ s mental functioning level, and are related to the patient ’ s ability to process and respond to empirical factual information, use judgment, and accurately perceive what is happening. The motor items are eating, grooming, bathing, dressing upper body, dressing lower body, toileting, bladder management, bowel management, transfer to bed/chair/wheelchair, transfer to toilet, walking or wheelchair use, and stair climbing. The cognitive items are comprehension, expression, social interaction, problem solving, and memory. (The CMS IRF

–PAI manual includes more information on these items.) Each item is generally recorded on a patient assessment instrument and scored on a scale of 1 to 7, with a 7 indicating complete independence in this area of functioning, and a 1 indicating that a patient is very impaired in this area of functioning.

As explained in the August 7, 2001 final rule (66 FR at 41349), the


### 30211 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

instructions for the IRF

–PAI require that providers record an 8 for an item to indicate that the activity did not occur (or was not observed), as opposed to a 1 through 7 indicating that the activity occurred and the estimated level of function connected with that activity.

Please note that when the IRF

–PAI form went through the approval process, the code 8 was removed and replaced with the code 0. Therefore, a 0 is now the code facilities use to record when an activity does not occur (or is not observed).

In order to determine the appropriate payment for patients for whom an activity is coded as 0 (that is, either not performed or not observed), we needed to decide an appropriate way of changing the 0 to another code for which payment could be assigned. As discussed in the August 7, 2001 final rule (66 FR at 41349), we decided to assign a code of 1 (indicating that the patient needed ‘‘ maximal assistance ’’ ) whenever a code of 0 appeared for one of the items on the IRF

–PAI used to determine payment. This was the most conservative approach we could have taken based on the best available data at the time because a value of 1 indicates that the patient needed maximal assistance performing the task. Thus, providers would receive the highest payment available for that item (although it might not be the highest payment overall, depending on the patient ’ s CMG, other functional abilities, and/or comorbidities).

We are proposing to change the way we treat a code of 0 on the IRF

–PAI for the transfer to toilet item. This is the only item for which we are proposing this change at this time because RAND ’ s regression analysis demonstrated that of all the motor score values, the evidence supporting a change in the motor score values was the strongest with respect to this item. We propose to assign a code of 2, instead of a code of 1, to patients for whom a 0 is recorded on the IRF

– PAI for the transfer to toilet item (as discussed below) because RAND ’ s analysis of calendar year 2002 and FY 2003 data indicates that patients for whom a 0 is recorded are more similar in terms of their characteristics and costliness to patients with a recorded score of 2 than to patients with a recorded score of 1. We are proposing to make this change in order to provide the most accurate payment for each patient.

Using regression analysis on the calendar year 2002 and FY 2003 data, which is more complete and provides more detailed information on patients ’ functional abilities than the FY 1999 data used to construct the IRF PPS (even though the 1999 data were the best available data at the time), RAND analyzed whether the assignment of 1 to items for which a 0 is recorded on the

IRF

–PAI continues to correctly assign payments based on patients ’ expected costliness. RAND examined all of the items in the motor score index, focusing on how often a code of 0 appears for the item, how similar patients with a code of 0 are to other patients with the same characteristics that have a score of 1 though 7, and how much a change in the item ’ s score affects the prediction of a patient ’ s expected costliness. Based on

RAND ’ s regression analysis, we believe it is appropriate to change the assignment of 0 on the transfer to toilet item from a 1 to a 2 for the purposes of determining IRF payments.

Until now, the IRF PPS has used standard motor and cognitive scores, the sum of either 12 or 13 motor items and the sum of 5 cognitive items, to assign patients to CMGs. This summing equally weights the components of the indices. These indices have been accepted and used for many years. Although the weighted motor score is an option that has been considered before, most experts believed that the data were not complete and accurate enough before the IRF PPS (although they were the most complete and accurate data available at the time). Now, it is believed that the data are complete and accurate enough to support proposing to use a weighted motor score index.

In developing candidate indices that would weight the items in the score, RAND had competing goals: to develop indices that would increase the predictive power of the system while at the same time maintaining simplicity and transparency in the payment system. For example, they found that an

‘‘ optimal ’’ weighting methodology from the standpoint of predictive power would require computing 378 different weights (18 different weights for the motor and cognitive indices that could all differ across 21 RICs). Rather than introduce this level of complexity to the system, RAND decided to explore simpler weighting methodologies that would still increase the predictive power of the system.

RAND used regression analysis to explore the relationship of the FIM motor and cognitive scores to cost. The idea of these models was to determine the impact of each of the FIM items on cost and then weight each item in the index according to its relative impact on cost. Based on the regression analysis, RAND was able to design a weighting methodology for the motor score that could potentially be applied uniformly across all RICs. RAND assessed different weighting methodologies for both the motor score index and the cognitive score index. They discovered that weighting the motor score index improved the predictive ability of the system, whereas weighting the cognitive score index did not. Furthermore, the cognitive score index has never had much of an effect (in some RICs, it has no effect) on the assignment of patients to CMGs because the motor score tends to be much stronger at predicting a patient ’ s expected costs in an IRF than the cognitive score.

For these reasons, we are proposing a weighting methodology for the motor score index at this time. We propose to continue using the same methodology we have been using since the IRF PPS was first implemented to compute the cognitive score index (that is, summing the components of the index) because, among other things, a change in methodology for calculating this component of the system failed to improve the accuracy of the IRF PPS payments. Therefore, it would be futile to expend resources on changing this method when it would not benefit the

program.

Table 5 below shows the proposed optimal weights for the components of the motor score, averaged across all RICs and normalized to sum to 100.0, obtained through the regression analysis. The weights relate to the FIM items ’ relative ability to predict treatment costs. Table 5 indicates that dressing lower, toilet, bathing, and eating are the most effective self-care items for predicting costs; bowel and bladder control may not be effective at predicting costs; and that the items grouped in the transfer and locomotion categories might be somewhat more effective at predicting costs than the other categories.



### TABLE 

### 5.

— P ROPOSED 

### O PTIMAL 

### W EIGHTS 

### , AVERAGED 

### A CROSS 

### R E



### HABILITATION 

### I MPAIRMENT 

### C AT



### EGORIES 

### (RIC S 

### ): M OTOR 

### I TEMS

Item type Functional independence item Average optimal weight

Self .............. Dressing lower .... 1.4 Self .............. Toilet ................... 1.2 Self .............. Bathing ................ 0.9 Self .............. Eating .................. 0.6 Self .............. Dressing upper .... 0.2 Self .............. Grooming ............ 0.2 Sphincter ..... Bladder ................ 0.5 Sphincter ..... Bowel .................. 0.2 Transfer ....... Transfer to bed ... 2.2 Transfer ....... Transfer to toilet .. 1.4 Transfer ....... Transfer to tub .... Not included


### 30212 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 5.

— P ROPOSED 

### O PTIMAL 

### W EIGHTS 

### , AVERAGED 

### A CROSS 

### R E



### HABILITATION 

### I MPAIRMENT 

### C AT



### EGORIES 

### (RIC S 

### ): M OTOR 

### I TEMS



### — Continued

Item type Functional independence item Average optimal weight

Locomotion .. Walking ............... 1.6 Locomotion .. Stairs ................... 1.6

Based on RAND ’ s analysis, we considered a number of different candidate indices before proposing a weighted index. We considered proposing to define some simple combinations of the four item types that make up the motor score index and assigning weights to the groups of items instead of to the individual items. For example, we considered proposing to sum the three transfer items together to form a group with a weight of two, since they contributed about twice as much in the cost regression as the self-care items. We also considered proposing to assign the self-care items a weight of one and the bladder and bowel items as a group a weight close to zero, since they contributed little to predicting cost in the regression analysis. We tried a number of variations and combinations of this, but RAND ’ s TEP generally rejected these weighting schemes. They believed that introducing elements of subjectivity into the development of the weighting scheme may invite controversy, and that it is better to use an objective algorithm to derive the appropriate weights. We agree that an objective weighting scheme is best because it is based on regression analysis of the amount that various components of the motor score index contribute to predicting patient costs, using the best available data we have. Therefore, we are proposing a weighting scheme that applies the average optimal weights. To develop the proposed weighting scheme, RAND used regression analysis to estimate the relative contribution of each item to the prediction of costs. Based on this analysis, we are proposing to use the weighting scheme indicated in Table 5 above and in the following simple equation: Motor score index=1.4*dressing lower + 1.2*toilet + 0.9*bathing + 0.6*eating + 0.2*dressing upper + 0.2*grooming + 0.5*bladder + 0.2*bowel + 2.2*transfer to bed + 1.4*transfer to toilet + 1.6*walking + 1.6*stairs. Another reason we are proposing to use a weighted motor score index to assign patients to CMGs is that RAND ’ s regression analysis showed that it predicts costs better than the current unweighted motor score index. Across all 21 RICs, the proposed weighted motor score index improves the explanation of variance within each RIC by 9.5 percent, on average.

3. Proposed Changes for Updating the Relative Weights

Section 1886(j)(2)(B) of the Act requires that an appropriate relative weight be assigned to each CMG. Relative weights that account for the variance in cost per discharge and resource utilization among paymentgroups are a primary element of a casemix adjusted prospective payment system. The accuracy of the relative weights helps to ensure that payments reflect as much as possible the relative costs of IRF patients and, therefore, that beneficiaries have access to care and receive the appropriate services.

Section 1886(j)(2)(C)(i) of the Act requires the Secretary from time to time to adjust the classifications and weighting factors to reflect changes in treatment patterns, technology, case mix, number of payment units for which payment to IRFs is made, and other factors which may affect the relative use of resources. In accordance with this section of the Act, we are proposing to recalculate a relative weight for each CMG that is proportional to the resources needed by an average inpatient rehabilitation case in that CMG. For example, cases in a CMG with a relative weight of 2, on average, would cost twice as much as cases in a CMG with a relative weight of 1. We are not proposing any changes to the methodology we are using for calculating the relative weights, as described in the August 7, 2001 final rule (66 FR 41316, 41351 through 41353); we are only proposing to update the relative weights themselves.

As previously stated, we believe that improved coding of data, the availability of more complete data, proposed changes to the tier comorbidities and CMGs, and changes in IRF cost structures make it very unlikely that the relative weights assigned to the CMGs when the IRF PPS was first implemented still accurately represent the differences in costs across CMGs and across tiers. Therefore, we are proposing to recalculate the relative weights. However, we are not proposing any changes to the methodology for calculating the relative weights. Instead, we are proposing to update the relative weights (the relative weights that are multiplied by the standard payment conversion factor to assign relative payments for each CMG and tier) using the same methodology as described in the August 7, 2001 final rule (66 FR 41316, 41351 through 41353) and as described in detail at the beginning of this section of this proposed rule, applied to FY 2003 Medicare billing data. To summarize, we are proposing to use the following basic steps to update the relative weights: The first step in calculating the CMG weights is to estimate the effects that comorbidities have on costs. The second step is to adjust the cost of each Medicare discharge (case) to reflect the effects found in the first step. In the third step, the adjusted costs from the second step are used to calculate ‘‘ relative adjusted weights ’’ in each CMG using the hospital-specific relative value method. The final steps are to calculate the CMG relative weights by modifying the

‘‘ relative adjusted weight ’’ with the effects of the existence of the comorbidity tiers (explained below) and normalize the weights to 1. Table 6 below shows the proposed relative weights, based on the 2003 data.


### 30213 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30214 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30215 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30216 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30217 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30218 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30219 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**BILLING CODE 4120**

**– 01** 

**– C** 

We are proposing to make the tier and the CMG changes in such a way that total estimated aggregate payments to IRFs for FY 2006 are the same with and without the proposed changes (that is, in a budget neutral manner) for the following reasons. First, we believe that the results of RAND ’ s analysis of 2002 and 2003 IRF cost data suggest that additional money does not need to be added to the IRF PPS. RAND ’ s analysis found, for example, that if all IRFs had been paid based on 100 percent of the IRF PPS payment rates throughout all of 2002 (some IRFs were still transitioning to PPS payments during 2002), PPS payments during 2002 would have been 17 percent higher than IRFs ’ costs. Furthermore, RAND did not find evidence that the overall costliness of patients (average case mix) in IRFs increased substantially in 2002 compared with 1999. As discussed in detail in section III.A of this proposed rule, RAND found that real case mix increased by at most 1.5 percent, and may have decreased by as much as 2.4 percent. The available evidence, therefore, suggests that resources in the IRF PPS are likely adequate to care for the types of patients IRFs treat. We are open to examining other evidence regarding the amount of aggregate payments in the system and the types of patients IRFs are currently treating.

The purpose of the CMG and tier changes is to ensure that the existing resources already in the IRF PPS are distributed better among IRFs according to the relative costliness of the types of patient they treat. Section 1886(j)(2)(C)(i) of the Act confers broad statutory authority upon the Secretary to adjust the classification and weighting factors in order to account for relative resource use. Consistent with that broad statutory authority, we are proposing to redistribute aggregate payments to more accurately reflect the IRF case mix.

To ensure that total estimated aggregate payments to IRFs do not change, we propose to apply a factor to the standard payment amount to ensure that estimated aggregate payments under this subsection in the FY are not greater or less than those that would


### 30220 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

have been made in the year without such adjustment. In section III.B.7 and section III.B.8 of this proposed rule, we discuss the methodology and factor we are proposing to apply to the standard payment amount. III. Proposed FY 2006 Federal Prospective Payment Rates

(If you choose to comment on issues in this section, please include the caption

‘‘ Proposed FY 2006 Federal Prospective Payment Rates ’’ at the beginning of your comments.) A. Proposed Reduction of the Standard Payment Amount to Account for Coding Changes

Section 1886(j)(2)(C)(ii) of the Act requires the Secretary to adjust the per payment unit payment rate for IRF services to eliminate the effect of coding or classification changes that do not reflect real changes in case mix if the Secretary determines that changes in coding or classification of patients have resulted or will result in changes in aggregate payments under the classification system. As described below, in accordance with this section of the Act and based on research conducted by RAND under contract with us, we are proposing to reduce the standard payment amount for patients treated in IRFs by 1.9 percent. However, as discussed below, RAND found a range of possible estimates that likely accounts for the amount of case mix change that was due to coding. In light of the range of estimates that may be appropriate, we are continuing to work with RAND to further analyze the data and are considering adoption of an alternative percentage reduction. Accordingly, we solicit comments on whether the proposed 1.9 percent is the percentage reduction that ought to be made, or if another percentage reduction (for example, the 3.4 percent observed case mix change or the 5.8 percent that RAND found in its study, detailed below, to be the maximum amount of change due to coding) should be applied.

We are proposing to reduce the standard payment amount by 1.9 percent because RAND ’ s regression analysis of calendar year 2002 data found that payments to IRFs were about $140 million more than expected during 2002 because of changes in the classification of patients in IRFs, and that a portion of this increase in payments was due to coding changes that do not reflect real changes in case mix. If IRF patients have more costly impairments, lower functional status, or more comorbidities, and thus require more resources in the IRF in 2002 than in 1999, we would consider this a real change in case mix. Conversely, if IRF patients have the same impairments, functional status, and comorbidities in 2002 as they did in 1999 but are coded differently resulting in higher payment, we consider this a case mix increase due to coding. We believe that changes in payment amounts should accurately reflect changes in IRFs ’ patient case mix (that is, the true cost of treating patients), and should not be influenced by changes in coding practices.

Under the IRF PPS, payments for each Medicare rehabilitation patient are determined using a multi-step process. First, a patient is assigned to a particular CMG and a tier based on four patient characteristics at admission: impairment, functional independence, comorbidities, and age. The amount of the payment for each patient is then calculated by taking the standard payment conversion factor ($12,958 in FY 2005) and adjusting it by multiplying by a relative weight, which depends on each patient ’ s CMG and tier assignment.

For example, an 80-year old hip replacement patient with a motor score between 47 and 54 and no comorbidities would be assigned to a particular CMG and tier based on these characteristics. The CMG and tier to which he is assigned would have an associated relative weight, in this case 0.5511 in FY 2005 (69 FR at 45725). This relative weight would be multiplied by the standard payment conversion factor of $12,958 to equal the payment of $7,141 in FY 2005 (0.5511 × $12,958 = $7,141). Based on the following discussion, we are proposing lowering the standard payment amount by 1.9 percent to account for coding changes that have increased payments to IRFs. However, we solicit comments regarding other possible percentage reductions within the range RAND identified, as discussed below.

As described in the August 7, 2001 final rule, we contracted with RAND to analyze IRF data to support our efforts in developing the classification system and the IRF PPS. We have continued our contract with RAND to support us in developing potential refinements to the classification system and the PPS for this proposed rule. As part of this research, we asked RAND to examine changes in case mix and coding since the IRF PPS. To examine these changes, RAND compared 2002 data from the first year of implementation of the PPS with the 1999 (pre-PPS) data used to construct the IRF PPS.

RAND ’ s analysis of the 2002 data, as described in more detail below, demonstrates that changes in the types of patients going to IRFs and changes in coding both caused increases in payments to IRFs between 1999 and 2002. The 2002 data are more complete than the 1999 data that were first used to design the IRF PPS because they include all Medicare-covered IRF cases. Although the 1999 data we used in designing the original standard payment rate for the IRF PPS were the best available data we had at the time, they were based on a sample (64 percent) of

IRF cases.

In addition, such review was necessary because, as explained below, we believe that the implementation of the IRF PPS caused important changes in coding. The IRF PPS likely improved the accuracy and consistency of coding across IRFs, because of the educational programs that were implemented in 2001 and 2002 and because items that previously did not affect payments (such as comorbidities) became important factors for determining the PPS payments. Since these items now affect payments, there is greater incentive to code for them. There were also changes to the IRF

–PAI instructions given for coding some of the items on the patient assessment instrument, so that the same patient may have been correctly coded differently in 2002 than in 1999.

Furthermore, implementation of the IRF PPS may have caused changes in case mix because it increased incentives for IRFs to take patients with greater impairment, lower function, or comorbidities. Under the Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) (Pub. L. 97

– 248), IRFs were paid on the basis of Medicare reasonable costs limited by a facility-specific target amount per discharge. IRFs were paid on a per discharge basis without per discharge adjustments being made for the impairments, functional status, or comorbidities of patients. Thus, IRFs had a strong incentive to admit less costly patients to ensure that the costs of treating patients did not exceed their TEFRA payments. Under the IRF PPS, however, IRFs ’ PPS payments are tied directly to the principle diagnosis and accompanying comorbidities of the patient. Thus, based on the characteristics of the patients (that is, impairments, functional status, and comorbidities), the more costly the patient is expected to be, the higher the PPS payment. Therefore, IRFs may have greater incentives than they had under TEFRA to admit more costly patients.

Thus, in light of these concerns, RAND performed an analysis using IRF Medicare claims data matched with FIM and IRF

–PAI data and comparing 2002data (post-PPS) with 1999 data (preVerDate jul<14>2003 16:45 May 24, 2005 Jkt 205001 PO 00000 Frm 00034 Fmt 4701 Sfmt 4702 E:\FR\FM\25MYP2.SGM 25MYP2

### 30221 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

PPS), RAND found that the observed case mix

—the expected costliness of patients

—in IRFs increased by 3.4 percent between the two time periods. Thus, we paid 3.4 percent, or about $140 million, more than expected during 2002 because of changes in the classification of cases in IRFs. However, RAND found little evidence that the patients admitted to IRFs in 2002 had higher resource needs (that is, more impairments, lower functioning, or more comorbidities) than the patients admitted in 1999. In fact, most of the changes in case mix that RAND documented from the acute care hospital records implied that IRF patients should have been less costly to treat in 2002 than in 1999. For example, RAND found a 16 percent decrease in the proportion of patients treated in IRFs following acute hospitalizations for stroke, when it compared the results of the 2002 data with the 1999 data. Stroke patients tend to be relatively more costly than other types of patients for IRFs because they tend to require more intensive services than other types of patients. A decrease in the proportion of stroke patients relative to other types of patients, therefore, would likely contribute to a decrease in the overall expected costliness of IRF patients. RAND also found a 22 percent increase in the proportion of cases treated in IRFs following a lower extremity joint replacement. Lower extremity joint replacement patients tend to be relatively less costly for IRFs than other types of patients because their care needs tend to be less intensive than other types of patients. For this reason, the increase in the proportion of these patients treated in IRFs would suggest a decrease in the overall expected costliness of IRF patients.

We asked RAND to quantify the amount of the case mix change that was due to real case mix change (that is, the extent to which IRF patients had more impairments, lower functioning, or more comorbidities) and the amount that was due to coding. However, while the data permit RAND to observe the total change in expected costliness of patients over time with some precision, estimating the amount of this total change that is real and the amount that is due to coding generally cannot be done with the same level of precision. Therefore, in order to quantify the amounts that were due to real case mix change and the amounts that were due to coding, RAND used two approaches to give a range of estimates within which the correct estimates would logically fall

— (1) one that potentially underestimates the amount of real case mix change and overestimates the amount of case mix change due to coding; and (2) one that potentially overestimates real change and underestimates change due to coding. These two approaches give us a range of estimates, which we are confident should logically border the actual amount of real case mix and coding change. The first approach uses the following assumptions:

• Changes over time in characteristics recorded during the acute hospitalizations preceding the inpatient rehabilitation facility stay were real case mix changes (as acute care hospitals had little incentive to change their coding of patients in response to the IRF PPS); and

• Changes over time in IRF coding that did not correspond with changes in the characteristics recorded during the acute hospitalizations were attributable to changes in IRF coding practices.

To illustrate this point, suppose, for example, that the IRF records showed that there were a greater number of patients with a pulmonary condition in IRFs in 2002 than in 1999. Patients with a pulmonary condition tend to be relatively more costly for IRFs to treat than other types of patients, so an increase in the number of these patients would indicate an increase in the costliness of IRF patients (that is, an increase in IRFs ’ case mix). However, in 2002 IRFs had a much greater incentive to record if patients had a pulmonary condition than they did in 1999 because they got paid more for this condition in 2002, whereas they did not in 1999. Therefore, it is reasonable to expect that some of the increase in the number of patients with a pulmonary condition was due to the fact that IRFs were recording that condition for patients more frequently, not that there were really more patients of that type (although there may also have been some more patients of that type). To determine the extent to which IRFs may have just been coding that condition more often versus the extent to which there actually may have been more patients with a pulmonary condition going to IRFs than before, RAND looked at the one source of information that we believe was least likely to be influenced by the incentive to code patients with this condition more frequently in the IRF: the acute care hospital record from the stay preceding the IRF stay. We believe that the acute care hospitals are not likely to be influenced by IRF PPS policies that only affect IRF payments (that is, changes in IRF payment policies would not likely result in monetary benefits to the acute care hospitals). Thus, if RAND found a substantial increase in the number of IRF patients with a pulmonary condition in the acute care hospital before going to the IRF, it would be reasonable to assume that more patients with a pulmonary condition were going to IRFs (a real increase in case mix). However, if there was little change in the number of IRF patients with a pulmonary condition in the acute care hospital before going to the IRF, then we believe it is reasonable to assume that a portion of the increase in patients with a pulmonary condition in IRFs was due to the incentives to code more of these patients in the IRFs.

We believe that this first approach shows that both factors, real case mix change and coding change, contributed to the amount of observed change in 2002, the first IRF PPS rate year. However, these estimates (based on the best available data) do not fully address all of the variables that may have contributed to the change in case mix. For example, the model does not account for the possibility that patients could develop impairments, functional problems, or comorbidities after they leave the acute care hospital (prior to the IRF admission) that would make them more costly when they are in the IRF. We note that the introduction of a new payment system may have interrelated effects on providers as they adapt to new (or perceived) program incentives. Thus, an analysis of first year experience may not be fully representative of providers ’ behavior under a fully implemented system. In addition, hospital coding practices may change at a different rate in facilities where the IRF is a unit of an acute care hospital compared with freestanding IRF hospitals. Although we attempted to identify all of the factors that cause the variation in costs among the IRFs ’ patient population, this may not have been possible given that the data are from the transitional year of the new PPS. Finally, we want to ensure that the rate reduction will not have an adverse effect on beneficiaries ’ access to IRF

care.

For the reasons described above, we believe we should provide some flexibility to account for the possibility that some of the observed changes may be attributable to other than coding changes. Thus, in determining the amount of the proposed reduction in the standard payment amount, we examined RAND ’ s second approach that recognizes the difficulty of precise measurement of real case mix and coding changes. Using this second approach, RAND developed an analytical procedure that allowed them to distinguish more fully between real case mix change and coding change


### 30222 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

based on patient characteristics. In part, this second approach involves analyzing some specific examples of coding that we know have changed over time, such as direct indications of improvements in impairment coding, changes in coding instruction for bladder and bowel functioning, and dramatic increases in coding of certain conditions that affect patients ’ placement into tiers (resulting in higher payments).

Using the two approaches, RAND found that real case mix changes in IRFs over this period ranged from a decrease of 2.4 percent (using the first approach) to an increase of 1.5 percent (using the second approach). This suggests that coding changes accounted for between 1.9 percent (if real case mix increased by 1.5 percent (that is, 3.4 percent minus 1.5 percent)) and 5.8 percent (if real case mix decreased by 2.4 percent (that is, 3.4 percent plus 2.4 percent)) of the increase in aggregate payments for 2002 compared with 1999. Thus, RAND recommended decreasing the standard per discharge payment amount by between 1.9 and 5.8 percent to adjust for the coding changes. We are proposing to reduce the standard payment amount by the lower of these two numbers, 1.9 percent, because we believe it is a reasonable estimate for the amount of coding change, based on RAND ’ s analysis of direct indications of coding change.

We considered proposing a reduction to the standard payment amount by an amount up to 5.8 percent because

RAND ’ s first approach suggested that coding changes could possibly have been responsible for up to 5.8 percent of the observed increase in IRFs ’ case mix. Furthermore, a separate analysis by RAND found that if all IRFs had been paid based on 100 percent of the IRF PPS payment rates throughout all of 2002 (some IRFs were still transitioning to PPS payments during 2002), PPS payments during 2002 would have been 17 percent higher than IRFs ’ costs. This suggests that we could potentially have proposed a reduction greater than 1.9 and up to 5.8 percent.

We decided to propose a reduction of 1.9 percent, the lowest possible amount of change attributable to coding change. However, we are continuing to work with RAND to further analyze the data and are soliciting comments on the following factors which may have an effect on the amount of the reduction. First, whether changes that occurred within the transitional IRF PPS rate year could have impacted coding and patient selection and affected these analyses. Second, since we feel it is crucial to maintain access to IRF care, we are soliciting comments on the effect of the proposed range of reductions on access to IRF care, particularly for patients with greater resource needs. The analyses described here are only the first of an ongoing series of studies to evaluate the existence and extent of payment increases due to coding changes. We will continue to review the need for any further reduction in the standard payment amount in subsequent years as part of our overall monitoring and evaluation of the IRF PPS.

Therefore, for FY 2006, we are proposing to reduce the standard payment amount by the lowest amount (1.9 percent) attributable to coding changes. We believe this approach, which is supported by RAND ’ s analysis of the data, would adequately adjust for the increased payments to IRFs caused by purely coding changes, but would still provide the flexibility to account for the possibility that some of the observed changes in case mix may be attributed to other than coding changes. Furthermore, we chose the amount of the proposed reduction in the standard payment amount in order to recognize that IRFs ’ current cost structures may be changing as they strive to comply with other recent Medicare policy changes, such as the criteria for IRF classification commonly known as the ‘‘ 75 percent rule. ’’ We are continuing to work with RAND to analyze the data and are soliciting comments on whether the proposed 1.9 percent is the percentage reduction that ought to be made, or if another percentage reduction (for example, the 3.4 percent observed case mix change or the 5.8 percent that RAND found to be maximum amount of change due to coding) should be applied.

To accomplish the proposed reduction of the standard payment conversion factor by 1.9 percent, we first propose to update the FY 2005 standard payment conversion factor by the estimated market basket of 3.1 percent to get the standard payment amount for FY 2006 ($12,958*1.031 = $13,360). Next, we propose to multiply the FY 2006 standard payment amount by 0.981, which reduces the standard payment amount by 1.9 percent ($13,360*0.981 = $13,106). In section III.B.7 of this proposed rule, we propose to further adjust the $13,106 by the proposed budget neutrality factors for the wage index and the other proposed refinements outlined in this proposed rule that would result in the proposed FY 2006 standard payment conversion factor. In section III.B.7 of this proposed rule, we provide a step-by-step calculation that results in the FY 2006 standard payment conversion factor. B. Proposed Adjustments to Determine the Proposed FY 2006 Standard Payment Conversion Factor 1. Proposed Market Basket Used for IRF Market Basket Index

Under the broad authority of section 1886(j)(3)(C) of the Act, the Secretary establishes an increase factor that reflects changes over time in the prices of an appropriate mix of goods and services included in covered IRF services, which is referred to as a market basket index. The market basket needs to include both operating and capital. Thus, although the Secretary is required to develop an increase factor under section 1886(j)(3)(C) of the Act, this provision gives the Secretary discretion in the design of such factor.

The index currently used to update payments for rehabilitation facilities is the Excluded hospital including capital market basket. This market basket is based on 1997 Medicare cost report data and includes Medicare-participating rehabilitation (IRF), LTCH, psychiatric (IPF), cancer, and children ’ s hospitals.

We are unable to create a separate market basket specifically for rehabilitation hospitals due to the small number of facilities and the limited data that are provided (for instance, only about 25 percent of rehabilitation facility cost reports reported contract labor cost data for 2002). Since all IRFs are paid under the IRF PPS, nearly all LTCHs are paid under the LTCH PPS, and IPFs for cost reporting periods beginning on or after January 1, 2005 will be paid under the IPF PPS, we propose to update payments for rehabilitation facilities using a market basket reflecting the operating and capital cost structures for IRFs, IPFs, and LTCHs, hereafter referred to as theRPL (rehabilitation, psychiatric, longterm care) market basket. We propose to exclude children ’ s and cancer hospitals from the RPL market basket because their payments are based entirely onreasonable costs subject to rate-ofincrease limits established under the authority of section 1886(b) of the Act, which is implemented in § 413.40 of the regulations. They are not reimbursed under a prospective payment system. Also, the FY 2002 cost structures for children ’ s and cancer hospitals are noticeably different than the cost structures of the IRFs, IPFs, and LTCHs. The services offered in IRFs, IPFs, andLTCHs are typically more laborintensive than those offered in cancer and children ’ s hospitals. Therefore, the compensation cost weights for IRFs, IPFs, and LTCHs are larger than those in cancer and children ’ s hospitals. In addition, the depreciation cost weights


### 30223 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

for IRFs, IPFs, and LTCHs are noticeably smaller than those for children ’ s and cancer hospitals.

In the following discussion, we provide a background on market baskets and describe the methodologies used to determine the operating and capital portions of the proposed FY 2002-based RPL market basket.

a. Overview of the Proposed RPL Market Basket

The proposed RPL market basket is a fixed weight, Laspeyres-type price index that is constructed in three steps. First, a base period is selected (in this case, FY 2002), and total base period expenditures are estimated for a set of mutually exclusive and exhaustive spending categories based upon type of expenditure. Then the proportion of total operating costs that each category represents is determined. These proportions are called cost or expenditure weights. Second, each expenditure category is matched to an appropriate price or wage variable, referred to as a price proxy. In nearly every instance, these price proxies are price levels derived from publicly available statistical series that are published on a consistent schedule, preferably at least on a quarterly basis.

Finally, the expenditure weight for each cost category is multiplied by the level of its respective price proxy for a given period. The sum of these products (that is, the expenditure weights multiplied by their price levels) for all cost categories yields the composite index level of the market basket in a given period. Repeating this step for other periods produces a series of market basket levels over time. Dividing an index level for a given period by an index level for an earlier period produces a rate of growth in the input price index over that time period.

A market basket is described as a fixed-weight index because it answers the question of how much it would cost, at another time, to purchase the same mix of goods and services purchased to provide hospital services in a base period. The effects on total expenditures resulting from changes in the quantity or mix of goods and services (intensity) purchased subsequent to the base period are not measured. In this manner, the market basket measures only the pure price change. Only when the index is rebased would the quantity and intensity effects be captured in the cost weights. Therefore, we rebase the market basket periodically so the cost weights reflect changes in the mix of goods and services that hospitals purchase (hospital inputs) to furnish patient care between base periods. The terms rebasing and revising, while often used interchangeably, actually denote different activities. Rebasing means moving the base year for the structure of costs of an input price index (for example, shifting the base year cost structure from FY 1997 to FY 2002). Revising means changing data sources, methodology, or price proxies used in the input price index. We are proposing to rebase and revise the market basket used to update the IRF PPS. b. Proposed Methodology for Operating Portion of the Proposed RPL Market Basket

The operating portion of the proposed FY 2002-based RPL market basket consists of several major cost categories derived from the FY 2002 Medicare cost reports for IRFs, IPFs, and LTCHs: Wages, drugs, professional liability insurance and a residual. We choose FY 2002 as the base year because we believe this is the most recent, relatively complete year of Medicare cost report data. Due to insufficient Medicare cost report data for IRFs, IPFs, and LTCHs, cost weights for benefits, contract labor, and blood and blood products were developed using the proposed FY 2002- based IPPS market basket (Section IV. Proposed Rebasing and Revision of the Hospital Market Baskets IPPS Hospital Proposed Rule for FY 2006), which we explain in more detail later in this section. For example, less than 30 percent of IRFs, IPFs, and LTCHs reported benefit cost data in FY 2002. We have noticed an increase in cost data for these expense categories over the last 4 years. The next time we rebase the RPL market basket, there may be sufficient IRFs, IPFs, and LTCHs cost report data to develop the weights for these expenditure categories.

Since the cost weights for the RPL market basket are based on facility costs, we are proposing to limit our sample to hospitals with a Medicare average length of stay within a comparable range of the total facility average length of stay. We believe this provides a more accurate reflection of the structure of costs for Medicare treatments. Our goal is to measure cost shares that are reflective of case mix and practice patterns associated with providing services to Medicare beneficiaries.

We propose to use those cost reports for IRFs and LTCHs whose Medicare average length of stay is within 15 percent (that is, 15 percent higher or lower) of the total facility average length of stay for the hospital. This is the same edit applied to the FY 1992 and FY 1997 excluded hospital with capital market baskets. We propose 15 percent because it includes those LTCHs and IRFs whose Medicare LOS is within approximately 5 days of the facility length of stay.

We propose to use a less stringent measure of Medicare length of stay for IPFs whose average length of stay is within 30 or 50 percent (depending on the total facility average length of stay) of the total facility length of stay. This less stringent edit allows us to increase our sample size by over 150 reports and produce a cost weight more consistent with the overall facility. The edit we applied to IPFs when developing the

FY

– 1997 based excluded hospital with capital market basket was based on the best available data at the time.

The detailed cost categories under the residual (that is, the remaining portion of the market basket after excluding wages and salaries, drugs, and professional liability cost weights) are derived from the proposed FY 2002- based IPPS market basket and the 1997 Benchmark Input-Output Tables published by the Bureau of Economic Analysis, U.S. Department of Commerce. The proposed FY 2002- based IPPS market basket is developed using FY 2002 Medicare hospital cost reports with the most recent and detailed cost data. The 1997 Benchmark

I

–O is the most recent, comprehensive source of cost data for all hospitals. Proposed cost weights for benefits, contract labor, and blood and blood products were derived using the proposed FY 2002-based IPPS market basket. For example, the ratio of the benefit cost weight to the wages and salaries cost weight in the proposed FY 2002-based IPPS market basket was applied to the RPL wages and salaries cost weight to derive a benefit cost weight for the RPL market basket. The remaining proposed operating cost categories were derived using the 1997 Benchmark Input-Output Tables aged to 2002 using relative price changes. (The methodology we used to age the data involves applying the annual price changes from the price proxies to the appropriate cost categories. We repeat this practice for each year.) Therefore, using this methodology roughly 59 percent of the proposed RPL market basket is accounted for by wages, drugs and professional liability insurance data from FY 2002 Medicare cost report data for IRFs, LTCHs, and IPFs.

Table 7 below sets forth the complete proposed FY 2002-based RPL market basket including cost categories, weights, and price proxies. For comparison purposes, the corresponding FY 1997-based excluded hospital with capital market basket is listed as well.


### 30224 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

Wages and salaries are 52.895 percent of total costs for the proposed FY 2002- based RPL market basket compared to 47.335 percent for FY 1997-based excluded hospital with capital market basket. Employee benefits are 12.982 percent for the proposed FY 2002-based RPL market basket compared to 10.244 percent for FY 1997-based excluded hospital with capital market basket. As a result, compensation costs (wages and salaries plus employee benefits) for the proposed FY 2002-based RPL market basket are 65.877 percent of costs compared to 57.579 percent for the FY 1997-based excluded hospital with capital market basket. Of the 8 percentage point difference between the compensation shares, approximately 3 percentage points are due to the proposed new base year (FY 2002 instead of FY 1997), 3 percentage points are due to the revised length of stay edit and the remaining 2 percentage points are due to the proposed exclusion of other hospitals (that is, only including IRFs, IPFs, and LTCHs in the market basket).

Following the table is a summary outlining the choice of the proxies used for the operating portion of the proposed market basket. The price proxies for the proposed capital portion are described in more detail in the capital methodology section. (See section III.B.1.c of this proposed rule.)

**BILLING CODE 4120**

**– 01** 

**– P** 


### 30225 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30226 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30227 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**BILLING CODE 4120**

**– 01** 

**– C** 

Below we provide the proxies that we are proposing to use for the FY 2002- based RPL market basket. With the exception of the Professional Liability proxy, all the proposed price proxies for the operating portion of the proposed RPL market basket are based on Bureau of Labor Statistics (BLS) data and are grouped into one of the following BLS categories: • Producer Price Indexes

—Producer Price Indexes (PPIs) measure price changes for goods sold in other than retail markets. PPIs are preferable price proxies for goods that hospitals purchase as inputs in producing their outputs because the PPIs would better reflect the prices faced by hospitals. For example, we use a special PPI for prescription drugs, rather than the Consumer Price Index (CPI) for prescription drugs because hospitals generally purchase drugs directly from the wholesaler. The PPIs that we use measure price change at the final stage of production.

• Consumer Price Indexes

— Consumer Price Indexes (CPIs) measure change in the prices of final goods and services bought by the typical consumer. Because they may not represent the price faced by a producer,


### 30228 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

we used CPIs only if an appropriate PPI was not available, or if the expenditures were more similar to those of retail consumers in general rather than purchases at the wholesale level. For example, the CPI for food purchased away from home is used as a proxy for contracted food services.

• Employment Cost Indexes

— Employment Cost Indexes (ECIs) measure the rate of change in employee wage rates and employer costs for employee benefits per hour worked. These indexes are fixed-weight indexes and strictly measure the change in wage rates and employee benefits per hour. Appropriately, they are not affected by shifts in employment mix.

We evaluated the price proxies using the criteria of reliability, timeliness, availability, and relevance. Reliability indicates that the index is based on valid statistical methods and has low sampling variability. Timeliness implies that the proxy is published regularly, at least once a quarter. Availability means that the proxy is publicly available. Finally, relevance means that the proxy is applicable and representative of the cost category weight to which it is applied. The CPIs, PPIs, and ECIs selected by us to be proposed in this regulation meet these criteria.

We note that the proposed proxies are the same as those used for the FY 1997- based excluded hospital with capital market basket. Because these proxies meet our criteria of reliability, timeliness, availability, and relevance, we believe they continue to be the best measure of price changes for the cost categories. For further discussion on the FY 1997-based excluded hospital with capital market basket, see the IPPS final rule (67 FR at 50042), published in the Federal Register on August 1, 2002. Wages and Salaries

For measuring the price growth of wages in the proposed FY 2002-based RPL market basket, we propose to use the ECI for wages and salaries for civilian hospital workers as the proxy for wages.

Employee Benefits

The proposed FY 2002-based RPL market basket would use the ECI for employee benefits for civilian hospital workers.

Nonmedical Professional Fees

The ECI for compensation for professional and technical workers in private industry would be applied to this category since it includes occupations such as management and consulting, legal, accounting and engineering services. Fuel, Oil, and Gasoline The percentage change in the price of gas fuels as measured by the PPI (Commodity Code #0552) would be applied to this component.

Electricity

The percentage change in the price of commercial electric power as measured by the PPI (Commodity Code #0542) would be applied to this component.

Water and Sewage

The percentage change in the price of water and sewage maintenance as measured by the Consumer Price Index (CPI) for all urban consumers (CPI Code # CUUR0000SEHG01) would be applied to this component.

Professional Liability Insurance

The proposed FY 2002-based RPL market basket would use the percentage change in the hospital professional liability insurance (PLI) premiums as estimated by the CMS Hospital professional liability index for the proxy of this category. In the FY 1997-based excluded hospital with capital market basket, the same price proxy was used.

We continue to research options for improving our proxy for professional liability insurance. This research includes exploring various options for expanding our current survey, including the identification of another entity that would be willing to work with us to collect more complete and comprehensive data. We are also exploring other options such as third party or industry data that might assist us in creating a more precise measure of PLI premiums. At this time we have not identified a preferred option, therefore, no change is proposed for the proxy in this proposed rule.

Pharmaceuticals

The percentage change in the price of prescription drugs as measured by the PPI (PPI Code # PPI32541DRX) would be used as a proxy for this category. This is a special index produced by BLS and is the same proxy used in the 1997- based excluded hospital with capital market basket.

Food, Direct Purchases

The percentage change in the price of processed foods and feeds as measured by the PPI (Commodity Code #02) would be applied to this component.

Food, Contract Services

The percentage change in the price of food purchased away from home as measured by the CPI for all urban consumers (CPI Code # CUUR0000SEFV) would be applied to this component.

Chemicals

The percentage change in the price of industrial chemical products as measured by the PPI (Commodity Code #061) would be applied to this component. While the chemicals hospital ’ s purchase include industrial as well as other types of chemicals, the industrial chemicals component constitutes the largest proportion by far. Thus, we believe that commodity Code #061 is the appropriate proxy.

Medical Instruments

The percentage change in the price of medical and surgical instruments as measured by the PPI (Commodity Code #1562) would be applied to this component Photographic Supplies

The percentage change in the price of photographic supplies as measured by the PPI (Commodity Code #1542) would be applied to this component.

Rubber and Plastics

The percentage change in the price of rubber and plastic products as measured by the PPI (Commodity Code #07) would be applied to this component.

Paper Products

The percentage change in the price of converted paper and paperboard products as measured by the PPI (Commodity Code #0915) would be used.

Apparel

The percentage change in the price of apparel as measured by the PPI (Commodity Code #381) would be applied to this component.

Machinery and Equipment

The percentage change in the price of machinery and equipment as measured by the PPI (Commodity Code #11) would be applied to this component.

Miscellaneous Products

The percentage change in the price of all finished goods less food and energy as measured by the PPI (Commodity Code #SOP3500) would be applied to this component. Using this index would remove the double-counting of food and energy prices, which are captured elsewhere in the market basket. The weight for this cost category is higher than in the 1997-based index because the weight for blood and blood products (1.322) is added to it. In the 1997-based excluded hospital with capital market basket we included a separate cost


### 30229 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

category for blood and blood products, using the BLS Producer Price Index for blood and derivatives as a price proxy. A review of recent trends in the PPI for blood and derivatives suggests that its movements may not be consistent with the trends in blood costs faced by hospitals. While this proxy did not match exactly with the product hospitals are buying, its trend over time appears to be reflective of the historical price changes of blood purchased by hospitals. However, an apparent divergence in trends in the PPI for blood and derivatives and trends in blood costs faced by hospitals over recent years led us to reevaluate whether the PPI for blood and derivatives was an appropriate measure of the changing price of blood. We ran test market baskets classifying blood in 3 separate cost categories: blood and blood products, contained within chemicals as was done for the 1992-based excluded hospital with capital market basket, and within miscellaneous products. These categories use as proxies the following PPIs: the PPI for blood and blood products, the PPI for chemicals, and the PPI for finished goods less food and energy, respectively. Of these three proxies, the PPI for finished goods less food and energy moved most like the recent blood cost and price trends. In addition, the impact on the overall market basket by using different proxies for blood was negligible, mostly due to the relatively small weight for blood in the market basket.

Therefore, we are proposing to use the PPI for finished goods less food and energy for the blood proxy because we believe it would best be able to proxy only price changes rather than nonprice factors such as changes in quantities or required tests associated with blood purchased by hospitals. We will continue to evaluate this proxy for its appropriateness and will explore the development of alternative price indexes to proxy the price changes associated with this cost.

Telephone

The percentage change in the price of telephone services as measured by the CPI for all urban consumers (CPI Code # CUUR0000SEED) would be applied to this component.

Postage

The percentage change in the price of postage as measured by the CPI for all urban consumers (CPI Code # CUUR0000SEEC01) would be applied to this component. Proposed Changes for All Other Services, Labor Intensive

The percentage change in the ECI for compensation paid to service workers employed in private industry would be applied to this component.

All Other Services, Nonlabor Intensive

The percentage change in the allitems component of the CPI for all urban consumers (CPI Code # CUUR0000SA0) would be applied to this component.

c. Proposed Methodology for Capital Portion of the RPL Market Basket

Unlike for the operating costs of the proposed FY 2002-based RPL market basket, we did not have IRFs, IPFs, and LTCHs FY 2002 Medicare cost report data for the capital cost weights, due to a change in the FY 2002 cost reporting requirements. Rather, we used these hospitals ’ expenditure data for the capital cost categories of depreciation, interest, and other capital expenses for the most recent year available (FY 2001), and aged the data to a FY 2002 base year using relevant price proxies.

We calculated weights for the RPL market basket capital costs using the same set of Medicare cost reports used to develop the operating share for IRFs, IPFs, and LTCHs. The resulting proposed capital weight for the FY 2002 base year is 10.149 percent. This is based on FY 2001 Medicare cost report data for IRFs, IPFs, and LTCHs, aged to FY 2002 using relevant price proxies.

Lease expenses are not a separate cost category in the market basket, but are distributed among the cost categories of depreciation, interest, and other, reflecting the assumption that the underlying cost structure of leases is similar to capital costs in general. We assumed 10 percent of lease expenses are overhead and assigned them to the other capital expenses cost category as overhead. We base this assignment of 10 percent of lease expenses to overhead on the common assumption that overhead is 10 percent of costs. The remaining lease expenses were distributed to the three cost categories based on the weights of depreciation, interest, and other capital expenses not including lease expenses.

Depreciation contains two subcategories: building and fixed equipment and movable equipment. The split between building and fixed equipment and movable equipment was determined using the FY 2001 Medicare cost reports for IRFs, IPFs, and LTCHs. This methodology was also used to compute the 1997-based index (67 FR at 50044).

Total interest expense cost category is split between the government/nonprofit and for-profit hospitals. The 1997-based excluded hospital with capital market basket allocated 85 percent of the total interest cost weight to the government/ nonprofit interest, proxied by average yield on domestic municipal bonds, and 15 percent to for-profit interest, proxied by average yield on Moody ’ s Aaa bonds.

We propose to derive the split using the relative FY 2001 Medicare cost report data for IPPS hospitals on interest expenses for the government/nonprofit and for-profit hospitals. Due to insufficient Medicare cost report data for IRFs, IPFs and LTCHs, we propose to use the same split used in the IPPS capital input price index, which is 75

– 25. We believe it is important that this split reflects the latest relative cost structure of interest expenses for hospitals. Therefore, we propose to use

a 75

– 25 split to allocate interest expenses to government/nonprofit and for-profit. See the Proposed IPPS Rule for FY 2006, Section IV.D, Capital Input Price Index Section.

Since capital is acquired and paid for over time, capital expenses in any given year are determined by both past and present purchases of physical and financial capital. The vintage-weighted capital index is intended to capture the long-term consumption of capital, using vintage weights for depreciation (physical capital) and interest (financial capital). These vintage weights reflect the purchase patterns of building and fixed equipment and movable equipment over time. Depreciation and interest expenses are determined by the amount of past and current capital purchases. Therefore, we are proposing to use the vintage weights to compute vintage-weighted price changes associated with depreciation and interest expense.

Vintage weights are an integral part of the proposed FY 2002-based RPL market basket. Capital costs are inherently complicated and are determined by complex capital purchasing decisions, over time, based on such factors as interest rates and debt financing. In addition, capital is depreciated over time instead of being consumed in the same period it is purchased. The capital portion of the proposed FY 2002-based RPL market basket would reflect the annual price changes associated with capital costs, and would be a useful simplification of the actual capital investment process. By accounting for the vintage nature of capital, we are able to provide an accurate, stable annualmeasure of price changes. Annual nonvintage price changes for capital are unstable due to the volatility of interest rate changes and, therefore, do not reflect the actual annual price changes


### 30230 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

for Medicare capital-related costs. The capital component of the proposed FY 2002-based RPL market basket would reflect the underlying stability of the capital acquisition process and provide hospitals with the ability to plan for changes in capital payments.

To calculate the vintage weights for depreciation and interest expenses, we needed a time series of capital purchases for building and fixed equipment and movable equipment. We found no single source that provides the best time series of capital purchases by hospitals for all of the above components of capital purchases. The early Medicare Cost Reports did not have sufficient capital data to meet this need because these data were not required. While the AHA Panel Survey provided a consistent database back to 1963, it did not provide annual capital purchases. The AHA Panel Survey provided a time series of depreciation expenses through 1997 which could be used to infer capital purchases over time. From 1998 to 2001, total hospital depreciation expenses were calculated by multiplying the AHA Annual Survey total hospital expenses by the ratio of depreciation to total hospital expenses from the Medicare cost reports. Beginning in 2001, the AHA Annual survey began collecting depreciation expenses. We hope to be able to use this data in future rebasings.

In order to estimate capital purchases from AHA data on depreciation and interest expenses, the expected life for each cost category (building and fixed equipment, movable equipment, and debt instruments) is needed. Due to insufficient Medicare cost report data for IRFs, IPFs and LTCHs, we propose to use FY 2001 Medicare cost reports for IPPS hospitals to determine the expected life of building and fixed equipment and movable equipment. The expected life of any piece of equipment can be determined by dividing the value of the asset (excluding fully depreciated assets) by its current year depreciation amount. This calculation yields the estimated useful life of an asset if depreciation were to continue at current year levels, assuming straight-line depreciation. From the FY 2001 Medicare cost reports for IPPS hospitals the expected life of building and fixed equipment was determined to be 23 years, and the expected life of movable equipment was determined to be 11

years.

Although we are proposing to use this methodology for deriving the useful life of an asset, we plan to review it between the publication of the proposed and final rules. We plan to review alternate data sources, if available, and analyze in more detail the hospital ’ s capital cost structure reported in the Medicare cost reports.

We also propose to use the fixed and movable weights derived from FY 2001 Medicare cost reports for IRFs, IPFs and LTCHs to separate the depreciation expenses into annual amounts of building and fixed equipment depreciation and movable equipment depreciation. By multiplying the annual depreciation amounts by the expected life calculations from the FY 2001 Medicare cost reports, year-end asset costs for building and fixed equipment and movable equipment could be determined. We then calculated a time series back to 1963 of annual capital purchases by subtracting the previous year asset costs from the current year asset costs. From this capital purchase time series we were able to calculate the vintage weights for building and fixed equipment, movable equipment, and debt instruments. Each of these sets of vintage weights are explained in detail below.

For proposed building and fixed equipment vintage weights, the real annual capital purchase amounts for building and fixed equipment derived from the AHA Panel Survey were used. The real annual purchase amount was used to capture the actual amount of the physical acquisition, net of the effect of price inflation. This real annual purchase amount for building and fixed equipment was produced by deflating the nominal annual purchase amount by the building and fixed equipment price proxy, the Boeckh Institutional Construction Index. This is the same proxy used for the FY 1997-based excluded hospital with capital market basket. We believe this proxy continues to meet our criteria of reliability, timeliness, availability, and relevance. Since building and fixed equipment has an expected life of 23 years, the vintage weights for building and fixed equipment are deemed to represent the average purchase pattern of building and fixed equipment over 23-year periods. With real building and fixed equipment purchase estimates available back to 1963, sixteen 23-year periods could be averaged to determine the average vintage weights for building and fixed equipment that are representative of average building and fixed equipment purchase patterns over time. Vintage weights for each 23-year period are calculated by dividing the real building and fixed capital purchase amount in any given year by the total amount of purchases in the 23-year period. This calculation is done for each year in the 23-year period, and for each of the sixteen 23-year periods. The average of each year across the sixteen 23-year periods is used to determine the 2002 average building and fixed equipment vintage weights.

For proposed movable equipment vintage weights, the real annual capital purchase amounts for movable equipment derived from the AHA Panel Survey were used to capture the actual amount of the physical acquisition, net of price inflation. This real annual purchase amount for movable equipment was calculated by deflating the nominal annual purchase amount by the movable equipment price proxy, the Producer Price Index for Machinery and Equipment. This is the same proxy used for the FY 1997-based excluded hospital with capital market basket. We believe this proxy, which meets our criteria, is the best measure of price changes for this cost category. Since movable equipment has an expected life of 11 years, the vintage weights for movable equipment are deemed to represent the average purchase pattern of movable equipment over 11-year periods. With real movable equipment purchase estimates available back to 1963, twenty-eight 11-year periods could be averaged to determine the average vintage weights for movable equipment that are representative of average movable equipment purchase patterns over time. Vintage weights for each 11- year period would be calculated by dividing the real movable capital purchase amount for any given year by the total amount of purchases in the 11- year period. This calculation is done for each year in the 11-year period, and for each of the twenty-eight 11-year periods. The average of each year across the twenty-eight 11-year periods would be used to determine the FY 2002 average movable equipment vintage weights.

For proposed interest vintage weights, the nominal annual capital purchase amounts for total equipment (building and fixed, and movable) derived from the AHA Panel and Annual Surveys were used. Nominal annual purchase amounts were used to capture the value of the debt instrument. Since hospital debt instruments have an expected life of 23 years, the vintage weights for interest are deemed to represent the average purchase pattern of total equipment over 23-year periods. With nominal total equipment purchase estimates available back to 1963, sixteen 23-year periods could be averaged to determine the average vintage weights for interest that are representative of average capital purchase patterns over time. Vintage weights for each 23-year period would be calculated by dividing the nominal total capital purchase


### 30231 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

amount for any given year by the total amount of purchases in the 23-year period. This calculation would be done for each year in the 23-year period and for each of the sixteen 23-year periods. The average of the sixteen 23-year periods would be used to determine the FY 2002 average interest vintage weights. The vintage weights for the index are presented in Table 8 below.

In addition to the proposed price proxies for depreciation and interest costs described above in the vintage weighted capital section, we propose to use the CPI

–U for Residential Rent as a price proxy for other capital-related costs. The price proxies for each of the capital cost categories are the same as those used for the IPPS final rule (67 FR at 50044) capital input price index.

**BILLING CODE 4120**

**– 01** 

**– P** 


### 30232 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**BILLING CODE 4120**

**– 01** 

**– C** 

The proposed FY 2006 update for IRF PPS using the proposed FY 2002-based RPL market basket and Global Insight ’ s 4th quarter 2004 forecast is be 3.1 percent. This includes increases in both the operating section and the capital section. Global Insight, Inc. is a nationally recognized economic and financial forecasting firm that contracts with CMS to forecast the components of the market baskets. Using the current FY 1997-based excluded hospital with capital market basket (66 FR at 41427), Global Insight ’ s fourth quarter 2004


### 30233 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

forecast for FY 2006 is also 3.1 percent. Table 4 below compares the proposed FY 2002-based RPL market basket and the FY 1997-based excluded hospital with capital market basket percent changes. For both the historical and forecasted periods between FY 2000 and FY 2008, the difference between the two market baskets is minor with the exception of FY 2002 where the proposed FY 2002-based RPL market basket increased three tenths of a percentage point higher than the FY 1997-based excluded hospital with capital market basket. This is primarily due to the proposed FY 2002-based RPL market basket having a larger compensation (that is, the sum of wages and salaries and benefits) cost weight than the FY 1997-based index and the price changes associated with compensation costs increasing much faster than the prices of other market basket components. Also contributing is the ‘‘ all other nonlabor intensive ’’ cost weight, which is smaller in the proposed FY 2002-based RPL market basket than in the FY 1997-based index, and the slower price changes associated with these costs.



### TABLE 9.

— P ROPOSED 

### FY 2002- BASED 

### RPL M ARKET 

### B ASKET AND 

### FY 1997- BASED 

### E XCLUDED 

### H OSPITAL 

### W ITH 

### C APITAL 

### M ARKET 

### B ASKET 

### P ERCENT 

### C HANGES 

### , FY 2000

– FY 2008

Fiscal year (FY) Proposed rebased FY 2002-based RPL market basket FY 1997-based excluded hospital market basket with capital

Historical data: FY 2000 ........................................................................................................................ .................... 3.1 3.1 FY 2001 ........................................................................................................................ .................... 4.0 4.0 FY 2002 ........................................................................................................................ .................... 3.9 3.6 FY 2003 ........................................................................................................................ .................... 3.8 3.7 FY 2004 ........................................................................................................................ .................... 3.6 3.6 Average FYs 2000

–2004 .................................................................................................................. 3.7 3.6 Forecast: FY 2005 ........................................................................................................................ .................... 3.7 3.8 FY 2006 ........................................................................................................................ .................... 3.1 3.1 FY 2007 ........................................................................................................................ .................... 2.9 2.8 FY 2008 ........................................................................................................................ .................... 2.9 2.8 Average FYs 2005

–2008 .................................................................................................................. 3.2 3.1

Source: Global Insight, Inc. 4th Qtr 2004, @USMACRO/CNTL1104 @CISSIM/TL1104.SIM

d. Labor-Related Share

Section 1886(j)(6) of the Act specifies that the Secretary shall adjust the proportion (as estimated by the Secretary from time to time) of rehabilitation facilities ’ costs which are attributable to wages and wage-related costs, of the prospective payment rates computed under paragraph (3) for area differences in wage levels by a factor (established by the Secretary) reflecting the relative hospital wage level in the geographic area of the rehabilitation facility compared to the national average wage level for such facilities. Not later than October 1, 2001 (and at least every 36 months thereafter), the Secretary shall update the factor under the preceding sentence on the basis of information available to the Secretary (and updated as appropriate) of the wages and wage-related costs incurred in furnishing rehabilitation services. Any adjustments or updates made under this paragraph for a fiscal year shall be made in a manner that assures that the aggregated payments under this subsection in the fiscal year shall be made in a manner that assures that the aggregated payments under this subsection in the fiscal year are not greater or less than those that would have been made in the year without such adjustment.

The labor-related share is determined by identifying the national average proportion of operating costs that are related to, influenced by, or vary with the local labor market. Using our currentdefinition of labor-related, the laborrelated share is the sum of the relative importance of wages and salaries, fringebenefits, professional fees, laborintensive services, and a portion of the capital share from an appropriate market basket. We used the proposed FY 2002-based RPL market basket costs to determine the proposed labor-related share for the IRF PPS. The proposed labor-related share for FY 2006 would be the sum of the proposed FY 2006 relative importance of each labor-related cost category, and would reflect the different rates of price change for these cost categories between the base year (FY 2002) and FY 2006. The sum of the proposed relative importance for FY 2006 for operating costs (wages and salaries, employee benefits, professional fees, and labor-intensive services) would be 71.782 percent, as shown in the chart below. The portion of capital that is influenced by local labor markets would estimated to be 46 percent, which is the same percentage currently used in the IRF prospective payment system. Since the relative importance for capital would be 9.079 percent of the proposed FY 2002-based RPL market basket in FY 2006, we are proposing to take 46 percent of 9.079 percent todetermine the proposed capital laborrelated share for FY 2006. The result would be 4.176 percent, which we propose to add to 71.782 percent for the operating cost amount to determine the total proposed labor-related share for FY 2006. Thus, the labor-related share that we propose to use for IRF PPS in FY 2006 would be 75.958 percent. This proposed labor-related share is determined using the same methodology as employed in calculating all previous IRF labor-related shares (66 FR at 41357).

Table 10 below shows the proposedFY 2006 relative importance laborrelated share using the proposed 2002- based RPL market basket and the FY 1997-based excluded hospital with capital market.


### 30234 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 10.

— P ROPOSED 

### T OTAL 

### LABOR 

### -R ELATED 

### S HARE

Cost category Proposed FY 2002- based RPL marketbasket relative importance (percent) FY 2006 FY 1997 excluded hospital with capitalmarket basket relative importance (percent) FY 2006

Wages and salaries ............................................................................................................. .................... 52.823 48.432 Employee benefits .............................................................................................................. ..................... 13.863 11.415 Professional fees .............................................................................................................. ....................... 2.907 4.540 All other labor intensive services ............................................................................................. ................ 2.189 4.496

Subtotal ....................................................................................................................... ...................... 71.782 68.883 Labor-related share of capital costs ........................................................................................... ............. 4.176 3.307

Total .......................................................................................................................... ........................ 75.958 72.190

We are currently continuing an evaluation of our labor-related share methodology used in the IPPS (see 67 FR at 31447 for discussion of our previous analysis). Our evaluation includes regression analysis and reviewing the makeup of cost categories based on our current labor-related definition. A complete discussion of our research is provided in the FY 2006 IPPS proposed rule (See FY 2006 IPPS proposed rule, Section IV, B, 3). The labor-related share used in the IPPS was the first labor-related share used in a prospective payment system. Our methodology for calculating the proposed labor-related share for the IRF PPS is based upon the methodology used in the IPPS.

2. Proposed Area Wage Adjustment

Section 1886(j)(6) of the Act requires the Secretary to adjust the proportion (as estimated by the Secretary from time to time) of rehabilitation facilities ’ coststhat are attributable to wages and wagerelated costs by a factor (established by the Secretary) reflecting the relative hospital wage level in the geographic area of the rehabilitation facility compared to the national average wage level for those facilities. Not later than October 1, 2001 and at least every 36 months thereafter, the Secretary is required to update the factor under the preceding sentence on the basis of information available to the Secretary (and updated as appropriate) of the wages and wage-related costs incurred in furnishing rehabilitation services. Any adjustments or updates made under section 1886(j)(6) of the Act for a FY shall be made in a manner that assures the aggregated payments under section 1886(j)(6) of the Act are not greater or less than those that would have been made in the year without such adjustment.

In our August 1, 2003 final rule, we acknowledged that on June 6, 2003, the Office of Management and Budget (OMB) issued ‘‘ OMB Bulletin No.03

– 04, ’’ announcing revised definitions of Metropolitan Statistical Areas, and new definitions of Micropolitan Statistical Areas and Combined Statistical Areas. A copy of the Bulletin may be obtained at the following Internet address: http:// www.whitehouse.gov/omb/bulletins/ b03–04.html. At that time, we did not propose to apply these new definitions known as the Core-Based Statistical Areas (CBSAs). After further analysis and discussed in detail below, we are proposing to use revised labor market area definitions as a result of the OMB revised definitions to adjust the FY 2006 IRF PPS payment rate. In addition, the IPPS is applying these revised definitions as discussed in the August 11, 2004 final rule (69 FR at 49207).

a. Proposed Revisions of the IRF PPS Geographic Classification

As discussed in the August 7, 2001 final rule, which implemented the IRF PPS (66 FR at 41316), in establishing an adjustment for area wage levels under § 412.624(e)(1), the labor-related portion of an IRF ’ s Federal prospective payment is adjusted by using an appropriate wage index. As set forth in § 412.624(e)(1), an IRF ’ s wage index is determined based on the location of the IRF in an urban or rural area as defined

in § 412.602 and further defined in § 412.62(f)(1)(ii) and § 412.62(f)(1)(iii) as urban and rural areas, respectively. An urban area, under the IRF PPS, is defined in § 412.62(f)(1)(ii) as a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA) as defined by the Office of Management and Budget (OMB). Under § 412.62(f)(1)(iii), a rural area is defined as any area outside of an urban area. In general, an urban area is defined as a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA) as defined by the Office of Management and Budget. Under § 412.62(f)(1)(iii), a rural area is defined as any area outside of an urban area. The urban and rural area geographic classifications defined in § 412.62(f)(1)(ii) and (f)(1)(iii), respectively, were used under the IPPS from FYs 1985 through 2004 (as specified in § 412.63(b)), and have been used under the IRF PPS since it was implemented for cost reporting periods beginning on or after January 1, 2002.

The wage index used for the IRF PPS is calculated by using the acute care IPPS wage index data on the basis of the labor market area in which the acute care hospital is located, but without taking into account geographic reclassification under sections 1886(d)(8) and (d)(10) of the Act and without applying the ‘‘ rural floor ’’ under section 4410 of Pub. L. 105

– 33 (BBA). In addition, Section 4410 of Pub.

L. 105

– 33 (BBA) provides that for the purposes of section 1886(d)(3)(E) of the Act, that the area wage index applicable to hospitals located in an urban area of a State may not be less than the area wage index applicable to hospitals located in rural areas in the State. Consistent with past IRF policy, we treat this provision, commonly referred to as the ‘‘ rural floor ’’ , as applicable to the acute inpatient hospitals and not IRFs. Therefore, the hospital wage index used for IRFs is commonly referred to as

‘‘ pre-floor ’’ indicating that ‘‘ rural floor ’’ provision is not applied. As a result, the applicable IRF wage index value is assigned to the IRF on the basis of the labor market area in which the IRF is geographically located.

Below, we will provide a description of the current labor markets that have been used for area wage adjustments under the IRF PPS since its implementation of cost reporting periods beginning on or after January 1, 2002. Previously, we have not described the labor market areas used under the IRF PPS in detail, although we have published each area ’ s wage index in tables, in the IRF PPS final rules and


### 30235 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

update notices, each year and noted the use of the geographic area in applying the wage index adjustment in IRF PPS payment examples in the final regulation implementing the IRF PPS (69 FR at 41367 through 41368). The IRF industry has also understood that the same labor market areas in use under the IPPS (from the time the IRF PPS was implemented, for cost reporting periods beginning on or after January 1, 2002) would be used under the IRF PPS. The OMB has adopted new statistical area definitions (as discussed in greater detail below) and we are proposing to adopt new labor market area definitions based on these areas under the IRF PPS (as discussed in greater detail below). Therefore, we believe it is helpful to provide a more detailed description of the current IRF PPS labor market areas, in order to better understand the proposed change to the IRF PPS labor market areas presented below in this proposed rule.

The current IRF PPS labor market areas are defined based on the definitions of MSAs, Primary MSAs (PMSAs), and NECMAs issued by the OMB (commonly referred to collectively

as ‘‘ MSAs ’’ ). These MSA definitions, which are discussed in greater detail below, are currently used under the IRF PPS and other prospective payment systems, such as LTCH, IPF, Home Health Agency (HHA), and SNF (Skilled Nursing Facility) PPSs. In the IPPS final rule (67 FR at 49026 through 49034), revised labor market area definitions were adopted under the hospital IPPS ( § 412.64(b)), which were effective October 1, 2004 for acute care hospitals. These new CBSAs standards were announced by the OMB late in 2000.

b. Current IRF PPS Labor Market Areas Based on MSAs

As mentioned earlier, since the implementation of the IRF PPS in the August 7, 2001 IRF PPS final rule, we have used labor market areas to further characterize urban and rural areas as determined under § 412.602 and further defined in § 412.62(f)(1)(ii) and (f)(1)(iii). To this end, we have defined labor market areas under the IRF PPS based on the definitions of MSAs, PMSAs, and NECMAs issued by the OMB, which is consistent with the IPPS approach. The OMB also designates Consolidated MSAs (CMSAs). A CMSA is a metropolitan area with a population of 1 million or more, comprising two or more PMSAs (identified by their separate economic and social character). For purposes of the wage index, we use the PMSAs rather than CMSAs because they allow a more precise breakdown of labor costs (as further discussed in section III.B.2.d.ii of this proposed rule). If a metropolitan area is not designated as part of a PMSA, we use the applicable MSA.

These different designations use counties as the building blocks upon which they are based. Therefore, IRFs are assigned to either an MSA, PMSA, or NECMA based on whether the county in which the IRF is located is part of that area. All of the counties in a State outside a designated MSA, PMSA, or NECMA are designated as rural. For the purposes of calculating the wage index, we combine all of the counties in a State outside a designated MSA, PMSA, or NECMA together to calculate the statewide rural wage index for each State.

c. Core-Based Statistical Areas (CBSAs)

OMB reviews its Metropolitan Area definitions preceding each decennial census. As discussed in the IPPS final rule (69 FR at 49027), in the fall of 1998, OMB chartered the Metropolitan Area Standards Review Committee to examine the Metropolitan Area standards and develop recommendations for possible changes to those standards. Three notices related to the review of the standards, providing an opportunity for public comment on the recommendations of the Committee, were published in the Federal Register on the following dates: December 21, 1998 (63 FR at 70526); October 20, 1999 (64 FR at 56628); and August 22, 2000 (65 FR at 51060).

In the December 27, 2000 Federal Register (65 FR at 82228 through 82238), OMB announced its new standards. In that notice, OMB defines CBSA, beginning in 2003, as ‘‘ a geographic entity associated with at least one core of 10,000 or more population, plus adjacent territory that has a high degree of social and economic integration with the core as measured by commuting ties. ’’ The standards designate and define two categories of CBSAs: MSAs and Micropolitan Statistical Areas (65 FR at 82235 through 82238).

According to OMB, MSAs are based on urbanized areas of 50,000 or more population, and Micropolitan Statistical Areas (referred to in this discussion as Micropolitan Areas) are based on urban clusters of at least 10,000 population, but less than 50,000 population. Counties that do not fall within CBSAs (either MSAs or Micropolitan Areas) are deemed ‘‘ Outside CBSAs. ’’ In the past, OMB defined MSAs around areas with a minimum core population of 50,000, and smaller areas were ‘‘ Outside MSAs. ’’ On June 6, 2003, OMB announced the new CBSAs, comprised of MSAs and the new Micropolitan Areas based on Census 2000 data. (A copy of the announcement may be obtained at the following Internet address: http://www.whitehouse.gov/ omb/bulletins/fy04/b04

– 03.html. )

The new CBSA designations recognize 49 new MSAs and 565 new Micropolitan Areas, and revise the composition of many of the existing MSAs. There are 1,090 counties in MSAs under the new CBSA designations (previously, there were 848 counties in MSAs). Of these 1,090 counties, 737 are in the same MSA as they were prior to the change in designations, 65 are in a different MSA, and 288 were not previously designated to any MSA. There are 674 counties in Micropolitan Areas. Of these, 41 were previously in an MSA, while 633 were not previously designated to an MSA. There are five counties that previously were designated to an MSA but are no longer designated to either an MSA or a new Micropolitan Area: Carter County, KY; St. James Parish, LA; Kane County, UT; Culpepper County, VA; and King George County, VA. For a more detailed discussion of the conceptual basis of the new CBSAs, refer to the IPPS final rule (67 FR at 49026 through 49034).

d. Proposed Revisions to the IRF PPS Labor Market Areas

In its June 6, 2003 announcement, OMB cautioned that these new definitions ‘‘ should not be used to develop and implement Federal, State, and local nonstatistical programs and policies without full consideration of the effects of using these definitions for such purposes. These areas should not serve as a general-purpose geographic framework for nonstatistical activities, and they may or may not be suitable for use in program funding formulas. ’’

We currently use MSAs to define labor market areas for purposes of the wage index. In fact, MSAs are also used to define labor market areas for purposes of the wage index for many of the other Medicare prospective payment systems (for example, LTCH, SNF, HHA, IPF, and Outpatient). While we recognize MSAs are not designed specifically to define labor market areas, we believe they represent a reasonable and appropriate proxy for this purpose, because they are based upon characteristics we believe also generally reflect the characteristics of unified labor market areas. For example, CBSAs reflect a core population plus an adjacent territory that reflects a high degree of social and economic integration. This integration is measured by commuting ties, thus demonstrating that these areas may draw workers from


### 30236 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

the same general areas. In addition, the most recent CBSAs reflect the most up to date information. The OMB reviews its MA definitions preceding each decennial census to reflect recent population changes and the CBSAs are based on the Census 2000 data. Our analysis and discussion here are focused on issues related to adopting the new CBSA designations to define labor market areas for the purposes of the IRF PPS.

Historically, Medicare PPSs have utilized Metropolitan Area (MA) definitions developed by OMB. The labor market areas currently used under the IRF PPS are based on the MA definitions issued by OMB. OMB reviews its MA definitions preceding each decennial census to reflect more recent population changes. Thus, the CBSAs are OMB ’ s latest MA definitions based on the Census 2000 data. Because we believe that the OMB ’ s latest MA designations more accurately reflect the local economies and wage levels of the areas in which hospitals are currently located, we are proposing to adopt the revised labor market area designations based on the OMB ’ s CBSA designations.

As specified in § 412.624(e)(1), we explained in the August 7, 2001 final rule that the IRF PPS wage index adjustment was intended to reflect the relative hospital wage levels in the geographic area of the hospital as compared to the national average hospital wage level. Since OMB ’ s CBSA designations are based on Census 2000 data and reflect the most recent available geographic classifications, we are proposing to revise the labor market area definitions used under the IRF PPS. Specifically, we are proposing to revise the IRF PPS labor market definitions based on the OMB ’ s new CBSA designations effective for IRF PPS discharges occurring on or after October 1, 2005. Accordingly, we are proposing to revise § 412.602 to specify that for discharges occurring on or after October 1, 2005, the application of the wage index under the IRF PPS would be made on the basis of the location of the facility in an urban or rural area as defined in § 412.64(b)(1)(ii)(A) through (C). (As a conforming change, we are also proposing to revise § 412.602, definitions for rural and urban areas effective for discharges occurring on or after October 1, 2005 would be defined in § 412.64(b)(1)(ii)(A) through (C). To further clarify, we will revise the regulation text to explicitly referenceurban and rural definitions for a costreporting period beginning on or after January 1, 2002, with respect to discharges occurring during the period covered by such cost reports but before October 1, 2005 under § 412.62(f)(1)(ii) and § 412.62(f)(1)(iii)).

We note that these are the same labor market area definitions (based on the OMB ’ s new CBSA designations) implemented under the IPPS at § 412.64(b), which were effective for those hospitals beginning October 1, 2004 as discussed in the IPPS final rule (69 FR at 49026 through 49034). The similarity between the IPPS and the IRF PPS includes the adoption in the initial implementation of the IRF PPS of the same labor market area definitions under the IRF PPS that existed under the IPPS at that time, as well as the use of acute care hospitals ’ wage data in calculating the IRF PPS wage index. In addition, the OMB ’ s CBSA-based designations reflect the most recent available geographic classifications and more accurately reflects current labor markets. Therefore, we believe that proposing to revise the IRF PPS labor market area definitions based on OMB ’ s CBSA-based designations are consistent with our historical practice of modeling IRF PPS policy after IPPS policy.

Below, we discuss the composition of the proposed IRF PPS labor market areas based on the OMB ’ s new CBSA designations.

i. New England MSAs

As stated above, in the August 7, 2001 final rule, we currently use NECMAs to define labor market areas in New England, because these are county-based designations rather than the 1990 MSA definitions for New England, which used minor civil divisions such as cities and towns. Under the current MSA definitions, NECMAs provided more consistency in labor market definitions for New England compared with the restof the country, where MSAs are countybased. Under the new CBSAs, OMB has now defined the MSAs and Micropolitan Areas in New England on the basis of counties. The OMB also established New England City and Town Areas, which are similar to the previous New England MSAs.

In order to create consistency among all labor market areas and to maintain these areas on the basis of counties, we are proposing to use the county-based areas for all MSAs in the nation, including those in New England. Census has now defined the New England area based on counties, creating a city- and town-based system as an alternative. We believe that adopting county-based labor market areas for the entire country except those in New England would lead to inconsistencies in our designations. Adopting county-based labor market areas for the entire country provides consistency and stability in Medicare program payment because all of the labor market areas throughout the country, including New England, would be defined using the same system (that is, counties) rather than different systems in different areas of the country, and minimizes programmatic complexity.

In addition, we have consistently employed a county-based system for New England for precisely that reason: to maintain consistency with the labor market area definitions used throughout the country. Because we have never used cities and towns for defining IRFlabor market areas, employing a countybased system in New England maintains that consistent practice. We note that this is consistent with the implementation of the CBSA-based designations under the IPPS for New England (see 69 FR at 49028). Accordingly, in this proposed rule, we are proposing to use the New England MSAs as determined under the proposed new CBSA-based labor market area definitions in defining the proposed revised IRF PPS labor market

areas. ii. Metropolitan Divisions

Under OMB ’ s new CBSA designations, a Metropolitan Division is a county or group of counties within a CBSA that contains a core population of at least 2.5 million, representing an employment center, plus adjacent counties associated with the main county or counties through commuting ties. A county qualifies as a main county if 65 percent or more of its employed residents work within the county and the ratio of the number of jobs located in the county to the number of employed residents is at least 0.75. A county qualifies as a secondary county if 50 percent or more, but less than 65 percent, of its employed residents work within the county and the ratio of the number of jobs located in the county to the number of employed residents is at least 0.75. After all the main and secondary counties are identified and grouped, each additional county that already has qualified for inclusion in the MSA falls within the Metropolitan Division associated with the main/ secondary county or counties with which the county at issue has the highest employment interchange measure. Counties in a Metropolitan Division must be contiguous (65 FR at 82236).

The construct of relatively large MSAs being comprised of Metropolitan Divisions is similar to the current construct of the CMSAs comprised of PMSAs. As noted above, in the past, OMB designated CMSAs as


### 30237 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

Metropolitan Areas with a population of 1 million or more and comprised of two or more PMSAs. Under the IRF PPS, we currently use the PMSAs rather than CMSAs to define labor market areas because they comprise a smaller geographic area with potentially varying labor costs due to different local economies. We believe that CMSAs may be too large of an area with a relatively large number of hospitals, to accurately reflect the local labor costs of all the individual hospitals included in that relatively ‘‘ large ’’ area. A large market area designation increased the likelihood of including many hospitals located in areas with very different labor market conditions within the same market area designation. This variation could increase the difficulty in calculating a single wage index that would be relevant for all hospitals within the market area designation. Similarly, we believe that MSAs with a population of 2.5 million or greater may be too large of an area to accurately reflect the local labor costs of all the individual hospitals included in that relatively ‘‘ large ’’ area. Furthermore, as indicated above, Metropolitan Divisions represent the closest approximation to PMSAs, the building block of the current IRF PPS labor market area definitions, and therefore, would most accurately maintain our current structuring of the IRF PPS labor market areas. Therefore, as implemented under the IPPS (69 FR at 49029), we are proposing to use the Metropolitan Divisions where applicable (as describebelow) under the proposed new CBSAbased labor market area definitions.

In addition to being comparable to the organization of the labor market areas under the current MSA designations (that is, the use of PMSAs rather than CMSAs), we believe that proposing to use Metropolitan Divisions where applicable (as described below) under the IRF PPS would result in a more accurate adjustment for the variation in local labor market areas for IRFs. Specifically, if we would recognize the relatively ‘‘ larger ’’ CBSA that comprises two or more Metropolitan Divisions as an independent labor market area for purposes of the wage index, it would be too large and would include the data from too many hospitals to compute a wage index that would accurately reflect the various local labor costs of all the individual hospitals included in that relatively ‘‘ large ’’ CBSA. As mentioned earlier, a large market area designation increases the likelihood of including many hospitals located in areas with very different labor market conditions within the same market area designation. This variation could increase the difficulty in calculating a single wage index that would be relevant for all hospitals within the market area designation. Rather, by proposing to recognize Metropolitan Divisions where applicable (as described below) under the proposed new CBSA-based labor market area definitions under the IRF PPS, we believe that in addition to more accurately maintaining the current structuring of the IRF PPS labor market areas, the local labor costs would be more accurately reflected, thereby resulting in a wage index adjustment that better reflects the variation in the local labor costs of the local economies of the IRFs located in these relatively

‘‘ smaller ’’ areas.

Below we describe where Metropolitan Divisions would be applicable under the proposed new CBSA-based labor market area definitions under the IRF PPS.

Under the OMB ’ s CBSA-based designations, there are 11 MSAs containing Metropolitan Divisions: Boston; Chicago; Dallas; Detroit; Los Angeles; Miami; New York; Philadelphia; San Francisco; Seattle; and Washington, DC. Although these MSAs were also CMSAs under the prior definitions, in some cases their areas have been altered. Under the current IRF PPS MSA designations, Boston is a single NECMA. Under the proposed CBSA-based labor market area designations, it would be comprised of four Metropolitan Divisions. Los Angeles would go from four PMSAs under the current IRF PPS MSA designations to two MetropolitanDivisions under the proposed CBSAbased labor market area designations. The New York CMSA would go from 15 PMSAs under the current IRF PPS MSA designations to only four MetropolitanDivisions under the proposed CBSAbased labor market area designations. The five PMSAs in Connecticut under the current IRF PPS MSA designations would become separate MSAs under the proposed CBSA-based labor market area designations because two MSAs became separate MSAs. The number of PMSAs in New Jersey, under the current IRF PPS MSA designations would go from five to two, with the consolidation of two New Jersey PMSAs (Bergen-Passaicand Jersey City) into the New YorkWayne-White Plains, NY-NJ Division, under the proposed CBSA-based labor market area designations. In SanFrancisco, under the proposed CBSAbased labor market area designations there are only two Metropolitan Divisions. Currently, there are six PMSAs, some of which are now separate MSAs under the current IRF PPS labor market area designations.

Under the current IRF PPS labor market area designations, Cincinnati, Cleveland, Denver, Houston, Milwaukee, Portland, Sacramento, and San Juan are all designated as CMSAs, but would no longer be designated as CMSAs under the proposed CBSA-based labor market area designations. As noted previously, the population threshold to be designated a CMSA under the current IRF PPS labor market area designations is 1 million. In most of these cases, counties currently in a PMSA would become separate, independent MSAs under the proposed CBSA-based labor market area designations, leaving only the MSA for the core area under the proposed CBSA-based labor market area designations.

iii. Micropolitan Areas

Under the new OMB ’ s CBSA-based designations, Micropolitan Areas are essentially a third area definition consisting primarily of areas that are currently rural, but also include some or all of areas that are currently designated as urban MSA. As discussed in greater detail in the IPPS final rule (69 FR at 49029 through 49032), how these areas are treated would have significant impacts on the calculation and application of the wage index. Specifically, whether or not Micropolitan Areas are included as part of the respective statewide rural wage indices would impact the value of the statewide rural wage index of any State that contains a Micropolitan Area because a hospital ’ s classification as urban or rural affects which hospitals ’ wage data are included in the statewide rural wage index. As discussed above in section III.B.2.b of this proposed rule, we combine all of the counties in a State outside a designated urban area to calculate the statewide rural wage index for each State.

Including Micropolitan Areas as part of the statewide rural labor market area would result in an increase to the statewide rural wage index because hospitals located in those Micropolitan Areas typically have higher labor costs than other rural hospitals in the State. Alternatively, if Micropolitan Areas were to be recognized as independent labor market areas, because there would be so few hospitals in those areas to complete a wage index, the wage indices for IRFs in those areas could become relatively unstable as they might change considerably from year to

year.

We currently use MSAs to define urban labor market areas and group all the hospitals in counties within each


### 30238 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

State that are not assigned to an MSA into a statewide rural labor market area. Therefore, we used the terms ‘‘ urban ’’ and ‘‘ rural ’’ wage indices in the past for ease of reference. However, the introduction of Micropolitan Areas by the OMB potentially complicates this terminology because these areas include many hospitals that are currently included in the statewide rural labor market areas.

We are proposing to treat Micropolitan Areas as rural labor market areas under the IRF PPS for the reasons outlined below. That is, counties that are assigned to a Micropolitan Area under the CBSA-based designations would be treated the same as other

‘‘ rural ’’ counties that are not assigned to either an MSA or a Micropolitan Area. Therefore, in determining an IRF ’ s applicable wage index (based on IPPS hospital wage index data) we are proposing that an IRF in a Micropolitan Area under OMB ’ s CBSA designations would be classified as ‘‘ rural ’’ and would be assigned the statewide rural wage index for the State in which it resides.

In the IPPS final rule (69 FR at 49029 through 49032), we discuss our evaluation of the impact of treating Micropolitan areas as part of the statewide rural labor market area instead of treating Micropolitan Areas as independent labor market areas for hospitals paid under the IPPS. As an alternative to treating Micropolitan Areas as part of the statewide rural labor market area for purposes of the IRF PPS, we examined treating Micropolitan Areas as separate (urban) labor market areas, just as we did when implementing the revised labor market areas under the IPPS. As discussed in greater detail in that same final rule, the designation of Micropolitan Areas as separate urban areas for wage index purposes would have a dramatic impact on the calculation of the wage index. This is because Micropolitan areas encompass smaller populations than MSAs, and tend to include fewer hospitals per Micropolitan area. Currently, there are only 25 MSAs with one hospital in the MSA. However, under the new proposed CBSA-based definitions, there are 373 Micropolitan Areas with one hospital, and 49 MSAs with only one hospital.

Since Micropolitan Areas encompass smaller populations than MSAs, they tend to include fewer hospitals per Micropolitan Area, recognizing Micropolitan Areas as independent labor market areas would generally increase the potential for dramatic shifts in those areas ’ wage indices from one year to the next because a single hospital (or group of hospitals) could have a disproportionate effect on the wage index of the area. The large number of labor market areas with only one hospital and the increased potential for dramatic shifts in the wage indexes from one year to the next is a problem for several reasons. First, it creates instability in the wage index from year to year for a large number of hospitals. Second, it reduces the averaging effect (this averaging effect allows for more data points to be used to calculate the representative standard of measured labor costs within a market area) lessening some of the incentive for hospitals to operate efficiently. This incentive is inherent in a system based on the average hourly wages for a large number of hospitals, as hospitals could profit more by operating below that average. In labor market areas with a single hospital, high wage costs are passed directly into the wage index with no counterbalancing averaging with lower wages paid at nearby competing hospitals. Third, it creates an arguably inequitable system when so many hospitals have wage indexes based solely on their own wages, while other hospitals ’ wage indexes are based on an average hourly wage across many hospitals. Therefore, in order to minimize the potential instability in payment levels from year to year, we believe it would be appropriate to treat Micropolitan Areas as part of the statewide rural labor market area under the IRF PPS.

For the reasons noted above, and consistent with the treatment of these areas under the IPPS, we are proposing not to adopt Micropolitan Areas as independent labor market areas under the IRF PPS. Under the proposed new CBSA-based labor market area definitions, we are proposing that Micropolitan Areas be considered a part of the statewide rural labor market area. Accordingly, we are proposing that the IRF PPS statewide rural wage index be determined using the acute-care IPPS hospital wage data (the rational for using IPPS hospital wage data is discussed in section III.B.2.f of this proposed rule) from hospitals located in non-MSA areas and that the statewide rural wage index be assigned to IRFs located in those areas.

e. Implementation of the Proposed Changes To Revise the Labor Market

Areas

Under section 1886(j) of the Act, as added by section 4421 of the Balanced Budget Act of 1997 (BBA) (Pub. L. 105

– 33) and as amended by section 125 of the Medicare, Medicaid, and State Children ’ s Health Insurance Program (SCHIP) Balanced Budget Refinement Act of 1999 (BBRA) (Pub. L. 106

– 113) and section 305 of the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106

– 554), which requires the implementation of such prospective payment system, the Secretary generally has broad authority in developing the IRF PPS, including whether and how to make adjustments to the IRF PPS.

To facilitate an understanding of the proposed policies related to the proposed change to the IRF PPS labor market areas discussed above, in Table 3 of the Addendum of this proposed rule, we are providing a listing of each

IRF ’ s state and county location; existing MSA labor market area designation; and its proposed new CBSA designation based on county information from our online survey, certification, and reporting (OSCAR) database, and an Iowa Foundation for Medical Care (IFMC) report listing providers and their state and county location that submitted

IRF

–PAIs during the past 18 months (report request made in February 2005). We encourage IRFs to review the county location and both the current and proposed labor market area assignments for accuracy. Any questions or corrections (including additions or deletions) to the information provided in Table 3 of the Addendum should be emailed to the following CMS Web address: IRFPPSInfo@cms.hhs.gov. A link to this address can be found on the following CMS Web page http:// www.cms.hhs.gov/providers/irfpps/

.

When the revised labor market areas based on OMB ’ s new CBSA-based designations were adopted under the IPPS beginning on October 1, 2004, a transition to the new designations was established due to the scope and substantial implications of these new boundaries and to buffer the subsequent substantial impacts on numerous hospitals. As discussed in the IPPS final rule (69 FR at 49032), during FY 2005, a blend of wage indices is calculated for those acute care IPPS hospitals experiencing a drop in their wage indices because of the adoption of the new labor market areas. The most substantial decrease in wage index impacts urban acute-care hospitals that were designated as rural under the CBSA-based designations.

While we recognize that, just like IPPS hospitals, IRFs may experience decreases in their wage index as a result of the proposed labor market area changes, our data analysis showed that a majority of IRFs either expect no change in wage index or an increase in wage index based on CBSA definitions.


### 30239 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

In addition, a very small number of IRFs (3 percent) would experience a decline of 5 percent or more in the wage index based on CBSA designations. A 5 percent decrease in the wage index for an IRF may result in a noticeable decrease in their wage index compared to what their wage index would have been for FY 2006 under the MSA-based designations. We also found that a very small number of IRFs (4 percent) would experience a change in either rural orurban designation under the CBSAbased definitions. Since a majority of IRFs would not be significantly impacted by the proposed labor market areas, we believe it is not necessary to propose a transition to the proposed new CBSA-based labor market area for the purposes of the IRF PPS wage index. The main purpose of a transition is to buffer hospitals that would be significantly impacted by a proposed policy. Since the impact of the proposed labor market areas upon IRFs would be minimal, the need to transition is absent. We recognize that there would be many alternatives to efficiently implement the proposed CBSA-based geographic designations. The statute confers broad authority to the Secretary under 1886(j)(6) of the Act to establish factor for area wage differences by a factor such that budget neutral wage index options may be considered. Thus, we considered three budget neutral alternatives that could implement the adoption of the proposed CBSA-based designations as discussed below. Even though a majority of IRFs would not be significantly impacted by the proposed labor market areas, we wanted to be diligent and at least examine transition policies and the affect on the system. We needed to conduct the analysis to determine how IRFs fare under such a proposed policy.

One alternative we considered institutes a one-year transition with a blended wage index, equal to 50 percent of the FY 2006 MSA-based wage indexand 50 percent of the FY 2006 CBSAbased wage index (both based on the FY 2001 hospital wage data), for all providers. In this scenario, a blended wage index of 50 percent of the FY 2006 MSA-based wage index and 50 percent of the FY 2006 CBSA-based wage index was used because in the IPPS final rule (69 FR at 49033) a blended wage index employed 50 percent of the FY 2001 hospital wage index data and the old labor market definitions, and 50 percent of the wage index employing FY 2001 wage index data and the new labor market definitions. However, we found that while this would help some IRFs that are adversely affected by the changes to the MSAs, it would also reduce the wage index values (compared to fully adopting the CBSA wage index value) for IRFs that would be positively affected by the changes. Thus, the unadjusted payment rate for all providers would be slightly reduced. Therefore, a majority of the IRFs would not benefit if all providers are given a blended wage index in a budget neutral manner (such that estimated aggregate, overall payments to IRFs would not change under the proposed labor market area definitions).

A second alternative we considered consists of a one-year transition with a blended wage index, equal to 50 percent of the FY 2006 MSA wage index and 50 percent of the FY 2006 CBSA-based wage index (both based on the FY 2001 hospital wage data), only for providers that would experience a decrease due solely to the changes in the labor market definitions. In this second alternative, a blended wage index of 50 percent of the FY 2006 MSA wage index and 50 percent of the FY 2006 CBSA-based wage index was determined because in the IPPS final rule (69 FR at 49033) a blended wage index employed 50 percent of the FY 2001 hospital wage index data and the old labor market definitions, and 50 percent of the wage index employing FY 2001 wage index data and the new labor market definitions. Therefore, providers that would experience a decrease in their FY 2006 wage index under the CBSA-based definitions compared to the wage index they would have received under the MSA-based definitions (in both cases using FY 2001 hospital wage data) would receive a blended wage index as described above.

When we performed our analysis, we found that the unadjusted payment amounts decreased substantially more under this option than they did either by using the first option discussedabove or by fully adopting the CBSAbased designations. As with the first alternative, the positive impact of blending in order decrease the impacts for a relatively small number of IRFs would require reduced payment rates for all providers, including the IRFs receiving a blended wage index.

As discussed in the August 11, 2004 IPPS final rule (69 FR at 49032), during FY 2005, a hold harmless policy was implemented to minimize the overall impact of hospitals that were in FY 2004 designated as urban under the MSA designations, but would become rural under the CBSA designations. In the same final rule, hospitals were afforded a three-year hold harmless policybecause the IPPS determined that acutecare hospitals that changed designations from urban to rural would be substantially impacted by the significant change in wage index. Although we considered a hold harmless policy for IRFs that would be substantially impacted from the change in wage index due to the CBSA-based designation, we found that an extremely small number of IRFs (4.4 percent) would change designations. In addition, currently urban facilities that become rural under the CBSA-based definitions would receive the rural facility adjustment, which we are proposing to increase from 19.14 percent to 24.1 percent (discussed in further detail in section III.B.4 of this proposed rule). Thus, the impact on urban facilities that become rural would be mitigated by the rural adjustment.

We also found that 91 percent of rural facilities that would be designated as urban under the CBSA-based definitions would experience an increase in the wage index. Furthermore, a majority (74 percent) of rural facilities that become urban would experience at least a 5 percent to 10 percent or more increase in wage index. Thus, we do not believe it is appropriate or necessary to adopt a hold harmless policy for facilities that would experience a change in designation under the CBSA-based definitions.

Finally, we note that section 505 of the MMA established new section 1886(d)(13) of the Act. The new section 1886(d)(13) requires that the Secretary establish a process to make adjustments to the hospital wage index based on commuting patterns of hospital employees. We believe that this requirement for an ‘‘ out-commuting ’’ or

‘‘ out-migration ’’ adjustment applies specifically to the IPPS. Therefore, we will not be proposing such an adjustment for the IRF PPS.

We are not proposing a transition, a hold harmless policy, nor an ‘‘ outcommuting ’’ adjustment under the IRF PPS from the current MSA-based labor market areas designations to the new CBSA-based labor market area designations as discussed below. We are proposing to adopt the new CBSA-based labor market area definitions beginning with the 2006 IRF PPS fiscal year without a transition period, without a hold harmless policy, and without an

‘‘ out-commuting ’’ adjustment. We believe that this proposed policy is appropriate because despite significant similarities between the IRF PPS and the IPPS, there are clear distinctions between the payment systems, particularly regarding wage index issues.

The most significant distinction upon which we have based this proposed


### 30240 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

policy determination is that where acute care hospitals have been paid using full wage index adjusted payments since 1983 and have used the previous IPPS MSA-based labor market area designations for over 10 years, under the IRF PPS we have been using theexcluded pre-reclassification and prefloor MSA-based wage index for cost reporting periods beginning on or after January 1, 2002. Since the implementation of the IRF PPS has only used the MSA-based labor market area designations since 2002 of which the first year was a transition year, many IRFs received a blended payment that consisted of a percentage of TEFRA and a percentage of the IRF PPS rate (as described below). Since many IRFs were initially under the transition period whereby many IRFs received a blend of TEFRA payments and the adjusted Federal prospective payment rates in accordance with section 1886(j)(1) of the Act and as specified in § 412.626, IRFs may still be adjusting to the changes in wage index and thus has not established a long history of an expected wage index from year to year. We may reasonably expect that IRFs would not experience a substantial impact on their respective wage indices because under a relatively new IRF PPS, IRFs are adjusting to the change of being paid a Federal prospective payment rate. Our data analysis also shows that a minimal number of IRFs would experience a decrease of more than 5 percent in the wage index. A 5 percent decrease in the wage index for an IRF would possibly result in a noticeable decrease in their wage index compared to what their wage index would have been for FY 2006 under the MSA-based designations. In addition, under the CBSA designation, a small number of IRFs would experience a change from their current urban or rural designation. Therefore, the overall impact of IRFs under the MSA-based designations versus the CBSA-based designations did not result in a dramatic change overall.

Although the wage index has been a stable feature of the acute care hospital IPPS since its 1983 implementation and has utilized the prior MSA-based labor market area designation for over 10 years, this is not the case for the IRF PPS which has only been implemented for cost reporting periods beginning on or after January 1, 2002. Therefore, if the proposed CBSA-based labor market area designations were adopted they would have a negligible impact on IRFs because the adoption of the CBSA-based designations are proposed in a budget neutral manner (as discussed in detail in section IV of this proposed rule). The impact of adopting the proposed CBSA-based wage index has shown in our impact analysis to have very little impact on the overall payment rates to the extent the proposed refinements to the overall system are also implemented (as discussed below). In addition, unlike other post-acute care payment systems, the IRF PPS payments apply a rural facility adjustment to account for higher costs in rural facilities (as discussed in 66 FR at 41359). We are proposing to increase the current rural adjustment from 19.14 percent to 24.1 percent (as discussed in section III.4 of this proposed rule). Therefore, IRFs that aredesignated as urban under the MSAbased definitions, but that would be classified as rural under the proposed CBSA-based definitions, will receive a facility add-on of 24.1 percent.

In sum, the IRF PPS has only been implemented for hospital cost reporting periods beginning on or after January 1, 2002 (which means that payment to IRFs have only been governed by the IRF PPS for slightly more than 3 years). In addition, a small number of IRFs would experience a change in rural orurban designations under the CBSAbased designations. To the extent the proposed changes in this rule are adopted, the change in labor market area for an urban facility to a rural facility is expected to be offset by the rural adjustment we are proposing to increase from 19.14 to 24.1 percent as discussed below. We also found that a majority of IRFs would experience no change in wage index or an increase. Thus, we areproposing to fully adopt the CBSAbased designations without a hold harmless policy. We believe that it is not appropriate or necessary to proposea transition to the proposed new CBSAbased labor market area for the purpose of the IRF PPS wage index adjustment as specified under § 412.624 as explained previously in this section. In addition, as explained above, we believe there are not sufficient data to support a transition from MSA-baseddesignations to the proposed CBSAbased designations.

f. Wage Index Data

In the August 7, 2001 final rule, we established an IRF wage index based on FY 1997 acute care hospital wage data to adjust the FY 2002 IRF payment rates. For the FY 2003 IRF PPS payment rates, we applied the same wage adjustment as used for FY 2002 IRF PPS rates because we determined that the application of the wage index and labor-related share used in FY 2002 provided an appropriate adjustment to account for geographic variation in wage levels that was consistent with the statute. For the FY 2004 IRF PPS payment rates, we used the hospital wage index based on FY 1999 acute care hospital wage data. For the FY 2005 IRF PPS payment rates, we used the hospital wage index based on FY 2000 acute care hospital wage data. We are proposing to use FY 2001 acute care hospital wage data for FY 2006 IRF PPS payment rates because it is the most recent final data available. We believe that a wage index based on acute care hospital wage data is the best proxy and most appropriate wage index to use in adjusting payments to IRFs, since both acute care hospitals and IRFs compete in the same labor markets. Since acute care hospitals compete in the same labor market areas as IRFs, the wage data of acute care hospitals should accurately capture the relationship of wages and wage-related costs of IRF in an area as comparable to the national average. In the August 1, 2001 final rule (66 FR at 41358) we established FY 2002 IRF PPS wage index values for the 2002 IRF PPS fiscal year calculated from the same data used to compute the FY 2001 acute care hospital inpatient wage index data without taking into account geographic reclassification under sections 1886(d)(8) and (d)(10) of the Act and without applying the ‘‘ rural floor ’’ under section 4410 of Pub. L.

105

– 33 (BBA) (as discussed in section III.B.2.a of this proposed rule). Acute care hospital inpatient wage index data is also used to establish the wage index adjustment used in other PPSs (for example, LTCH, IPF, HHA, and SNF). As we discussed in the August 7, 2001 final rule (66 FR at 41316, 41358), since hospitals that are excluded from theIPPS are not required to provide wagerelated information on the Medicare cost report and because we would need to establish instructions for the collection of this IRF data it is not appropriate at this time to propose a wage index specific to IRF facilities. Because we do not have an IRF specific wage index that we can compare to the hospital wage index, we are unable to determine at this time the degree to which the acute care hospital data fully represent IRF wages or if a geographic reclassification adjustment under the IRF PPS is appropriate. However, we believe that a wage index based on acute care hospital data is the best and most appropriate wage index to use in adjusting payments to IRFs, since both acute care hospitals and IRFs compete in the same labor markets. Also, we propose to continue to use the same method for calculating wage indices as was indicated in the August 7, 2001 final rule (69 FR at 41357 through 41358). In addition, 1886(d)(8) and


### 30241 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

1886(d)(10) of the Act which permits reclassification is applicable only to inpatient acute care hospitals at this time. The wage adjustment established under the IRF PPS is based on an IRF ’ s actual location without regard to the urban or rural designation of any related or affiliated provider.

In proposing to adopt the CBSA-based designations, we recognize that there may be geographic areas where there are no hospitals, and thus no hospital wage data on which to base the calculation of the IRF PPS wage index. We found that this occurred in two States

— Massachusetts and Puerto Rico

—where, using the CBSA-based designations, there were no hospitals located in rural areas. At present, no IRFs are affected by this lack of data, because currently there are no rural IRFs in these two States. If, rural IRFs open in these two States, we propose, for FY 2006, to use the rural FY 2001 MSA-based hospital wage data for that State to determine the wage index of such IRFs. In other words, we would use the same wage data (the FY 2001 hospital wage data) used to calculate the FY 2006 IRF wage index. However, rather than using CBSA-based designations, we would use MSA-based designations to determine the rural wage index of the State. Using such MSA-based designations there would be rural wage indices for both Massachusetts and Puerto Rico. We believe this is the most reasonable approach, as we would be using the same hospital wage data used to calculate the CBSA-based wage indices.

In the event this occurs in urban areas where IRFs are located, we are proposing to use the average of the urban hospital wage data throughout the State as a reasonable proxy for the urban areas without hospital wage data. Therefore, urban IRFs located in geographic areas without any hospital wage data would receive a wage index based on the average wage index for all urban areas within the State. This does not presently affect any urban IRFs for FY 2006 because there are no IRFs located in urban areas without hospital wage data. However, the policy would apply to future years when there may be urban IRFs located in geographic areas with no corresponding hospital wage data.

We believe this policy is reasonable because it maintains a CBSA-based wage index system, while creating an urban proxy for IRFs located in urban areas without corresponding hospital wage data. We note that we could not apply a similar averaging in rural areas, because in the rural areas there is no State rural hospital wage data available for averaging on a State-wide basis. For example, in Massachusetts and Puerto Rico, using a CBSA-based designation system, there are simply no rural hospitals in the State upon which we could base an average.

In addition, we note that the Secretary has broad authority under 1886(j)(6) to update the wage index on the basis of information available to the Secretary (and updated as appropriate) of the wages and wage-related costs incurred in furnishing rehabilitation services. Therefore, for FY 2006 we propose to use FY 2001 MSA-based hospital wage data for rural Massachusetts and rural Puerto Rico in the event there are rural IRFs in such States. In addition, for FY 2006 and thereafter, we propose to calculate a statewide urban average in the event that there exist urban IRFs in geographic areas with no corresponding hospital wage data. We solicit comments on these approaches to calculate the wage index values for areas without hospital wage data for this and subsequent fiscal years. We note that for fiscal years 2007 and thereafter,we likely will not calculate the MSAbased rural area indices, as the acute care hospital IPPS will no longer publish MSA-based wage tables. Thus, we specifically request comments on the approach to be used for IRFs in rural areas without corresponding hospital wage data for fiscal years 2007 and thereafter.

For the reasons discussed above, we are proposing to continue the use of the acute care hospital inpatient wage index data generated from cost reporting periods beginning during FY 2001 without taking into account geographic reclassification as specified under sections 1886(d)(8) and (d)(10) of the Act and without applying the ‘‘ rural floor ’’ under section 4410 of Pub. L.

105

– 33 (BBA) (as discussed in section III.B.2.a of this proposed rule). We believe that cost reporting period FY 2001 would be used to determine the applicable wage index values under the IRF PPS because these are the best available data. These data are the same FY 2001 acute care hospital inpatient wage data that were used to compute the FY 2005 wage indices. The proposed full wage index values that would be applicable for IRF PPS discharges occurring on or after October 1, 2005 are shown in Addendum 1, Tables 2a (for urban areas) and 2b (for rural areas) in the Addendum of this proposed rule.

In addition, any proposed adjustment or update to the IRF wage index made as specified under section 1886(j)(6) of the Act would be made in a budget neutral manner that assures that the estimated aggregated payments under this subsection in the FY year are not greater or less than those that would have been made in the year without such adjustment. Therefore, we are proposing to calculate a budget-neutral wage adjustment factor as established in the July 30, 2004 notice and as specified in § 412.624(e)(1). We will continue to use the following steps to ensure that the proposed FY 2006 IRF standard payment conversion factor reflects the update to the proposed CBSA wageindices and to the proposed laborrelated share in a budget neutral

manner:

Step 1: Determine the total amount of the estimated FY 2005 IRF PPS rates using the FY 2005 standard payment conversion factor and the labor-related share and the wage indices from FY 2005 (as published in the July 30, 2004 final notice).

Step 2: Calculate the total amount of estimated IRF PPS payments using the FY 2005 standard payment conversionfactor and the proposed updated CBSAbased FY 2006 labor-related share and wage indices described above.

Step 3: Divide the amount calculated in step 1 by the amount calculated in step 2, which equals the proposed FY 2006 budget-neutral wage adjustment factor of 0.9996.

Step 4: Apply the proposed FY 2006 budget-neutral wage adjustment factor from step 3 to the FY 2005 IRF PPS standard payment conversion factor after the application of the market basket update, described above, to determine the proposed FY 2006 standard payment conversion factor.

3. Proposed Teaching Status Adjustment

Section 1886(j)(3)(A)(v) of the Act requires the Secretary to adjust the prospective payment rates for the IRF PPS by such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among rehabilitation facilities. Under this authority, in the August 7, 2001 final rule (66 FR 41316, 41359), we considered implementing an adjustment for IRFs that are, or are part of, teaching institutions. However, because the results of our regression analysis, using FY 1999 data, showed that the indirect teaching cost variable was not significant, we did not implement a payment adjustment for indirect teaching costs in that final rule. The regression analysis conducted by RAND for this proposed rule, using FY 2003 data, shows that the indirect teaching cost variable is significant in explaining the higher costs of IRFs that have teaching programs. Therefore, we are proposing to establish a facility level adjustment to the Federal per discharge base rate for IRFs that are, or are part of,


### 30242 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

teaching institutions for the reasons discussed below (the ‘‘ teaching status adjustment ’’ ). However, as discussed below, we have some concerns about proposing a teaching status adjustment. The policy implications of implementing a teaching status adjustment on the basis of the results of

RAND ’ s recent analysis oblige us to seek assurance that these results do not reflect an aberration based on only a single year ’ s data and that the teaching status adjustment can be implemented in such a way that it would be equitable to all IRFs. Analysis of future data (FY 2004 or later) would give us such assurance because it would allow the effects of the other proposed changes outlined in this proposed rule to be realized and allow us to determine whether the significant coefficient on the teaching variable continues to be present in the future data.

The purpose of the proposed teaching status adjustment would be to account for the higher indirect operating costs experienced by facilities that participate in graduate medical education

programs.

We are proposing to implement the proposed teaching status adjustment in a budget neutral manner (that is, keeping aggregate payments for FY 2006 with the proposed teaching adjustment the same as aggregate payments for FY 2006 without the proposed teaching adjustment) for the reasons discussed below. (As a conforming change, we are proposing to revise § 412.624 to add a new section (e)(4) as the teaching status adjustment. Specifically, § 412.624(e)(4) would be for discharges on or after October 1, 2005. We propose to adjust the Federal prospective payment on a facility basis by a factor as specified by CMS for facilities that are teaching institutions or units of teaching institutions. This adjustment would be made on a claim basis as an interim payment and the final payment in full for the claim would be made during the final settlement of the cost report. Thus, we would redesignate the current (e)(4) and (e)(5) as (e)(5) and (e)(6)).

Medicare makes direct graduate medical education (GME) payments (for direct costs such as resident and teaching physician salaries, and other direct teaching costs) to all teaching hospitals including those paid under the IPPS, and those that were once paid under the TEFRA rate of increase limits but are now paid under other PPSs. These direct GME payments are made separately from payments for hospital operating costs and are not part of the PPSs. However, the direct GME payments may not address the higher indirect operating costs which may often be experienced by teaching hospitals. For teaching hospitals paid under the TEFRA rate-of-increase limits, Medicare did not make separate medical education payments because payments to these hospitals were based on the hospitals ’ reasonable costs. Because payments under TEFRA were based on hospitals ’ reasonable costs, the higher indirect costs that might be associated with teaching programs would automatically have been factored into the TEFRA payments.

When the IRF PPS was implemented, we did not adjust payments to IRFs for indirect medical education costs because we did not find that adjustments for such costs were supported by the regression analyses or by the impact analyses. As discussed in the August 7, 2001 final rule (69 FR 41316, 41359), the indirect teaching variable was not significant for either the fully specified regression or the payment regression in RAND ’ s analysis. Furthermore, the impacts among the various classes of facilities reflecting the fully phased-in IRF PPS illustrated that IRFs with the highest measure of indirect teaching would lose approximately 2 percent of estimated payments under the IRF PPS when compared with payments under TEFRA rate-of-increase limits. These impacts did not account for changes in behavior that facilities were likely to adopt in response to the inherent incentives of the IRF PPS, and we believed that IRFs could change their behavior to mitigate any potential reduction in payments.

The earlier research conducted by RAND was based on 1999 data and on a sample of IRFs. RAND recently conducted research to support us in developing potential refinements to the IRF classification system and the PPS. The regression analysis conducted by RAND for this proposed rule, using FY 2003 data, showed that the indirect teaching cost variable is significant in explaining the higher costs of IRFs that have teaching programs.

In conducting the analysis on the FY 2003 data, RAND used the resident counts that were reported on the hospital cost reports (worksheet S

– 3, line 25, column 9 for freestanding IRF hospitals and worksheet S

– 3, Part 1, line 14 (or line 14.01 for subprovider 2), column 9 for rehabilitation units of acute care hospitals). That is, for the freestanding rehabilitation hospitals, RAND used the number of residents and interns reported for the entire hospital. For the rehabilitation units of acute care hospitals, RAND used the number of residents and interns reported for the rehabilitation unit (reported separately on the cost report from the number reported for the rest of the hospital). RAND did not distinguish between different types of resident specialties, nor did they distinguish among the different types of services residents provide, because this information is not reported on the cost reports.

RAND used regression analysis (with the logarithm of costs as the dependent variable) to re-examine the effect of

IRFs ’ teaching status on the costs of care. With FY 2003 data that include all Medicare-covered IRF discharges, RAND found a statistically significant difference in costs between IRFs with teaching programs and those without teaching programs in the regression analysis. The different results obtained using the FY 2003 data (compared with the 1999 data) may be due to improvements in IRF coding after implementation of the IRF PPS. More accurately coded data may have allowed RAND to determine better the differences in case mix among hospitals with and without teaching programs, which would then have allowed the effect of whether or not an IRF has a teaching program to become significant in the regression analysis. There are two main reasons that indirect operating costs may be higher in teaching hospitals: (1) Because the teaching activities themselves result in inefficiencies that increase costs, and (2) because patients needing more costly services tend to be treated more often in teaching hospitals than in non-teaching hospitals, that is, the case mix that is drawn to teaching hospitals. Quantifying more precisely the amount of cost increase that is due to teaching hospitals ’ case mix allows RAND to more precisely quantify the amount of increase due to the inefficiencies associated with a teaching program.

We would propose to treat the teaching status adjustment as an additional payment to the Federal prospective payment rate, similar to the IME payments made under the IPPS (see § 412.105). Any such teaching status adjustments for the IRF PPS facilities would be made on a claim basis as interim payments, but the final payment in full for the cost reporting period would be made through the cost report. The difference between those interim payments and the actual teaching status adjustment amount computed in the cost report would be adjusted through lump sum payments/recoupments when the cost report is filed and later settled.

As in the IPF PPS, we would propose to calculate a teaching adjustment based on the IRF ’ s ‘‘ teaching variable, ’’ which would be one plus the ratio of the number of FTE residents training in the IRF (subject to limitations described


### 30243 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

further below) to the IRF ’ s average daily census (ADC). In RAND ’ s most recent cost regressions using data from FY 2003, the logarithm of the teaching variable has a coefficient value of 1.083. We would propose to convert this cost effect to a teaching status payment adjustment by treating the regression coefficient as an exponent and raising the teaching variable to a power equal to the coefficient value

— currently 1.083 (that is, the teaching status adjustment would be calculated by raising the teaching variable (1 + FTE residents/ ADC) to the 1.083 power). For a facility with a teaching variable of 0.10, and using a coefficient based upon the coefficient value (1.083) from the FY 2003 data, this method would yield a 10.9 percent increase in the per discharge payment; for a facility with a teaching variable of 0.05, the payment would increase by 5.4 percent. We note that the coefficient value of 1.083 is based on regression analysis holding all other components of the payment system constant. Because we are proposing a number of other revisions to the payment system in this proposed rule, the coefficient value is subject to change for the final rule depending on the other revisions included in the final rule. Moreover, we are concerned that

IRFs ’ responses to other proposed changes described in this proposed rule will influence the effects of a teaching variable on IRFs ’ costs.

In addition, the teaching adjustment we would propose would limit the incentives for IRFs to add FTE residents for the purpose of increasing their teaching adjustment, as has been done in the payment systems for psychiatric facilities and acute inpatient hospitals. Thus, we would propose to impose a cap on the number of FTE residents that may be counted for purposes of calculating the teaching adjustment, similar to that established by sections 4621 (IME FTE cap for IPPS hospitals) and 4623 (direct GME FTE cap for all hospitals) of the BBA. We note that the FTE resident cap already applies to teaching hospitals, including IRFs, for purposes of direct GME payments as specified in § 413.75 through § 413.83. The proposed cap would limit the number of residents that teaching hospitals may count for the purposes of calculating the IRF PPS teaching status adjustment, not the number of residents teaching institutions can hire or train.

The proposed FTE resident cap would be identical in freestanding teaching rehabilitation hospitals and in distinct part rehabilitation units with GME programs. Similar to the regulations for counting FTE residents under the IPPS as described in § 412.105(f), we are proposing to calculate a number of FTE residents that trained in the IRF during

a ‘‘ base year ’’ and use that FTE resident number as the cap. An IRF ’ s FTE resident cap would ultimately be determined based on the final settlement of the IRF ’ s most recent cost reporting period ending on or before November 15, 2003. We would also propose that, similar to new IPPS teaching hospitals, IRFs that first begin training residents after November 15, 2003 would initially receive an FTE cap of ‘‘ 0 ’’ . The FTE caps for new IRFs (as well as existing IRFs) that start training residents in a new GME program (as defined in § 413.79(l)) may be subsequently adjusted in accordance with the policies that are being applied in the IPF PPS (as described in § 412.424(d)(1)(iii)(B)(2)), which in turn are made in accordance with the policies described in 42 CFR 413.79(e) for IPPS hospitals. However, contrary to the policy for IME FTE resident caps under the IPPS, we would not allow IRFs to aggregate the FTE resident caps used to compute the IRF PPS teaching status adjustment through affiliation agreements. We are proposing these policies because we believe it is important to limit the total pool of resident FTE cap positions within the IRF community and avoid incentives for IRFs to add FTE residents in order to increase their payments. We also want to avoid the possibility of hospitals transferring residents between IPPS and IRF training settings in order to increase Medicare payments. We recognize that under the regulations applicable to the IPPS IME adjustment, a new teaching hospital that trains residents from an existing program (not a new program as defined in 42 CFR 413.79(l)) can receive an adjustment to its IME FTE cap by entering into a Medicare GME affiliation agreement (see § 412.105(f)(1)(vi), § 413.75(b), and § 413.79(f)) with other hospitals. However, this option would not be available to new teaching IRFs because, as noted above, we would propose not to allow IRFs to aggregate the FTE resident caps used to compute the IRF PPS teaching adjustment through affiliation agreements.

We would propose that residents with less than full-time status and residents rotating through the rehabilitation hospital or unit for less than a full year be counted in proportion to the time they spend in their assignment with theIRF (for example, a resident on a fulltime, 3-month rotation to the IRF would be counted as 0.25 FTEs for purposes of counting residents to calculate the ratio). No FTE resident time counted for purposes of the IPPS IME adjustment would be allowed to be counted for purposes of the teaching status adjustment for the IRF PPS.

The denominator that we would propose to use to calculate the teaching status adjustment under the IPF PPS would be the IRF ’ s average daily census (ADC) from the current cost reporting period because it is closely related to the IRF ’ s patient load, which determines the number of interns and residents the IRF can train. We also believe the ADC is a measure that can be defined precisely and is difficult to manipulate. Although the IPPS IME adjustment uses the hospital ’ s number of beds as the denominator, the capital PPS (as specified at § 412.322) and the IPF PPS (as specified at § 412.424) both use the ADC as the denominator for the indirect graduate medical education adjustments.

If a rehabilitation hospital or unit has more FTE residents in a given year than in the base year (the base year being used to establish the cap), we would base payments in that year on the lower number (the cap amount). This approach would be consistent with the IME adjustment under the IPPS and the IPF PPS. The IRF would be free to add FTE residents above the cap amount, but it would not be allowed to count the number of FTE residents above the cap for purposes of calculating the teaching adjustment. This means that the cap would be an upper limit on the number of FTE residents that may be counted for purposes of calculating the teaching status adjustment. IRFs could adjust their number of FTE residents counted for purposes of calculating the teaching adjustment as long as they remained under the cap.

On the other hand, if a rehabilitation hospital or unit were to have fewer FTE residents in a given year than in the base year (that is, fewer residents than its FTE resident cap), an adjustment in payments in that year would be based on the lower number (the actual number of FTE residents the facility hires and trains).

We would propose to implement a teaching status adjustment in such a way that total estimated aggregate payments to IRFs for FY 2006 would be the same with and without the proposed adjustment (that is, in a budget neutral manner). This is because we believe that the results of RAND ’ s analysis of 2002 and 2003 IRF cost data suggest that additional money does not need to be added to the IRF PPS. RAND ’ s analysis found, for example, that if all IRFs had been paid based on 100 percent of the IRF PPS payment rates throughout all of 2002 (some IRFs were still transitioning to PPS payments during 2002), PPS


### 30244 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

payments during 2002 would have been 17 percent higher than IRFs ’ costs. We are open to examining other evidence regarding the amount of aggregate payments in the system.

Consideration of an adjustment to payments based on an IRF ’ s teaching status is consistent with section 1886 (j)(3)(A)(v) of the Act, which confers broad statutory authority upon the Secretary to adjust the per payment unit payment rate by such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among rehabilitation facilities.

As mentioned above and discussed below, we have some concerns with implementing a teaching status adjustment for IRFs at this time. We are concerned about volatility in the data given the many changes to the IRF PPS that have been made in recent years and may be adopted in this rulemaking process. Other proposed payment policy changes have the potential to change the magnitude or even the effect of a teaching variable on costs once IRFs have fully responded to the other proposed policy changes in this proposed rule. We also believe it is important to ensure that the data accurately counts residents who provide services to IRF patients.

We note that the significant coefficient we found in the analysis of the FY 2003 data contrasts with the statistically insignificant coefficient we found in the analysis of the 1999 data used to construct the initial IRF PPS. Although we currently believe it may be appropriate to propose a teaching status adjustment for IRFs based on analysis of the FY 2003 data, we recognize that we may need to examine new data (that is, FY 2004 or later) to help us to reconcile these contradictory findings. We also believe the analysis of this new data could potentially lead us to conclude that a teaching status adjustment is not needed.

The results of RAND ’ s analysis using FY 2003 data also show that certain refinements to the IRF case mix system (as discussed in section II of this proposed rule) would improve the system by more appropriately accounting for the variation in costs among different types of IRF patients. In this proposed rule, we propose numerous changes to the CMGs and tiers, and to the threshold amount used to determine whether cases qualify for outlier payments, in order to better align IRF payments with the costs of providing care to Medicare beneficiaries in IRFs. In addition, this proposed rule proposes substantial changes to the wage index (the adoption of CBSA market area definitions) and to the rural and the LIP adjustments. We believe that these proposed changes may have an impact on cost differences between teaching and non-teaching IRFs, and that we will be able to assess their impact on teaching and non-teaching IRFs only after the proposed changes have been implemented.

Furthermore, we believe it is important to ensure that the data accurately count residents who participate in managing the rehabilitation of IRF patients. We are particularly interested in ensuring that the FTE resident counts used for the proposed IRF teaching status adjustment do not duplicate resident counts used for purposes of the IPPS IME adjustment, and that hospitals do not have incentives to shift residents from the acute care hospital to the hospital ’ s rehabilitation unit for purposes of computing the proposed IRF teaching adjustment. We are soliciting comments on the most valid and reliable method of counting residents for purposes of a proposed teaching status adjustment. We note that any changes we may make, based on our further investigation of this issue or on comments we receive on this proposed rule, to the methodology for counting residents could affect the magnitude of the proposed teaching adjustment or even whether the data continue to indicate that the proposed teaching status adjustment is appropriate.

In addition, we recognize that the proposed new teaching status adjustment, especially if implemented in a budget-neutral manner, is an important issue for all providers because it involves a redistribution of resources among facilities. That is, under the proposal, IRFs with teaching programs would receive additional payments, while IRFs without teaching programs would have their payments lowered to maintain total estimated payments for FY 2006 at the same level as without the proposed adjustment. For this reason, we believe caution is warranted in this case.

We are specifically soliciting comments on our consideration of the IRF teaching status adjustment.

4. Proposed Adjustment for Rural Location

Consistent with the broad statutory authority conferred upon the Secretary in section 1886(j)(3)(A)(v) of the Act, we adjust the Federal prospective payment amount associated with a CMG to account for an IRF ’ s geographic wage variation, low-income patients and, if applicable, location in a rural area, as described in § 412.624(e). Under the broad statutory authority conferred upon the Secretary in section 1886(j)(3)(A)(v) of the Act, we are proposing to increase the adjustment to the Federal prospective payment amount for IRFs located in rural areas from 19.14 percent to 24.1 percent. We are proposing this change because

RAND ’ s regression analysis, using the best available data we have (FY 2003), indicates that rural facilities now have 24.1 percent higher costs of caring for Medicare patients than urban facilities. We note that we propose to use the same statistical approach, as described in the November 3, 2000 proposed rule (65 FR 66304, 66356 through 66357) and adopted in the August 7, 2001 final rule (66 FR at 41359) to estimate the proposed update to the rural adjustment. The statistical approach RAND used both when the PPS was first implemented and for the proposed update described in this proposed rule relies on the coefficient determined from the regression analysis. The 19.14 percent rural adjustment has been applied to payments for IRFs located in rural areas since the implementation of the IRF PPS. We note that the FY 2003 data are the best available data we have, just as the 1998 and 1999 data used in the initial development of the IRF PPS were the best available data at that time.

We are proposing to implement the proposed update to the rural adjustment so that total estimated aggregate payments for FY 2006 are the same with the proposed update to the adjustment as they would have been without the proposed update to the adjustment (that is, in a budget neutral manner). We are proposing to make this proposed update to the rural adjustment in a budget neutral manner because we believe that the results of RAND ’ s analysis of 2002 and 2003 IRF cost data (as discussed previously in this proposed rule) suggest that additional money does not need to be added to the IRF PPS.

RAND ’ s analysis found, for example, that if all IRFs had been paid based on 100 percent of the IRF PPS payment rates throughout all of 2002 (some IRFs were still transitioning to PPS payments during 2002), PPS payments during 2002 would have been 17 percent higher than IRFs ’ costs. We are open to examining other evidence regarding the amount of estimated aggregate payments in the system.

This is consistent with section 1886(j)(3)(A)(v) of the Act which confers broad statutory authority upon the Secretary to adjust the per payment unit payment rate by such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among rehabilitation


### 30245 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

facilities. To ensure that total estimated aggregate payments to IRFs do not change, we propose to apply a factor to the standard payment conversion factor to assure that the estimated aggregate payments under this subsection in the FY are not greater or less than those that would have been made in the year without the proposed update to the adjustment. In sections III.B.7 and III.B.8 of this proposed rule, we discuss the methodology and factor we are proposing to apply to the standard payment amount. 5. Proposed Adjustment for Disproportionate Share of Low-Income Patients

Consistent with the broad statutory authority conferred upon the Secretary in section 1886(j)(3)(A)(v) of the Act, we adjust the Federal prospective payment amount associated with a CMG to account for an IRF ’ s geographic wage variation, low-income patients and, if applicable, location in a rural area, as described in § 412.624(e).

Under the broad statutory authority conferred upon the Secretary in section 1886(j)(3)(A)(v) of the Act, we are proposing to update the low-income patient (LIP) adjustment to the Federal prospective payment rate to account for differences in costs among IRFs associated with differences in the proportion of low-income patients they

treat. RAND ’ s regression analysis of 2003 data indicates that the LIP formula could be updated to better distribute current payments among facilitiesaccording to the proportion of lowincome patients they treat. Although the current formula appropriately distributed LIP-adjusted payments among facilities when the IRF PPS was first implemented, we believe the formula should be updated from time to time to reflect changes in the costs of caring for low-income patients.

The proposed LIP adjustment is based on the formula used to account for the costs of furnishing care to low-income patients as discussed in the August 7, 2001 final rule (67 FR at 41360). We propose to update the LIP adjustment from the power of 0.4838 to the power of 0.636. Therefore, the proposed formula to calculate the LIP adjustment would be as follows: (1 + DSH patient percentage) raised to the power of (.636) Where DSH patient percentage =



### Medicare SSI Days Medicaid, NonMedicare Days Total Days Total Medicare Days +

We note that we propose to use the same statistical approach, as described in the August 7, 2001 final rule (66 FR at 41359 through 41360), that was used to develop the original LIP adjustment. We note that the FY 2003 data we propose to use in calculating this adjustment are the best available data, just as the 1998 and 1999 data used in the initial development of the IRF PPS were the best available data at that time.

We are proposing to implement the proposed update to the LIP adjustment so that total estimated aggregate payments for FY 2006 are the same with the proposed update to the adjustment as they would have been without the proposed update to the adjustment (that is, in a budget neutral manner). We are proposing to make this proposed update to the LIP adjustment in a budget neutral manner because we believe that the results of RAND ’ s analysis of 2002 and 2003 IRF cost data (as discussed previously in this proposed rule) suggest that additional money does not need to be added to the IRF PPS.

RAND ’ s analysis found, for example, that if all IRFs had been paid based on 100 percent of the IRF PPS payment rates throughout all of 2002 (some IRFs were still transitioning to PPS payments during 2002), PPS payments during 2002 would have been 17 percent higher than IRFs ’ costs. We are open to examining other evidence regarding the amount of estimated aggregate payments in the system.

This is consistent with section 1886 (j)(3)(A)(v) of the Act which confers broad statutory authority upon the Secretary to adjust the per payment unit payment rate by such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among rehabilitation facilities. To ensure that total estimated aggregate payments to IRFs do not change, we propose to apply a factor to the standard payment conversion factor to assure that the estimated aggregate payments under this subsection in the FY are not greater or less than those that would have been made in the year without the proposed update to the adjustment. In sections III.B.7 and III.B.8 of this proposed rule, we discuss the methodology and factor we are proposing to apply to the standard payment amount.

6. Proposed Update to the Outlier Threshold Amount

Consistent with the broad statutory authority conferred upon the Secretary in sections 1886(j)(4)(A)(i) and 1886(j)(4)(A)(ii) of the Act, we are proposing to update the outlier threshold amount from the $11,211 threshold amount for FY 2005 to $4,911 in FY 2006 to maintain total estimated outlier payments at 3 percent of total estimated payments. In the August 7, 2001 final rule, we discuss our rationale for setting estimated outlier payments at 3 percent of total estimated payments (66 FR at 41362). We continue to propose to use 3 percent for the same reasons outlined in the August 7, 2001 final rule. We believe it is necessary to update the outlier threshold amount because RAND ’ s analysis of the calendar year 2002 and FY 2003 data indicates that total estimated outlier payments will not equal 3 percent of total estimated payments unless we update the outlier loss threshold. We will continue to analyze the estimated outlier payments for subsequent years and adjust as appropriate in order to maintain estimated outlier payments at 3 percent of total estimated payments. The reasons for estimated outlier payments not equaling 3 percent of total estimated payments are discussed in more detail below.

Section 1886(j)(4) of the Act provides the Secretary with the authority to make payments in addition to the basic IRF prospective payments for cases incurring extraordinarily high costs. In the August 7, 2001 final rule, we codified at § 412.624(e)(4) of the regulations (which would be redesignated as § 412.624(e)(5)) the provision to make an adjustment for additional payments for outlier cases that have extraordinarily high costs relative to the costs of most discharges. Providing additional payments for outliers strongly improves the accuracy of the IRF PPS in determining resource costs at the patient and facility level because facilities receive additional compensation over and above the adjusted Federal prospective payment amount for uniquely high-cost cases. These additional payments reduce the financial losses that would otherwise be caused by treating patients who require more costly care and, therefore, reduce the incentives to underserve these patients.


### 30246 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

Under § 412.624(e)(4) (which would be redesignated as § 412.624(e)(5)), we make outlier payments for any discharges if the estimated cost of a case exceeds the adjusted IRF PPS payment for the CMG plus the adjusted threshold amount (we are proposing to make this $4,911, which is then adjusted for each IRF by the facility ’ s wage adjustment, its LIP adjustment, its rural adjustment, and its teaching status adjustment, if applicable). We calculate the estimated cost of a case by multiplying the IRF ’ s overall cost-to-charge ratio by the Medicare allowable covered charge. In accordance with § 412.624(e)(4), we pay outlier cases 80 percent of the difference between the estimated cost of the case and the outlier threshold (the sum of the adjusted IRF PPS payment for the CMG and the adjusted fixed threshold dollar amount).

Consistent with the broad statutory authority conferred upon the Secretary in sections 1886(j)(4)(A)(i) and 1886(j)(4)(A)(ii) of the Act, and in accordance with the methodology stated in the August 1, 2003 final rule (68 FR at 45692 through 45693), we propose to continue to apply a ceiling to an IRF ’ s cost-to-charge ratios (CCR). Also, in the August 1, 2003 final rule (68 FR at 45693 through 45694), we stated the methodology we use to adjust IRF outlier payments and the methodology we use to make these adjustments. We indicated that the methodology is codified in § 412.624(e)(4) (which would be redesignated as § 412.624(e)(5)) and § 412.84(i)(3).

On February 6, 2004, we issued manual instructions in Change Request 2998 stating that we would set forth the upper threshold (ceiling) and the national CCRs applicable to IRFs in each

year ’ s annual notice of prospective payment rates published in the Federal Register . The upper threshold CCR for IRFs that we are proposing for FY 2006 would be 1.52 based on CBSA-based geographic designations. We are proposing to base this upper threshold CCR on the CBSA-based geographic designations because the CBSAs are the geographic designations we are proposing to adopt for purposes of computing the proposed wage index adjustment to IRF payments for FY 2006. If, instead, we were to use the MSA geographic designations, the upper threshold CCR amount would likely be different than the 1.52 we are proposing above. In addition, this is an estimated threshold and is subject to change in the final rule based on more recent data.

In addition, we are proposing to update the national urban and rural CCRs for IRFs. Under § 412.624(e)(4) (which would be redesignated as § 412.624(e)(5)) and § 412.84(i)(3), we are proposing to apply the national CCRs to the following situations:

• New IRFs that have not yet submitted their first Medicare cost report.

• IRFs whose operating or capital CCR is in excess of 3 standard deviations above the corresponding national geometric mean.

• Other IRFs for whom the fiscal intermediary obtains accurate data with which to calculate either an operating or capital CCR (or both) are not available.

The national CCR based on the facility location of either urban or rural would be used in each of the three situations cited above. Specifically, for FY 2006, we have estimated a proposed national CCR of 0.631 for rural IRFs and 0.518 for urban IRFs. For new facilities, we are proposing to use these national ratios until the facility ’ s actual CCR can be computed using the first tentative settled or final settled cost report data, which will then be used for the subsequent cost report period.

In the August 7, 2001 final rule (66 FR at 41362 through 41363), we describe the process by which we calculate the outlier threshold. We continue to use this process for this proposed rule. We begin by simulating aggregate payments with and without an outlier policy, and applying an iterative process to determine a threshold that would result in outlier payments being equal to 3 percent of total simulated payments under the simulation. We note that the simulation analysis used to calculate the proposed $4,911 outlier threshold includes all of the proposed changes to the PPS discussed in this proposed rule, and is therefore subject to change in the final rule depending on the policies contained in the final rule. In addition, we will continue to analyze the estimated outlier payments for subsequent years and adjust as appropriate in order to maintain estimated outlier payments at 3 percent of total estimated payments.

In this proposed rule, we are proposing to update the threshold amount to $4,911 so that outlier payments will continue to equal 3 percent of total estimated payments under the IRF PPS. RAND found that 2002 outlier payments were equal to 3.1 percent of total payments in 2002. Nevertheless, the outlier loss threshold is affected by cost-to-charge ratios because the cost-to-charge ratios are used to compute the estimated cost of a case, which in turn is used to determine if a particular case qualifies for an outlier payment or not. For example, if the cost-to-charge ratio decreases, then the estimated costs of a case with the same reported charges would decrease. Thus, the chances that the case would exceed the outlier loss threshold and qualify for an outlier payment would decrease, decreasing the likelihood that the case would qualify for an outlier payment. If fewer cases were to qualify for outlier payments, then total estimated outlier payments could fall below 3 percent of total estimated payments.

Our analyses of cost report data from FY 1999 through FY 2002 (and projections for FY 2004 though FY2006) indicate that the overall cost-tocharge ratios in IRFs have been falling since the IRF PPS was implemented. We are still analyzing possible reasons forthis finding. However, because cost-tocharge ratios are used to determine whether a particular case qualifies for an outlier payment, this drop in the cost-to-charge ratios is likely responsible for much of the drop in total estimated outlier payments below 3 percent of total estimated payments. Thus, the outlier threshold would need to be lowered from $11,211 to $4,911 for FY 2006 in order that total estimated outlier payments would equal 3 percent of total estimated payments.

In addition, we are proposing to adjust the outlier threshold for FY 2006 because RAND ’ s analysis of calendar year 2002 and FY 2003 data indicates that many of the other proposed changes discussed in this proposed rule would affect what the outlier threshold would need to be in order for total estimated outlier payments to equal 3 percent of total estimated payments. The outlier loss threshold is affected by the definitions of all other elements of the IRF PPS, including the structure of the CMGs and the tiers, the relative weights, the policies for very short-stay cases and for cases in which the patient expires in the facility (that is, cases that qualify for the special CMG assignments), and the facility-level adjustments (such as the rural adjustment, the LIP adjustment, and the proposed teaching status adjustment). In this proposed rule, we are proposing to change many of these components of the IRF PPS. For the reasons discussed above, then, we believe it is appropriate to update the outlier loss threshold for FY 2006. We expect to continue to adjust the outlier threshold in the future when the data indicate that total estimated outlier payments would deviate from equaling 3 percent of total estimated payments.

7. Proposed Budget Neutrality Factor Methodology for Fiscal Year 2006

We are proposing to make a one-time revision (for FY 2006) to the methodology found in § 412.624(d) in


### 30247 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

order to make the proposed changes to the tiers and CMGs, the rural adjustment, the LIP adjustment, and the proposed teaching status adjustment in a budget neutral manner. Accordingly, we are proposing to revise § 412.624(d) by adding a section § 412.624(d)(4) for fiscal year 2006. Specifically, we are proposing to revise the methodology found in § 412.624(d) by adding a new paragraph (d)(4). The addition of this paragraph would provide for the application of a factor, as specified by the Secretary, which would be applied to the standard payment amount in order to make the proposed changes described in this preamble in a budget neutral manner for FY 2006. In addition, this paragraph would be used in future years if we propose refinements to the above-cited adjustments. According to the revised methodology, we propose to apply the market basket increase factor (3.1 percent) to the standard payment conversion factor for FY 2005 ($12,958), which equals $13,360. Then, we propose a one-time reduction to the standard payment amount of 1.9 percent to adjust for coding changes that increased payment to IRFs (as discussed in section III.A of this proposed rule), which equals $13,106. We then propose to apply the budget neutral wage adjustment (as discussed in section III.B.2.f of this proposed rule) of 0.9996 to $13,106, which would result in a standard payment amount of $13,101. For FY 2006 only, we propose to change the methodology for computing the standard payment conversion factor by applying budget neutrality factors for the proposed changes to the tiers and CMGs, the rural adjustment, the LIP adjustment, and the proposed teaching status adjustment. The next section contains a detailed explanation of these proposed budget neutrality factors, including the steps for computing these factors and how they affect total estimated aggregate payments and payments to individual IRF providers. The factors we are proposing to apply (as discussed in the next section) are 0.9994 for the proposed tier and CMG changes, 0.9865 for the proposed teaching status adjustment, 0.9963 for the proposed change to the rural adjustment, and 0.9836 for the proposed change to the LIP adjustment. These factors are subject to change as we analyze more current data. We have combined these factors, by multiplying the four factors together, into one budget neutrality factor for all four of these proposed changes (0.9994 * 0.9865 * 0.9963 * 0.9836 = 0.9662). We apply this overall budget neutrality factor to $13,101, resulting in a standard payment conversion factor for FY 2006 of $12,658. Note that the FY 2006 standard payment conversion factor is lower than it was in FY 2005 because it needed to be reduced to ensure that estimated aggregate payments for FY 2006 would remain the same as they otherwise would have been without the proposed changes. If we did not proposed to decrease the standard payment conversion factor, each of the proposed changes would increase total estimated aggregate payments by increasing payments to rural and teaching facilities, and to facilities with a higher average case mix of patients and facilities that treat a higher proportion of low-income patients. To assess how overall payments to a particular type of IRF would likely be affected by the proposed budget-neutral changes, please see Table 13 of this proposed rule.

The FY 2006 standard payment conversion factor would be applied to each CMG relative weight shown in Table 6, Proposed Relative Weights for Case-Mix Groups, to compute the proposed unadjusted IRF prospective payment rates for FY 2006 shown in Table 12. To further clarify, the proposed one-time budget neutrality factors described above will only be applied for FY 2006. In addition, if no further refinements are proposed for subsequent fiscal years, we will use the methodology as described in § 412.624(c)(3)(ii).

8. Description of the Methodology Used To Implement the Proposed Changes in a Budget Neutral Manner

Section 1886(j)(2)(C)(i) of the Act confers broad statutory authority upon the Secretary to adjust the classification and weighting factors in order to account for relative resource use. In addition, section 1886(j)(2)(C)(ii) provides that insofar as the Secretary determines that such adjustments for a previous fiscal year (or estimates of such adjustments for a future fiscal year) did (or are likely to) result in a change in aggregated payments under the classification system during the fiscal year that are a result of changes in the coding or classification of patients that do not reflect real changes in case mix, the Secretary shall adjust the per payment unit payment rate for subsequent years to eliminate the effect of such coding or classification changes. Similarly, section 1886(j)(3)(A)(v) of the Act confers broad statutory authority upon the Secretary to adjust the per discharge payment rate by such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among IRFs. Consistent with this broad statutory authority, we are proposing to better distribute aggregate payments among IRFs to more accurately reflect their case mix and the increased costs associated with IRFs that have teaching programs, are located in rural areas, or treat a high proportion of low-income patients.

To ensure that total estimated aggregate payments to IRFs do not change with these proposed changes, we propose to apply a factor to the standard payment amount for each of the proposed changes to ensure that estimated aggregate payments in FY 2006 are not greater or less than those that would have been made in the year without the proposed changes. We propose to calculate these four factors using the following steps:

Step 1: Determine the FY 2006 IRF PPS standard payment amount using the FY 2005 standard payment conversion factor increased by the estimated market basket of 3.1 percent and reduced by 1.9 percent to account for coding changes (as discussed in section III.A of this proposed rule).

Step 2: Multiply the CBSA-based budget neutrality factor discussed in this preamble by the standard payment amount computed in step 1 to account for the wage index and labor-related share (0.9996), as discussed in section III.B.2.f of this proposed rule.

Step 3: Calculate the estimated total amount of IRF PPS payments for FY 2006 (with no change to the tiers and CMGs, no teaching status adjustment, and no changes to the rural and LIP adjustments).

Step 4: Apply the proposed new tier and CMG assignments (as discussed in section II) to calculate the estimated total amount of IRF PPS payments for

FY 2006.

Step 5: Divide the amount calculated in step 3 by the amount calculated in step 4 to determine the factor (currently estimated to be 0.9994) that maintains the same total estimated aggregate payments in FY 2006 with and without the proposed changes to the tier and CMG assignments.

Step 6: Apply the factor computed in step 5 to the standard payment amount from step 2, and calculate estimated total IRF PPS payment for FY 2006.

Step 7: Apply the proposed change to the rural adjustment (as discussed in section III.B.4 of this proposed rule) to calculate the estimated total amount of IRF PPS payments for FY 2006.

Step 8: Divide the amount calculated in step 6 by the amount calculated in step 7 to determine the factor (currently estimated to be 0.9963) that keeps total estimated payments in FY 2006 the


### 30248 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

same with and without the proposed change to the rural adjustment.

Step 9: Apply the factor computed in step 8 to the standard payment amount from step 6, and calculate estimated total IRF PPS payment for FY 2006.

Step 10: Apply the proposed change to the LIP adjustment (as discussed in section III.B.5 of this proposed rule) to calculate the estimated total amount of IRF PPS payments for FY 2006.

Step 11: Divide the amount calculated in step 9 by the amount calculated in step 10 to determine the factor (currently estimated to be 0.9836) that maintains the same total estimated aggregate payments in FY 2006 with and without the proposed change to the LIP adjustment.

Step 12: Apply the factor computed in step 11 to the standard payment amount from step 9, and calculate estimated total IRF PPS payment for FY 2006.

Step 13: Apply the proposed teaching status adjustment (as discussed in section III.B.5 of this proposed rule) to calculate the estimated total amount of IRF PPS payments for FY 2006.

Step 14: Divide the amount calculated in step 12 by the amount calculated in step 13 to determine the factor (currently estimated to be 0.9865) that maintains the same total estimated aggregate payments in FY 2006 with and without the proposed teaching status adjustment.

As discussed in section III.B.9 of this proposed rule, the proposed FY 2006 IRF PPS standard payment conversion factor that accounts for the proposed new tier and CMG assignments, the proposed changes to the rural and the LIP adjustments, and the proposed teaching status adjustment applies the following factors: the market basket update, the reduction of 1.9 percent toaccount for coding changes, the budgetneutral CBSA-based wage index and labor-related share budget neutrality factor of 0.9996, the proposed tier and CMG changes budget neutrality factor of 0.9994, the proposed rural adjustment budget neutrality factor of 0.9963, the proposed LIP adjustment budget neutrality factor of 0.9836, and the proposed teaching status adjustment budget neutrality factor of 0.9865.

Each of these proposed budget neutrality factors lowers the proposed standard payment amount. The budget neutrality factor for the proposed tier and CMG changes lowers the standard payment amount from $13,101 to $13,093. The budget neutrality factor for the proposed change to the rural adjustment lowers the standard payment amount from $13,093 to $13,045. The budget neutrality factor for the proposed change to the LIP adjustment lowers the standard payment amount from $13,045 to $12,831. Finally, the budget neutrality factor for the proposed teaching status adjustment lowers the standard payment amount from $12,831 to $12,658. As indicated previously, the standard payment conversion factor would need to be lowered in order to ensure that total estimated payments for FY 2006 with the proposed changes equal total estimated payments for FY 2006 without the proposed changes. This is because these four proposed changes would result in an increase, on average, to total estimated aggregate payments to IRFs, because IRFs with teaching programs, IRFs located in rural areas, IRFs with higher case mix, andIRFs with higher proportions of lowincome patients would receive higher payments. To maintain the same total estimated aggregate payments to all IRFs, then, we are proposing to redistribute payments among IRFs. Thus, some redistribution of payments occurs among facilities, while total estimated aggregate payments do not change. To determine how these proposed changes are estimated to affect payments among different types of facilities, please see Table 13 in this proposed rule.

9. Description of the Proposed IRF Standard Payment Conversion Factor for Fiscal Year 2006

In the August 7, 2001 final rule, we established a standard payment amount referred to as the budget neutral conversion factor under § 412.624(c). In accordance with the methodology described in § 412.624(c)(3)(i), the budget neutral conversion factor for FY 2002, as published in the August 7,2001 final rule, was $11,838.00. Under § 412.624(c)(3)(i), this amount reflects, as appropriate, any adjustments for outlier payments, budget neutrality, and coding and classification changes as described in § 412.624(d).

The budget neutral conversion factor is a standardized payment amount and the amount reflects the budget neutrality adjustment for FY 2002. The statute required a budget neutrality adjustment only for FYs 2001 and 2002. Accordingly, we believed it was more consistent with the statute to refer to the standard payment as a standard payment conversion factor, rather than refer to it as a budget neutral conversion factor. Consequently, we changed all references to budget neutral conversion factor to ‘‘ standard payment conversion factor. ’’

Under § 412.624(c)(3)(i), the standard payment conversion factor for FY 2002 of $11,838.00 reflected the budget neutrality adjustment described in § 412.624(d)(2). Under the then existing § 412.624(c)(3)(ii), we updated the FY 2002 standard payment conversion factor ($11,838.00) to FY 2003 by applying an increase factor (the market basket) of 3.0 percent, as described in the update notice published in the August 1, 2002 Federal Register (67 FR at 49931). This yielded the FY 2003 standard payment conversion factor of $12,193.00 that was published in the August 1, 2002 update notice (67 FR at 49931). The FY 2003 standard payment conversion factor ($12,193) was used to update the FY 2004 standard payment conversion factor by applying an increase factor (the market basket) of 3.2 percent and budget neutrality factor of 0.9954, as described in the August 1,

2003 Federal Register (68 FR at 45689). This yielded the FY 2004 standard payment conversion factor of $12,525 that was published in the August 1,

2003 Federal Register (68 FR at 45689). The FY 2004 standard payment conversion factor ($12,525) was used to update the FY 2005 standard payment conversion factor by applying an increase factor (the market basket) of 3.1 percent and budget neutrality factor of 1.0035, as described in the July 30, 2004 Federal Register (69 FR at 45766). This yielded the FY 2005 standard payment conversion factor of $12,958 as published in the July 30, 2004 Federal Register (69 FR at 45766).

We propose to use the revised methodology in accordance with § 412.624(c)(3)(ii)and as described in section III.B.7 of this proposed rule. To calculate the standard payment conversion factor for FY 2006, we are proposing to apply the market basket increase factor (3.1 percent) to the standard payment conversion factor for FY 2005 ($12,958), which equals $13,360. Then, we propose a one-time reduction to the standard payment amount of 1.9 percent to adjust for coding changes that increased payment to IRFs, which equals $13,106. We then propose to apply the budget neutral wage adjustment of 0.9996 to $13,106, which would result in a standard payment amount of $13,101. Next, we propose to apply a one-time budget neutrality factor (for FY 2006 only) for the proposed budget neutral refinements to the tiers and CMGs, the teaching status adjustment, the rural adjustment, and the adjustment for the proportion of low-income patients (of 0.9662) to $13,101, which would result in a standard payment conversion factor for FY 2006 of $12,658. The FY 2006 standard payment conversion factor would be applied to each CMG weight


### 30249 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

shown in Table 6, Proposed Relative Weights for Case-Mix Groups, to compute the unadjusted IRF prospective payment rates for FY 2006 shown in Table 12.

10. Example of the Proposed Methodology for Adjusting the Federal Prospective Payment Rates

To illustrate the methodology that we propose to use to adjust the Federal prospective payments (as described in section III.B.7 and section III.B.8 of this proposed rule), we provide an example in Table 11 below. One beneficiary is in Facility A, an IRF located in rural Montana, and another beneficiary is in Facility B, anIRF located in the New York City corebased statistical area. Facility A, a nonteaching hospital, has a disproportionate share hospital (DSH)adjustment of 5 percent, with a lowincome patient adjustment of (1.0315), a wage index of (0.8701), and an applicable rural area adjustment (24.1 percent). Facility B, a teaching hospital, has a DSH of 15 percent, with a LIP adjustment of (1.0929), a wage index of (1.3311), and an applicable teaching status adjustment of (1.109). Both Medicare beneficiaries are classified to CMG 0110 (without comorbidities). To calculate each IRF ’ s total proposed adjusted Federal prospective payment, we compute the wage-adjusted Federal prospective payment and multiply the result by the appropriate low-income patient adjustment, the rural adjustment (if applicable), and the teaching hospital adjustment (if applicable). Table 11 illustrates the components of the proposed adjusted payment calculation.

**BILLING CODE 4120**

**– 01** 

**– P** 

Thus, the proposed adjusted payment for Facility A would be $31,671.57, and the adjusted payment for Facility B would be $41,637.65.


### 30250 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30251 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30252 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**BILLING CODE 4120**

**– 01** 

**– C**  IV. Provisions of the Proposed Regulations

(If you choose to comment on issues in this section, please include the caption

‘‘ Provisions of the Proposed Regulations ’’ at the beginning of your comments.)

We are proposing to make revisions to the regulation in order to implement the proposed prospective payment for IRFs for FY 2006 and subsequent fiscal years. Specifically, we are proposing to make conforming changes in 42 CFR part 412. These proposed revisions and others are discussed in detail below.

A. Section 412.602 Definitions

In § 412.602, we are proposing to revise the definitions of ‘‘ Rural area ’’ and ‘‘ Urban area ’’ to read as follows:

Rural area means: For cost-reporting periods beginning on or after January 1, 2002, with respect to discharges occurring during the period covered by such cost reports but before October 1, 2005, an area as defined in § 412.62(f)(1)(iii). For discharges occurring on or after October 1, 2005, rural area means an area as defined in § 412.64(b)(1)(ii)(C).

Urban area means: For cost-reporting periods beginning on or after January 1, 2002, with respect to discharges occurring during the period covered by such cost reports but before October 1, 2005, an area as defined in § 412.62(f)(1)(ii). For discharges occurring on or after October 1, 2005, urban area means an area as defined in § 412.64(b)(1)(ii)(A) and § 412.64(b)(1)(ii)(B).


### 30253 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

B. Section 412.622 Basis of payment

In this section, we are proposing to correct the cross references in paragraphs (b)(1) and (b)(2)(i). In paragraph (b)(1), we are proposing to remove the cross references ‘‘§§ 413.85 and 413.86 of this chapter ’’ and add in their place ‘‘§ 413.75 and § 413.85 of this chapter. ’’ In paragraph (b)(2)(i), we are proposing to remove the cross reference ‘‘§ 413.80 of this chapter ’’ and add in its place ‘‘§ 413.89 of this chapter. ’’ C. Section 412.624 Methodology for calculating the Federal prospective payment rates.

• In paragraph (d)(1), removing the cross reference to ‘‘ paragraph (e)(4) ’’ and adding in its place ‘‘ paragraph (e)(5). ’’

• Adding a new paragraph (d)(4).

• Redesignating paragraphs (e)(4) and (e)(5) as paragraphs (e)(5) and (e)(6).

• Adding a new paragraph (e)(4).

• Revising newly redesignated paragraph (e)(5).

• Revising newly redesignated paragraph (e)(6).

• In paragraph (f)(2)(v), removing the cross references to ‘‘ paragraphs (e)(1), (e)(2), and (e)(3) of this section ’’ and adding in their place ‘‘ paragraphs (e)(1), (e)(2), (e)(3), and (e)(4) of this section. ’’

D. Additional Changes

• Reduce the standard payment conversion factor by 1.9 percent to account for coding changes.

• Revise the comorbidity tiers and CMGs.

• Use a weighted motor score index in assigning patients to CMGs.

• Update the relative weights.

• Update payments for rehabilitation facilities using a market basket reflecting the operating and capital cost structures for the RPL market basket.

• Provide the weights and proxies to use for the FY 2002-based RPL market basket.

• Indicate the methodology for the capital portion of the RPL market basket.

• Adopt the new geographic labor market area definitions as specified in § 412.64(b)(1)(ii)(A)

– (C).

• Use the New England MSAs as determined under the proposed new CBSA-based labor market area definitions.

• Use FY 2001 acute care hospital wage data in computing the FY 2006 IRF PPS payment rates.

• Implement a teaching status adjustment.

• Update the formulas used to compute the rural and the LIP adjustments to IRF payments. • Update the outlier threshold amount to maintain total outlier payments at 3 percent of total estimated payments.

• Revise the methodology for computing the standard payment conversion factor (for FY 2006 only) to make the proposed CMG and tier changes, the proposed teaching status adjustment, and the proposed updates to the rural and LIP adjustments in a budget neutral manner.

V. Collection of Information Requirements

This document does not impose information collection and recordkeeping requirements. Consequently, it need not be reviewed by the Office of Management and Budget under the authority of the Paperwork Reduction Act of 1995.

VI. Response to Comments

Because of the large number of public comments we normally receive on Federal Register documents, 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 preamble, and, when we proceed with a subsequent document, we will respond to the comments in the preamble to that document.

VII. Regulatory Impact Analysis [If you choose to comment on issues in this section, please include the caption

‘‘ Regulatory Impact Analysis ’’ at the beginning of your comments.]

A. Introduction

The August 7, 2001 final rule established the IRF PPS for the payment of Medicare services for cost reporting periods beginning on or after January 1, 2002. We incorporated a number ofelements into the IRF PPS, such as caselevel adjustments, a wage adjustment,an adjustment for the percentage of lowincome patients, a rural adjustment, and outlier payments. This proposed rule sets forth updates of the IRF PPS rates contained in the August 7, 2001 final rule and proposes policy changes with regard to the IRF PPS based on analyses conducted by RAND under contract with us on calendar year 2002 and FY 2003 data (updated from the 1999 data used to design the IRF PPS).

In constructing these impacts, we do not attempt to predict behavioral responses, nor do we make adjustments for future changes in such variables as discharges or case-mix. We note that certain events may combine to limit the scope or accuracy of our impact analysis, because such an analysis is future-oriented and, thus, susceptible to forecasting errors due to other changes in the forecasted impact time period. Some examples of such possible events are newly legislated general Medicare program funding changes by the Congress, or changes specifically related to IRFs. In addition, changes to the Medicare program may continue to be made as a result of the BBA, the BBRA, the BIPA, or new statutory provisions. Although these changes may not be specific to the IRF PPS, the nature of the Medicare program is such that the changes may interact, and the complexity of the interaction of these changes could make it difficult to predict accurately the full scope of the impact upon IRFs.

We have examined the impacts of this proposed rule as required by Executive Order 12866 (September 1993, Regulatory Planning and Review) and the Regulatory Flexibility Act (RFA) and Impact on Small Hospitals (September 16, 1980, Pub. L. 96

– 354), section 1102(b) of the Social Security Act, the Unfunded Mandates Reform Act of 1995 (Pub. L. 104

–4), and Executive Order

13132.

1. Executive Order 12866

Executive Order 12866 (as amended by Executive Order 13258, which merely reassigns responsibility of duties) directs agencies to assess all costs and benefits of available regulatory alternatives and, if regulation is necessary, to select regulatory approaches that maximize net benefits (including potential economic, environmental, public health and safety effects, distributive impacts, and equity). A regulatory impact analysis (RIA) must be prepared for major rules with economically significant effects ($100 million or more in any 1 year).

We estimate that the cost to the Medicare program for IRF services in FY 2006 will increase by $180 million over FY 2005 levels. The updates to the IRF labor-related share and wage indices are made in a budget neutral manner. We are proposing to make changes to the CMGs and the tiers, the teaching status adjustment, and the rural and LIP adjustments in a budget neutral manner (that is, in order that total estimated aggregate payments with the changes equal total estimated aggregate payments without the changes). This means that we are proposing to improve the distribution of payments among facilities depending on the mix of patients they treat, their teaching status, their geographic location (rural vs.urban), and the percentage of lowincome patients they treat, without changing total estimated aggregate


### 30254 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

payments. To accomplish this redistribution of payments among facilities, we lower the base payment amount, which then gets adjusted upward for each facility according to the facility ’ s characteristics. This proposed redistribution would not, however, affect aggregate payments to facilities. Thus, the proposed changes to the IRF labor-related share and the wage indices, the proposed changes to the CMGs, the tiers, and the motor score index, the proposed teaching status adjustment, the proposed update to the rural adjustment, and the proposed update to the LIP adjustment would have no overall effect on estimated costs to the Medicare program. Therefore, the estimated increased cost to the Medicare program is due to the updated IRF market basket of 3.1 percent, the 1.9 percent reduction to the standard payment conversion factor to account for changes in coding that affect total aggregate payments, and the update to the outlier threshold amount. We have determined that this proposed rule is a major rule as defined in 5 U.S.C. 804(2). Based on the overall percentage change in payments per case estimated using our payment simulation model (a 2.9 percent increase), we estimate that the total impact of these proposed changes for FY 2006 payments compared to FY 2005 payments would be approximately a $180 million increase. This amount does not reflect changes in IRF admissions or case-mix intensity, which would also affect overall payment changes.

2. Regulatory Flexibility Act (RFA)

The RFA requires agencies to analyze the economic impact of our regulations on small entities. If we determine that the proposed regulation would impose a significant burden on a substantial number of small entities, we must examine options for reducing the burden. For purposes of the RFA, small entities include small businesses, nonprofit organizations, and government agencies. Most IRFs and most other providers and suppliers are considered small entities, either by nonprofit status or by having revenues of $6 million to $29 million in any 1 year. (For details, see the Small Business Administration ’ s regulation that set forth size standards for health care industries at 65 at FR 69432.) Because we lack data on individual hospital receipts, we cannot determine the number of small proprietary IRFs. Therefore, we assume that all IRFs (approximate total of 1,200 IRFs, of which approximately 60 percent are nonprofit facilities) are considered small entities for the purpose of the analysis that follows. Medicare fiscal intermediaries and carriers are not considered to be small entities. Individuals and States are not included in the definition of a small entity.

3. Impact on Rural Hospitals

Section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any proposed rule that may have a significant impact on the operations of a substantial number of small rural hospitals. This analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we previously defined a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA). However, under the new labor market definitions that we are proposing to adopt, we would no longer employ NECMAs to define urban areas in New England. Therefore, for purposes of this analysis, we now define a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA).

As discussed in detail below, the rates and policies set forth in this proposed rule would not have an adverse impact on rural hospitals based on the data of the 169 rural units and 21 rural hospitals in our database of 1,188 IRFs for which data were available.

4. Unfunded Mandates Reform Act

Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L.

104

–4) also requires that agencies assess anticipated costs and benefits before issuing any proposed rule that may result in an expenditure in any 1 year by State, local, or tribal governments, in the aggregate, or by the private sector, of at least $110 million. This proposed rule would not mandate any requirements for State, local, or tribal governments, nor would it affect private sector costs.

5. Executive Order 13132

Executive Order 13132 establishes certain requirements that an agency must meet when it promulgates a proposed rule that imposes substantial direct requirement costs on State and local governments, preempts State law, or otherwise has Federalism implications. We have reviewed this proposed rule in light of Executive Order 13132 and have determined that it would not have any negative impact on the rights, roles, or responsibilities of State, local, or tribal governments. 6. Overall Impact The following analysis, in conjunction with the remainder of this document, demonstrates that this proposed rule is consistent with the regulatory philosophy and principles identified in Executive Order 12866, the RFA, and section 1102(b) of the Act. We have determined that the proposed rule would have a significant economic impact on a substantial number of small entities or a significant impact on the operations of a substantial number of small rural hospitals.

B. Anticipated Effects of the Proposed Rule

We discuss below the impacts of this proposed rule on the budget and on

IRFs.

1. Basis and Methodology of Estimates

In this proposed rule, we are proposing policy changes and payment rate updates for the IRF PPS. Based on the overall percentage change in payments per discharge estimated using a payment simulation model developed by RAND under contract with CMS (a 2.9 percent increase), we estimate the total impact of these proposed changes for FY 2006 payments compared to FY 2005 payments to be approximately a $180 million increase. This amount does not reflect changes in hospital admissions or case-mix intensity, which would also affect overall payment changes.

We have prepared separate impact analyses of each of the proposed changes to the IRF PPS. RAND ’ s payment simulation model relies on the most recent available data (FY 2003) to enable us to estimate the impacts on payments per discharge of certain changes we are proposing in this proposed rule.

The data used in developing the quantitative analyses of changes in payments per discharge presented below are taken from the FY 2003 MedPAR file and the most current Provider-Specific File that is used for payment purposes. Data from the most recently available IRF cost reports were used to estimate costs and to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to the proposed policy changes, and we do not adjust for future changes in such variables as admissions, lengths of stay, or case-mix. Second, due to the interdependent nature of the IRF PPS payment components, it is very difficult to precisely quantify the impact associated with each proposed change.


### 30255 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

Using cases in the FY 2003 MedPAR file, we simulated payments under the IRF PPS given various combinations of payment parameters.

The proposed changes discussed separately below are the following:

• The effects of the proposed annual market basket update (using the proposed rehabilitation hospital, psychiatric hospital, and long-term care hospital (RPL) market basket) to IRF PPS payment rates required by sections 1886(j)(3)(A)(i) and 1886(j)(3)(C) of the

Act.

• The effects of applying the proposed budget-neutral labor-related share and wage index adjustment, as required under section 1886(j)(6) of the

Act.

• The effects of the proposed decrease to the standard payment conversion factor to account for the increase in estimated aggregate payments due to changes in coding, as required under section 1886(j)(2)(C)(ii) of the Act.

• The effects of the proposed budgetneutral changes to the tier comorbidities, CMGs, motor score index, and relative weights, under the authority of section 1886(j)(2)(C)(i) of the Act.

• The effects of the proposed adoption of new CBSAs based on the new geographic area definitions announced by OMB in June 2003.

• The effects of the proposed implementation of a budget-neutral teaching status adjustment, as permitted under section 1886(j)(3)(A)(v) of the Act.

• The effects of the proposed budgetneutral update to the percentage amount by which payments are adjusted for IRFs located in rural areas, as permitted under section 1886(j)(3)(A)(v) of the Act.

• The effects of the proposed budgetneutral update to the formula used to calculate the payment adjustment forIRFs based on the percentage of lowincome patients they treat, as permitted under section 1886(j)(3)(A)(v) of the Act.

• The effects of the proposed change to the outlier loss threshold amount to maintain total estimated outlier payments at 3 percent of total estimated payments to IRFs in FY 2006, consistent with section 1886(j)(4) of the Act.

• The total change in payments based on the proposed FY 2006 policies relative to payments based on FY 2005 policies. To illustrate the impacts of the proposed FY 2006 changes, our analysis begins with a FY 2005 baseline simulation model using: IRF charges inflated to FY 2005 using the market basket; the FY 2005 PRICER; the estimated percent of outlier payments in FY 2005; the FY 2005 CMG GROUPER (version 1.22); the MSA designations for IRFs based on OMB ’ s MSA definitions prior to June 2003; the FY 2005 wage index; the FY 2005 labor-market share; the FY 2005 formula for the LIP adjustment; and the FY 2005 percentage amount of the rural adjustment.

Each proposed policy change is then added incrementally to this baseline model, finally arriving at a FY 2006 model incorporating all of the proposed changes to the IRF PPS. This allows us to isolate the effects of each change. Note that, in computing estimated payments per discharge for each of the proposed policy changes, the outlier loss threshold has been adjusted so that estimated outlier payments are 3 percent of total estimated payments.

Our final comparison illustrates the percent change in payments per discharge from FY 2005 to FY 2006. One factor that affects the proposed changes in IRFs ’ payments from FY 2005 to FY 2006 is that we currently estimate total outlier payments during FY 2005 to be 1.2 percent of total estimated payments. As discussed in the August 7, 2001 final rule (66 FR at 41362), our policy is to set total estimated outlier payments at 3 percent of total estimated payments. Because estimated outlier payments during FY 2005 were below 3 percent of total payments, payments in FY 2006 would increase by an additional 1.8 percent over payments in FY 2005 because of the proposed change in the outlier loss threshold to achieve the 3 percent target. 2. Analysis of Table 13

Table 13 displays the results of our analysis. The table categorizes IRFs by geographic location, including urban or rural location and location with respect to CMS ’ nine regions of the country. In addition, the table divides IRFs into those that are separate rehabilitation hospitals (otherwise called freestanding hospitals in this section), those that are rehabilitation units of a hospital (otherwise called hospital units in this section), rural or urban facilities by ownership (otherwise called for-profit, non-profit, and government), and by teaching status. The top row of the table shows the overall impact on the 1,188 IRFs included in the analysis.

The next twelve rows of Table 13 contain IRFs categorized according to their geographic location, designation as either a freestanding hospital or a unit of a hospital, and by type of ownership: all urban, which is further divided into urban units of a hospital, urban freestanding hospitals, by type of ownership, and rural, which is further divided into rural units of a hospital, rural freestanding hospitals, and by type of ownership. There are 998 IRFs located in urban areas included in our analysis. Among these, there are 802 IRF units of hospitals located in urban areas and 196 freestanding IRF hospitals located in urban areas. There are 190 IRFs located in rural areas included in our analysis. Among these, there are 169 IRF units of hospitals located in rural areas and 21 freestanding IRF hospitalslocated in rural areas. There are 354 forprofit IRFs. Among these, there are 295 IRFs in urban areas and 59 IRFs in rural areas. There are 708 non-profit IRFs. Among these, there are 603 urban IRFs and 105 rural IRFs. There are 126 government owned IRFs. Among these, there are 100 urban IRFs and 26 rural

IRFs.

The following three parts of Table 13 show IRFs grouped by their geographic location within a region, and the last part groups IRFs by teaching status. First, IRFs located in urban areas are categorized with respect to their location within a particular one of nine geographic regions. Second, IRFs located in rural areas are categorized with respect to their location within a particular one of the nine CMS regions. In some cases, especially for rural IRFs located in the New England, Mountain, and Pacific regions, the number of IRFs represented is small. Finally, IRFs are grouped by teaching status, including non-teaching IRFs, IRFs with an intern and resident to ADC ratio less than 10 percent, IRFs with an intern and resident to ADC ratio greater than or equal to 10 percent and less than or equal to 19 percent, and IRFs with an intern and resident to ADC ratio greater than 19 percent.

**BILLING CODE 4120**

**– 01** 

**– P** 


### 30256 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30257 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30258 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30259 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

3. Impact of the Proposed Market Basket Update to the IRF PPS Payment Rates (Using the RPL Market Basket) (Column 6, Table 13)

In column 6 of Table 13, we present the effects of the proposed market basket update to the IRF PPS payment rates, as discussed in section III.B.1 of this proposed rule. Section 1886(j)(3)(A)(i) of the Act requires us annually to update the per discharge prospective payment rate for IRFs by an increase factor specified by the Secretary and based on an appropriate percentage increase in a market basket of goods and services comprising services for which payment is made to IRFs, as specified in section 1886(j)(3)(C) of the Act.

As discussed in detail in section III.B.1 of this proposed rule, we are proposing to use a new market basket that reflects the operating and capital cost structures of inpatient rehabilitation facilities, inpatient psychiatric facilities, and long-term care hospitals, referred to as the rehabilitation hospital, psychiatric hospital, and long-term care hospital (RPL) market basket. The proposed FY 2006 update for IRF PPS payments using the proposed FY 2002-based RPL market basket and the Global Insight ’ s 4th quarter 2004 forecast would be 3.1 percent.

In the aggregate, and across all hospital groups, the proposed update would result in a 3.1 percent increase in overall payments to IRFs.

4. Impact of Updating the BudgetNeutral Labor-Related Share and MSABased Wage Index Adjustment (Column 4, Table 14)

In column 4 of Table 14, we present the effects of a budget-neutral update to the labor-related share and the wage index adjustment (using the geographic area definitions developed by OMB before June 2003), as discussed in section III.B.2 of this proposed rule. Since we are not proposing to use the MSA labor market definitions, table 14 is for reference purposes only.

Section 1886(j)(6) of the Act requires us annually to adjust the proportion of rehabilitation facilities ’ costs that are attributable to wages and wage-related costs, of the prospective payment rates under the IRF PPS for area differences in wage levels by a factor reflecting the relative hospital wage level in the geographic area of the rehabilitation facility compared to the national average wage level for such facilities. This section of the Act also requires any such adjustments to be made in a budget-neutral manner.

In accordance with section 1886(j)(6) of the Act, we are proposing to update the labor-related share and adopt the wage index adjustment based on CBSA designations in a budget neutral manner. However, if we do not adopt the CBSA-based designations, this would not change aggregated payments to IRF as indicated in the first row of column 4 in Table 14. If we only updatethe MSA-based wage index and laborrelated share, there would be small distributional effects among different categories of IRFs. For example, rural IRFs would experience a 1.0 percent decrease while urban facilities would experience a 0.1 percent increase inpayments based on the RLP laborrelated share and MSA-based wage index. Rural IRFs in the East South Central region would experience the largest decrease of 1.8 percent based on the proposed FY 2006 labor-related share and MSA-based wage index. Urban IRFs in the Pacific region would experience the largest increase in payments of 0.8 percent.


### 30260 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30261 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30262 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules


### 30263 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

**BILLING CODE 4120**

**– 01** 

**– C**  5. Impact of the Proposed 1.9 Percent Decrease in the Standard Payment Amount to Account for Coding Changes (Column 11, Table 13)

In column 11 of Table 13, we present the effects of the proposed decrease in the standard payment amount to account for the increase in aggregate payments due to changes in coding that do not reflect real changes in case mix, as discussed in section III.A of this proposed rule. Section 1886(j)(2)(C)(ii) of the Act requires us to adjust the per discharge PPS payment rate to eliminate the effect of coding or classification changes that do not reflect real changes in case mix if we determine that such changes result in a change in aggregate payments under the classification system. In the aggregate, and across all hospital groups, the proposed update would result in a 1.9 percent decrease in overall payments to IRFs. Thus, we estimate that the 1.9 percent reduction in the standard payment amount would result in a cost savings to the Medicare program of approximately $120 million.


### 30264 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

6. Impact of the Proposed Changes to the CMG Reclassifications and Recalibration of Relative Weights (Column 7, Table 13)

In column 7 of Table 13, we present the effects of the proposed changes to the tier comorbidities, the CMGs, the motor score index, and the proposed recalibration of the relative weights, as discussed in section II.A of this proposed rule. Section 1886(j)(2)(C)(i) of the Act requires us to adjust from time to time the classifications and weighting factors as appropriate to reflect changes in treatment patterns, technology, case mix, number of payment units for which payment under the IRF PPS is made, and any other factors which may affect the relative use of resources.

As described in section II.A.3 of this proposed rule, we are proposing to update the tier comorbidities to remove condition codes from the list that we believe no longer merit additional payments, move dialysis patients to tier one to increase payments for these patients, and to align payments with the comorbidity conditions according to their effects on the relative costliness of patients. We are also proposing to update the CMGs and the relative weights for the CMGs so that they better reflect the relative costliness of different types of IRF patients. We are also proposing to replace the current motor score index with a weighted motor score index that better estimates the relative costliness of IRF patients. Finally, we are proposing to change the coding of patients with missing information for the transfer to toilet item in the motor score index from 1 to 2.

To assess the impact of these proposed changes, we compared aggregate payments using the FY 2005 CMG relative weights (GROUPER version 1.22) to aggregate payments using the proposed FY 2006 CMG relative weights (GROUPER version 1.30). We note that, under the authority in section 1886(j)(2)(C)(i) of the Act and consistent with our rationale as described in section II.B.4 of this proposed rule, we have applied a budget neutrality factor to ensure that the overall payment impact of the proposed CMG changes is budget neutral (that is, in order that total estimated aggregate payments for FY 2006 with the change are equal to total estimated aggregate payment for FY 2006 without the change). Because we found that the proposed relative weights we would use for calculating the FY 2006 payment rates are slightly higher, on average, than the relative weights we are currently using, and that the effect of this would be to increase aggregate payments, the proposed budget neutrality factor for the CMG and tier changes lowers the standard payment amount somewhat. Because the lower standard payment amount is balanced by the higher average weights, the effect is no change in overall payments to IRFs. However, the distribution of payments among facilities is affected, with some facilities receiving higher payments and some facilities receiving lower payments as a result of the tier and CMG changes, as shown in column 7 of Table 13.

Although, in the aggregate, these proposed changes would not change overall payments to IRFs, as shown in the zero impact in the first row of column 7, there are distributional effects of these changes. On average, the impacts of these proposed changes on any particular group of IRFs are very small, with urban IRFs experiencing a 0.1 percent decrease and rural IRFs experiencing a 1.2 percent increase in aggregate payments. The largest impacts are a 2.7 percent increase among rural IRFs in the West North Central region and a 2.7 percent decrease among rural IRFs in the Pacific region.

7. Impact of the Proposed Changes to New Labor Market Areas (Column 4, Table 13)

In accordance with the broad discretion under section 1886(j)(6) of the Act, we currently define hospital labor market areas based on the definitions of Metropolitan Statistical Areas (MSAs), Primary MSAs (PMSAs), and New England County Metropolitan Areas (NECMAs) issued by OMB as discussed in section III.B.2 of this proposed rule. On June 6, 2003, OMB announced new Core-Based Statistical Areas (CBSAs), comprised of MSAs and the new Micropolitan Statistical Areas based on Census 2000 data. We are proposing to adopt the new MSA definitions, consistent with the inpatient prospective payment system, including the 49 new Metropolitan areas designated under the new definitions. We are also proposing to adopt MSA definitions in New England in place of NECMAs. We are proposing not to adopt the newly defined Micropolitan Statistical Areas for use in the payment system, as Micropolitan Statistical Areas would remain part of the statewide rural areas for purposes of the IRF PPS payments, consistent with payments under the inpatient prospective payment system.

The effects of these proposed changes to the new CBSA-based designations are isolated in column 4 of Table 13 by holding all other payment parameters constant in this simulation. That is, column 4 shows the percentage changes in payments when going from a model using the current MSA designations to a model using the proposed new CBSA designations (for Metropolitan areas only).

Table 15 below compares the shifts in proposed wage index values for IRFs for FY 2006 relative to FY 2005. A small number of IRFs (1.6 percent) would experience an increase of between 5 and 10 percent and 1.5 percent of IRFs would experience an increase of more than 10 percent. A small number of IRFs (2.5 percent) would experience decreases in their wage index values of at least 5 percent, but less than 10 percent. Furthermore, IRFs that would experience decreases in their wage index values of greater than 10 percent would be 0.7 percent.

The following table shows the projected impact for IRFs.



### TABLE 

### 15.

— P ROPOSED 

### I MPACT OF

THE 

### P ROPOSED 

### FY 2006 CBSABASED 

### A REA 

### WAGE 

### I NDEX

Percent change in area wage index Percent of IRFs

Decrease Greater Than 10.0 ......... 0.7 Decrease Between 5.0 and 10.0 .... 2.5 Decrease Between 2.0 and 5.0 ...... 5.7 Decrease Between 0 and 2.0 ......... 25.6 No Change ..................................... 37.2 Increase Between 0 and 2.0 .......... 22.1 Increase Between 2.0 and 5.0 ....... 3.3 Increase Between 5.0 and 10.0 ..... 1.6 Increase Greater Than 10.0 ........... 1.5

Total 1 .......................................... 100.0

1 May not exactly equal 100 percent due to rounding. 8. Impact of the Proposed Adjustment to the Outlier Threshold Amount (Column 5, Table 13)

We estimate total outlier payments in FY 2005 to be approximately 1.2 percent of total estimated payments, so we are proposing to update the threshold from $11,211 in FY 2005 to $4,911 in FY 2006 in order to set total estimated outlier payments in FY 2006 equal to 3 percent of total estimated payments in

FY 2006.

The impact of this proposed change (as shown in column 5 of table 13) is to increase total estimated payments to IRFs by about 1.8 percent.

The effect on payments to rural IRFs would be to increase payments by 3.9 percent, and the effect on payments to urban IRFs would be to increase payments by 1.6 percent. The largest effect would be a 9.5 percent increase in payments to rural IRFs in the Mountain region, and the smallest effect would be


### 30265 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

no change in payments for urban IRFs located in the East South Central region.

9. Impact of the Proposed BudgetNeutral Teaching Status Adjustment (Column 10, Table 13)

In column 10 of Table 13, we presentthe effects of the proposed budgetneutral implementation of a teaching status adjustment to the Federal prospective payment rate for IRFs that have teaching programs, as discussed in section III.B.3 of this proposed rule. Section 1886(j)(3)(A)(v) of the Act requires the Secretary to adjust the Federal prospective payment rates for IRFs under the IRF PPS for such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among rehabilitation facilities. Under the authority of section 1886 (j)(3)(A)(v) of the Act, we are proposing to apply a budget neutrality factor to ensure that the overall payment impact of the proposed teaching status adjustment is budget neutral (that is, in order that total estimated aggregate payments for FY 2006 with the proposed adjustment would equal total estimated aggregate payments for FY 2006 without the proposed adjustment). Because IRFs with teaching programs would receive additional payments from the implementation of this proposed new teaching status adjustment, the effect of the proposed budget neutrality factor would be to reduce the standard payment amount, therefore reducing payments to IRFs without teaching programs. By design, however, the increased payments to teaching facilities would balance the decreased payments to non-teaching facilities, and total estimated aggregate payments to all IRFs would remain unchanged. Therefore, the first row of column 10 of Table 13 indicates a zero impact in the aggregate. However, the rest of column 10 gives the distributional effects among different types of providers of this change. Some providers ’ payments increase and some decrease with this change.

On average, the impacts of this proposed change on any particular group of IRFs are very small, with urban IRFs experiencing a 0.1 percent increase and rural IRFs experiencing a 1.1 percent decrease. The largest impacts are a 2.0 percent increase among urban IRFs in the Middle Atlantic region and 1.2 percent decreases among rural IRFs in the Middle Atlantic, South Atlantic, and West South Central regions.

Overall, non-teaching hospitals would experience a 1.1 percent decrease. The largest impacts are a 24.3 percent increase among teaching facilities with intern and resident to ADC ratios greater than 19 percent. Teaching facilities that have intern and resident to ADC ratios greater than or equal to 10 percent and less than or equal to 19 percent would experience an increase of 11 percent. Teaching facilities with resident and intern to ADC ratios less than 10 percent would experience an increase of 2.6 percent. 10. Impact of the Proposed Update to the Rural Adjustment (Column 8, Table 13)

In column 8 of Table 13, we presentthe effects of the proposed budgetneutral update to the percentage adjustment to the Federal prospective payment rates for IRFs located in rural areas, as discussed in section III.B.4 of this proposed rule. Section 1886(j)(3)(A)(v) of the Act requires the Secretary to adjust the Federal prospective payment rates for IRFs under the IRF PPS for such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among rehabilitation facilities.

In accordance with section 1886(j)(3)(A)(v) of the Act, we are proposing to change the rural adjustment percentage, based on FY 2003 data, from 19.14 percent to 24.1 percent.

Because we are proposing to make this proposed update to the rural adjustment in a budget neutral manner under the broad authority conferred by section 1886(j)(3)(A)(v) of the Act, payments to urban facilities would decrease in proportion to the total increase in payments to rural facilities. To accomplish this redistribution of resources between urban and rural facilities, we propose to apply a budget neutrality factor to reduce the standard payment amount. Rural facilities would receive an increase in payments to this amount, and urban facilities would not. Overall, aggregate payments to IRFs would not change, as indicated by the zero impact in the first row of column 8. However, payments would be redistributed among rural and urban IRFs, as indicated by the rest of the column. On average, because there are a relatively small number of rural facilities, the impacts of this proposed change on urban IRFs are relatively small, with all urban IRFs experiencing a 0.3 percent decrease. The impact on rural IRFs is somewhat larger, with rural IRFs experiencing a 3.4 percent increase. The largest impacts are a 3.6 percent increase among rural IRFs in the Middle Atlantic region.

11. Impact of the Proposed Update to the LIP Adjustment (Column 9, Table 13)

In column 9 of Table 13, we presentthe effects of the proposed budgetneutral update to the adjustment to the Federal prospective payment rates forIRFs according to the percentage of lowincome patients they treat, as discussed in section III.B.5 of this proposed rule. Section 1886(j)(3)(A)(v) of the Act requires the Secretary to adjust the Federal prospective payment rates for IRFs under the IRF PPS for such factors as the Secretary determines are necessary to properly reflect variations in necessary costs of treatment among rehabilitation facilities.

In accordance with section 1886(j)(3)(A)(v) of the Act, we are proposing to change the formula for the LIP adjustment, based on FY 2003 data, to raise the amount of 1 plus the DSH patient percentage to the power of 0.636 instead of the power of 0.4838. Therefore, the formula to calculate the low-income patient or LIP adjustment would be as follows:

(1 + DSH patient percentage) raised to the power of (.636) Where DSH patient percentage =



### Medicare SSI Days Medicaid, NonMedicare Days Total Days Total Medicare Days +

Because we are proposing to make this proposed update to the LIP adjustment in a budget neutral manner, payments would be redistributed amongproviders, according to their lowincome percentages, but total estimated aggregate payments to facilities would not change. To do this, we propose to apply a budget neutrality factor that lowers the standard payment amount in proportion to the amount of payment increase that is attributable to the increased LIP adjustment payments. This would result in no change to aggregate payments, which is reflected in the zero impact shown in the first row of column 9 of Table 13. The remaining rows of the column show the


### 30266 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

impacts on different categories of providers. On average, the impacts of this proposed change on any particular group of IRFs are small, with urban IRFs experiencing no change in aggregate payments and rural IRFs experiencing a 0.1 percent decrease in aggregate payments. The largest impacts are a 1.2 percent increase among IRFs with 10 percent or higher intern and resident to ADC ratios and 0.9 percent decrease among rural IRFs in the Pacific region.

12. All Proposed Changes (Column 12, Table 13)

Column 12 of Table 13 compares our estimates of the proposed payments per discharge, incorporating all proposed changes reflected in this proposed rule for FY 2006, to our estimates of payments per discharge in FY 2005 (without these proposed changes). This column includes all of the proposed policy changes.

Column 12 reflects all FY 2006 proposed changes relative to FY 2005, shown in columns 4 though 11. The average increase for all IRFs is approximately 2.9 percent. This increase includes the effects of the proposed 3.1 percent market basket update. It also reflects the 1.8 percentage point difference between the estimated outlier payments in FY 2005 (1.2 percent of total estimated payments) and the proposed estimate of the percentage of outlier payments in FY 2006 (3 percent), as described in the introduction to the Addendum to this proposed rule. As a result, payments per discharge are estimated to be 1.8 percent lower in FY 2005 than they would have been had the 3 percent target outlier payment percentage been met, resulting in a 1.8 percent greater increase in total FY 2006 payments than would otherwise have occurred.

It also includes the impact of the proposed one-time 1.9 percent reduction in the standard payment conversion factor to account for changes in coding that increased payments to IRFs. Because we propose to make the remainder of the proposed changes outlined in this proposed rule in a budget-neutral manner, they do not affect total IRF payments in the aggregate. However, as described in more detail in each section, they do affect the distribution of payments among providers.

There might also be interactive effects among the various proposed factors comprising the payment system that we are not able to isolate. For these reasons, the values in column 12 may not equal the sum of the proposed changes described above. The proposed overall change in payments per discharge for IRFs in FY 2006 would increase by 2.9 percent, as reflected in column 12 of Table 13. IRFs in urban areas would experience a 2.6 percent increase in payments per discharge compared with FY 2005. IRFs in rural areas, meanwhile, would experience a 6.8 percent increase. Rehabilitation units in urban areas would experience a 5 percent increase in payments per discharge, while freestanding rehabilitation hospitals in urban areas would experience a 1.1 percent decrease in payments per discharge. Rehabilitation units in rural areas would experience a 6.5 percent increase in payments per discharge, while freestanding rehabilitation hospitals in rural areas would experience a 8.1 percent increase in payments per discharge.

Overall, the largest payment increase would be 32.1 percent among teaching IRFs with an intern and resident to ADC ratio greater than 19 percent and 15.8 percent among teaching IRFs with an intern and resident to ADC ratio greater than or equal to 10 percent and less than or equal to 19 percent. This is largely due to the proposed teaching status adjustment. Other than for teaching IRFs, the largest payment increase would be 12.3 percent among rural IRFs located in the Middle Atlantic region. This is due largely to the change in the proposed CBSA-based designation from urban to rural, whereby the number of cases in the rural Middle Atlantic Region that would receive the proposed new rural adjustment of 24.1 percent would increase. The only overall decreases in payments would occur among all urban freestanding IRFs and urban IRFs located in the New England, East South Central, and Mountain census regions. The largest of these overall payment decreases would be 1.3 percent among all urban freestanding hospitals. This is due largely to the proposed change in the CBSA-based designation from rural to urban. For non-profit IRFs, we found that rural non-profit facilities would receive the largest payment increase of 8 percent. Conversely, for-profit urban facilities would experience a 1.1 percent overall decrease.

13. Accounting Statement

As required by OMB Circular A

–4 (available at http:// www.whitehouse.gov/omb/circulars/ a004/a-4.pdf ), in Table 16 below, we have prepared an accounting statement showing the classification of the expenditures associated with the provisions of this proposed rule. This table provides our best estimate of the increase in Medicare payments under the IRF PPS as a result of the proposed changes presented in this proposed rule based on the data for 1,188 IRFs in our database. All expenditures are classified as transfers to Medicare providers (that is, IRFs).



### TABLE 

### 16.

—A CCOUNTING 

### S TATEMENT 

### : C LASSIFICATION OF 

### E STIMATED 

### E X



### PENDITURES 

### , F ROM 

### FY 2005 TO 

### FY 2006 (I N MILLIONS 

### )

Category Transfers

Annualized Monetized

Transfers. $180

From Whom To

Whom? Federal Government To IRF Medicare Providers.

List of Subjects in 42 CFR Part 412

Administrative practice and procedure, Health facilities, Medicare, Puerto Rico, Reporting and recordkeeping requirements.

For the reasons set forth in the preamble, the Centers for Medicare & Medicaid Services proposes to amend 42 CFR chapter IV as follows:

**PART 412**

**— PROSPECTIVE PAYMENT**  **SYSTEMS FOR INPATIENT HOSPITAL SERVICES** 

1. The authority citation for part 412 continues to read as follows:

Authority: Secs. 1102 and 1871 of the Social Security Act (42 U.S.C. 1302 and 1395hh).

**Subpart P**

**— Prospective Payment for**  **Inpatient Rehabilitation Hospitals and Rehabilitation Units** 

2. Section 412.602 is amended by revising the definitions of ‘‘ Rural area ’’ and ‘‘ Urban area ’’ to read as follows:

**§ 412.602 Definitions.** 

* * * * *

Rural area means: For cost-reporting periods beginning on or after January 1, 2002, with respect to discharges occurring during the period covered by such cost reports but before October 1, 2005, an area as defined in § 412.62(f)(1)(iii). For discharges occurring on or after October 1, 2005, rural area means an area as defined in § 412.64(b)(1)(ii)(C).

* * * * *

Urban area means: For cost-reporting periods beginning on or after January 1, 2002, with respect to discharges occurring during the period covered by such cost reports but before October 1, 2005, an area as defined in § 412.62(f)(1)(ii). For discharges occurring on or after October 1, 2005,


### 30267 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

urban area means an area as defined in § 412.64(b)(1)(ii)(A) and § 412.64(b)(1)(ii)(B).

**§ 412.622 [Amended]** 

3. Section 412.622 is amended by

— A. In paragraph (b)(1), removing the cross references ‘‘§§ 413.85 and 413.86 of this chapter ’’ and adding in their place ‘‘§ 413.75 and § 413.85 of this chapter ’’

.

B. In paragraph (b)(2)(i), removing the cross reference to ‘‘§ 413.80 of this chapter ’’ and adding in its place ‘‘§ 413.89 of this chapter ’’

.

4. Section 412.624 is amended by

— a. In paragraph (d)(1), removing the cross reference to ‘‘ paragraph (e)(4) ’’ and adding in its place ‘‘ paragraph (e)(5) ’’

.

b. Adding a new paragraph (d)(4). c. Redesignating paragraphs (e)(4) and (e)(5) as paragraphs (e)(5) and (e)(6).

d. Adding a new paragraph (e)(4). e. Revising newly redesignated paragraph (e)(5).

f. Revising newly redesignated paragraph (e)(6).

g. In paragraph (f)(2)(v), removing the cross references to ‘‘ paragraphs (e)(1), (e)(2), and (e)(3) of this section ’’ and adding in their place ‘‘ paragraphs (e)(1), (e)(2), (e)(3), and (e)(4) of this section ’’

.

The revisions and additions read as follows:

**§ 412.624 Methodology for calculating the**  **Federal prospective payment rates.**

* * * * *

(d) * * * (4) Payment adjustment for Federal fiscal year 2006 and subsequent Federal fiscal years. CMS adjusts the standard payment conversion factor based on any updates to the adjustments specified in paragraph (e)(2), (e)(3), and (e)(4), of this section, and to any revision specified in § 412.620(c).

(e) * * * (4) Adjustments for teaching hospitals. For discharges on or after October 1, 2005, CMS adjusts the Federal prospective payment on a facility basis by a factor as specified by CMS for facilities that are teaching institutions or units of teaching institutions. This adjustment is made on a claim basis as an interim payment and the final payment in full for the claim is made during the final settlement of the cost report.

(5) Adjustment for high-cost outliers. CMS provides for an additional payment to an inpatient rehabilitation facility if its estimated costs for a patient exceed a fixed dollar amount (adjusted for area wage levels and factors to account for treating low-income patients, for rural location, and for teaching programs) as specified by CMS. The additional payment equals 80 percent of the difference between the estimated cost of the patient and the sum of the adjusted Federal prospective payment computed under this section and the adjusted fixed dollar amount. Effective for discharges occurring on or after October 1, 2003, additional payments made under this section will be subject to the adjustments at § 412.84(i), except that national averages will be used instead of statewide averages. Effective for discharges occurring on or after October 1, 2003, additional payments made under this section will also be subject to adjustments at § 412.84(m).

(6) Adjustments related to the patient

assessment instrument. An adjustment to a facility ’ s Federal prospective payment amount for a given discharge will be made, as specified under § 412.614(d), if the transmission of data from a patient assessment instrument is late.

* * * * * (Catalog of Federal Domestic Assistance Program No. 93.773, Medicare

—Hospital Insurance; and Program No. 93.774, Medicare

— Supplementary Medical Insurance Program)

Dated: April 14, 2005. Mark B. McClellan, Administrator, Centers for Medicare & Medicaid Services.

Approved: May 4, 2005. Michael O. Leavitt, Secretary.

The following addendum will not appear in the Code of Federal Regulations.

Addendum

This addendum contains the tables referred to throughout the preamble to this proposed rule. The tables presented below are as follows:

Table 1A.

—FY 2006 IRF PPS MSA Labor Market Area Designations for Urban Areas for the purposes of comparing Wage Index values with Table 2A.

Table 1B.

—FY 2006 IRF PPS MSA Labor Market Area Designations for Rural Areas for the purposes of comparing Wage Index values with Table 2B.

Table 2A.

—Proposed Inpatient Rehabilitation Facility (IRF) wage index for urban areas based on proposed CBSA labor market areas for discharges occurring on or after October 1, 2005.

Table 2B.

—Proposed Inpatient Rehabilitation Facility (IRF) wage index based on proposed CBSA labor market areas for rural areas for discharges occurring on or after October 1, 2005.

Table 3

—Inpatient Rehabilitation Facilities with Corresponding State and County Location; Current Labor Market Area Designation; and Proposed New CBSA-based Labor Market Area Designation.



### TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A

MSA Urban area (Constituent Counties or County Equivalents) Wage index

0040 ......... Abilene, TX ....................................................................................................... ..................................................................... 0.8009 Taylor, TX. 0060 ......... Aguadilla, PR ..................................................................................................... .................................................................... 0.4294 Aguada, PR. Aguadilla, PR. Moca, PR. 0080 ......... Akron, OH ......................................................................................................... ..................................................................... 0.9055 Portage, OH. Summit, OH. 0120 ......... Albany, GA ........................................................................................................ ..................................................................... 1.1266 Dougherty, GA. Lee, GA. 0160 ......... Albany-Schenectady-Troy, NY ....................................................................................... ....................................................... 0.8570 Albany, NY. Montgomery, NY. Rensselaer, NY.


### 30268 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Saratoga, NY. Schenectady, NY. Schoharie, NY. 0200 ......... Albuquerque, NM ................................................................................................... ................................................................ 1.0485 Bernalillo, NM. Sandoval, NM. Valencia, NM. 0220 ......... Alexandria, LA .................................................................................................... ................................................................... 0.8171 Rapides, LA. 0240 ......... Allentown-Bethlehem-Easton, PA .................................................................................... ...................................................... 0.9536 Carbon, PA. Lehigh, PA. Northampton, PA. 0280 ......... Altoona, PA ....................................................................................................... ..................................................................... 0.8462 Blair, PA. 0320 ......... Amarillo, TX ...................................................................................................... ..................................................................... 0.9178 Potter, TX. Randall, TX. 0380 ......... Anchorage, AK ..................................................................................................... .................................................................. 1.2109 Anchorage, AK. 0440 ......... Ann Arbor, MI ..................................................................................................... ................................................................... 1.0816 Lenawee, MI. Livingston, MI. Washtenaw, MI. 0450 ......... Anniston,AL ....................................................................................................... ..................................................................... 0.7881 Calhoun, AL. 0460 ......... Appleton-Oshkosh-Neenah, WI ....................................................................................... ...................................................... 0.9115 Calumet, WI. Outagamie, WI. Winnebago, WI. 0470 ......... Arecibo, PR ....................................................................................................... ..................................................................... 0.3757 Arecibo, PR. Camuy, PR. Hatillo, PR. 0480 ......... Asheville, NC ..................................................................................................... .................................................................... 0.9501 Buncombe, NC. Madison, NC. 0500 ......... Athens, GA ........................................................................................................ .................................................................... 1.0202 Clarke, GA. Madison, GA. Oconee, GA. 0520 ......... Atlanta, GA ....................................................................................................... ..................................................................... 0.9971 Barrow, GA. Bartow, GA. Carroll, GA. Cherokee, GA. Clayton, GA. Cobb, GA. Coweta, GA. De Kalb, GA. Douglas, GA. Fayette, GA. Forsyth, GA. Fulton, GA. Gwinnett, GA. Henry, GA. Newton, GA. Paulding, GA. Pickens, GA. Rockdale, GA. Spalding, GA. Walton, GA. 0560 ......... Atlantic City-Cape May, NJ ........................................................................................ ........................................................... 1.0907 Atlantic City, NJ. Cape May, NJ. 0580 ......... Auburn-Opelika, AL ................................................................................................ ............................................................... 0.8215 Lee, AL. 0600 ......... Augusta-Aiken, GA-SC .............................................................................................. ............................................................ 0.9208 Columbia, GA. McDuffie, GA.


### 30269 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Richmond, GA. Aiken, SC. Edgefield, SC. 0640 ......... Austin-San Marcos, TX ............................................................................................. ............................................................. 0.9595 Bastrop, TX. Caldwell, TX. Hays, TX. Travis, TX. Williamson, TX. 0680 ......... Bakersfield, CA ................................................................................................... ................................................................... 1.0036 Kern, CA. 0720 ......... Baltimore, MD ..................................................................................................... ................................................................... 0.9907 Anne Arundel, MD. Baltimore, MD. Baltimore City, MD. Carroll, MD. Harford, MD. Howard, MD. Queen Annes, MD. 0733 ......... Bangor, ME ........................................................................................................ .................................................................... 0.9955 Penobscot, ME. 0743 ......... Barnstable-Yarmouth, MA ........................................................................................... .......................................................... 1.2335 Barnstable, MA. 0760 ......... Baton Rouge, LA ................................................................................................... ................................................................ 0.8354 Ascension, LA. East Baton Rouge. Livingston, LA. West Baton Rouge, LA. 0840 ......... Beaumont-Port Arthur, TX .......................................................................................... ........................................................... 0.8616 Hardin, TX. Jefferson, TX. Orange, TX. 0860 ......... Bellingham, WA .................................................................................................... ................................................................. 1.1642 Whatcom, WA. 0870 ......... Benton Harbor, MI ................................................................................................. ................................................................ 0.8847 Berrien, MI. 0875 ......... Bergen-Passaic, NJ ................................................................................................ ............................................................... 1.1967 Bergen, NJ. Passaic, NJ. 0880 ......... Billings, MT ...................................................................................................... ...................................................................... 0.8961 Yellowstone, MT. 0920 ......... Biloxi-Gulfport-Pascagoula, MS .................................................................................... ......................................................... 0.8649 Hancock, MS. Harrison, MS. Jackson, MS. 0960 ......... Binghamton, NY .................................................................................................... ................................................................. 0.8447 Broome, NY. Tioga, NY. 1000 ......... Birmingham, AL .................................................................................................... ................................................................. 0.9198 Blount, AL. Jefferson, AL. St. Clair, AL. Shelby, AL. 1010 ......... Bismarck, ND ...................................................................................................... ................................................................... 0.7505 Burleigh, ND. Morton, ND. 1020 ......... Bloomington, IN ................................................................................................... .................................................................. 0.8587 Monroe, IN. 1040 ......... Bloomington-Normal, IL ............................................................................................ ............................................................. 0.9111 McLean, IL. 1080 ......... Boise City, ID .................................................................................................... ..................................................................... 0.9352 Ada, ID. Canyon, ID. 1123 ......... Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH .................................................................. ....................................... 1.1290 Bristol, MA. Essex, MA. Middlesex, MA. Norfolk, MA. Plymouth, MA. Suffolk, MA.


### 30270 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Worcester, MA. Hillsborough, NH. Merrimack, NH. Rockingham, NH. Strafford, NH. 1125 ......... Boulder-Longmont, CO .............................................................................................. ............................................................ 1.0046 Boulder, CO. 1145 ......... Brazoria, TX ...................................................................................................... ..................................................................... 0.8524 Brazoria, TX. 1150 ......... Bremerton, WA ..................................................................................................... ................................................................. 1.0614 Kitsap, WA. 1240 ......... Brownsville-Harlingen-San Benito, TX .............................................................................. .................................................... 1.0125 Cameron, TX. 1260 ......... Bryan-College Station, TX ......................................................................................... ............................................................ 0.9243 Brazos, TX. 1280 ......... Buffalo-Niagara Falls, NY ......................................................................................... ............................................................. 0.9339 Erie, NY. Niagara, NY. 1303 ......... Burlington, VT .................................................................................................... .................................................................... 0.9322 Chittenden, VT. Franklin, VT. Grand Isle, VT. 1310 ......... Caguas, PR ........................................................................................................ ................................................................... 0.4061 Caguas, PR. Cayey, PR. Cidra, PR. Gurabo, PR. San Lorenzo, PR. 1320 ......... Canton-Massillon, OH .............................................................................................. .............................................................. 0.8895 Carroll, OH. Stark, OH. 1350 ......... Casper, WY ........................................................................................................ ................................................................... 0.9243 Natrona, WY. 1360 ......... Cedar Rapids, IA .................................................................................................. ................................................................. 0.8975 Linn, IA. 1400 ......... Champaign-Urbana, IL .............................................................................................. ............................................................ 0.9527 Champaign, IL. 1440 ......... Charleston-North Charleston, SC ................................................................................... ....................................................... 0.9420 Berkeley, SC. Charleston, SC. Dorchester, SC. 1480 ......... Charleston, WV .................................................................................................... .................................................................. 0.8876 Kanawha, WV. Putnam, WV. 1520 ......... Charlotte-Gastonia-Rock Hill, NC-SC ............................................................................... ..................................................... 0.9711 Cabarrus, NC. Gaston, NC. Lincoln, NC. Mecklenburg, NC. Rowan, NC. Union, NC. York, SC. 1540 ......... Charlottesville, VA ............................................................................................... .................................................................. 1.0294 Albemarle, VA. Charlottesville City, VA. Fluvanna, VA. Greene, VA. 1560 ......... Chattanooga, TN-GA ................................................................................................ ............................................................. 0.9207 Catoosa, GA. Dade, GA. Walker, GA. Hamilton, TN. Marion, TN. 1580 ......... Cheyenne, WY ...................................................................................................... ................................................................. 0.8980 Laramie, WY. 1600 ......... Chicago, IL ....................................................................................................... ...................................................................... 1.0851 Cook, IL. De Kalb, IL. Du Page, IL. Grundy, IL.


### 30271 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Kane, IL. Kendall, IL. Lake, IL. McHenry, IL. Will, IL. 1620 ......... Chico-Paradise, CA ................................................................................................ ............................................................... 1.0542 Butte, CA. 1640 ......... Cincinnati, OH-KY-IN .............................................................................................. ............................................................... 0.9595 Dearborn, IN. Ohio, IN. Boone, KY. Campbell, KY. Gallatin, KY. Grant, KY. Kenton, KY. Pendleton, KY. Brown, OH. Clermont, OH. Hamilton, OH. Warren, OH. 1660 ......... Clarksville-Hopkinsville, TN-KY ................................................................................... .......................................................... 0.8022 Christian, KY. Montgomery, TN. 1680 ......... Cleveland-Lorain-Elyria, OH ....................................................................................... ........................................................... 0.9626 Ashtabula, OH. Geauga, OH. Cuyahoga, OH. Lake, OH. Lorain, OH. Medina, OH. 1720 ......... Colorado Springs, CO .............................................................................................. ............................................................. 0.9792 El Paso, CO. 1740 ......... Columbia MO ....................................................................................................... .................................................................. 0.8396 Boone, MO. 1760 ......... Columbia, SC ...................................................................................................... ................................................................... 0.9450 Lexington, SC. Richland, SC. 1800 ......... Columbus, GA-AL ................................................................................................... ............................................................... 0.8690 Russell, AL. Chattanoochee, GA. Harris, GA. Muscogee, GA. 1840 ......... Columbus, OH ...................................................................................................... ................................................................. 0.9753 Delaware, OH. Fairfield, OH. Franklin, OH. Licking, OH. Madison, OH. Pickaway, OH. 1880 ......... Corpus Christi, TX ................................................................................................ ................................................................. 0.8647 Nueces, TX. San Patricio, TX. 1890 ......... Corvallis, OR ..................................................................................................... ..................................................................... 1.0545 Benton, OR. 1900 ......... Cumberland, MD-WV ................................................................................................. ............................................................ 0.8662 Allegany MD. Mineral WV. 1920 ......... Dallas, TX ........................................................................................................ ...................................................................... 1.0054 Collin, TX. Dallas, TX. Denton, TX. Ellis, TX. Henderson, TX. Hunt, TX. Kaufman, TX. Rockwall, TX. 1950 ......... Danville, VA ...................................................................................................... ..................................................................... 0.8643 Danville City, VA. Pittsylvania, VA. 1960 ......... Davenport-Moline-Rock Island, IA-IL ............................................................................... ...................................................... 0.8773


### 30272 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Scott, IA. Henry, IL. Rock Island, IL. 2000 ......... Dayton-Springfield, OH ............................................................................................ .............................................................. 0.9231 Clark, OH. Greene, OH. Miami, OH. Montgomery, OH. 2020 ......... Daytona Beach, FL ................................................................................................. ............................................................... 0.8900 Flagler, FL. Volusia, FL. 2030 ......... Decatur, AL ....................................................................................................... ..................................................................... 0.8894 Lawrence, AL. Morgan, AL. 2040 ......... Decatur, IL ....................................................................................................... ...................................................................... 0.8122 Macon, IL. 2080 ......... Denver, CO ........................................................................................................ .................................................................... 1.0904 Adams, CO. Arapahoe, CO. Broomfield, CO. Denver, CO. Douglas, CO. Jefferson, CO. 2120 ......... Des Moines, IA .................................................................................................... .................................................................. 0.9266 Dallas, IA. Polk, IA. Warren, IA. 2160 ......... Detroit, MI ....................................................................................................... ....................................................................... 1.0227 Lapeer, MI. Macomb, MI. Monroe, MI. Oakland, MI. St. Clair, MI. Wayne, MI. 2180 ......... Dothan, AL ........................................................................................................ ..................................................................... 0.7596 Dale, AL. Houston, AL. 2190 ......... Dover, DE ......................................................................................................... ..................................................................... 0.9825 Kent, DE. 2200 ......... Dubuque, IA ....................................................................................................... .................................................................... 0.8748 Dubuque, IA. 2240 ......... Duluth-Superior, MN-WI ............................................................................................ ............................................................ 1.0356 St. Louis, MN. Douglas, WI. 2281 ......... Dutchess County, NY ............................................................................................... ............................................................. 1.1657 Dutchess, NY. 2290 ......... Eau Claire, WI .................................................................................................... ................................................................... 0.9139 Chippewa, WI. Eau Claire, WI. 2320 ......... El Paso, TX ....................................................................................................... ..................................................................... 0.9181 El Paso, TX. 2330 ......... Elkhart-Goshen, IN ................................................................................................ ................................................................ 0.9278 Elkhart, IN. 2335 ......... Elmira, NY ........................................................................................................ ...................................................................... 0.8445 Chemung, NY. 2340 ......... Enid, OK .......................................................................................................... ...................................................................... 0.9001 Garfield, OK. 2360 ......... Erie, PA .......................................................................................................... ........................................................................ 0.8699 Erie, PA. 2400 ......... Eugene-Springfield, OR ............................................................................................ ............................................................. 1.0940 Lane, OR. 2440 ......... Evansville-Henderson, IN-KY ....................................................................................... ......................................................... 0.8395 Posey, IN. Vanderburgh, IN. Warrick, IN. Henderson, KY. 2520 ......... Fargo-Moorhead, ND-MN ............................................................................................. ......................................................... 0.9114 Clay, MN. Cass, ND. 2560 ......... Fayetteville, NC .................................................................................................. ................................................................... 0.9363


### 30273 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Cumberland, NC. 2580 ......... Fayetteville-Springdale-Rogers, AR ................................................................................ ...................................................... 0.8636 Benton, AR. Washington, AR. 2620 ......... Flagstaff, AZ-UT .................................................................................................. .................................................................. 1.0611 Coconino, AZ. Kane, UT. 2640 ......... Flint, MI ......................................................................................................... ......................................................................... 1.1178 Genesee, MI. 2650 ......... Florence, AL ...................................................................................................... .................................................................... 0.7883 Colbert, AL. Lauderdale, AL. 2655 ......... Florence, SC ...................................................................................................... .................................................................... 0.8960 Florence, SC. 2670 ......... Fort Collins-Loveland, CO ......................................................................................... ............................................................ 1.0218 Larimer, CO. 2680 ......... Ft. Lauderdale, FL ................................................................................................ ................................................................. 1.0165 Broward, FL. 2700 ......... Fort Myers-Cape Coral, FL ......................................................................................... ........................................................... 0.9371 Lee, FL. 2710 ......... Fort Pierce-Port St. Lucie, FL .................................................................................... ............................................................ 1.0046 Martin, FL. St. Lucie, FL. 2720 ......... Fort Smith, AR-OK ................................................................................................. ................................................................ 0.8303 Crawford, AR. Sebastian, AR. Sequoyah, OK. 2750 ......... Fort Walton Beach, FL ............................................................................................. ............................................................. 0.8786 Okaloosa, FL. 2760 ......... Fort Wayne, IN .................................................................................................... .................................................................. 0.9737 Adams, IN. Allen, IN. De Kalb, IN. Huntington, IN. Wells, IN. Whitley, IN. 2800 ......... Forth Worth-Arlington, TX ......................................................................................... ............................................................. 0.9520 Hood, TX. Johnson, TX. Parker, TX. Tarrant, TX. 2840 ......... Fresno, CA ........................................................................................................ ..................................................................... 1.0407 Fresno, CA. Madera, CA. 2880 ......... Gadsden, AL ....................................................................................................... ................................................................... 0.8049 Etowah, AL. 2900 ......... Gainesville, FL ................................................................................................... .................................................................... 0.9459 Alachua, FL. 2920 ......... Galveston-Texas City, TX .......................................................................................... ............................................................ 0.9403 Galveston, TX. 2960 ......... Gary, IN .......................................................................................................... ....................................................................... 0.9342 Lake, IN. Porter, IN. 2975 ......... Glens Falls, NY ................................................................................................... ................................................................... 0.8467 Warren, NY. Washington, NY. 2980 ......... Goldsboro, NC ..................................................................................................... .................................................................. 0.8778 Wayne, NC. 2985 ......... Grand Forks, ND-MN ................................................................................................ ............................................................. 0.9091 Polk, MN. Grand Forks, ND. 2995 ......... Grand Junction, CO ................................................................................................ ............................................................... 0.9900 Mesa, CO. 3000 ......... Grand Rapids-Muskegon-Holland, MI ................................................................................. .................................................. 0.9519 Allegan, MI. Kent, MI. Muskegon, MI. Ottawa, MI. 3040 ......... Great Falls, MT ................................................................................................... ................................................................... 0.8810 Cascade, MT.


### 30274 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

3060 ......... Greeley, CO ....................................................................................................... .................................................................... 0.9444 Weld, CO. 3080 ......... Green Bay, WI ..................................................................................................... .................................................................. 0.9586 Brown, WI. 3120 ......... Greensboro-Winston-Salem-High Point, NC ........................................................................... .............................................. 0.9312 Alamance, NC. Davidson, NC. Davie, NC. Forsyth, NC. Guilford, NC. Randolph, NC. Stokes, NC. Yadkin, NC. 3150 ......... Greenville, NC .................................................................................................... ................................................................... 0.9183 Pitt, NC. 3160 ......... Greenville-Spartanburg-Anderson, SC ............................................................................... ................................................... 0.9400 Anderson, SC. Cherokee, SC. Greenville, SC. Pickens, SC. Spartanburg, SC. 3180 ......... Hagerstown, MD .................................................................................................... ................................................................ 0.9940 Washington, MD. 3200 ......... Hamilton-Middletown, OH ........................................................................................... ........................................................... 0.9066 Butler, OH. 3240 ......... Harrisburg-Lebanon-Carlisle, PA ................................................................................... ........................................................ 0.9286 Cumberland, PA. Dauphin, PA. Lebanon, PA. Perry, PA. 3283 ......... Hartford, CT ...................................................................................................... ..................................................................... 1.1054 Hartford, CT. Litchfield, CT. Middlesex, CT. Tolland, CT. 3285 ......... Hattiesburg, MS ................................................................................................... .................................................................. 0.7362 Forrest, MS. Lamar, MS. 3290 ......... Hickory-Morganton-Lenoir, NC ...................................................................................... ........................................................ 0.9502 Alexander, NC. Burke, NC. Caldwell, NC. Catawba, NC. 3320 ......... Honolulu, HI ...................................................................................................... ..................................................................... 1.1013 Honolulu, HI. 3350 ......... Houma, LA ......................................................................................................... .................................................................... 0.7721 Lafourche, LA. Terrebonne, LA. 3360 ......... Houston, TX ....................................................................................................... .................................................................... 1.0117 Chambers, TX. Fort Bend, TX. Harris, TX. Liberty, TX. Montgomery, TX. Waller, TX. 3400 ......... Huntington-Ashland, WV-KY-OH ...................................................................................... ..................................................... 0.9564 Boyd, KY. Carter, KY. Greenup, KY. Lawrence, OH. Cabell, WV. Wayne, WV. 3440 ......... Huntsville, AL .................................................................................................... ..................................................................... 0.8851 Limestone, AL. Madison, AL. 3480 ......... Indianapolis, IN .................................................................................................. .................................................................... 1.0039 Boone, IN. Hamilton, IN. Hancock, IN. Hendricks, IN.


### 30275 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Johnson, IN. Madison, IN. Marion, IN. Morgan, IN. Shelby, IN. 3500 ......... Iowa City, IA ..................................................................................................... ..................................................................... 0.9654 Johnson, IA. 3520 ......... Jackson, MI ....................................................................................................... ..................................................................... 0.9146 Jackson, MI. 3560 ......... Jackson, MS ....................................................................................................... ................................................................... 0.8406 Hinds, MS. Madison, MS. Rankin, MS. 3580 ......... Jackson, TN ....................................................................................................... .................................................................... 0.8900 Chester, TN. Madison, TN. 3600 ......... Jacksonville, FL .................................................................................................. ................................................................... 0.9548 Clay, FL. Duval, FL. Nassau, FL. St. Johns, FL. 3605 ......... Jacksonville, NC .................................................................................................. .................................................................. 0.8401 Onslow, NC. 3610 ......... Jamestown, NY ..................................................................................................... ................................................................. 0.7589 Chautaqua, NY. 3620 ......... Janesville-Beloit, WI ............................................................................................. ................................................................. 0.9583 Rock, WI. 3640 ......... Jersey City, NJ ................................................................................................... ................................................................... 1.0923 Hudson, NJ. 3660 ......... Johnson City-Kingsport-Bristol, TN-VA ............................................................................. .................................................... 0.8202 Carter, TN. Hawkins, TN. Sullivan, TN. Unicoi, TN. Washington, TN. Bristol City, VA. Scott, VA. Washington, VA. 3680 ......... Johnstown, PA ..................................................................................................... .................................................................. 0.7980 Cambria, PA. Somerset, PA. 3700 ......... Jonesboro, AR ..................................................................................................... .................................................................. 0.8144 Craighead, AR. 3710 ......... Joplin, MO ........................................................................................................ ...................................................................... 0.8721 Jasper, MO. Newton, MO. 3720 ......... Kalamazoo-Battlecreek, MI ......................................................................................... ........................................................... 1.0350 Calhoun, MI. Kalamazoo, MI. Van Buren, MI. 3740 ......... Kankakee, IL ...................................................................................................... .................................................................... 1.0603 Kankakee, IL. 3760 ......... Kansas City, KS-MO ................................................................................................ .............................................................. 0.9641 Johnson, KS. Leavenworth, KS. Miami, KS. Wyandotte, KS. Cass, MO. Clay, MO. Clinton, MO. Jackson, MO. Lafayette, MO. Platte, MO. Ray, MO. 3800 ......... Kenosha, WI ....................................................................................................... ................................................................... 0.9772 Kenosha, WI. 3810 ......... Killeen-Temple, TX ................................................................................................ ................................................................ 0.9242 Bell, TX. Coryell, TX. 3840 ......... Knoxville, TN ..................................................................................................... ..................................................................... 0.8508


### 30276 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Anderson, TN. Blount, TN. Knox, TN. Loudon, TN. Sevier, TN. Union, TN. 3850 ......... Kokomo, IN ........................................................................................................ .................................................................... 0.8986 Howard, IN. Tipton, IN. 3870 ......... La Crosse, WI-MN .................................................................................................. ............................................................... 0.9289 Houston, MN. La Crosse, WI. 3880 ......... Lafayette, LA ..................................................................................................... ..................................................................... 0.8105 Acadia, LA. Lafayette, LA. St. Landry, LA. St. Martin, LA. 3920 ......... Lafayette, IN ..................................................................................................... ..................................................................... 0.9067 Clinton, IN. Tippecanoe, IN. 3960 ......... Lake Charles, LA .................................................................................................. ................................................................. 0.7972 Calcasieu, LA. 3980 ......... Lakeland-Winter Haven, FL ......................................................................................... .......................................................... 0.8930 Polk, FL. 4000 ......... Lancaster, PA ..................................................................................................... ................................................................... 0.9883 Lancaster, PA. 4040 ......... Lansing-East Lansing, MI .......................................................................................... ............................................................ 0.9658 Clinton, MI. Eaton, MI. Ingham, MI. 4080 ......... Laredo, TX ........................................................................................................ ..................................................................... 0.8747 Webb, TX. 4100 ......... Las Cruces, NM .................................................................................................... ................................................................. 0.8784 Dona Ana, NM. 4120 ......... Las Vegas, NV-AZ .................................................................................................. ............................................................... 1.1121 Mohave, AZ. Clark, NV. Nye, NV. 4150 ......... Lawrence, KS ...................................................................................................... .................................................................. 0.8644 Douglas, KS. 4200 ......... Lawton, OK ........................................................................................................ .................................................................... 0.8212 Comanche, OK. 4243 ......... Lewiston-Auburn, ME ............................................................................................... ............................................................. 0.9562 Androscoggin, ME. 4280 ......... Lexington, KY ..................................................................................................... ................................................................... 0.9219 Bourbon, KY. Clark, KY. Fayette, KY. Jessamine, KY. Madison, KY. Scott, KY. Woodford, KY. 4320 ......... Lima, OH .......................................................................................................... ...................................................................... 0.9258 Allen, OH. Auglaize, OH. 4360 ......... Lincoln, NE ....................................................................................................... ..................................................................... 1.0208 Lancaster, NE. 4400 ......... Little Rock-North Little, AR ...................................................................................... .............................................................. 0.8826 Faulkner, AR. Lonoke, AR. Pulaski, AR. Saline, AR. 4420 ......... Longview-Marshall, TX ............................................................................................. ............................................................. 0.8739 Gregg, TX. Harrison, TX. Upshur, TX. 4480 ......... Los Angeles-Long Beach, CA ........................................................................................ ....................................................... 1.1732 Los Angeles, CA. 4520 ......... Louisville, KY-IN ................................................................................................. ................................................................... 0.9162 Clark, IN.


### 30277 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Floyd, IN. Harrison, IN. Scott, IN. Bullitt, KY. Jefferson, KY. Oldham, KY. 4600 ......... Lubbock, TX ....................................................................................................... .................................................................... 0.8777 Lubbock, TX. 4640 ......... Lynchburg, VA ..................................................................................................... .................................................................. 0.9017 Amherst, VA. Bedford City, VA. Bedford, VA. Campbell, VA. Lynchburg City, VA. 4680 ......... Macon, GA ......................................................................................................... .................................................................... 0.9596 Bibb, GA. Houston, GA. Jones, GA. Peach, GA. Twiggs, GA. 4720 ......... Madison, WI ....................................................................................................... .................................................................... 1.0395 Dane, WI. 4800 ......... Mansfield, OH ..................................................................................................... ................................................................... 0.9105 Crawford, OH. Richland, OH. 4840 ......... Mayaguez, PR ...................................................................................................... ................................................................. 0.4769 Anasco, PR. Cabo Rojo, PR. Hormigueros, PR. Mayaguez, PR. Sabana Grande, PR. San German, PR. 4880 ......... McAllen-Edinburg-Mission, TX ...................................................................................... ........................................................ 0.8602 Hidalgo, TX. 4890 ......... Medford-Ashland, OR ............................................................................................... ............................................................. 1.0534 Jackson, OR. 4900 ......... Melbourne-Titusville-Palm Bay, FL ................................................................................. ....................................................... 0.9633 Brevard, FL. 4920 ......... Memphis, TN-AR-MS ................................................................................................. ............................................................ 0.9234 Crittenden, AR. De Soto, MS. Fayette, TN. Shelby, TN. Tipton, TN. 4940 ......... Merced, CA ........................................................................................................ .................................................................... 1.0575 Merced, CA. 5000 ......... Miami, FL ......................................................................................................... ...................................................................... 0.9870 Dade, FL. 5015 ......... Middlesex-Somerset-Hunterdon, NJ .................................................................................. .................................................... 1.1360 Hunterdon, NJ. Middlesex, NJ. Somerset, NJ. 5080 ......... Milwaukee-Waukesha, WI ............................................................................................ ......................................................... 1.0076 Milwaukee, WI. Ozaukee, WI. Washington, WI. Waukesha, WI. 5120 ......... Minneapolis-St. Paul, MN-WI ....................................................................................... ......................................................... 1.1066 Anoka, MN. Carver, MN. Chisago, MN. Dakota, MN. Hennepin, MN. Isanti, MN. Ramsey, MN. Scott, MN. Sherburne, MN. Washington, MN. Wright, MN. Pierce, WI.


### 30278 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

St. Croix, WI. 5140 ......... Missoula, MT ...................................................................................................... ................................................................... 0.9618 Missoula, MT. 5160 ......... Mobile, AL ........................................................................................................ ...................................................................... 0.7932 Baldwin, AL. Mobile, AL. 5170 ......... Modesto, CA ....................................................................................................... ................................................................... 1.1966 Stanislaus, CA. 5190 ......... Monmouth-Ocean, NJ ................................................................................................ ............................................................ 1.0888 Monmouth, NJ. Ocean, NJ. 5200 ......... Monroe, LA ........................................................................................................ .................................................................... 0.7913 Ouachita, LA. 5240 ......... Montgomery, AL .................................................................................................... ................................................................ 0.8300 Autauga, AL. Elmore, AL. Montgomery, AL. 5280 ......... Muncie, IN ........................................................................................................ ...................................................................... 0.8580 Delaware, IN. 5330 ......... Myrtle Beach, SC .................................................................................................. ................................................................. 0.9022 Horry, SC. 5345 ......... Naples, FL ........................................................................................................ ..................................................................... 1.0558 Collier, FL. 5360 ......... Nashville, TN ..................................................................................................... .................................................................... 1.0108 Cheatham, TN. Davidson, TN. Dickson, TN. Robertson, TN. Rutherford, TN. Sumner, TN. Williamson, TN. Wilson, TN. 5380 ......... Nassau-Suffolk, NY ................................................................................................ ............................................................... 1.2907 Nassau, NY. Suffolk, NY. 5483 ......... New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT ............................................................... .................................... 1.2254 Fairfield, CT. New Haven, CT. 5523 ......... New London-Norwich, CT ............................................................................................ ......................................................... 1.1596 New London, CT. 5560 ......... New Orleans, LA ................................................................................................... ................................................................ 0.9103 Jefferson, LA. Orleans, LA. Plaquemines, LA. St. Bernard, LA. St. Charles, LA. St. James, LA. St. John The Baptist, LA. St. Tammany, LA. 5600 ......... New York, NY ...................................................................................................... .................................................................. 1.3586 Bronx, NY. Kings, NY. New York, NY. Putnam, NY. Queens, NY. Richmond, NY. Rockland, NY. Westchester, NY. 5640 ......... Newark, NJ ........................................................................................................ .................................................................... 1.1625 Essex, NJ. Morris, NJ. Sussex, NJ. Union, NJ. Warren, NJ. 5660 ......... Newburgh, NY-PA ................................................................................................... .............................................................. 1.1170 Orange, NY. Pike, PA. 5720 ......... Norfolk-Virginia Beach-Newport News, VA-NC ........................................................................ ............................................. 0.8894 Currituck, NC. Chesapeake City, VA.


### 30279 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

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 ....................................................................................................... ................................................................... 1.5220 Alameda, CA. Contra Costa, CA. 5790 ......... Ocala, FL ......................................................................................................... ...................................................................... 0.9153 Marion, FL. 5800 ......... Odessa-Midland, TX ................................................................................................ .............................................................. 0.9632 Ector, TX. Midland, TX. 5880 ......... Oklahoma City, OK ................................................................................................. ............................................................... 0.8966 Canadian, OK. Cleveland, OK. Logan, OK. McClain, OK. Oklahoma, OK. Pottawatomie, OK. 5910 ......... Olympia, WA ....................................................................................................... ................................................................... 1.1006 Thurston, WA. 5920 ......... Omaha, NE-IA ...................................................................................................... ................................................................. 0.9754 Pottawattamie, IA. Cass, NE. Douglas, NE. Sarpy, NE. Washington, NE. 5945 ......... Orange County, CA ................................................................................................. .............................................................. 1.1611 Orange, CA. 5960 ......... Orlando, FL ....................................................................................................... ..................................................................... 0.9742 Lake, FL. Orange, FL. Osceola, FL. Seminole, FL. 5990 ......... Owensboro, KY ..................................................................................................... ................................................................. 0.8434 Daviess, KY. 6015 ......... Panama City, FL ................................................................................................... ................................................................. 0.8124 Bay, FL. 6020 ......... Parkersburg-Marietta, WV-OH ....................................................................................... ........................................................ 0.8288 Washington, OH. Wood, WV. 6080 ......... Pensacola, FL ..................................................................................................... ................................................................... 0.8306 Escambia, FL. Santa Rosa, FL. 6120 ......... Peoria-Pekin, IL .................................................................................................. ................................................................... 0.8886 Peoria, IL. Tazewell, IL. Woodford, IL. 6160 ......... Philadelphia, PA-NJ ............................................................................................... ................................................................ 1.0824 Burlington, NJ. Camden, NJ. Gloucester, NJ. Salem, NJ. Bucks, PA. Chester, PA. Delaware, PA. Montgomery, PA. Philadelphia, PA. 6200 ......... Phoenix-Mesa, AZ .................................................................................................. ............................................................... 0.9982 Maricopa, AZ. Pinal, AZ.


### 30280 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

6240 ......... Pine Bluff, AR .................................................................................................... .................................................................... 0.8673 Jefferson, AR. 6280 ......... Pittsburgh, PA .................................................................................................... .................................................................... 0.8756 Allegheny, PA. Beaver, PA. Butler, PA. Fayette, PA. Washington, PA. Westmoreland, PA. 6323 ......... Pittsfield, MA .................................................................................................... ...................................................................... 1.0439 Berkshire, MA. 6340 ......... Pocatello, ID ..................................................................................................... ..................................................................... 0.9601 Bannock, ID. 6360 ......... Ponce, PR ......................................................................................................... ..................................................................... 0.4954 Guayanilla, PR. Juana Diaz, PR. Penuelas, PR. Ponce, PR. Villalba, PR. Yauco, PR. 6403 ......... Portland, ME ...................................................................................................... .................................................................... 1.0112 Cumberland, ME. Sagadahoc, ME. York, ME. 6440 ......... Portland-Vancouver, OR-WA ......................................................................................... ........................................................ 1.1403 Clackamas, OR. Columbia, OR. Multnomah, OR. Washington, OR. Yamhill, OR. Clark, WA. 6483 ......... Providence-Warwick-Pawtucket, RI .................................................................................. ..................................................... 1.1061 Bristol, RI. Kent, RI. Newport, RI. Providence, RI. Washington, RI. 6520 ......... Provo-Orem, UT .................................................................................................... ................................................................ 0.9613 Utah, UT. 6560 ......... Pueblo, CO ........................................................................................................ .................................................................... 0.8752 Pueblo, CO. 6580 ......... Punta Gorda, FL ................................................................................................... ................................................................. 0.9441 Charlotte, FL. 6600 ......... Racine, WI ........................................................................................................ ..................................................................... 0.9045 Racine, WI. 6640 ......... Raleigh-Durham-Chapel Hill, NC .................................................................................... ....................................................... 1.0258 Chatham, NC. Durham, NC. Franklin, NC. Johnston, NC. Orange, NC. Wake, NC. 6660 ......... Rapid City, SD .................................................................................................... ................................................................... 0.8912 Pennington, SD. 6680 ......... Reading, PA ....................................................................................................... .................................................................... 0.9215 Berks, PA. 6690 ......... Redding, CA ....................................................................................................... ................................................................... 1.1835 Shasta, CA. 6720 ......... Reno, NV .......................................................................................................... ..................................................................... 1.0456 Washoe, NV. 6740 ......... Richland-Kennewick-Pasco, WA ...................................................................................... ..................................................... 1.0520 Benton, WA. Franklin, WA. 6760 ......... Richmond-Petersburg, VA ........................................................................................... .......................................................... 0.9397 Charles City County, VA. Chesterfield, VA. Colonial Heights City, VA. Dinwiddie, VA. Goochland, VA. Hanover, VA.


### 30281 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Henrico, VA. Hopewell City, VA. New Kent, VA. Petersburg City, VA. Powhatan, VA. Prince George, VA. Richmond City, VA. 6780 ......... Riverside-San Bernardino, CA ...................................................................................... ........................................................ 1.0970 Riverside, CA. San Bernardino, CA. 6800 ......... Roanoke, VA ....................................................................................................... ................................................................... 0.8428 Botetourt, VA. Roanoke, VA. Roanoke City, VA. Salem City, VA. 6820 ......... Rochester, MN ..................................................................................................... .................................................................. 1.1504 Olmsted, MN. 6840 ......... Rochester, NY ..................................................................................................... .................................................................. 0.9196 Genesee, NY. Livingston, NY. Monroe, NY. Ontario, NY. Orleans, NY. Wayne, NY. 6880 ......... Rockford, IL ...................................................................................................... ..................................................................... 0.9626 Boone, IL. Ogle, IL. Winnebago, IL. 6895 ......... Rocky Mount, NC ................................................................................................... ............................................................... 0.8998 Edgecombe, NC. Nash, NC. 6920 ......... Sacramento, CA .................................................................................................... ................................................................ 1.1848 El Dorado, CA. Placer, CA. Sacramento, CA. 6960 ......... Saginaw-Bay City-Midland, MI ...................................................................................... ........................................................ 0.9696 Bay, MI. Midland, MI. Saginaw, MI. 6980 ......... St. Cloud, MN ..................................................................................................... ................................................................... 1.0215 Benton, MN. Stearns, MN. 7000 ......... St. Joseph, MO .................................................................................................... .................................................................. 1.0013 Andrews, MO. Buchanan, MO. 7040 ......... St. Louis, MO-IL .................................................................................................. ................................................................... 0.9081 Clinton, IL. Jersey, IL. Madison, IL. Monroe, IL. St. Clair, IL. Franklin, MO. Jefferson, MO. Lincoln, MO. St. Charles, MO. St. Louis, MO. St. Louis City, MO. Warren, MO. Sullivan City, MO. 7080 ......... Salem, OR ......................................................................................................... .................................................................... 1.0556 Marion, OR. Polk, OR. 7120 ......... Salinas, CA ....................................................................................................... ..................................................................... 1.3823 Monterey, CA. 7160 ......... Salt Lake City-Ogden, UT .......................................................................................... ........................................................... 0.9487 Davis, UT. Salt Lake, UT. Weber, UT. 7200 ......... San Angelo, TX .................................................................................................... ................................................................. 0.8167 Tom Green, TX.


### 30282 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

7240 ......... San Antonio, TX ................................................................................................... ................................................................. 0.9023 Bexar, TX. Comal, TX. Guadalupe, TX. Wilson, TX. 7320 ......... San Diego, CA ..................................................................................................... .................................................................. 1.1267 San Diego, CA. 7360 ......... San Francisco, CA ................................................................................................. ................................................................ 1.4712 Marin, CA. San Francisco, CA. San Mateo, CA. 7400 ......... San Jose, CA ...................................................................................................... ................................................................... 1.4744 Santa Clara, CA. 7440 ......... San Juan-Bayamon, PR .............................................................................................. .......................................................... 0.4802 Aguas Buenas, PR. Barceloneta, PR. Bayamon, PR. Canovanas, PR. Carolina, PR. Catano, PR. Ceiba, PR. Comerio, PR. Corozal, PR. Dorado, PR. Fajardo, PR. Florida, PR. Guaynabo, PR. Humacao, PR. Juncos, PR. Los Piedras, PR. Loiza, PR. Luguillo, PR. Manati, PR. Morovis, PR. Naguabo, PR. Naranjito, PR. Rio Grande, PR. San Juan, PR. Toa Alta, PR. Toa Baja, PR. Trujillo Alto, PR. Vega Alta, PR. Vega Baja, PR. Yabucoa, PR. 7460 ......... San Luis Obispo-Atascadero-Paso Robles, CA ........................................................................ ............................................ 1.1118 San Luis Obispo, CA. 7480 ......... Santa Barbara-Santa Maria-Lompoc, CA .............................................................................. ................................................ 1.0771 Santa Barbara, CA. 7485 ......... Santa Cruz-Watsonville, CA ........................................................................................ .......................................................... 1.4779 Santa Cruz, CA. 7490 ......... Santa Fe, NM ...................................................................................................... .................................................................. 1.0590 Los Alamos, NM. Santa Fe, NM. 7500 ......... Santa Rosa, CA .................................................................................................... ................................................................. 1.2961 Sonoma, CA. 7510 ......... Sarasota-Bradenton, FL ............................................................................................ ............................................................ 0.9629 Manatee, FL. Sarasota, FL. 7520 ......... Savannah, GA ...................................................................................................... ................................................................. 0.9460 Bryan, GA. Chatham, GA. Effingham, GA. 7560 ......... Scranton

—Wilkes-Barre

— Hazleton, PA ................................................................................................................... ............. 0.8522 Columbia, PA. Lackawanna, PA. Luzerne, PA. Wyoming, PA. 7600 ......... Seattle-Bellevue-Everett, WA ...................................................................................... .......................................................... 1.1479 Island, WA. King, WA.


### 30283 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Snohomish, WA. 7610 ......... Sharon, PA ........................................................................................................ .................................................................... 0.7881 Mercer, PA. 7620 ......... Sheboygan, WI ..................................................................................................... ................................................................. 0.8948 Sheboygan, WI. 7640 ......... Sherman-Denison, TX ............................................................................................... ............................................................ 0.9617 Grayson, TX. 7680 ......... Shreveport-Bossier City, LA ....................................................................................... ........................................................... 0.9111 Bossier, LA. Caddo, LA. Webster, LA. 7720 ......... Sioux City, IA-NE ................................................................................................. .................................................................. 0.9094 Woodbury, IA. Dakota, NE. 7760 ......... Sioux Falls, SD ................................................................................................... ................................................................... 0.9441 Lincoln, SD. Minnehaha, SD. 7800 ......... South Bend, IN .................................................................................................... .................................................................. 0.9447 St. Joseph, IN. 7840 ......... Spokane, WA ....................................................................................................... .................................................................. 1.0660 Spokane, WA. 7880 ......... Springfield, IL ................................................................................................... ...................................................................... 0.8738 Menard, IL. Sangamon, IL. 7920 ......... Springfield, MO ................................................................................................... ................................................................... 0.8597 Christian, MO. Greene, MO. Webster, MO. 8003 ......... Springfield, MA ................................................................................................... ................................................................... 1.0173 Hampden, MA. Hampshire, MA. 8050 ......... State College, PA ................................................................................................. ................................................................. 0.8461 Centre, PA. 8080 ......... Steubenville-Weirton, OH-WV ....................................................................................... ........................................................ 0.8280 Jefferson, OH. Brooke, WV. Hancock, WV. 8120 ......... Stockton-Lodi, CA ................................................................................................. ................................................................. 1.0564 San Joaquin, CA. 8140 ......... Sumter, SC ........................................................................................................ .................................................................... 0.8520 Sumter, SC. 8160 ......... Syracuse, NY ...................................................................................................... ................................................................... 0.9394 Cayuga, NY. Madison, NY. Onondaga, NY. Oswego, NY. 8200 ......... Tacoma, WA ........................................................................................................ .................................................................. 1.1078 Pierce, WA. 8240 ......... Tallahassee, FL ................................................................................................... .................................................................. 0.8655 Gadsden, FL. Leon, FL. 8280 ......... Tampa-St. Petersburg-Clearwater, FL ............................................................................... ................................................... 0.9024 Hernando, FL. Hillsborough, FL. Pasco, FL. Pinellas, FL. 8320 ......... Terre Haute, IN ................................................................................................... ................................................................... 0.8582 Clay, IN. Vermillion, IN. Vigo, IN. 8360 ......... Texarkana, AR-Texarkana, TX ....................................................................................... ....................................................... 0.8413 Miller, AR. Bowie, TX. 8400 ......... Toledo, OH ........................................................................................................ .................................................................... 0.9524 Fulton, OH. Lucas, OH. Wood, OH. 8440 ......... Topeka, KS ........................................................................................................ .................................................................... 0.8904 Shawnee, KS. 8480 ......... Trenton, NJ ....................................................................................................... ..................................................................... 1.0276


### 30284 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Mercer, NJ. 8520 ......... Tucson, AZ ........................................................................................................ .................................................................... 0.8926 Pima, AZ. 8560 ......... Tulsa, OK ......................................................................................................... ...................................................................... 0.8729 Creek, OK. Osage, OK. Rogers, OK. Tulsa, OK. Wagoner, OK. 8600 ......... Tuscaloosa, AL .................................................................................................... .................................................................. 0.8440 Tuscaloosa, AL. 8640 ......... Tyler, TX ......................................................................................................... ....................................................................... 0.9502 Smith, TX. 8680 ......... Utica-Rome, NY .................................................................................................... ................................................................. 0.8295 Herkimer, NY. Oneida, NY. 8720 ......... Vallejo-Fairfield-Napa, CA ........................................................................................ ............................................................. 1.3517 Napa, CA. Solano, CA. 8735 ......... Ventura, CA ....................................................................................................... .................................................................... 1.1105 Ventura, CA. 8750 ......... Victoria, TX ...................................................................................................... ...................................................................... 0.8469 Victoria, TX. 8760 ......... Vineland-Millville-Bridgeton, NJ .................................................................................. ........................................................... 1.0573 Cumberland, NJ. 8780 ......... Visalia-Tulare-Porterville, CA .................................................................................... ............................................................. 0.9975 Tulare, CA. 8800 ......... Waco, TX .......................................................................................................... ..................................................................... 0.8146 McLennan, TX. 8840 ......... Washington, DC-MD-VA-WV ........................................................................................... ...................................................... 1.0971 District of Columbia, DC. Calvert, MD. Charles, MD. Frederick, MD. Montgomery, MD. Prince Georges, MD. Alexandria City, VA. Arlington, VA. Clarke, VA. Culpepper, VA. Fairfax, VA. Fairfax City, VA. Falls Church City, VA. Fauquier, VA. Fredericksburg City, VA. King George, VA. Loudoun, VA. Manassas City, VA. Manassas Park City, VA. Prince William, VA. Spotsylvania, VA. Stafford, VA. Warren, VA. Berkeley, WV. Jefferson, WV. 8920 ......... Waterloo-Cedar Falls, IA .......................................................................................... ............................................................. 0.8633 Black Hawk, IA. 8940 ......... Wausau, WI ........................................................................................................ ................................................................... 0.9570 Marathon, WI. 8960 ......... West Palm Beach-Boca Raton, FL .................................................................................... ................................................... 1.0362 Palm Beach, FL. 9000 ......... Wheeling, OH-WV ................................................................................................... .............................................................. 0.7449 Belmont, OH. Marshall, WV. Ohio, WV. 9040 ......... Wichita, KS ....................................................................................................... ..................................................................... 0.9486 Butler, KS. Harvey, KS. Sedgwick, KS. 9080 ......... Wichita Falls, TX ................................................................................................. ................................................................... 0.8395


### 30285 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 1A.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNATIONS FOR 

### U RBAN 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES WITH 

### TABLE 

### 2 A



### —Continued

MSA Urban area (Constituent Counties or County Equivalents) Wage index

Archer, TX. Wichita, TX. 9140 ......... Williamsport, PA .................................................................................................. .................................................................. 0.8485 Lycoming, PA. 9160 ......... Wilmington-Newark, DE-MD .......................................................................................... ........................................................ 1.1121 New Castle, DE. Cecil, MD. 9200 ......... Wilmington, NC .................................................................................................... .................................................................. 0.9237 New Hanover, NC. Brunswick, NC. 9260 ......... Yakima, WA ........................................................................................................ ................................................................... 1.0322 Yakima, WA. 9270 ......... Yolo, CA .......................................................................................................... ....................................................................... 0.9378 Yolo, CA. 9280 ......... York, PA .......................................................................................................... ....................................................................... 0.9150 York, PA. 9320 ......... Youngstown-Warren, OH ............................................................................................. .......................................................... 0.9517 Columbiana, OH. Mahoning, OH. Trumbull, OH. 9340 ......... Yuba City, CA ..................................................................................................... ................................................................... 1.0363 Sutter, CA. Yuba, CA. 9360 ......... Yuma, AZ .......................................................................................................... ..................................................................... 0.8871 Yuma, AZ.



### TABLE 

### 1B.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNA



### TIONS FOR 

### R URAL 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES 

### W ITH 

### TABLE 

### 2B

Nonurban area Wage Index

Alabama ........................................ 0.7637 Alaska ........................................... 1.1637 Arizona .......................................... 0.9140 Arkansas ....................................... 0.7703 California ....................................... 1.0297 Colorado ....................................... 0.9368 Connecticut ................................... 1.1917 Delaware ....................................... 0.9503 Florida ........................................... 0.8721 Georgia ......................................... 0.8247 Guam ............................................ 0.9611 Hawaii ........................................... 1.0522 Idaho ............................................. 0.8826 Illinois ............................................ 0.8340 Indiana .......................................... 0.8736 Iowa .............................................. 0.8550 Kansas .......................................... 0.8087 Kentucky ....................................... 0.7844 Louisiana ...................................... 0.7290 Maine ............................................ 0.9039 

### TABLE 

### 1B.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNA



### TIONS FOR 

### R URAL 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES 

### W ITH 

### TABLE 

### 2B

— Continued

Nonurban area Wage Index

Maryland ....................................... 0.9179 Massachusetts .............................. 1.0216 Michigan ....................................... 0.8740 Minnesota ..................................... 0.9339 Mississippi .................................... 0.7583 Missouri ........................................ 0.7829 Montana ........................................ 0.8701 Nebraska ...................................... 0.9035 Nevada ......................................... 0.9832 New Hampshire ............................ 0.9940 New Jersey 1

................................. ................ New Mexico .................................. 0.8529 New York ...................................... 0.8403 North Carolina .............................. 0.8500 North Dakota ................................ 0.7743 Ohio .............................................. 0.8759 Oklahoma ..................................... 0.7537 Oregon .......................................... 1.0049 

### TABLE 

### 1B.

— FY 2006 IRF PPS MSA LABOR 

### M ARKET 

### A REA 

### D ESIGNA



### TIONS FOR 

### R URAL 

### A REAS FOR THE 

### P URPOSES OF 

### C OMPARING 

### WAGE 

### I NDEX 

### VALUES 

### W ITH 

### TABLE 

### 2B

— Continued

Nonurban area Wage Index

Pennsylvania ................................ 0.8348 Puerto Rico ................................... 0.4047

Rhode Island 1

.............................. ................ South Carolina .............................. 0.8640 South Dakota ................................ 0.8393

Tennessee .................................... 0.7876 Texas ............................................ 0.7910 Utah .............................................. 0.8843 Vermont ........................................ 0.9375 Virginia .......................................... 0.8479 Virgin Islands ................................ 0.7456 Washington ................................... 1.0072 West Virginia ................................ 0.8083 Wisconsin ..................................... 0.9498 Wyoming ....................................... 0.9182

1 All counties within the State are classified urban.



### TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

CBSA code Urban area (Constituent counties) Full wage Index

10180 ....... Abilene, TX ........................................................................................................ .................................................................... 0.7850 Callahan County, TX. Jones County, TX. Taylor County, TX. 10380 ....... Aguadilla-Isabela-San Sebastia  ́ n, PR .......................................................................................................................... ......... 0.4280 Aguada Municipio, PR.


### 30286 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Aguadilla Municipio, PR. Aasco Municipio, PR. Isabela Municipio, PR. Lares Municipio, PR. Moca Municipio, PR. Rincı  ́ n Municipio, PR. San Sebastia  ́ n Municipio, PR. 10420 ....... Akron, OH .......................................................................................................... .................................................................... 0.9055 Portage County, OH. Summit County, OH. 10500 ....... Albany, GA ......................................................................................................... .................................................................... 1.1266 Baker County, GA. Dougherty County, GA. Lee County, GA. Terrell County, GA. Worth County, GA. 10580 ....... Albany-Schenectady-Troy, NY ........................................................................................ ...................................................... 0.8650 Albany County, NY. Rensselaer County, NY. Saratoga County, NY. Schenectady County, NY. Schoharie County, NY. 10740 ....... Albuquerque, NM .................................................................................................... ............................................................... 1.0485 Bernalillo County, NM. Sandoval County, NM. Torrance County, NM. Valencia County, NM. 10780 ....... Alexandria, LA ..................................................................................................... .................................................................. 0.8171 Grant Parish, LA. Rapides Parish, LA. 10900 ....... Allentown-Bethlehem-Easton, PA-NJ .................................................................................. .................................................. 0.9501 Warren County, NJ. Carbon County, PA. Lehigh County, PA. Northampton County, PA. 11020 ....... Altoona, PA ........................................................................................................ .................................................................... 0.8462 Blair County, PA. 11100 ....... Amarillo, TX ....................................................................................................... .................................................................... 0.9178 Armstrong County, TX. Carson County, TX. Potter County, TX. Randall County, TX. 11180 ....... Ames, IA ........................................................................................................... ..................................................................... 0.9479 Story County, IA. 11260 ....... Anchorage, AK ...................................................................................................... ................................................................. 1.2165 Anchorage Municipality, AK. Matanuska-Susitna Borough, AK. 11300 ....... Anderson, IN ....................................................................................................... ................................................................... 0.8713 Madison County, IN. 11340 ....... Anderson, SC ....................................................................................................... ................................................................. 0.8670 Anderson County, SC. 11460 ....... Ann Arbor, MI ...................................................................................................... .................................................................. 1.1022 Washtenaw County, MI. 11500 ....... Anniston-Oxford, AL ................................................................................................ .............................................................. 0.7881 Calhoun County, AL. 11540 ....... Appleton, WI ....................................................................................................... ................................................................... 0.9131 Calumet County, WI. Outagamie County, WI. 11700 ....... Asheville, NC ...................................................................................................... ................................................................... 0.9191 Buncombe County, NC. Haywood County, NC. Henderson County, NC. Madison County, NC. 12020 ....... Athens-Clarke County, GA ........................................................................................... ......................................................... 1.0202 Clarke County, GA. Madison County, GA. Oconee County, GA. Oglethorpe County, GA. 12060 ....... Atlanta-Sandy Springs-Marietta, GA ................................................................................. .................................................... 0.9971 Barrow County, GA.


### 30287 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Bartow County, GA. Butts County, GA. Carroll County, GA. Cherokee County, GA. Clayton County, GA. Cobb County, GA. Coweta County, GA. Dawson County, GA. DeKalb County, GA. Douglas County, GA. Fayette County, GA. Forsyth County, GA. Fulton County, GA. Gwinnett County, GA. Haralson County, GA. Heard County, GA. Henry County, GA. Jasper County, GA. Lamar County, GA. Meriwether County, GA. Newton County, GA. Paulding County, GA. Pickens County, GA. Pike County, GA. Rockdale County, GA. Spalding County, GA. Walton County, GA. 12100 ....... Atlantic City, NJ .................................................................................................. ................................................................... 1.0931 Atlantic County, NJ. 12220 ....... Auburn-Opelika, AL ................................................................................................. .............................................................. 0.8215 Lee County, AL. 12260 ....... Augusta-Richmond County, GA-SC ..................................................................................... ................................................. 0.9154 Burke County, GA. Columbia County, GA. McDuffie County, GA. Richmond County, GA. Aiken County, SC. Edgefield County, SC. 12420 ....... Austin-Round Rock, TX .............................................................................................. ........................................................... 0.9595 Bastrop County, TX. Caldwell County, TX. Hays County, TX. Travis County, TX. Williamson County, TX. 12540 ....... Bakersfield, CA .................................................................................................... .................................................................. 1.0036 Kern County, CA. 12580 ....... Baltimore-Towson, MD ............................................................................................... ........................................................... 0.9907 Anne Arundel County, MD. Baltimore County, MD. Carroll County, MD. Harford County, MD. Howard County, MD. Queen Anne ’ s County, MD. Baltimore City, MD. 12620 ....... Bangor, ME ......................................................................................................... ................................................................... 0.9955 Penobscot County, ME. 12700 ....... Barnstable Town, MA ................................................................................................ ............................................................ 1.2335 Barnstable County, MA. 12940 ....... Baton Rouge, LA .................................................................................................... ............................................................... 0.8319 Ascension Parish, LA. East Baton Rouge Parish, LA. East Feliciana Parish, LA. Iberville Parish, LA. Livingston Parish, LA. Pointe Coupee Parish, LA. St. Helena Parish, LA. West Baton Rouge Parish, LA. West Feliciana Parish, LA. 12980 ....... Battle Creek, MI ................................................................................................... .................................................................. 0.9366 Calhoun County, MI.


### 30288 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

13020 ....... Bay City, MI ....................................................................................................... .................................................................... 0.9574 Bay County, MI. 13140 ....... Beaumont-Port Arthur, TX ........................................................................................... .......................................................... 0.8616 Hardin County, TX. Jefferson County, TX. Orange County, TX. 13380 ....... Bellingham, WA ..................................................................................................... ................................................................ 1.1642 Whatcom County, WA. 13460 ....... Bend, OR ........................................................................................................... .................................................................... 1.0603 Deschutes County, OR. 13644 ....... Bethesda-Frederick-Gaithersburg, MD ................................................................................ .................................................. 1.0956 Frederick County, MD. Montgomery County, MD. 13740 ....... Billings, MT ....................................................................................................... ..................................................................... 0.8961 Carbon County, MT. Yellowstone County, MT. 13780 ....... Binghamton, NY ..................................................................................................... ................................................................ 0.8447 Broome County, NY. Tioga County, NY. 13820 ....... Birmingham-Hoover, AL .............................................................................................. .......................................................... 0.9157 Bibb County, AL. Blount County, AL. Chilton County, AL. Jefferson County, AL. St. Clair County, AL. Shelby County, AL. Walker County, AL. 13900 ....... Bismarck, ND ....................................................................................................... .................................................................. 0.7505 Burleigh County, ND. Morton County, ND. 13980 ....... Blacksburg-Christiansburg-Radford, VA .............................................................................. .................................................. 0.7951 Giles County, VA. Montgomery County, VA. Pulaski County, VA. Radford City, VA. 14020 ....... Bloomington, IN .................................................................................................... ................................................................. 0.8587 Greene County, IN. Monroe County, IN. Owen County, IN. 14060 ....... Bloomington-Normal, IL ............................................................................................. ............................................................ 0.9111 McLean County, IL. 14260 ....... Boise City-Nampa, ID ............................................................................................... ............................................................. 0.9352 Ada County, ID. Boise County, ID. Canyon County, ID. Gem County, ID. Owyhee County, ID. 14484 ....... Boston-Quincy, MA .................................................................................................. .............................................................. 1.1771 Norfolk County, MA. Plymouth County, MA. Suffolk County, MA. 14500 ....... Boulder, CO ........................................................................................................ ................................................................... 1.0046 Boulder County, CO. 14540 ....... Bowling Green, KY .................................................................................................. .............................................................. 0.8140 Edmonson County, KY. Warren County, KY. 14740 ....... Bremerton-Silverdale, WA ........................................................................................... .......................................................... 1.0614 Kitsap County, WA. 14860 ....... Bridgeport-Stamford-Norwalk, CT .................................................................................... ..................................................... 1.2835 Fairfield County, CT. 15180 ....... Brownsville-Harlingen, TX .......................................................................................... ........................................................... 1.0125 Cameron County, TX. 15260 ....... Brunswick, GA ...................................................................................................... ................................................................. 1.1933 Brantley County, GA. Glynn County, GA. McIntosh County, GA. 15380 ....... Buffalo-Niagara Falls, NY .......................................................................................... ............................................................ 0.9339 Erie County, NY. Niagara County, NY. 15500 ....... Burlington, NC ..................................................................................................... .................................................................. 0.8967


### 30289 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Alamance County, NC. 15540 ....... Burlington-South Burlington, VT .................................................................................... ........................................................ 0.9322 Chittenden County, VT. Franklin County, VT. Grand Isle County, VT. 15764 ....... Cambridge-Newton-Framingham, MA .................................................................................... ............................................... 1.1189 Middlesex County, MA. 15804 ....... Camden, NJ ......................................................................................................... .................................................................. 1.0675 Burlington County, NJ. Camden County, NJ. Gloucester County, NJ. 15940 ....... Canton-Massillon, OH ............................................................................................... ............................................................. 0.8895 Carroll County, OH. Stark County, OH. 15980 ....... Cape Coral-Fort Myers, FL .......................................................................................... .......................................................... 0.9371 Lee County, FL. 16180 ....... Carson City, NV .................................................................................................... ................................................................. 1.0352 Carson City, NV. 16220 ....... Casper, WY ......................................................................................................... .................................................................. 0.9243 Natrona County, WY. 16300 ....... Cedar Rapids, IA ................................................................................................... ................................................................ 0.8975 Benton County, IA. Jones County, IA. Linn County, IA. 16580 ....... Champaign-Urbana, IL ............................................................................................... ........................................................... 0.9527 Champaign County, IL. Ford County, IL. Piatt County, IL. 16620 ....... Charleston, WV ..................................................................................................... ................................................................. 0.8876 Boone County, WV. Clay County, WV. Kanawha County, WV. Lincoln County, WV. Putnam County, WV. 16700 ....... Charleston-North Charleston, SC .................................................................................... ...................................................... 0.9420 Berkeley County, SC. Charleston County, SC. Dorchester County, SC. 16740 ....... Charlotte-Gastonia-Concord, NC-SC .................................................................................. .................................................. 0.9743 Anson County, NC. Cabarrus County, NC. Gaston County, NC. Mecklenburg County, NC. Union County, NC. York County, SC. 16820 ....... Charlottesville, VA ................................................................................................ ................................................................. 1.0294 Albemarle County, VA. Fluvanna County, VA. Greene County, VA. Nelson County, VA. Charlottesville City, VA. 16860 ....... Chattanooga, TN-GA ................................................................................................. ............................................................ 0.9207 Catoosa County, GA. Dade County, GA. Walker County, GA. Hamilton County, TN. Marion County, TN. Sequatchie County, TN. 16940 ....... Cheyenne, WY ....................................................................................................... ................................................................ 0.8980 Laramie County, WY. 16974 ....... Chicago-Naperville-Joliet, IL ...................................................................................... ............................................................ 1.0868 Cook County, IL. DeKalb County, IL. DuPage County, IL. Grundy County, IL. Kane County, IL. Kendall County, IL. McHenry County, IL. Will County, IL. 17020 ....... Chico, CA .......................................................................................................... ..................................................................... 1.0542


### 30290 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Butte County, CA. 17140 ....... Cincinnati-Middletown, OH-KY-IN .................................................................................... ..................................................... 0.9516 Dearborn County, IN. Franklin County, IN. Ohio County, IN. Boone County, KY. Bracken County, KY. Campbell County, KY. Gallatin County, KY. Grant County, KY. Kenton County, KY. Pendleton County, KY. Brown County, OH. Butler County, OH. Clermont County, OH. Hamilton County, OH. Warren County, OH. 17300 ....... Clarksville, TN-KY ................................................................................................. ................................................................. 0.8022 Christian County, KY. Trigg County, KY. Montgomery County, TN. Stewart County, TN. 17420 ....... Cleveland, TN ...................................................................................................... .................................................................. 0.7844 Bradley County, TN. Polk County, TN. 17460 ....... Cleveland-Elyria-Mentor, OH ........................................................................................ ......................................................... 0.9650 Cuyahoga County, OH. Geauga County, OH. Lake County, OH. Lorain County, OH. Medina County, OH. 17660 ....... Coeur d ’ Alene, ID ...................................................................................................................... ............................................ 0.9339 Kootenai County, ID. 17780 ....... College Station-Bryan, TX .......................................................................................... ........................................................... 0.9243 Brazos County, TX. Burleson County, TX. Robertson County, TX. 17820 ....... Colorado Springs, CO ............................................................................................... ............................................................ 0.9792 El Paso County, CO. Teller County, CO. 17860 ....... Columbia, M ........................................................................................................ ................................................................... 0.8396 Boone County, MO. Howard County, MO. 17900 ....... Columbia, SC ....................................................................................................... .................................................................. 0.9392 Calhoun County, SC. Fairfield County, SC. Kershaw County, SC. Lexington County, SC. Richland County, SC. Saluda County, SC. 17980 ....... Columbus, GA-AL .................................................................................................... .............................................................. 0.8690 Russell County, AL. Chattahoochee County, GA. Harris County, GA. Marion County, GA. Muscogee County, GA. 18020 ....... Columbus, IN ....................................................................................................... .................................................................. 0.9388 Bartholomew County, IN. 18140 ....... Columbus, OH ....................................................................................................... ................................................................ 0.9737 Delaware County, OH. Fairfield County, OH. Franklin County, OH. Licking County, OH. Madison County, OH. Morrow County, OH. Pickaway County, OH. Union County, OH. 18580 ....... Corpus Christi, TX ................................................................................................. ................................................................ 0.8647 Aransas County, TX. Nueces County, TX.


### 30291 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

San Patricio County, TX. 18700 ....... Corvallis, OR ...................................................................................................... .................................................................... 1.0545 Benton County, OR. 19060 ....... Cumberland, MD-WV .................................................................................................. ........................................................... 0.8662 Allegany County, MD. Mineral County, WV. 19124 ....... Dallas-Plano-Irving, TX ............................................................................................ .............................................................. 1.0074 Collin County, TX. Dallas County, TX. Delta County, TX. Denton County, TX. Ellis County, TX. Hunt County, TX. Kaufman County, TX. Rockwall County, TX. 19140 ....... Dalton, GA ......................................................................................................... .................................................................... 0.9558 Murray County, GA. Whitfield County, GA. 19180 ....... Danville, IL ....................................................................................................... ...................................................................... 0.8392 Vermilion County, IL. 19260 ....... Danville, VA ....................................................................................................... .................................................................... 0.8643 Pittsylvania County, VA. Danville City, VA. 19340 ....... Davenport-Moline-Rock Island, IA-IL ................................................................................ ..................................................... 0.8773 Henry County, IL. Mercer County, IL. Rock Island County, IL. Scott County, IA. 19380 ....... Dayton, OH ......................................................................................................... ................................................................... 0.9303 Greene County, OH. Miami County, OH. Montgomery County, OH. Preble County, OH. 19460 ....... Decatur, AL ........................................................................................................ .................................................................... 0.8894 Lawrence County, AL. Morgan County, AL. 19500 ....... Decatur, IL ........................................................................................................ ..................................................................... 0.8122 Macon County, IL. 19660 ....... Deltona-Daytona Beach-Ormond Beach, FL ............................................................................. ............................................ 0.8898 Volusia County, FL. 19740 ....... Denver-Aurora, CO .................................................................................................. .............................................................. 1.0904 Adams County, CO. Arapahoe County, CO. Broomfield County, CO. Clear Creek County, CO. Denver County, CO. Douglas County, CO. Elbert County, CO. Gilpin County, CO. Jefferson County, CO. Park County, CO. 19780 ....... Des Moines, IA ..................................................................................................... ................................................................. 0.9266 Dallas County, IA. Guthrie County, IA. Madison County, IA. Polk County, IA. Warren County, IA. 19804 ....... Detroit-Livonia-Dearborn, MI ....................................................................................... .......................................................... 1.0349 Wayne County, MI. 20020 ....... Dothan, AL ......................................................................................................... .................................................................... 0.7537 Geneva County, AL. Henry County, AL. Houston County, AL. 20100 ....... Dover, DE .......................................................................................................... .................................................................... 0.9825 Kent County, DE. 20220 ....... Dubuque, IA ........................................................................................................ ................................................................... 0.8748 Dubuque County, IA. 20260 ....... Duluth, MN-WI ...................................................................................................... ................................................................. 1.0340 Carlton County, MN. St. Louis County, MN.


### 30292 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Douglas County, WI. 20500 ....... Durham, NC ......................................................................................................... .................................................................. 1.0363 Chatham County, NC. Durham County, NC. Orange County, NC. Person County, NC. 20740 ....... Eau Claire, WI ..................................................................................................... .................................................................. 0.9139 Chippewa County, WI. Eau Claire County, WI. 20764 ....... Edison, NJ ......................................................................................................... .................................................................... 1.1136 Middlesex County, NJ. Monmouth County, NJ. Ocean County, NJ. Somerset County, NJ. 20940 ....... El Centro, CA ...................................................................................................... ................................................................... 0.8856 Imperial County, CA. 21060 ....... Elizabethtown, KY .................................................................................................. ................................................................ 0.8684 Hardin County, KY. Larue County, KY. 21140 ....... Elkhart-Goshen, IN ................................................................................................. ............................................................... 0.9278 Elkhart County, IN. 21300 ....... Elmira, NY ......................................................................................................... ..................................................................... 0.8445 Chemung County, NY. 21340 ....... El Paso, TX ........................................................................................................ .................................................................... 0.9181 El Paso County, TX. 21500 ....... Erie, PA ........................................................................................................... ....................................................................... 0.8699 Erie County, PA. 21604 ....... Essex County, MA ................................................................................................... .............................................................. 1.0662 Essex County, MA. 21660 ....... Eugene-Springfield, OR ............................................................................................. ............................................................ 1.0940 Lane County, OR. 21780 ....... Evansville, IN-KY .................................................................................................. ................................................................. 0.8372 Gibson County, IN. Posey County, IN. Vanderburgh County, IN. Warrick County, IN. Henderson County, KY. Webster County, KY. 21820 ....... Fairbanks, AK ...................................................................................................... .................................................................. 1.1146 Fairbanks North Star Borough, AK. 21940 ....... Fajardo, PR ........................................................................................................ .................................................................... 0.3939 Ceiba Municipio, PR. Fajardo Municipio, PR. Luquillo Municipio, PR. 22020 ....... Fargo, ND-MN ....................................................................................................... ................................................................ 0.9114 Cass County, ND. Clay County, MN. 22140 ....... Farmington, NM ..................................................................................................... ................................................................ 0.8049 San Juan County, NM. 22180 ....... Fayetteville, NC ................................................................................................... .................................................................. 0.9363 Cumberland County, NC. Hoke County, NC. 22220 ....... Fayetteville-Springdale-Rogers, AR-MO .............................................................................. ................................................. 0.8636 Benton County, AR. Madison County, AR. Washington County, AR. McDonald County, MO. 22380 ....... Flagstaff, AZ ...................................................................................................... .................................................................... 1.0787 Coconino County, AZ. 22420 ....... Flint, MI .......................................................................................................... ........................................................................ 1.1178 Genesee County, MI. 22500 ....... Florence, SC ....................................................................................................... ................................................................... 0.8833 Darlington County, SC. Florence County, SC. 22520 ....... Florence-Muscle Shoals, AL ......................................................................................... ......................................................... 0.7883 Colbert County, AL. Lauderdale County, AL. 22540 ....... Fond du Lac, WI .................................................................................................... ................................................................ 0.9897 Fond du Lac County, WI. 22660 ....... Fort Collins-Loveland, CO .......................................................................................... ........................................................... 1.0218


### 30293 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Larimer County, CO. 22744 ....... Fort Lauderdale-Pompano Beach-Deerfield Beach, FL .................................................................. ...................................... 1.0165 Broward County, FL. 22900 ....... Fort Smith, AR-OK .................................................................................................. ............................................................... 0.8283 Crawford County, AR. Franklin County, AR. Sebastian County, AR. Le Flore County, OK. Sequoyah County, OK. 23020 ....... Fort Walton Beach-Crestview-Destin, FL ............................................................................. ................................................. 0.8786 Okaloosa County, FL. 23060 ....... Fort Wayne, IN ..................................................................................................... ................................................................. 0.9807 Allen County, IN. Wells County, IN. Whitley County, IN. 23104 ....... Fort Worth-Arlington, TX ........................................................................................... ............................................................. 0.9472 Johnson County, TX. Parker County, TX. Tarrant County, TX. Wise County, TX. 23420 ....... Fresno, CA ......................................................................................................... .................................................................... 1.0536 Fresno County, CA. 23460 ....... Gadsden, AL ........................................................................................................ .................................................................. 0.8049 Etowah County, AL. 23540 ....... Gainesville, FL .................................................................................................... ................................................................... 0.9459 Alachua County, FL. Gilchrist County, FL. 23580 ....... Gainesville, GA .................................................................................................... .................................................................. 0.9557 Hall County, GA. 23844 ....... Gary, IN ........................................................................................................... ...................................................................... 0.9310 Jasper County, IN. Lake County, IN. Newton County, IN. Porter County, IN. 24020 ....... Glens Falls, NY .................................................................................................... .................................................................. 0.8467 Warren County, NY. Washington County, NY. 24140 ....... Goldsboro, NC ...................................................................................................... ................................................................. 0.8778 Wayne County, NC. 24220 ....... Grand Forks, ND-MN ................................................................................................. ............................................................ 0.9091 Polk County, MN. Grand Forks County, ND. 24300 ....... Grand Junction, CO ................................................................................................. .............................................................. 0.9900 Mesa County, CO. 24340 ....... Grand Rapids-Wyoming, MI ........................................................................................... ....................................................... 0.9420 Barry County, MI. Ionia County, MI. Kent County, MI. Newaygo County, MI. 24500 ....... Great Falls, MT .................................................................................................... .................................................................. 0.8810 Cascade County, MT. 24540 ....... Greeley, CO ........................................................................................................ ................................................................... 0.9444 Weld County, CO. 24580 ....... Green Bay, WI ...................................................................................................... ................................................................. 0.9590 Brown County, WI. Kewaunee County, WI. Oconto County, WI. 24660 ....... Greensboro-High Point, NC .......................................................................................... ......................................................... 0.9190 Guilford County, NC. Randolph County, NC. Rockingham County, NC. 24780 ....... Greenville, NC ..................................................................................................... .................................................................. 0.9183 Greene County, NC. Pitt County, NC. 24860 ....... Greenville, SC ..................................................................................................... ................................................................... 0.9557 Greenville County, SC. Laurens County, SC. Pickens County, SC. 25020 ....... Guayama, PR ........................................................................................................ ................................................................ 0.4005 Arroyo Municipio, PR.


### 30294 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Guayama Municipio, PR. Patillas Municipio, PR. 25060 ....... Gulfport-Biloxi, MS ................................................................................................ ................................................................. 0.8950 Hancock County, MS. Harrison County, MS. Stone County, MS. 25180 ....... Hagerstown-Martinsburg, MD-WV ...................................................................................... ................................................... 0.9715 Washington County, MD. Berkeley County, WV. Morgan County, WV. 25260 ....... Hanford-Corcoran, CA ............................................................................................... ............................................................ 0.9296 Kings County, CA. 25420 ....... Harrisburg-Carlisle, PA ............................................................................................ .............................................................. 0.9359 Cumberland County, PA. Dauphin County, PA. Perry County, PA. 25500 ....... Harrisonburg, VA ................................................................................................... ................................................................ 0.9275 Rockingham County, VA. Harrisonburg City, VA. 25540 ....... Hartford-West Hartford-East Hartford, CT ........................................................................... .................................................. 1.1054 Hartford County, CT. Litchfield County, CT. Middlesex County, CT. Tolland County, CT. 25620 ....... Hattiesburg, MS .................................................................................................... ................................................................. 0.7362 Forrest County, MS. Lamar County, MS. Perry County, MS. 25860 ....... Hickory-Lenoir-Morganton, NC ....................................................................................... ....................................................... 0.9502 Alexander County, NC. Burke County, NC. Caldwell County, NC. Catawba County, NC. 25980 ....... Hinesville-Fort Stewart, GA ........................................................................................ ........................................................... 0.7715 Liberty County, GA. Long County, GA. 26100 ....... Holland-Grand Haven, MI ............................................................................................ .......................................................... 0.9388 Ottawa County, MI. 26180 ....... Honolulu, HI ....................................................................................................... .................................................................... 1.1013 Honolulu County, HI. 26300 ....... Hot Springs, AR .................................................................................................... ................................................................. 0.9249 Garland County, AR. 26380 ....... Houma-Bayou Cane-Thibodaux, LA ..................................................................................... ................................................. 0.7721 Lafourche Parish, LA. Terrebonne Parish, LA. 26420 ....... Houston-Baytown-Sugar Land, TX ..................................................................................... ................................................... 0.9973 Austin County, TX. Brazoria County, TX. Chambers County, TX. Fort Bend County, TX. Galveston County, TX. Harris County, TX. Liberty County, TX. Montgomery County, TX. San Jacinto County, TX. Waller County, TX. 26580 ....... Huntington-Ashland, WV-KY-OH ....................................................................................... .................................................... 0.9564 Boyd County, KY. Greenup County, KY. Lawrence County, OH. Cabell County, WV. Wayne County, WV. 26620 ....... Huntsville, AL ..................................................................................................... .................................................................... 0.8851 Limestone County, AL. Madison County, AL. 26820 ....... Idaho Falls, ID .................................................................................................... ................................................................... 0.9059 Bonneville County, ID. Jefferson County, ID. 26900 ....... Indianapolis, IN ................................................................................................... ................................................................... 1.0113 Boone County, IN.


### 30295 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Brown County, IN. Hamilton County, IN. Hancock County, IN. Hendricks County, IN. Johnson County, IN. Marion County, IN. Morgan County, IN. Putnam County, IN. Shelby County, IN. 26980 ....... Iowa City, IA ...................................................................................................... .................................................................... 0.9654 Johnson County, IA. Washington County, IA. 27060 ....... Ithaca, NY ......................................................................................................... ..................................................................... 0.9589 Tompkins County, NY. 27100 ....... Jackson, MI ........................................................................................................ .................................................................... 0.9146 Jackson County, MI. 27140 ....... Jackson, MS ........................................................................................................ .................................................................. 0.8291 Copiah County, MS. Hinds County, MS. Madison County, MS. Rankin County, MS. Simpson County, MS. 27180 ....... Jackson, TN ........................................................................................................ ................................................................... 0.8900 Chester County, TN. Madison County, TN. 27260 ....... Jacksonville, FL ................................................................................................... .................................................................. 0.9537 Baker County, FL. Clay County, FL. Duval County, FL. Nassau County, FL. St. Johns County, FL. 27340 ....... Jacksonville, NC ................................................................................................... ................................................................. 0.8401 Onslow County, NC. 27500 ....... Janesville, WI ..................................................................................................... .................................................................... 0.9583 Rock County, WI. 27620 ....... Jefferson City, MO ................................................................................................. ................................................................ 0.8338 Callaway County, MO. Cole County, MO. Moniteau County, MO. Osage County, MO. 27740 ....... Johnson City, TN ................................................................................................... ................................................................ 0.8146 Carter County, TN. Unicoi County, TN. Washington County, TN. 27780 ....... Johnstown, PA ...................................................................................................... ................................................................. 0.8380 Cambria County, PA. 27860 ....... Jonesboro, AR ...................................................................................................... ................................................................. 0.8144 Craighead County, AR. Poinsett County, AR. 27900 ....... Joplin, MO ......................................................................................................... ..................................................................... 0.8721 Jasper County, MO. Newton County, MO. 28020 ....... Kalamazoo-Portage, MI .............................................................................................. ........................................................... 1.0676 Kalamazoo County, MI. Van Buren County, MI. 28100 ....... Kankakee-Bradley, IL ............................................................................................... ............................................................. 1.0603 Kankakee County, IL. 28140 ....... Kansas City, MO-KS ................................................................................................. ............................................................. 0.9629 Franklin County, KS. Johnson County, KS. Leavenworth County, KS. Linn County, KS. Miami County, KS. Wyandotte County, KS. Bates County, MO. Caldwell County, MO. Cass County, MO. Clay County, MO. Clinton County, MO. Jackson County, MO.


### 30296 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Lafayette County, MO. Platte County, MO. Ray County, MO. 28420 ....... Kennewick-Richland-Pasco, WA ....................................................................................... .................................................... 1.0520 Benton County, WA. Franklin County, WA. 28660 ....... Killeen-Temple-Fort Hood, TX ....................................................................................... ........................................................ 0.9242 Bell County, TX. Coryell County, TX. Lampasas County, TX. 28700 ....... Kingsport-Bristol-Bristol, TN-VA ................................................................................... ......................................................... 0.8240 Hawkins County, TN. Sullivan County, TN. Bristol City, VA. Scott County, VA. Washington County, VA. 28740 ....... Kingston, NY ....................................................................................................... ................................................................... 0.9000 Ulster County, NY. 28940 ....... Knoxville, TN ...................................................................................................... .................................................................... 0.8548 Anderson County, TN. Blount County, TN. Knox County, TN. Loudon County, TN. Union County, TN. 29020 ....... Kokomo, IN ......................................................................................................... ................................................................... 0.8986 Howard County, IN. Tipton County, IN. 29100 ....... La Crosse, WI-MN ................................................................................................... .............................................................. 0.9289 Houston County, MN. La Crosse County, WI. 29140 ....... Lafayette, IN ...................................................................................................... .................................................................... 0.9067 Benton County, IN. Carroll County, IN. Tippecanoe County, IN. 29180 ....... Lafayette, LA ...................................................................................................... .................................................................... 0.8306 Lafayette Parish, LA. St. Martin Parish, LA. 29340 ....... Lake Charles, LA ................................................................................................... ................................................................ 0.7935 Calcasieu Parish, LA. Cameron Parish, LA. 29404 ....... Lake County-Kenosha County, IL-WI .................................................................................. .................................................. 1.0342 Lake County, IL. Kenosha County, WI. 29460 ....... Lakeland, FL ....................................................................................................... ................................................................... 0.8930 Polk County, FL. 29540 ....... Lancaster, PA ...................................................................................................... .................................................................. 0.9883 Lancaster County, PA. 29620 ....... Lansing-East Lansing, MI ........................................................................................... ........................................................... 0.9658 Clinton County, MI. Eaton County, MI. Ingham County, MI. 29700 ....... Laredo, TX ......................................................................................................... .................................................................... 0.8747 Webb County, TX. 29740 ....... Las Cruces, NM ..................................................................................................... ................................................................ 0.8784 Dona Ana County, NM. 29820 ....... Las Vegas-Paradise, NV ............................................................................................. .......................................................... 1.1378 Clark County, NV. 29940 ....... Lawrence, KS ....................................................................................................... ................................................................. 0.8644 Douglas County, KS. 30020 ....... Lawton, OK ......................................................................................................... ................................................................... 0.8212 Comanche County, OK. 30140 ....... Lebanon, PA ........................................................................................................ .................................................................. 0.8570 Lebanon County, PA. 30300 ....... Lewiston, ID-WA .................................................................................................... ................................................................ 0.9314 Nez Perce County, ID. Asotin County, WA. 30340 ....... Lewiston-Auburn, ME ................................................................................................ ............................................................ 0.9562 Androscoggin County, ME. 30460 ....... Lexington-Fayette, KY .............................................................................................. ............................................................. 0.9359 Bourbon County, KY.


### 30297 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Clark County, KY. Fayette County, KY. Jessamine County, KY. Scott County, KY. Woodford County, KY. 30620 ....... Lima, OH ........................................................................................................... ..................................................................... 0.9330 Allen County, OH. 30700 ....... Lincoln, NE ........................................................................................................ .................................................................... 1.0208 Lancaster County, NE. Seward County, NE. 30780 ....... Little Rock-North Little Rock, AR .................................................................................. ......................................................... 0.8826 Faulkner County, AR. Grant County, AR. Lonoke County, AR. Perry County, AR. Pulaski County, AR. Saline County, AR. 30860 ....... Logan, UT-ID ....................................................................................................... .................................................................. 0.9094 Franklin County, ID. Cache County, UT. 30980 ....... Longview, TX ....................................................................................................... .................................................................. 0.8801 Gregg County, TX. Rusk County, TX. Upshur County, TX. 31020 ....... Longview, WA ....................................................................................................... ................................................................. 1.0224 Cowlitz County, WA. 31084 ....... Los Angeles-Long Beach-Glendale, CA ................................................................................ ................................................ 1.1732 Los Angeles County, CA. 31140 ....... Louisville, KY-IN .................................................................................................. .................................................................. 0.9122 Clark County, IN. Floyd County, IN. Harrison County, IN. Washington County, IN. Bullitt County, KY. Henry County, KY. Jefferson County, KY. Meade County, KY. Nelson County, KY. Oldham County, KY. Shelby County, KY. Spencer County, KY. Trimble County, KY. 31180 ....... Lubbock, TX ........................................................................................................ ................................................................... 0.8777 Crosby County, TX. Lubbock County, TX. 31340 ....... Lynchburg, VA ...................................................................................................... ................................................................. 0.9017 Amherst County, VA. Appomattox County, VA. Bedford County, VA. Campbell County, VA. Bedford City, VA. Lynchburg City, VA. 31420 ....... Macon, GA .......................................................................................................... ................................................................... 0.9887 Bibb County, GA. Crawford County, GA. Jones County, GA. Monroe County, GA. Twiggs County, GA. 31460 ....... Madera, CA ......................................................................................................... ................................................................... 0.8521 Madera County, CA. 31540 ....... Madison, WI ........................................................................................................ ................................................................... 1.0306 Columbia County, WI. Dane County, WI. Iowa County, WI. 31700 ....... Manchester-Nashua, NH .............................................................................................. ......................................................... 1.0642 Hillsborough County, NH. Merrimack County, NH. 31900 ....... Mansfield, OH ...................................................................................................... .................................................................. 0.9189 Richland County, OH. 32420 ....... Mayaguez, PR ....................................................................................................... ................................................................ 0.4493


### 30298 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Hormigueros Municipio, PR. Mayaguez Municipio, PR. 32580 ....... McAllen-Edinburg-Pharr, TX ......................................................................................... ......................................................... 0.8602 Hidalgo County, TX. 32780 ....... Medford, OR ........................................................................................................ .................................................................. 1.0534 Jackson County, OR. 32820 ....... Memphis, TN-MS-AR .................................................................................................. ........................................................... 0.9217 Crittenden County, AR. DeSoto County, MS. Marshall County, MS. Tate County, MS. Tunica County, MS. Fayette County, TN. Shelby County, TN. Tipton County, TN. 32900 ....... Merced, CA ......................................................................................................... ................................................................... 1.0575 Merced County, CA. 33124 ....... Miami-Miami Beach-Kendall, FL ...................................................................................... ...................................................... 0.9870 Miami-Dade County, FL. 33140 ....... Michigan City-La Porte, IN ......................................................................................... ........................................................... 0.9332 LaPorte County, IN. 33260 ....... Midland, TX ........................................................................................................ .................................................................... 0.9384 Midland County, TX. 33340 ....... Milwaukee-Waukesha-West Allis, WI .................................................................................. .................................................. 1.0076 Milwaukee County, WI. Ozaukee County, WI. Washington County, WI. Waukesha County, WI. 33460 ....... Minneapolis-St. Paul-Bloomington, MN-WI ............................................................................ ............................................... 1.1066 Anoka County, MN. Carver County, MN. Chisago County, MN. Dakota County, MN. Hennepin County, MN. Isanti County, MN. Ramsey County, MN. Scott County, MN. Sherburne County, MN. Washington County, MN. Wright County, MN. Pierce County, WI. St. Croix County, WI. 33540 ....... Missoula, MT ....................................................................................................... .................................................................. 0.9618 Missoula County, MT. 33660 ....... Mobile, AL ......................................................................................................... ..................................................................... 0.7995 Mobile County, AL. 33700 ....... Modesto, CA ........................................................................................................ .................................................................. 1.1966 Stanislaus County, CA. 33740 ....... Monroe, LA ......................................................................................................... ................................................................... 0.7903 Ouachita Parish, LA. Union Parish, LA. 33780 ....... Monroe, MI ......................................................................................................... .................................................................... 0.9506 Monroe County, MI. 33860 ....... Montgomery, AL ..................................................................................................... ............................................................... 0.8300 Autauga County, AL. Elmore County, AL. Lowndes County, AL. Montgomery County, AL. 34060 ....... Morgantown, WV ..................................................................................................... .............................................................. 0.8730 Monongalia County, WV. Preston County, WV. 34100 ....... Morristown, TN ..................................................................................................... ................................................................. 0.7790 Grainger County, TN. Hamblen County, TN. Jefferson County, TN. 34580 ....... Mount Vernon-Anacortes, WA ......................................................................................... ...................................................... 1.0576 Skagit County, WA. 34620 ....... Muncie, IN ......................................................................................................... ..................................................................... 0.8580 Delaware County, IN. 34740 ....... Muskegon-Norton Shores, MI ......................................................................................... ....................................................... 0.9741


### 30299 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Muskegon County, MI. 34820 ....... Myrtle Beach-Conway-North Myrtle Beach, SC ......................................................................... ........................................... 0.9022 Horry County, SC. 34900 ....... Napa, CA ........................................................................................................... .................................................................... 1.2531 Napa County, CA. 34940 ....... Naples-Marco Island, FL ............................................................................................ ........................................................... 1.0558 Collier County, FL. 34980 ....... Nashville-Davidson

— Murfreesboro, TN ............................................................................................................... ................. 1.0086 Cannon County, TN. Cheatham County, TN. Davidson County, TN. Dickson County, TN. Hickman County, TN. Macon County, TN. Robertson County, TN. Rutherford County, TN. Smith County, TN. Sumner County, TN. Trousdale County, TN. Williamson County, TN. Wilson County, TN. 35004 ....... Nassau-Suffolk, NY ................................................................................................. .............................................................. 1.2907 Nassau County, NY. Suffolk County, NY. 35084 ....... Newark-Union, NJ-PA ................................................................................................ ............................................................ 1.1687 Essex County, NJ. Hunterdon County, NJ. Morris County, NJ. Sussex County, NJ. Union County, NJ. Pike County, PA. 35300 ....... New Haven-Milford, CT .............................................................................................. ........................................................... 1.1807 New Haven County, CT. 35380 ....... New Orleans-Metairie-Kenner, LA .................................................................................... ..................................................... 0.9103 Jefferson Parish, LA. Orleans Parish, LA. Plaquemines Parish, LA. St. Bernard Parish, LA. St. Charles Parish, LA. St. John the Baptist Parish, LA. St. Tammany Parish, LA. 35644 ....... New York-Wayne-White Plains, NY-NJ ................................................................................. ................................................ 1.3311 Bergen County, NJ. Hudson County, NJ. Passaic County, NJ. Bronx County, NY. Kings County, NY. New York County, NY. Putnam County, NY. Queens County, NY. Richmond County, NY. Rockland County, NY. Westchester County, NY. 35660 ....... Niles-Benton Harbor, MI ............................................................................................ ............................................................ 0.8847 Berrien County, MI. 35980 ....... Norwich-New London, CT ............................................................................................. ........................................................ 1.1596 New London County, CT. 36084 ....... Oakland-Fremont-Hayward, CA ........................................................................................ .................................................... 1.5220 Alameda County, CA. Contra Costa County, CA. 36100 ....... Ocala, FL .......................................................................................................... ..................................................................... 0.9153 Marion County, FL. 36140 ....... Ocean City, NJ ..................................................................................................... ................................................................. 1.0810 Cape May County, NJ. 36220 ....... Odessa, TX ......................................................................................................... ................................................................... 0.9798 Ector County, TX. 36260 ....... Ogden-Clearfield, UT ............................................................................................... .............................................................. 0.9216 Davis County, UT. Morgan County, UT. Weber County, UT.


### 30300 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

36420 ....... Oklahoma City, OK .................................................................................................. .............................................................. 0.8982 Canadian County, OK. Cleveland County, OK. Grady County, OK. Lincoln County, OK. Logan County, OK. McClain County, OK. Oklahoma County, OK. 36500 ....... Olympia, WA ........................................................................................................ .................................................................. 1.1006 Thurston County, WA. 36540 ....... Omaha-Council Bluffs, NE-IA ........................................................................................ ........................................................ 0.9754 Harrison County, IA. Mills County, IA. Pottawattamie County, IA. Cass County, NE. Douglas County, NE. Sarpy County, NE. Saunders County, NE. Washington County, NE. 36740 ....... Orlando, FL ........................................................................................................ .................................................................... 0.9742 Lake County, FL. Orange County, FL. Osceola County, FL. Seminole County, FL. 36780 ....... Oshkosh-Neenah, WI ................................................................................................. ........................................................... 0.9099 Winnebago County, WI. 36980 ....... Owensboro, KY ...................................................................................................... ................................................................ 0.8434 Daviess County, KY. Hancock County, KY. McLean County, KY. 37100 ....... Oxnard-Thousand Oaks-Ventura, CA ................................................................................... ................................................ 1.1105 Ventura County, CA. 37340 ....... Palm Bay-Melbourne-Titusville, FL .................................................................................. ...................................................... 0.9633 Brevard County, FL. 37460 ....... Panama City-Lynn Haven, FL ......................................................................................... ...................................................... 0.8124 Bay County, FL. 37620 ....... Parkersburg-Marietta, WV-OH ........................................................................................ ....................................................... 0.8288 Washington County, OH. Pleasants County, WV. Wirt County, WV. Wood County, WV. 37700 ....... Pascagoula, MS ..................................................................................................... ................................................................ 0.7974 George County, MS. Jackson County, MS. 37860 ....... Pensacola-Ferry Pass-Brent, FL ..................................................................................... ...................................................... 0.8306 Escambia County, FL. Santa Rosa County, FL. 37900 ....... Peoria, IL ......................................................................................................... ...................................................................... 0.8886 Marshall County, IL. Peoria County, IL. Stark County, IL. Tazewell County, IL. Woodford County, IL. 37964 ....... Philadelphia, PA ................................................................................................... ................................................................. 1.0865 Bucks County, PA. Chester County, PA. Delaware County, PA. Montgomery County, PA. Philadelphia County, PA. 38060 ....... Phoenix-Mesa-Scottsdale, AZ ........................................................................................ ....................................................... 0.9982 Maricopa County, AZ. Pinal County, AZ. 38220 ....... Pine Bluff, AR ..................................................................................................... ................................................................... 0.8673 Cleveland County, AR. Jefferson County, AR. Lincoln County, AR. 38300 ....... Pittsburgh, PA ..................................................................................................... ................................................................... 0.8736 Allegheny County, PA. Armstrong County, PA. Beaver County, PA.


### 30301 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Butler County, PA. Fayette County, PA. Washington County, PA. Westmoreland County, PA. 38340 ....... Pittsfield, MA ..................................................................................................... ..................................................................... 1.0439 Berkshire County, MA. 38540 ....... Pocatello, ID ...................................................................................................... .................................................................... 0.9601 Bannock County, ID. Power County, ID. 38660 ....... Ponce, PR .......................................................................................................... .................................................................... 0.5006 Juana Daz Municipio, PR. Ponce Municipio, PR. Villalba Municipio, PR. 38860 ....... Portland-South Portland-Biddeford, ME .............................................................................. .................................................. 1.0112 Cumberland County, ME. Sagadahoc County, ME. York County, ME. 38900 ....... Portland-Vancouver-Beaverton, OR-WA ................................................................................ ............................................... 1.1403 Clackamas County, OR. Columbia County, OR. Multnomah County, OR. Washington County, OR. Yamhill County, OR. Clark County, WA. Skamania County, WA. 38940 ....... Port St. Lucie-Fort Pierce, FL ..................................................................................... ........................................................... 1.0046 Martin County, FL. St. Lucie County, FL. 39100 ....... Poughkeepsie-Newburgh-Middletown, NY ............................................................................... ............................................. 1.1363 Dutchess County, NY. Orange County, NY. 39140 ....... Prescott, AZ ....................................................................................................... .................................................................... 0.9892 Yavapai County, AZ. 39300 ....... Providence-New Bedford-Fall River, RI-MA ........................................................................... ............................................... 1.0929 Bristol County, MA. Bristol County, RI. Kent County, RI. Newport County, RI. Providence County, RI. Washington County, RI. 39340 ....... Provo-Orem, UT ..................................................................................................... ............................................................... 0.9588 Juab County, UT. Utah County, UT. 39380 ....... Pueblo, CO ......................................................................................................... ................................................................... 0.8752 Pueblo County, CO. 39460 ....... Punta Gorda, FL .................................................................................................... ................................................................ 0.9441 Charlotte County, FL. 39540 ....... Racine, WI ......................................................................................................... .................................................................... 0.9045 Racine County, WI. 39580 ....... Raleigh-Cary, NC ................................................................................................... ................................................................ 1.0057 Franklin County, NC. Johnston County, NC. Wake County, NC. 39660 ....... Rapid City, SD ..................................................................................................... .................................................................. 0.8912 Meade County, SD. Pennington County, SD. 39740 ....... Reading, PA ........................................................................................................ ................................................................... 0.9215 Berks County, PA. 39820 ....... Redding, CA ........................................................................................................ .................................................................. 1.1835 Shasta County, CA. 39900 ....... Reno-Sparks, NV .................................................................................................... ............................................................... 1.0456 Storey County, NV. Washoe County, NV. 40060 ....... Richmond, VA ....................................................................................................... ................................................................. 0.9397 Amelia County, VA. Caroline County, VA. Charles City County, VA. Chesterfield County, VA. Cumberland County, VA. Dinwiddie County, VA.


### 30302 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Goochland County, VA. Hanover County, VA. Henrico County, VA. King and Queen County, VA. King William County, VA. Louisa County, VA. New Kent County, VA. Powhatan County, VA. Prince George County, VA. Sussex County, VA. Colonial Heights City, VA. Hopewell City, VA. Petersburg City, VA. Richmond City, VA. 40140 ....... Riverside-San Bernardino-Ontario, CA ............................................................................... .................................................. 1.0970 Riverside County, CA. San Bernardino County, CA. 40220 ....... Roanoke, VA ........................................................................................................ .................................................................. 0.8415 Botetourt County, VA. Craig County, VA. Franklin County, VA. Roanoke County, VA. Roanoke City, VA. Salem City, VA. 40340 ....... Rochester, MN ...................................................................................................... ................................................................. 1.1504 Dodge County, MN. Olmsted County, MN. Wabasha County, MN. 40380 ....... Rochester, NY ...................................................................................................... ................................................................. 0.9281 Livingston County, NY. Monroe County, NY. Ontario County, NY. Orleans County, NY. Wayne County, NY. 40420 ....... Rockford, IL ....................................................................................................... .................................................................... 0.9626 Boone County, IL. Winnebago County, IL. 40484 ....... Rockingham County-Strafford County, NH ............................................................................. .............................................. 1.0221 Rockingham County, NH. Strafford County, NH. 40580 ....... Rocky Mount, NC .................................................................................................... .............................................................. 0.8998 Edgecombe County, NC. Nash County, NC. 40660 ....... Rome, GA ........................................................................................................... ................................................................... 0.8878 Floyd County, GA. 40900 ....... Sacramento

—Arden-Arcade

— Roseville, CA .................................................................................................................. ...... 1.1700 El Dorado County, CA. Placer County, CA. Sacramento County, CA. Yolo County, CA. 40980 ....... Saginaw-Saginaw Township North, MI ................................................................................. ................................................ 0.9814 Saginaw County, MI. 41060 ....... St. Cloud, MN ...................................................................................................... .................................................................. 1.0215 Benton County, MN. Stearns County, MN. 41100 ....... St. George, UT ..................................................................................................... ................................................................. 0.9458 Washington County, UT. 41140 ....... St. Joseph, MO-KS .................................................................................................. .............................................................. 1.0013 Doniphan County, KS. Andrew County, MO. Buchanan County, MO. DeKalb County, MO. 41180 ....... St. Louis, MO-IL ................................................................................................... .................................................................. 0.9076 Bond County, IL. Calhoun County, IL. Clinton County, IL. Jersey County, IL. Macoupin County, IL. Madison County, IL. Monroe County, IL.


### 30303 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

St. Clair County, IL. Crawford County, MO. Franklin County, MO. Jefferson County, MO. Lincoln County, MO. St. Charles County, MO. St. Louis County, MO. Warren County, MO. Washington County, MO. St. Louis City, MO. 41420 ....... Salem, OR .......................................................................................................... ................................................................... 1.0556 Marion County, OR. Polk County, OR. 41500 ....... Salinas, CA ........................................................................................................ .................................................................... 1.3823 Monterey County, CA. 41540 ....... Salisbury, MD ...................................................................................................... .................................................................. 0.9123 Somerset County, MD. Wicomico County, MD. 41620 ....... Salt Lake City, UT ................................................................................................. ................................................................ 0.9561 Salt Lake County, UT. Summit County, UT. Tooele County, UT. 41660 ....... San Angelo, TX ..................................................................................................... ................................................................ 0.8167 Irion County, TX. Tom Green County, TX. 41700 ....... San Antonio, TX .................................................................................................... ................................................................ 0.9003 Atascosa County, TX. Bandera County, TX. Bexar County, TX. Comal County, TX. Guadalupe County, TX. Kendall County, TX. Medina County, TX. Wilson County, TX. 41740 ....... San Diego-Carlsbad-San Marcos, CA .................................................................................. ................................................. 1.1267 San Diego County, CA. 41780 ....... Sandusky, OH ....................................................................................................... ................................................................. 0.9017 Erie County, OH. 41884 ....... San Francisco-San Mateo-Redwood City, CA ........................................................................... ........................................... 1.4712 Marin County, CA. San Francisco County, CA. San Mateo County, CA. 41900 ....... San German-Cabo Rojo, PR ........................................................................................... ...................................................... 0.5240 Cabo Rojo Municipio, PR. Lajas Municipio, PR. Sabana Grande Municipio, PR. San German Municipio, PR. 41940 ....... San Jose-Sunnyvale-Santa Clara, CA ................................................................................. ................................................. 1.4722 San Benito County, CA. Santa Clara County, CA. 41980 ....... San Juan-Caguas-Guaynabo, PR ....................................................................................... .................................................. 0.4645 Aguas Buenas Municipio, PR. Aibonito Municipio, PR. Arecibo Municipio, PR. Barceloneta Municipio, PR. Barranquitas Municipio, PR. Bayamo  ́ n Municipio, PR. Caguas Municipio, PR. Camuy Municipio, PR. Cano  ́ vanas Municipio, PR. Carolina Municipio, PR. Catan  ̃ o Municipio, PR. Cayey Municipio, PR. Ciales Municipio, PR. Cidra Municipio, PR. Comero Municipio, PR. Corozal Municipio, PR. Dorado Municipio, PR. Florida Municipio, PR. Guaynabo Municipio, PR.


### 30304 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Gurabo Municipio, PR. Hatillo Municipio, PR. Humacao Municipio, PR. Juncos Municipio, PR. Las Piedras Municipio, PR. Lo ı

 ́za Municipio, PR. Manat ı  ́ Municipio, PR. Maunabo Municipio, PR. Morovis Municipio, PR. Naguabo Municipio, PR. Naranjito Municipio, PR. Orocovis Municipio, PR. Quebradillas Municipio, PR. R ı

 ́o Grande Municipio, PR. San Juan Municipio, PR. San Lorenzo Municipio, PR. Toa Alta Municipio, PR. Toa Baja Municipio, PR. Trujillo Alto Municipio, PR. Vega Alta Municipio, PR. Vega Baja Municipio, PR. Yabucoa Municipio, PR. 42020 ....... San Luis Obispo-Paso Robles, CA .................................................................................... ................................................... 1.1118 San Luis Obispo County, CA. 42044 ....... Santa Ana-Anaheim-Irvine, CA ....................................................................................... ...................................................... 1.1611 Orange County, CA. 42060 ....... Santa Barbara-Santa Maria-Goleta, CA ............................................................................... ................................................. 1.0771 Santa Barbara County, CA. 42100 ....... Santa Cruz-Watsonville, CA ......................................................................................... ......................................................... 1.4779 Santa Cruz County, CA. 42140 ....... Santa Fe, NM ....................................................................................................... ................................................................. 1.0909 Santa Fe County, NM. 42220 ....... Santa Rosa-Petaluma, CA ............................................................................................ ........................................................ 1.2961 Sonoma County, CA. 42260 ....... Sarasota-Bradenton-Venice, FL ...................................................................................... ...................................................... 0.9629 Manatee County, FL. Sarasota County, FL. 42340 ....... Savannah, GA ....................................................................................................... ................................................................ 0.9460 Bryan County, GA. Chatham County, GA. Effingham County, GA. 42540 ....... Scranton

—Wilkes-Barre, PA ............................................................................................................... .................................. 0.8543 Lackawanna County, PA. Luzerne County, PA. Wyoming County, PA. 42644 ....... Seattle-Bellevue-Everett, WA ....................................................................................... ......................................................... 1.1492 King County, WA. Snohomish County, WA. 43100 ....... Sheboygan, WI ...................................................................................................... ................................................................ 0.8948 Sheboygan County, WI. 43300 ....... Sherman-Denison, TX ................................................................................................ ........................................................... 0.9617 Grayson County, TX. 43340 ....... Shreveport-Bossier City, LA ........................................................................................ .......................................................... 0.9132 Bossier Parish, LA. Caddo Parish, LA. De Soto Parish, LA. 43580 ....... Sioux City, IA-NE-SD ............................................................................................... .............................................................. 0.9070 Woodbury County, IA. Dakota County, NE. Dixon County, NE. Union County, SD. 43620 ....... Sioux Falls, SD .................................................................................................... .................................................................. 0.9441 Lincoln County, SD. McCook County, SD. Minnehaha County, SD. Turner County, SD. 43780 ....... South Bend-Mishawaka, IN-MI ........................................................................................ ...................................................... 0.9447 St. Joseph County, IN. Cass County, MI. 43900 ....... Spartanburg, SC .................................................................................................... ................................................................ 0.9519


### 30305 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Spartanburg County, SC. 44060 ....... Spokane, WA ........................................................................................................ ................................................................. 1.0660 Spokane County, WA. 44100 ....... Springfield, IL .................................................................................................... ..................................................................... 0.8738 Menard County, IL. Sangamon County, IL. 44140 ....... Springfield, MA .................................................................................................... .................................................................. 1.0176 Franklin County, MA. Hampden County, MA. Hampshire County, MA. 44180 ....... Springfield, MO .................................................................................................... .................................................................. 0.8557 Christian County, MO. Dallas County, MO. Greene County, MO. Polk County, MO. Webster County, MO. 44220 ....... Springfield, OH .................................................................................................... .................................................................. 0.8748 Clark County, OH. 44300 ....... State College, PA .................................................................................................. ................................................................ 0.8461 Centre County, PA. 44700 ....... Stockton, CA ....................................................................................................... ................................................................... 1.0564 San Joaquin County, CA. 44940 ....... Sumter, SC ......................................................................................................... ................................................................... 0.8520 Sumter County, SC. 45060 ....... Syracuse, NY ....................................................................................................... .................................................................. 0.9468 Madison County, NY. Onondaga County, NY. Oswego County, NY. 45104 ....... Tacoma, WA ......................................................................................................... ................................................................. 1.1078 Pierce County, WA. 45220 ....... Tallahassee, FL .................................................................................................... ................................................................. 0.8655 Gadsden County, FL. Jefferson County, FL. Leon County, FL. Wakulla County, FL. 45300 ....... Tampa-St. Petersburg-Clearwater, FL ................................................................................ .................................................. 0.9024 Hernando County, FL. Hillsborough County, FL. Pasco County, FL. Pinellas County, FL. 45460 ....... Terre Haute, IN .................................................................................................... .................................................................. 0.8517 Clay County, IN. Sullivan County, IN. Vermillion County, IN. Vigo County, IN. 45500 ....... Texarkana, TX-Texarkana, AR ........................................................................................ ...................................................... 0.8413 Miller County, AR. Bowie County, TX. 45780 ....... Toledo, OH ......................................................................................................... ................................................................... 0.9524 Fulton County, OH. Lucas County, OH. Ottawa County, OH. Wood County, OH. 45820 ....... Topeka, KS ......................................................................................................... ................................................................... 0.8904 Jackson County, KS. Jefferson County, KS. Osage County, KS. Shawnee County, KS. Wabaunsee County, KS. 45940 ....... Trenton-Ewing, NJ .................................................................................................. ............................................................... 1.0276 Mercer County, NJ. 46060 ....... Tucson, AZ ......................................................................................................... ................................................................... 0.8926 Pima County, AZ. 46140 ....... Tulsa, OK .......................................................................................................... ..................................................................... 0.8690 Creek County, OK. Okmulgee County, OK. Osage County, OK. Pawnee County, OK. Rogers County, OK. Tulsa County, OK.


### 30306 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Wagoner County, OK. 46220 ....... Tuscaloosa, AL ..................................................................................................... ................................................................. 0.8336 Greene County, AL. Hale County, AL. Tuscaloosa County, AL. 46340 ....... Tyler, TX .......................................................................................................... ...................................................................... 0.9502 Smith County, TX. 46540 ....... Utica-Rome, NY ..................................................................................................... ................................................................ 0.8295 Herkimer County, NY. Oneida County, NY. 46660 ....... Valdosta, GA ....................................................................................................... ................................................................... 0.8341 Brooks County, GA. Echols County, GA. Lanier County, GA. Lowndes County, GA. 46700 ....... Vallejo-Fairfield, CA .............................................................................................. ................................................................. 1.4279 Solano County, CA. 46940 ....... Vero Beach, FL ..................................................................................................... ................................................................. 0.9477 Indian River County, FL. 47020 ....... Victoria, TX ....................................................................................................... ..................................................................... 0.8470 Calhoun County, TX. Goliad County, TX. Victoria County, TX. 47220 ....... Vineland-Millville-Bridgeton, NJ ................................................................................... .......................................................... 1.0573 Cumberland County, NJ. 47260 ....... Virginia Beach-Norfolk-Newport News, VA-NC ......................................................................... ............................................ 0.8894 Currituck County, NC. Gloucester County, VA. Isle of Wight County, VA. James City County, VA. Mathews County, VA. Surry County, VA. York County, VA. Chesapeake City, VA. Hampton City, VA. Newport News City, VA. Norfolk City, VA. Poquoson City, VA. Portsmouth City, VA. Suffolk City, VA. Virginia Beach City, VA. Williamsburg City, VA. 47300 ....... Visalia-Porterville, CA ............................................................................................ ................................................................ 0.9975 Tulare County, CA. 47380 ....... Waco, TX ........................................................................................................... .................................................................... 0.8146 McLennan County, TX. 47580 ....... Warner Robins, GA .................................................................................................. ............................................................. 0.8489 Houston County, GA. 47644 ....... Warren-Farmington Hills-Troy, MI ................................................................................... ...................................................... 1.0112 Lapeer County, MI. Livingston County, MI. Macomb County, MI. Oakland County, MI. St. Clair County, MI. 47894 ....... Washington-Arlington-Alexandria, DC-VA&-MD-WV ...................................................................... ....................................... 1.1023 District of Columbia, DC. Calvert County, MD. Charles County, MD. Prince George ’ s County, MD. Arlington County, VA. Clarke County, VA. Fairfax County, VA. Fauquier County, VA. Loudoun County, VA. Prince William County, VA. Spotsylvania County, VA. Stafford County, VA. Warren County, VA. Alexandria City, VA. Fairfax City, VA.


### 30307 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

Falls Church City, VA. Fredericksburg City, VA. Manassas City, VA. Manassas Park City, VA. Jefferson County, WV. 47940 ....... Waterloo-Cedar Falls, IA ........................................................................................... ............................................................ 0.8633 Black Hawk County, IA. Bremer County, IA. Grundy County, IA. 48140 ....... Wausau, WI ......................................................................................................... .................................................................. 0.9570 Marathon County, WI. 48260 ....... Weirton-Steubenville, WV-OH ........................................................................................ ....................................................... 0.8280 Jefferson County, OH. Brooke County, WV. Hancock County, WV. 48300 ....... Wenatchee, WA ...................................................................................................... ............................................................... 0.9427 Chelan County, WA. Douglas County, WA. 48424 ....... West Palm Beach-Boca Raton-Boynton Beach, FL ....................................................................... ....................................... 1.0362 Palm Beach County, FL. 48540 ....... Wheeling, WV-OH .................................................................................................... ............................................................. 0.7449 Belmont County, OH. Marshall County, WV. Ohio County, WV. 48620 ....... Wichita, KS ........................................................................................................ .................................................................... 0.9457 Butler County, KS. Harvey County, KS. Sedgwick County, KS. Sumner County, KS. 48660 ....... Wichita Falls, TX .................................................................................................. .................................................................. 0.8332 Archer County, TX. Clay County, TX. Wichita County, TX. 48700 ....... Williamsport, PA ................................................................................................... ................................................................. 0.8485 Lycoming County, PA. 48864 ....... Wilmington, DE-MD-NJ ............................................................................................... ........................................................... 1.1049 New Castle County, DE. Cecil County, MD. Salem County, NJ. 48900 ....... Wilmington, NC ..................................................................................................... ................................................................. 0.9237 Brunswick County, NC. New Hanover County, NC. Pender County, NC. 49020 ....... Winchester, VA-WV .................................................................................................. ............................................................. 1.0496 Frederick County, VA. Winchester City, VA. Hampshire County, WV. 49180 ....... Winston-Salem, NC .................................................................................................. ............................................................. 0.9401 Davie County, NC. Forsyth County, NC. Stokes County, NC. Yadkin County, NC. 49340 ....... Worcester, MA ...................................................................................................... ................................................................. 1.0996 Worcester County, MA. 49420 ....... Yakima, WA ......................................................................................................... .................................................................. 1.0322 Yakima County, WA. 49500 ....... Yauco, PR .......................................................................................................... .................................................................... 0.4493 Gua  ́ nica Municipio, PR. Guayanilla Municipio, PR. Pen

 ̃ uelas Municipio, PR. Yauco Municipio, PR. 49620 ....... York-Hanover, PA ................................................................................................... ............................................................... 0.9150 York County, PA. 49660 ....... Youngstown-Warren-Boardman, OH-PA .................................................................................. ............................................. 0.9237 Mahoning County, OH. Trumbull County, OH. Mercer County, PA. 49700 ....... Yuba City, CA ...................................................................................................... .................................................................. 1.0363 Sutter County, CA. Yuba County, CA.


### 30308 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 2 A



### . — P ROPOSED 

### I NPATIENT 

### R EHABILITAION 

### F ACILITY 

### WAGE 

### I NDEX FOR 

### U RBAN 

### A REAS 

### B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### F OR 

### D ISCHARGES 

### O CCURRING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Urban area (Constituent counties) Full wage Index

49740 ....... Yuma, AZ ........................................................................................................... .................................................................... 0.8871 Yuma County, AZ.



### TABLE 

### 2 B



### . — P ROPOSED 

### I NPATIENT 

### R E



### HABILITATION 

### F ACILITY 

### WAGE 

### I NDEX 

### (B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### ) FOR 

### R URAL 

### A REAS FOR 

### D ISCHARGES 

### O CCUR



### RING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

CBSA code Nonurban area Full wage index

01 ............. Alabama .................. 0.7628 02 ............. Alaska ..................... 1.1746 03 ............. Arizona .................... 0.8936 04 ............. Arkansas ................. 0.7406 05 ............. California ................. 1.0524 06 ............. Colorado ................. 0.9368 07 ............. Connecticut ............. 1.1917 08 ............. Delaware ................. 0.9503 10 ............. Florida ..................... 0.8574 11 ............. Georgia ................... 0.7733 12 ............. Hawaii ..................... 1.0522 13 ............. Idaho ....................... 0.8227 14 ............. Illinois ...................... 0.8339 15 ............. Indiana .................... 0.8653 16 ............. Iowa ........................ 0.8475 17 ............. Kansas .................... 0.8079 18 ............. Kentucky ................. 0.7755 19 ............. Louisiana ................ 0.7345 20 ............. Maine ...................... 0.9039 21 ............. Maryland ................. 0.9220 22 ............. Massachusetts 2 ...... 1.0216 

### TABLE 

### 2 B



### . — P ROPOSED 

### I NPATIENT 

### R E



### HABILITATION 

### F ACILITY 

### WAGE 

### I NDEX 

### (B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### ) FOR 

### R URAL 

### A REAS FOR 

### D ISCHARGES 

### O CCUR



### RING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Nonurban area Full wage index

23 ............. Michigan ................. 0.8786 24 ............. Minnesota ............... 0.9330 25 ............. Mississippi .............. 0.7635 26 ............. Missouri .................. 0.7762 27 ............. Montana .................. 0.8701 28 ............. Nebraska ................ 0.9035 29 ............. Nevada ................... 0.9280 30 ............. New Hampshire ...... 0.9940 31 ............. New Jersey 1

........... ................ 32 ............. New Mexico ............ 0.8680 33 ............. New York ................ 0.8151 34 ............. North Carolina ........ 0.8563 35 ............. North Dakota .......... 0.7743 36 ............. Ohio ........................ 0.8693 37 ............. Oklahoma ............... 0.7686 38 ............. Oregon .................... 0.9914 39 ............. Pennsylvania .......... 0.8310 40 ............. Puerto Rico 2 ........... 0.4047 41 ............. Rhode Island 1

........ ................ 42 ............. South Carolina ........ 0.8683 43 ............. South Dakota .......... 0.8398 

### TABLE 

### 2 B



### . — P ROPOSED 

### I NPATIENT 

### R E



### HABILITATION 

### F ACILITY 

### WAGE 

### I NDEX 

### (B ASED ON 

### P ROPOSED 

### CBSA LABOR 

### M ARKET 

### A REAS 

### ) FOR 

### R URAL 

### A REAS FOR 

### D ISCHARGES 

### O CCUR



### RING ON OR 

### A FTER 

### O CTOBER 

### 1, 2005

—Continued

CBSA code Nonurban area Full wage index

44 ............. Tennessee .............. 0.7869

45 ............. Texas ...................... 0.7966

46 ............. Utah ........................ 0.8287

47 ............. Vermont .................. 0.9375 48 ............. Virgin Islands .......... 0.7456 49 ............. Virginia .................... 0.8049 50 ............. Washington ............. 1.0312 51 ............. West Virginia .......... 0.7865

52 ............. Wisconsin ............... 0.9492 53 ............. Wyoming ................. 0.9182 65 ............. Guam ...................... 0.9611

1 All counties within the State are classified urban.

2 Massachusetts and Puerto Rico haveareas designated as rural, however, no shortterm, acute care hospitals are located in thearea(s) for FY 2006 under CBSA-based designations. Therefore, we are proposing to use FY 2001 MSA based hospital wage data.



### TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

26T107 ..... 9TH FLOOR REHAB ..................................................................................................... ................ 26470 3760 28140 39T231 ..... DABINGTON MEMORIAL HOSPITAL ......................................................................................... . 39560 6160 37964 193067 ..... ACADIA REHABILITATION HOSPITAL ...................................................................................... . 19000 3880 19 24T043 ..... ACUTE CARE REHABILITATION-ALMC ..................................................................................... 2 4230 24 24 42T070 ..... ACUTE REHAB UNIT AT TUOMEY HEALTHCARE SYSTEM ................................................... 42420 8140 44940 14T182 ..... ADVOCATE ILLINOIS MASONIC MEDICAL CENTER ................................................................ 14141 1600 169 74 14T223 ..... ADVOCATE LUTHERAN GENERAL HOSPITAL ......................................................................... 14141 1600 16974 19T202 ..... AHS SUMMIT HOSPITAL LLC ............................................................................................. ........ 19160 0760 12940 05T320 ..... ALAMEDA COUNTY MEDICAL CENTER .................................................................................... 050 00 5775 36084 02T017 ..... ALASKA REGIONAL HOSPITAL ............................................................................................ ...... 02020 0380 11260 33T013 ..... ALBANY MEDICAL CENTER HOSP .......................................................................................... .. 33000 0160 10580 14T258 ..... ALEXIAN BROTHERS MEDICAL CENTER ................................................................................. 1414 1 1600 16974 05T281 ..... ALHAMBRA HOSPITAL MEDICAL CENTER ............................................................................... 05200 4480 31084 52T096 ..... ALL SAINTS HEALTHCARE, INC. ......................................................................................... ...... 52500 6600 39540 39T074 ..... ALLEGHENY GENERAL HOSPITAL SUBURBAN CAMPUS ...................................................... 39010 6280 38300 17T116 ..... ALLEN COUNTY HOSPITAL ............................................................................................... ......... 17000 17 17 36T131 ..... ALLIANCE COMMUNITY HOSPITAL ......................................................................................... .. 36770 1320 15940 393030 ..... ALLIED SERVICES INST OF REHAB SERVICES ...................................................................... 39420 756 0 42540 05T305 ..... ALTA BATES MEDICAL CENTER ........................................................................................... .... 05000 5775 36084 39T073 ..... ALTOONA HOSPITAL .................................................................................................... .............. 39120 0280 11020 39T121 ..... ALTOONA REGIONAL HEALTH SYSTEM .................................................................................. 3912 0 0280 11020 35T019 ..... ALTRU REHABILITATION CENTER ......................................................................................... ... 35170 2985 24220 05T583 ..... ALVARADO HOSPITAL MEDICAL CENTER INC. ...................................................................... 05470 7320 41740 33T010 ..... AMSTERDAM MEMORIAL HOSPITAL ........................................................................................ 3 3380 0160 33


### 30309 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

01T036 ..... ANDALUSIA REGIONAL HOSPITAL ......................................................................................... .. 01190 01 01 393051 ..... ANGELA JANE PAVILION ................................................................................................ ............ 39620 6160 37964 423029 ..... ANMED HEALTHSOUTH REHABILITATION HOSPITAL ............................................................ 42030 3160 11340 04T039 ..... ARKANSAS METHODIST HOSPITAL ......................................................................................... . 04270 04 04 39T163 ..... ARMSTRONG COUNTY MEMORIAL HOSPITAL ....................................................................... 39070 39 3830 0 11T115 ..... ATLANTA MEDICAL CENTER .............................................................................................. ....... 11470 0520 12060 15T074 ..... AUGUST F. HOOK REHAB CENTER ......................................................................................... . 15480 3480 26900 49T018 ..... AUGUSTA MEDICAL CENTER .............................................................................................. ...... 49891 49 49 52T193 ..... AURORA BAYCARE MEDICAL CENTER .................................................................................... 520 40 3080 24580 52T102 ..... AURORA LAKELAND MEDICAL CENTER REHAB UNIT ........................................................... 52630 52 52 52T035 ..... AURORA SHEBOYGAN MEMORIAL MEDICAL CENTER REHAB UNI ..................................... 52580 7620 43100 52T064 ..... AURORA SINAI MEDICAL CENTER ......................................................................................... .. 52390 5080 33340 43T016 ..... AVERA MCKENNAN HOSPITAL ............................................................................................. ..... 43490 7760 43620 43T012 ..... AVERA SACRED HEART HOSPITAL ......................................................................................... . 43670 43 43 43T014 ..... AVERA ST. LUKE ’ S ...................................................................................................................... 43060 43 4 3 45T280 ..... BACHARACH INSTITUTE FOR REHABILITATION ..................................................................... 31000 1920 19124 313030 ..... BALL MEMORIAL HOSPITAL-REHAB ........................................................................................ . 15170 0560 12100 15T089 ..... BAPTIST HEALTH REHABILITATION INSTITUTE ...................................................................... 04590 52 80 34620 043026 ..... BAPTIST HEALTH SYSTEM ............................................................................................... ......... 45130 4400 30780 45T058 ..... BAPTIST HOSPITAL DAVIS CTR FOR REHABILITATION ........................................................ 10120 7240 41700 10T008 ..... BAPTIST HOSPITAL DESOTO ............................................................................................. ....... 25160 5000 33124 25T141 ..... BAPTIST HOSPITAL EAST ............................................................................................... ........... 18550 4920 32820 18T130 ..... BAPTIST HOSPITALS OF SOUTHEAST TEXAS ........................................................................ 45700 452 0 31140 45T346 ..... BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI ............................................................ 25350 0840 1314 0 25T034 ..... BAPTIST MEMORIAL MED CENTER, NO LITTLE ROCK .......................................................... 04590 25 25 04T036 ..... BAPTIST REGIONAL MEDICAL CENTER ................................................................................... 18 990 4400 30780 18T080 ..... BAPTIST REHAB CENTER ................................................................................................ .......... 44180 18 18 44T133 ..... BAPTIST REHABILITATION GERMANTOWN ............................................................................. 44780 5 360 34980 44T147 ..... BARBERTON CITIZENS HOSPITAL ......................................................................................... ... 36780 4920 32820 36T019 ..... BARTLETT REGIONAL HOSPITAL .......................................................................................... ... 02110 0080 10420 02T008 ..... BASTROP REHABILITATION HOSPITAL .................................................................................... 1 9330 02 02 193058 ..... BATON ROUGE GENERAL MEDICAL CENTER ........................................................................ 19160 19 19 19T065 ..... BAXTER REGIONAL MEDICAL CENTER ................................................................................... 040 20 0760 12940 04T027 ..... BAY MEDICAL CENTER FOR REHABILITATION ....................................................................... 23080 04 0 4 23T041 ..... BAYHEALTH MEDICAL CENTER ............................................................................................ .... 08000 6960 13020 08T004 ..... BAYLOR ALL SAINTS MEDICAL CENTER OF FORT WORTH ................................................. 45910 2190 20100 45T137 ..... BAYLOR INSTITUTE FOR REHABILITATION AT GASTON ...................................................... 45390 2800 23104 453036 ..... BAYLOR MEDICAL CENTER ............................................................................................... ........ 45390 1920 19124 45T079 ..... BAYLOR MEDICAL CENTER AT GARLAND .............................................................................. 45390 1 920 19124 45T097 ..... BAYSHORE MEDICAL CENTER ............................................................................................. .... 45610 3360 26420 27T012 ..... BELLEVUE HOSPITAL CENTRE ............................................................................................ ..... 33420 3040 24500 33T204 ..... BELMONT COMMUNITY HOSPITAL .......................................................................................... . 36060 5600 35644 36T153 ..... BELOIT MEMORIAL HOSPITAL ............................................................................................ ...... 52520 9000 48540 52T100 ..... BENEDICTINE HOSPITAL ................................................................................................ ........... 33740 3620 27500 33T224 ..... BENEFIS HEALTHCARE .................................................................................................. ............ 27060 33 28740 15T088 ..... BENNETT REHAB CENTER SAINT JOHN ’ S HEALTH SYSTEM ............................................... 15470 3480 11300 193070 ..... BENTON REHABILITATION HOSPITAL ...................................................................................... 19160 0760 12940 36T170 ..... BERGER HEALTH SYSTEM ................................................................................................ ........ 36660 1840 18140 22T046 ..... BERKSHIRE MEDICAL CENTER ............................................................................................ ..... 22010 6323 38340 33T169 ..... BETH ISRAEL MEDICAL CENTER .......................................................................................... .... 33420 5600 35644 36T179 ..... BETHESDA NORTH HOSPITAL ............................................................................................. ..... 36310 1640 17140 01T104 ..... BIRMINGHAM BAPT MED CNTR MONTCLAIR SNU ................................................................. 01360 1000 1382 0 10T213 ..... BLAKE MEDICAL CENTER ................................................................................................ .......... 10400 7510 42260 14T015 ..... BLESSING HOSPITAL ................................................................................................... ............... 14000 14 14 23T135 ..... BOGALUSA COMMUNITY REHABILITAION HOSPITAL ............................................................ 19580 2160 19804 193052 ..... BON SECOUR ST. FRANCIS INPATIENT REHAB CENTER ..................................................... 42220 19 19 42T023 ..... BONE AND JOINT HOSPITAL REHAB CENTER ....................................................................... 37540 3160 24860 37T105 ..... BOONE HOSPITAL CENTER ............................................................................................... ........ 26090 5880 36420 26T068 ..... BORGESS-PIPP HEALTH CENTER .......................................................................................... .. 23380 1740 17860 23T117 ..... BOSTON MED CTR CORP/UNIVE HOSP CAMPUS .................................................................. 22160 3720 2802 0 22T031 ..... BOTHWELL REGIONAL HEALTH CENTER ................................................................................ 26790 1123 14484 26T009 ..... BOTSFORD GENERAL HOSPITAL ........................................................................................... .. 23620 26 26 23T151 ..... BOULDER COMMUNITY HOSPITAL .......................................................................................... . 06060 2160 47644 06T027 ..... BRANDYWINE HOSPITAL ................................................................................................. .......... 39210 1125 14500 39T076 ..... BRAZOSPORT MEMORIAL HOSPITAL ...................................................................................... 45 180 6160 37964 45T072 ..... BRIDGEPORT HOSPITAL ................................................................................................. ........... 07010 1145 26420 07T010 ..... BROADWAY METHODIST REHAB ............................................................................................ .. 15440 3283 25540


### 30310 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

15T132 ..... BROKEN ARROW REHABILITATION ......................................................................................... . 37710 2960 23844 37T176 ..... BROMENN REGIONAL MEDICAL CENTER ............................................................................... 14650 8 560 46140 14T127 ..... BRONSON VICKSBURG HOSPITAL .......................................................................................... . 23380 1040 14060 23T190 ..... BROOKS REHABILITATION HOSPITAL ..................................................................................... 1 0150 3720 28020 103039 ..... BROOKWOOD MEDICAL CENTER ............................................................................................ . 01360 3600 27260 01T139 ..... BROTMAN MEDICAL CENTER .............................................................................................. ..... 05200 1000 13820 05T144 ..... BROWNSVILLE GENERAL HOSPITAL ....................................................................................... 3 9330 4480 31084 39T166 ..... BROWNWOOD REGIONAL MEDICAL CENTER ........................................................................ 45220 6280 38 300 45T587 ..... BRUNSWICK HOSPITAL .................................................................................................. ............ 33700 45 45 33T314 ..... BRYANLGH MEDICAL CENTER WEST ...................................................................................... 28 540 5380 35004 28T003 ..... BRYANT T. ALDRIDGE REHABILITATION CENTER ................................................................. 34630 4360 30 700 34T147 ..... BRYN MAWR REHABILITATION HOSPITAL .............................................................................. 39210 6895 40580 393025 ..... BSA HEALTH SYSTEM ................................................................................................... ............. 45860 6160 37964 45T231 ..... BUFFALO MERCY REHABILITATION UNIT ............................................................................... 3324 0 0320 11100 33T279 ..... BURBANK REHABILITATION CENTER ...................................................................................... 2 2170 1280 15380 22T001 ..... BURKE REHABILIATION HOSPITAL ........................................................................................ ... 33800 1123 49340 333028 ..... CABRINI MEDICAL CENTER .............................................................................................. ......... 33420 5600 35644 39T160 ..... CALDWELL MEMORIAL HOSPITAL .......................................................................................... .. 19100 6280 38300 33T133 ..... CAMERON REGIONAL MEDICAL CTR ....................................................................................... 2 6240 5600 35644 19T190 ..... CANONSBURG GENERAL HOSPITAL ....................................................................................... 39 750 19 19 26T057 ..... CAPITAL REGION MEDICAL CENTER ....................................................................................... 26250 3760 28140 26T047 ..... CARDINAL HILL REHABILITATION HOSPITAL .......................................................................... 18330 26 27620 183026 ..... CARILION HEALTH SYSTEM .............................................................................................. ........ 49801 4280 30460 49T024 ..... CARLE FOUNDATION HOSPITAL ........................................................................................... .... 14090 6800 40220 14T091 ..... CARLISLE REGIONAL MEDICAL CENTER ................................................................................ 3927 0 1400 16580 39T058 ..... CARLSBAD MEDICAL CENTER ............................................................................................. ..... 32070 3240 25420 32T063 ..... CAROLINAS HOSPITAL SYSTEM ........................................................................................... .... 42200 32 32 42T091 ..... CARONDELET ST JOSEPHS HOSPITAL ................................................................................... 030 90 2655 22500 03T011 ..... CARONDELET ST MARYS HOSPITAL ....................................................................................... 0 3090 8520 46060 03T010 ..... CARSON REHABILITATION CENTER ........................................................................................ 29120 8520 46060 293029 ..... CARTHAGE AREA HOSPITAL .............................................................................................. ....... 33330 29 16180 33T263 ..... CASA COLINA HOSP FOR REHAB MEDICINE .......................................................................... 05200 33 33 053027 ..... CATAWBA VALLEY MEDICAL CENTER ..................................................................................... 34 170 4480 31084 34T143 ..... CATHOLIC MEDICAL CENTER ............................................................................................. ...... 30050 3290 25860 30T034 ..... CATSKILL REGIONAL MEDICAL CENTER ................................................................................. 337 10 1123 31700 33T386 ..... CAYUGA MEDICAL CENTER ............................................................................................... ....... 33730 33 33 33T307 ..... CCMH INPATIENT REHAB ................................................................................................ .......... 39640 33 27060 39T246 ..... CEDARS-SINAI MEDICAL CENTER ......................................................................................... ... 05200 39 39 44T161 ..... CENTENNIAL MEDICAL CENTER ........................................................................................... .... 44180 5360 34980 05T625 ..... CENTINELA HOSPITAL MEDICAL CENTER .............................................................................. 05200 4480 31084 05T240 ..... CENTRAL ARKANSAS HOSPITAL ........................................................................................... ... 04720 4480 31084 04T014 ..... CENTRAL KANSAS MEDICAL CENTER ..................................................................................... 17 040 04 04 17T033 ..... CENTRAL MAINE REHABILITATION CENTER .......................................................................... 20000 17 17 20T024 ..... CENTRAL MONTGOMERY MEDICAL CENTER ......................................................................... 39560 4243 3 0340 39T012 ..... CENTURA HEALTH-ST. ANTHONY CENTRAL HOSPITAL ....................................................... 06150 6160 37964 06T015 ..... CGRMC ACUTE REHABILITATION UNIT ................................................................................... 03 100 2080 19740 03T016 ..... CHALMETTE MEDICAL CENTER ............................................................................................ .... 19430 6200 38060 45T035 ..... CHAMBERSBURG HOSPITAL ............................................................................................... ...... 39350 3360 26420 45T237 ..... CHARLESTON AREA MED CNTR ............................................................................................ ... 51190 7240 41700 19T185 ..... CHARLOTTE INSTITUTE OF REHABILITATION ........................................................................ 34590 55 60 35380 39T151 ..... CHATTANOOGA ......................................................................................................... .................. 44320 39 39 51T022 ..... CHELSEA COMMUNITY HOSPITAL .......................................................................................... . 23800 1480 16620 343026 ..... CHESHIRE MEDICAL CENTER ............................................................................................. ...... 30020 1520 16740 44T162 ..... CHESTNUT HILL REHABILITATION HOSPITAL ........................................................................ 39620 15 60 16860 23T259 ..... CHNE REHAB .......................................................................................................... ..................... 26940 0440 11460 30T019 ..... CHRISTUS JASPER MEMORIAL HOSPITAL .............................................................................. 45690 30 30 393032 ..... CHRISTUS SANTA ROSA HOSPITAL ........................................................................................ . 45130 6160 37964 26T180 ..... CHRISTUS SCHUMPERT HEALTH SYSTEM ............................................................................. 19080 70 40 41180 45T573 ..... CHRISTUS SPOHN HOSPITAL SHORELINE ............................................................................. 45830 4 5 45 19T041 ..... CHRISTUS ST MICHAEL REHAB HOSPITAL ............................................................................. 45170 7680 43340 45T046 ..... CHRISTUS ST. FRANCES CABRINI HOSPITAL ........................................................................ 19390 18 80 18580 453065 ..... CHRISTUS ST. JOHN ................................................................................................... ............... 45610 8360 45500 19T019 ..... CHRISTUS ST. JOSEPH HOSPITAL ........................................................................................ ... 45610 0220 10780 45T709 ..... CHRISTUS ST. PATRICK HOSPITAL ....................................................................................... ... 19090 3360 26420 19T027 ..... CHS,INC DBA ST CHARLES MEDICAL CTR ............................................................................. 38080 3960 29340 38T047 ..... CITRUS VALLEY MEDICAL CENTER-VQ CAMPUS .................................................................. 05200 38 13460 05T369 ..... CJW INPATIENT REHAB ................................................................................................. ............ 49791 4480 31084


### 30311 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

49T112 ..... CL .................................................................................................................. ................................ 45610 6760 40060 45T617 ..... CLAXTON-HEPBURN MEDICAL CENTER .................................................................................. 3363 0 3360 26420 33T211 ..... CLINCH VALLEY MEDICAL CENTER ........................................................................................ . 49920 33 33 49T060 ..... CLINTON MEMORIAL HOSPITAL ........................................................................................... .... 36130 49 49 36T175 ..... COASTAL REHABILITATION CTR .......................................................................................... .... 34240 36 36 36T172 ..... COLISEUM REHABILITATION CENTER ..................................................................................... 1 1090 1680 17460 34T131 ..... COLLEGE STATION MEDICAL CENTER .................................................................................... 45 190 34 34 11T164 ..... COLLETON MEDICAL CENTER ............................................................................................. ..... 42140 4680 31420 45T299 ..... COLORADO PLAINS MEDICAL CTR ......................................................................................... . 06430 1260 17780 42T030 ..... COLORADO RIVER MEDICAL CENTER ..................................................................................... 05 460 42 42 06T044 ..... COLUMBIA HOSPITAL ................................................................................................... .............. 52390 06 06 05T469 ..... COLUMBIA REGIONAL HOSPITAL .......................................................................................... ... 26090 6780 40140 52T140 ..... COLUMBUS REGIONAL HOSPITAL .......................................................................................... . 15020 5080 33340 26T178 ..... COMANCHE COUNTY MEMORIAL HOSPITAL .......................................................................... 37150 1740 17860 15T112 ..... COMMUNITY GENERAL HOSPITAL PM&R ............................................................................... 33520 1 5 18020 37T056 ..... COMMUNITY HEALTH PARTNERS OF OH-WEST .................................................................... 36480 4200 300 20 33T159 ..... COMMUNITY HOSPITAL LOS GATOS ....................................................................................... 0 5530 8160 45060 05T188 ..... COMMUNITY HOSPITAL OF SPRINGFIELD .............................................................................. 36110 7400 41940 36T187 ..... COMMUNITY HOSPITAL/WELLNESS CTRS MONTPELI .......................................................... 36870 2000 44220 36R327 .... COMMUNITY HOSPITALS OF WILLIAMS COUNTY .................................................................. 36870 36 36 36T121 ..... COMMUNITY HOSPTIAL .................................................................................................. ........... 15440 36 36 15T125 ..... COMMUNITY MEDICAL CENTER ............................................................................................ ... 27310 2960 23844 27T023 ..... COMMUNITY MEMORIAL HOSPITAL ......................................................................................... 52660 5140 33540 52T103 ..... COMMUNITY REHABILITATION CENTER .................................................................................. 231 00 5080 33340 23T078 ..... COMMUNITY REHABILITATION HOSPITAL OF COUSHATTA ................................................. 19400 0870 35660 193080 ..... CONEY ISLAND HOSPITAL ............................................................................................... .......... 33331 19 19 33T196 ..... CORNERSTONE REHABILITATION HOSPITAL ......................................................................... 45650 560 0 35644 453085 ..... CORONA REGINAL MEDICAL CENTER ..................................................................................... 05 430 4880 32580 05T329 ..... CORPUS CHRISTI WARM SPGS REHAB HOSP ....................................................................... 45830 6780 4 0140 453055 ..... COTTAGE HOSPITAL .................................................................................................... .............. 23810 1880 18580 45T040 ..... COVENANT HEALTH SYSTEM .............................................................................................. ..... 45770 4600 31180 23T070 ..... COVENANT HEALTHCARE ................................................................................................. ........ 23720 6960 40980 16T067 ..... COVENANT MEDICAL CENTER ............................................................................................. .... 16060 8920 47940 26T040 ..... COX HEALTH SYSTEMS .................................................................................................. ........... 26380 7920 44180 05T008 ..... CPMC REGIONAL REHABILITATION CENTER ......................................................................... 05480 736 0 41884 39T110 ..... CRICHTON REHABILITATION CENTER ..................................................................................... 3 9160 3680 27780 04T042 ..... CRITTENDEN MEMORIAL HOSPITAL ........................................................................................ 04170 4920 32820 23T254 ..... CRITTENTON REHABCENTRE .............................................................................................. ..... 23730 2160 47644 44T175 ..... CROCKETT HOSPITAL REHAB ............................................................................................. ..... 44490 44 44 26T198 ..... CROSSROADS REGIONAL MEDICAL CENTER ........................................................................ 26910 7040 4 1180 193088 ..... CROWLEY REHAB HOSP, LLC ............................................................................................. ...... 19000 3880 19 39T180 ..... CROZER CHESTER MEDICAL CENTER .................................................................................... 392 90 6160 37964 34T008 ..... CTR FOR REHAB SCOTLAND MEMORIAL HOSPIT ................................................................. 34820 34 34 39T233 ..... CTR. FOR ACUTE REHABILITATIVE MEDICINE AT HANOVER .............................................. 39800 9280 49620 07T033 ..... DANBURY HOSPITAL .................................................................................................... .............. 07000 5483 14860 05T729 ..... DANIEL FREEMAN ...................................................................................................... ................. 05200 4480 31084 49T075 ..... DANVILLE REGIONAL MEDICAL CENTER ................................................................................ 4924 1 1950 19260 19T003 ..... DAUTERIVE HOSPITAL .................................................................................................. ............. 19220 19 19 15T061 ..... DAVIESS COMMUNITY HOSPITAL .......................................................................................... ... 15130 15 15 46T041 ..... DAVIS HOSPITAL AND MEDICAL CENTER ............................................................................... 4605 0 7160 36260 36T038 ..... DEACONESS HOSPITAL .................................................................................................. ........... 36310 1640 17140 37T032 ..... DEACONESS HOSPITAL .................................................................................................. ........... 37540 5880 36420 15T019 ..... DEACONESS ST. JOSEPHS ............................................................................................... ........ 15180 15 15 11T076 ..... DEKALB MEDICAL CENTER REHABILITATION ........................................................................ 11370 052 0 12060 03T093 ..... DEL E. WEBB MEMORIAL HOSPITAL ....................................................................................... . 03060 6200 38060 45T646 ..... DEL SOL MEDICAL CENTER .............................................................................................. ........ 45480 2320 21340 39T081 ..... DELAWARE COUNTY MEMORIAL HOSPITAL ........................................................................... 39290 616 0 37964 25T082 ..... DELTA REGIONAL MEDICAL CENTER ...................................................................................... 2 5750 25 25 45T634 ..... DENTON REGIONAL MEDICAL CENTER .................................................................................. 4541 0 1920 19124 06T011 ..... DENVER HEALTH MEDICAL CENTER ....................................................................................... 0 6150 2080 19740 49T011 ..... DEPAUL CENTER FOR PHYSICAL REHABILITATION .............................................................. 49641 5720 4726 0 26T176 ..... DES PERES HOSPITAL .................................................................................................. ............. 26940 7040 41180 05T243 ..... DESERT REGIONAL MEDICAL CENTER ................................................................................... 054 30 6780 40140 45T147 ..... DETAR HOSPITAL ...................................................................................................... ................. 45948 8750 47020 19T115 ..... DOCTORS HOSPITAL .................................................................................................... .............. 11840 7680 43340 11T177 ..... DOCTORS HOSPITAL OF OPELOUSAS .................................................................................... 194 80 0600 12260 19T191 ..... DOCTORS HOSPITAL OF SHREVEPORT ................................................................................. 19080 3880 19


### 30312 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

36T151 ..... DOCTORS HOSPITAL OF STARK COUNTY .............................................................................. 36770 1 320 15940 05T242 ..... DOMINICAN HOSPITAL .................................................................................................. ............. 05540 7485 42100 39T203 ..... DOYLESTOWN HOSPITAL ................................................................................................. ......... 39140 6160 37964 46T021 ..... DRMC ACUTE REHABILITATION ........................................................................................... ..... 46260 46 41100 39T086 ..... DUBOIS REGNL MED CNTR ............................................................................................... ........ 39230 39 39 34T155 ..... DURHAM REGIONAL HOSPITAL ............................................................................................ .... 34310 6640 20500 23T230 ..... E W SPARROW INPATIENT REHAB ......................................................................................... . 23320 4040 29620 19T146 ..... EAST JEFFERSON GENERAL HOSPITAL ................................................................................. 1925 0 5560 35380 453072 ..... EAST TEXAS MED CTR REHAB HOSP ..................................................................................... 45 892 8640 46340 01T011 ..... EASTERN HEALTH REHAB CENTER, MCE .............................................................................. 01360 1 000 13820 20T033 ..... EASTERN MAINE MEDICAL CENTER ........................................................................................ 20090 0733 12620 39T162 ..... EASTON HOSPITAL ..................................................................................................... ................ 39590 0240 10900 333029 ..... EDDY COHOES REHABILITATION CTR .................................................................................... 33 000 0160 10580 45T119 ..... EDINBURG REGIONAL MEDICAL ........................................................................................... .... 45650 4880 32580 36T241 ..... EDWIN SHAW REHABILITATION HOSPITAL ............................................................................. 36780 0080 10420 14T208 ..... EHS CHRIST HOSPITAL & MEDICAL CENTER ......................................................................... 14141 16 00 16974 03T080 ..... EL DORADO HOSPITAL .................................................................................................. ............ 03090 8520 46060 15T018 ..... ELKHART GENERAL HEALTHCARE SYSTEMS ........................................................................ 15190 2330 2 1140 39T289 ..... ELKINS PARK HOSPITAL ................................................................................................ ............ 39560 6160 37964 33T128 ..... ELMHURST HOSPITAL CENTER ............................................................................................ .... 33590 5600 35644 11T010 ..... EMORY HOSPITAL CTR FOR REHAB ....................................................................................... 1 1370 0520 12060 05T158 ..... ENCINO-TARZANA REGIONAL MEDICAL CENTER .................................................................. 05200 4480 310 84 05T039 ..... ENLOE MEDICAL CENTER ................................................................................................ ......... 05030 1620 17020 45T833 ..... ENNIS REGIONAL MEDICAL CENTER ....................................................................................... 45470 1920 19124 39T225 ..... EPHRATA COMMUNITY HOSPITAL .......................................................................................... . 39440 4000 29540 33T219 ..... ERIE COUNTY MEDICAL CENTER .......................................................................................... ... 33240 1280 15380 19T078 ..... EUNICE COMMUNITY MEDICAL CENTER ................................................................................ 19480 3880 19 39T013 ..... EVANGELICAL COMMUNITY HOSPITAL ................................................................................... 397 20 39 39 14T010 ..... EVANSTON NORTHWESTERN HEALTHCARE ......................................................................... 14141 1600 16 974 50T124 ..... EVERGREEN HEALTHCARE ................................................................................................ ....... 50160 7600 42644 36T072 ..... FAIRFIELD MEDICAL CENTER ............................................................................................ ....... 36230 1840 18140 223029 ..... FAIRLAWN REHABILITATION HOSPITAL .................................................................................. 22 170 1123 49340 36T077 ..... FAIRVIEW HOSPITAL ................................................................................................... ............... 36170 1680 17460 11T125 ..... FAIRVIEW PARK HOSPITAL .............................................................................................. ......... 11660 11 11 28T125 ..... FAITH REGIONAL HEALTH SERVICES ...................................................................................... 28590 28 28 10T236 ..... FAWCETT MEMORIAL HOSPITAL ........................................................................................... ... 10070 6580 39460 33T044 ..... FAXTON-ST. LUKES HEALTHCARE ......................................................................................... .. 33510 8680 46540 15T064 ..... FAYETTE MEMORIAL HOSPITAL ........................................................................................... .... 15200 15 15 36T025 ..... FIRELANDS REGIONAL MEDICAL CENTER ............................................................................. 36220 3 6 41780 34T115 ..... FIRSTHEALTH MOORE REGIONAL HOSPITAL ........................................................................ 34620 34 34 47T003 ..... FLETCHER ALLEN HEALTH CARE .......................................................................................... .. 47030 1303 15540 10T068 ..... FLORIDA HOSPITAL ORMOND DIVISION ................................................................................. 106 30 2020 19660 10T007 ..... FLORIDA HOSPITAL REHABILITATION AND SPORTS MEDICIN ............................................ 10470 5960 36740 36T074 ..... FLOWER REHABILITATION CENTER ........................................................................................ 36490 8400 45780 11T054 ..... FLOYD MEDICAL CENTER ................................................................................................ ......... 11460 11 40660 39T267 ..... FORBES REGIONAL HOSPITAL ............................................................................................ ..... 39010 6280 38300 26T021 ..... FOREST PARK ......................................................................................................... .................... 26950 7040 41180 25T078 ..... FORREST GENERAL HOSPITAL REHAB UNIT ......................................................................... 25170 328 5 25620 36T132 ..... FORT REHABILITATION CENTER .......................................................................................... .... 36080 3200 17140 10T223 ..... FORT WALTON BEACH MEDICAL CENT .................................................................................. 1045 0 2750 23020 453041 ..... FORT WORTH REHABILITATION HOSPITAL ............................................................................ 45910 2 800 23104 26T137 ..... FR .................................................................................................................. ................................ 26480 3710 27900 52T004 ..... FRANCISCAN SKEMP MEDICAL CENTER REHAB ................................................................... 52310 3870 291 00 18T040 ..... FRAZIER REHAB INSTITUTE ............................................................................................. ......... 18550 4520 31140 17T074 ..... FRED C BRAMLAGE INPATIENT REHABILITATION UNIT ....................................................... 17300 17 17 52T177 ..... FROEDTERT MEMORIAL LUTHERAN HOSPITAL ..................................................................... 52390 5080 33 340 34T116 ..... FRYE REGIONAL MEDICAL CENTER ........................................................................................ 34170 3290 25860 36T194 ..... GALION COMMUNITY HOSPITAL ........................................................................................... .... 36160 4800 36 23T244 ..... GARDEN CITY HOSPITAL ................................................................................................ ........... 23810 2160 19804 05T432 ..... GARFIELD MEDICAL CENTER ............................................................................................. ...... 05200 4480 31084 44T035 ..... GATEWAY MEDICAL CENTER .............................................................................................. ..... 44620 1660 17300 14T125 ..... GATEWAY REGIONAL MEDICAL CENTER ................................................................................ 14680 7040 41180 183031 ..... GATEWAY REHAB HOSPITAL .............................................................................................. ...... 18550 4520 31140 183030 ..... GATEWAY REHABILITATION HOSPITAL ................................................................................... 18 070 1640 17140 33T058 ..... GE .................................................................................................................. ............................... 33530 6840 40380 393047 ..... GEISINGER HEALTHSOUTH REHABILITATION HOSPITAL ..................................................... 39580 39 39 39T270 ..... GEISINGER WYOMING VALLEY MEDICAL CENTER ............................................................... 39480 7560 42540


### 30313 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

36T039 ..... GENESIS HEALTH CARE SYSTEM .......................................................................................... .. 36610 36 36 16T033 ..... GENESIS MEDICAL CENTER .............................................................................................. ....... 16810 1960 19340 23T197 ..... GENESYS REGIONAL MEDICAL CTR ........................................................................................ 23240 2640 22420 373026 ..... GEORGE NIGH REBABILITATION CTR ..................................................................................... 3 7550 37 46140 45T191 ..... GEORGETOWN HEALTHCARE SYSTEM .................................................................................. 45970 0 640 12420 11T087 ..... GLANCY .............................................................................................................. .......................... 11530 0520 12060 05T239 ..... GLENDALE ADVENTIST MEDICAL CENTER ............................................................................. 05200 4 480 31084 05T058 ..... GLENDALE MEMORIAL HOSPITAL .......................................................................................... .. 05200 4480 31084 33T191 ..... GLENS FALLS HOSPITAL ................................................................................................ ........... 33750 2975 24020 19T160 ..... GLENWOOD REHABILITATION CENTER .................................................................................. 1936 0 5200 33740 26T175 ..... GOLDEN VALLEY MEMORIAL HO INPATIENT REHAB FACILITY ........................................... 26410 26 26 05T471 ..... GOOD SAMARITAN HOSPITAL ............................................................................................. ..... 05200 4480 31084 15T042 ..... GOOD SAMARITAN HOSPITAL ............................................................................................. ..... 15410 15 15 28T009 ..... GOOD SAMARITAN HOSPITAL ............................................................................................. ..... 28090 28 28 36T134 ..... GOOD SAMARITAN HOSPITAL ............................................................................................. ..... 36310 1640 17140 50T079 ..... GOOD SAMARITAN HOSPITAL ............................................................................................. ..... 50260 8200 45104 14T046 ..... GOOD SAMARITAN REGIONAL HEALTH CENTER .................................................................. 14490 14 14 03T002 ..... GOOD SAMARITAN REHABILITATION INSTITUTE ................................................................... 03060 6200 3 8060 39T031 ..... GOOD SAMARITAN-STINE ACUTE REHAB ............................................................................... 39650 39 39 45T037 ..... GOOD SHEPHERD MEDICAL CENTER ..................................................................................... 455 70 4420 30980 393035 ..... GOOD SHEPHERD REHABILITATION HOSPITAL ..................................................................... 39470 0240 1 0900 393050 ..... GOOD SHEPHERD REHABILITATION HOSPITAL ..................................................................... 39590 0240 1 0900 24T064 ..... GRAND ITASCA CLINIC & HOSPITAL ...................................................................................... .. 24300 24 24 36T133 ..... GRANDVIEW MEDICAL CENTER ............................................................................................ ... 36580 2000 19380 36T017 ..... GRANT/RIVERSIDE METHODIST HOSPITALS .......................................................................... 36250 18 40 18140 23T030 ..... GRATIOT COMMUNITY HOSPITAL .......................................................................................... .. 23280 23 23 16T057 ..... GREAT RIVER MEDICAL CENTER .......................................................................................... ... 16280 16 16 09T008 ..... GREATER SOUTHEAST COMMUNITY HOSPITAL .................................................................... 09000 8840 478 94 363032 ..... GREENBRIAR REHABILITATION HOSPITAL ............................................................................. 36510 9320 49660 36T026 ..... GREENE MEMORIAL HOSPITAL ............................................................................................ .... 36290 2000 19380 05T026 ..... GROSSMONT HOSPITAL SHARP ............................................................................................ .. 05470 7320 41740 45T104 ..... GUADALUPE VALLEY HOSPITAL ........................................................................................... .... 45581 7240 41700 45T214 ..... GULF COAST MEDICAL CENTER ........................................................................................... ... 45954 45 45 52T087 ..... GUNDERSEN LUTHERAN MEDICAL CENTER,INC. .................................................................. 52310 3870 291 00 39T185 ..... GUNDERSON REHABILITATION CENTER ................................................................................ 39480 7560 42540 513028 ..... H/S REHAB HOSPITAL OF HUNTINGTON ................................................................................. 510 50 3400 26580 23T066 ..... HACKLEY HOSPITAL .................................................................................................... ............... 23600 3000 34740 36T137 ..... HANNA HOUSE INPATIENT REHAB CENTER .......................................................................... 36170 168 0 17460 50T064 ..... HARBORVIEW MEDICAL CENTER ........................................................................................... .. 50160 7600 42644 33T240 ..... HARLEM HOSPITAL/COLUMBIA UNIVERSITY .......................................................................... 33420 56 00 35644 45T289 ..... HARRIS COUNTY HOSPITAL DISTRICT .................................................................................... 4 5610 3360 26420 45T135 ..... HARRIS METHODIST FORT WORTH ......................................................................................... 45910 2800 23104 45T639 ..... HARRIS METHODIST HEB ................................................................................................ .......... 45910 2800 23104 07T025 ..... HARTFORD HOSPITAL ................................................................................................... ............. 07010 3283 25540 03T069 ..... HAVASU REGIONAL MEDICAL CENTER ................................................................................... 030 70 4120 03 17T013 ..... HAYS MEDICAL CENTER ................................................................................................. ........... 17250 17 17 18T029 ..... HAZARD ARH REGIONAL MEDICAL CENTER .......................................................................... 18960 18 1 8 013028 ..... HEALTH SOUTH REHAB HOSPITAL OF MONTGOMERY ........................................................ 01500 5240 33860 23T275 ..... HEALTHSOURCE SAGINAW ................................................................................................ ....... 23720 6960 40980 053031 ..... HEALTHSOUTH BAKERSFIELD REHAB HOSPITAL ................................................................. 05140 0680 1254 0 223027 ..... HEALTHSOUTH BRAINTREE REHAB HOSPITAL ..................................................................... 22130 1123 14 484 443030 ..... HEALTHSOUTH CANE CREEK REHAB HOSPITAL .................................................................. 44910 44 44 113027 ..... HEALTHSOUTH CENTRAL GA REHAB HOSPITAL ................................................................... 11090 4680 314 20 213028 ..... HEALTHSOUTH CHESAPEAKE REHAB HOSPITAL .................................................................. 21220 21 41540 103040 ..... HEALTHSOUTH EMERALD COAST REHABILITATION HOSPITAL .......................................... 10020 6015 37460 393027 ..... HEALTHSOUTH HARMARVILLE REHABILITATION HOSPITAL ............................................... 39010 6280 38300 013025 ..... HEALTHSOUTH LAKESHORE REHABILITATION HOSPITAL ................................................... 01360 1000 13820 033025 ..... HEALTHSOUTH MERIDIAN POINT REHAB HOSP .................................................................... 03060 6200 38 060 513030 ..... HEALTHSOUTH MOUNTAINVIEW REGIONAL REHAB HOSPITAL .......................................... 51300 51 34060 393039 ..... HEALTHSOUTH NITTANY VALLEY REHABILITATION HOSPITAL ........................................... 39200 8050 44300 183027 ..... HEALTHSOUTH NORTHERN KENTUCKY REHABILITATION ................................................... 18580 1640 17140 393040 ..... HEALTHSOUTH OF ALTOONA, INC ......................................................................................... .. 39120 0280 11020 423027 ..... HEALTHSOUTH OF CHARLESTON, INC ................................................................................... 421 70 1440 16700 453047 ..... HEALTHSOUTH PLANO REHABILITATION HOSP .................................................................... 45310 1920 19 124 043032 ..... HEALTHSOUTH REHAB HOSP IN PART WITH RE ................................................................... 04710 2580 22 220 453044 ..... HEALTHSOUTH REHAB HOSP OF AUSTIN .............................................................................. 45940 0 640 12420 183028 ..... HEALTHSOUTH REHAB HOSP OF CENTRAL KY ..................................................................... 18460 18 2106 0


### 30314 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

063030 ..... HEALTHSOUTH REHAB HOSP OF COLORADO SPGS ............................................................ 06200 1720 17820 423026 ..... HEALTHSOUTH REHAB HOSP OF FLORENCE ........................................................................ 42200 2655 2 2500 013029 ..... HEALTHSOUTH REHAB HOSP OF NORTH ALA ....................................................................... 01440 3440 2 6620 103042 ..... HEALTHSOUTH REHAB HOSP OF SPRING HILL ..................................................................... 10260 8280 4 5300 223030 ..... HEALTHSOUTH REHAB HOSP OF WESTERN MA ................................................................... 22070 8003 4414 0 033029 ..... HEALTHSOUTH REHAB HOSPITAL .......................................................................................... . 03090 8520 46060 103031 ..... HEALTHSOUTH REHAB HOSPITAL .......................................................................................... . 10570 7510 42260 103038 ..... HEALTHSOUTH REHAB HOSPITAL OF MIAMI ......................................................................... 10120 500 0 33124 453059 ..... HEALTHSOUTH REHAB HOSPITAL OF NORTH HOUSTON .................................................... 45801 3360 26420 393026 ..... HEALTHSOUTH REHAB HOSPITAL OF READING ................................................................... 39110 6680 397 40 103033 ..... HEALTHSOUTH REHAB HOSPITAL OF TALLHASSEE ............................................................. 10360 8240 45220 453054 ..... HEALTHSOUTH REHAB HOSPITAL OF WICHITA FALLS ........................................................ 45960 9080 48660 453031 ..... HEALTHSOUTH REHAB INSTITUTE OF SAN ANTONIO .......................................................... 45130 7240 41700 033028 ..... HEALTHSOUTH REHAB INSTITUTE OF TUCSON .................................................................... 03090 8520 46 060 393031 ..... HEALTHSOUTH REHAB OF MECHANICSBURG-ACUTE REHAB ............................................ 39270 3240 25420 393046 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF ERIE .......................................................... 39320 2360 21500 423028 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 42450 15 20 16740 443029 ..... HEALTHSOUTH REHABILITATION CENTER OF MEMPHIS ..................................................... 44780 4920 32820 153027 ..... HEALTHSOUTH REHABILITATION HOSP OF KOK ................................................................... 15330 3850 29 020 393037 ..... HEALTHSOUTH REHABILITATION HOSP YORK ...................................................................... 39800 9280 4 9620 013030 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 01340 21 80 20020 043028 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 04650 27 20 22900 103037 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 10510 82 80 45300 153029 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 15830 83 20 45460 303027 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 30060 11 23 31700 323027 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 32000 02 00 10740 403025 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 40640 74 40 41980 443027 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 44810 36 60 28700 453029 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 45610 33 60 26420 453048 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 45700 08 40 13140 443031 ..... HEALTHSOUTH REHABILITATION HOSPITAL-NORTH ............................................................ 44780 4920 32820 193031 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF ALEXANDRIA ............................................ 19090 3960 29340 453040 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF ARLINGTON .............................................. 45910 2800 23104 423025 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF COLUMBIA ................................................ 42390 1760 17900 043029 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF JONESBORO ............................................ 04150 3700 27860 293026 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF LAS VEGAS .............................................. 29010 4120 29820 313029 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF NEW JERSEY ........................................... 31310 5190 20764 453090 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF ODESSA .................................................... 45451 5800 36220 393045 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF SEWICKLEY .............................................. 39010 6280 38300 453053 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF TEXARKANA ............................................. 45170 8360 45500 453056 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF TYLER ....................................................... 45892 8640 46340 463025 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF UTAH ......................................................... 46170 7160 41620 493028 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF VIRGINIA ................................................... 49430 6760 40060 013032 ..... HEALTHSOUTH REHABILITATION OF GADSDEN .................................................................... 01270 2880 23 460 453057 ..... HEALTHSOUTH REHABILITATION OF MIDLAND ODESSA ..................................................... 45794 5800 33260 293032 ..... HEALTHSOUTH REHABILITIATION HOSPITAL OF HENDERSON ........................................... 29010 4120 29820 103034 ..... HEALTHSOUTH SEA PINES REHABILITATION HOSPITAL ...................................................... 10050 2680 22744 193085 ..... HEALTHSOUTH SPECIALTY HOSPITAL .................................................................................... 19 350 5560 35380 45T758 ..... HEALTHSOUTH SPECIALTY HOSPTIAL, INC. .......................................................................... 45390 1 920 19124 103028 ..... HEALTHSOUTH SUNRISE REHABILITATION HOSPITAL ......................................................... 10050 2680 22744 103032 ..... HEALTHSOUTH TREASURE COAST REHAB HOSPITAL ......................................................... 10300 10 46940 153025 ..... HEALTHSOUTH TRI-STATE REHABILITATION HOSPITAL ...................................................... 15810 2440 21780 053034 ..... HEALTHSOUTH TUSTIN REHABILITATION HOSP ................................................................... 05400 5945 42 044 033032 ..... HEALTHSOUTH VALLEY OF THE SUN ...................................................................................... 0 3060 6200 38060 513027 ..... HEALTHSOUTH WESTERN HILLS REGIONAL REHAB HOSPITAL ......................................... 51530 6020 37620 193074 ..... HEALTHWEST REHABILITATION HOSPITAL ............................................................................ 19250 5 560 35380 26T006 ..... HEARTLAND REGIONAL MEDICAL CENTER ............................................................................ 26100 70 00 41140 333027 ..... HELEN HAYES HOSPITAL ................................................................................................ .......... 33620 5600 35644 04T085 ..... HELENA REGIONAL REHABILITATION CENTER ...................................................................... 04530 04 04 45T229 ..... HENDRICK CENTER FOR REHABILITATION ............................................................................ 45911 0 040 10180 49T118 ..... HENRICO DOCTORS HOSPITAL PARHA .................................................................................. 4943 0 6760 40060 23T204 ..... HENRY FORD BI-COUNTY HOSPITAL ....................................................................................... 23490 2160 47644 23T146 ..... HENRY FORD WYANDOTTE HOSPITAL ................................................................................... 2381 0 2160 19804 05T624 ..... HENRY MAYO NEWHALL MEMORIAL HOSPITAL .................................................................... 05200 4480 310 84 34T107 ..... HERITAGE HOSPITAL ................................................................................................... .............. 34320 6895 40580 45T068 ..... HERMANN HOSPITAL .................................................................................................... ............. 45610 3360 26420 23T120 ..... HERRICK MEMORIAL HOSPITAL ........................................................................................... .... 23450 0440 23


### 30315 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

14T011 ..... HERRIN HOSPITAL ..................................................................................................... ................. 14990 14 14 34T004 ..... HIGH POINT REGIONAL HOSPITAL ........................................................................................ ... 34400 3120 24660 453086 ..... HIGHLANDS REGIONAL REHABILITATION HOS ...................................................................... 45480 2320 21340 50T011 ..... HIGHLINE COMMUNITY HOSPITAL ......................................................................................... .. 50160 7600 42644 45T101 ..... HILLCREST BAPTIST MEDICAL CENTER ................................................................................. 457 80 8800 47380 37T001 ..... HILLCREST KAISER REHABILITATION CENTER ...................................................................... 37710 856 0 46140 363026 ..... HILLSIDE REHABILITATION HOSPITAL .................................................................................... . 36790 9320 49660 14T122 ..... HINSDALE HOSPITAL

— PAULSON REHAB NETWORK ............................................................ 14250 1600 16974 10T225 ..... HOLLYWOOD MEDICAL CENTER ............................................................................................ .. 10050 2680 22744 10T073 ..... HOLY CROSS HOSPITAL ................................................................................................. ........... 10050 2680 22744 14T133 ..... HOLY CROSS HOSPITAL ................................................................................................. ........... 14141 1600 16974 52T107 ..... HOLY FAMILY MEMORIAL, INC ........................................................................................... ....... 52350 52 52 36T054 ..... HOLZER MEDICAL CENTER ............................................................................................... ........ 36270 36 36 45T236 ..... HOPKINS COUNTY MEMORIAL HOSPITAL ............................................................................... 45654 45 45 44T046 ..... HORIZON MEDICAL CENTER .............................................................................................. ....... 44210 5360 34980 33T389 ..... HOSPITAL FOR JOINT DISEASES ......................................................................................... .... 33420 5600 35644 07T001 ..... HOSPITAL OF SAINT RAPHAEL ........................................................................................... ...... 07040 5483 35300 39T111 ..... HOSPITAL OF UNIV OF PENNSYLVANIA .................................................................................. 39 620 6160 37964 04T076 ..... HOT SPRING COUNTY MEDICAL CENTER .............................................................................. 04290 0 4 04 153039 ..... HOWARD REGIONAL HEALTH SYSTEM-WEST CAMPUS ....................................................... 15330 3850 29020 52T091 ..... HOWARD YOUNG MEDICAL CENTER ....................................................................................... 52 420 52 52 11T200 ..... HUGHSTON ORTHOPEDIC HOSPITAL ...................................................................................... 11 780 1800 17980 05T438 ..... HUNTINGTON MEMORIAL HOSPITAL ....................................................................................... 0 5200 4480 31084 23T132 ..... HURLEY MEDICAL CENTER ............................................................................................... ........ 23240 2640 22420 17T020 ..... HUTCHINSON HOSPITAL CORP. ........................................................................................... .... 17770 17 17 133025 ..... IDAHO ELKS REHABILITATION HOSPITAL ............................................................................... 130 00 1080 14260 13T018 ..... IDAHO REGIONAL MEDICAL CENTER ...................................................................................... 1 3090 13 26820 28T081 ..... IMMANUEL REHABILITATION CENTER ..................................................................................... 2 8270 5920 36540 26T095 ..... INDEPENDENCE REGIONAL HEALTH CENTER ....................................................................... 26470 3760 2 8140 14T191 ..... INGALLS MEMORIAL HOSPITAL ........................................................................................... ..... 14141 1600 16974 23T167 ..... INGHAM REGIONAL MEDICAL CENTER ................................................................................... 233 20 4040 29620 49T122 ..... INOVA REHAB CENTER @ INOVA MOUNT VERNON HOSPITAL ........................................... 49290 8840 47894 45T132 ..... INPATIENT REHAB ..................................................................................................... ................. 45451 5800 36220 453025 ..... INSTUTUTE FOR REHAB & RESEARCH,THE ........................................................................... 45610 33 60 26420 37T106 ..... INTEGRIS SOUTHWEST MEDICAL CENTER ............................................................................ 37540 58 80 36420 323029 ..... INTERFACE INC DBA LIFECOURSE REHAB SERVICES ......................................................... 32220 32 22140 16T082 ..... IOWA METHODIST MEDICAL CENTER ..................................................................................... 16 760 2120 19780 15T024 ..... J.W. SOMMER REHABILIATION UNIT ...................................................................................... .. 01160 3480 26900 01T157 ..... JACKSON MEMORIAL HOSPITAL ........................................................................................... ... 10120 2650 22520 33T014 ..... JACOBI MEDICAL CENTER ............................................................................................... ......... 33020 5600 35644 10T022 ..... JAMAICA HOSPITAL MEDICAL CENTER ................................................................................... 33 590 5000 33124 33T127 ..... JAMESON HOSPITAL .................................................................................................... .............. 39450 5600 35644 39T016 ..... JANE PHILLIPS MEMORIAL MEDICAL CENTER ....................................................................... 37730 39 3 9 37T018 ..... JEANES HOSPITAL ..................................................................................................... ................. 39620 37 37 39T080 ..... JEANNETTE HOSPITAL .................................................................................................. ............. 39770 6160 37964 39T010 ..... JEFFERSON REGIONAL MEDICAL CENTER ............................................................................ 04340 62 80 38300 04T071 ..... JEFFERSON REGIONAL MEDICAL CENTER ............................................................................ 39010 62 40 38220 39T265 ..... JFK JOHNSON REHAB INSTITUTE ......................................................................................... ... 31270 6280 38300 31T108 ..... JIM THORPE REHAB UNIT ............................................................................................... .......... 37190 5015 20764 37T029 ..... JOHN D. ARCHBOLD MEMORIAL HOSPITAL ........................................................................... 11890 37 37 11T038 ..... JOHN HEINZ INST OF REHAB MEDICINE ................................................................................. 39 680 11 11 393036 ..... JOHN MUIR MEDICAL CENTER ............................................................................................ ..... 05060 3680 39 05T180 ..... JOHNSON CITY MEDICAL CTR ............................................................................................ ...... 44890 5775 36084 44T063 ..... JOHNSON REGIONAL REHABILITATION CENTER .................................................................. 04350 3660 277 40 04T002 ..... JOHNSTON R. BOWMAN HEALTH CTR. ................................................................................... 141 41 04 04 14T119 ..... JOINT TOWNSHIP DISTRICT MEMORIAL HOSPITAL, REHABIL ............................................. 36050 1600 16974 36T032 ..... KADLEC MEDICAL CENTER ............................................................................................... ........ 50020 4320 36 33T005 ..... KAISER FOUNDATION HOSPITAL-FONTANA REHAB CENTER ............................................. 05460 1280 15380 50T058 ..... KAISER MEDICAL CENTER ............................................................................................... ......... 05580 6740 28420 05T140 ..... KALEIDA HEALTH ...................................................................................................... .................. 33240 6780 40140 05T073 ..... KALISPELL REGIONAL MEDICAL CENTER ............................................................................... 2714 0 8720 46700 27T051 ..... KANSAS REHABILITATION HOSPITAL, INC .............................................................................. 178 80 27 27 173025 ..... KANSAS UNIVERSITY REHAB ............................................................................................. ....... 17986 8440 45820 17T040 ..... KAPLAN REHABILITATION HOSPITAL ...................................................................................... . 19560 3760 28140 193057 ..... KAWEAH DELTA REHABILITATION HOSPITAL ........................................................................ 05640 19 1 9 05T057 ..... KENMORE MERCY HOSPITAL .............................................................................................. ..... 33240 8780 47300 33T102 ..... KENT COUNTY MEMORIAL HOSPITAL ..................................................................................... 41 010 1280 15380


### 30316 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

41T009 ..... KEOKUK AREA HOSPITAL ................................................................................................ .......... 16550 6483 39300 16T008 ..... KESSLER REHAB ....................................................................................................... ................. 31200 16 16 313025 ..... KESSLER ADVENTIST REHABILITATION HOSPITAL ............................................................... 21150 5640 350 84 213029 ..... KETTERING MEDICAL CENTER ............................................................................................ ..... 36580 8840 13644 36T079 ..... KINGMAN REGIONAL MEDICAL CENTER ................................................................................. 0307 0 2000 19380 03T055 ..... KINGS COUNTY HOSPITAL CENTER ........................................................................................ 33331 4120 03 33T202 ..... KING ’ S DAUGHTER MEDICAL CENTER .................................................................................... 18090 5600 35644 18T009 ..... KINGSBROOK JEWISH MEDICAL CENTER .............................................................................. 33331 3 400 26580 33T201 ..... KINGWOOD MEDICAL CENTER ............................................................................................. .... 45610 5600 35644 45T775 ..... KOOTENAI MEDICAL CENTER ............................................................................................. ...... 13270 3360 26420 13T049 ..... LA PALMA INTERCOMMUNITY HOSPITAL ................................................................................ 0540 0 13 17660 05T580 ..... LABETTE COUNTY MEDICAL CENTER ..................................................................................... 17 490 5945 42044 17T120 ..... LAC/RANCHO LOS AMIGOS NATIONAL MED CTR .................................................................. 05400 17 17 05T717 ..... LAFAYETTE GENERAL MEDICAL CENTER .............................................................................. 19270 5 945 42044 19T002 ..... LAGRANGE COMMUNITY HOSPITAL ........................................................................................ 1 5430 3880 29180 15T096 ..... LAKE CHARLES MEMORIAL HOSPITAL .................................................................................... 19 090 15 15 19T060 ..... LAKE CUMBERLAND REGIONAL HOSP .................................................................................... 189 72 3960 29340 18T132 ..... LAKE HOSPITAL SYSTEM INC ............................................................................................ ....... 36440 18 18 36T098 ..... LAKE REGION HEALTHCARE CORPORATION ......................................................................... 24550 1680 17460 24T052 ..... LAKELAND HOSPITAL, ST. JOSEPH ....................................................................................... .. 23100 24 24 23T021 ..... LAKESHORE CARRAWAY REHABILITATION HOSPITAL ......................................................... 01360 0870 35660 01T064 ..... LAKEWAY REGIONAL HOSPITAL ........................................................................................... ... 44310 1000 13820 44T067 ..... LAKEWOOD HOSPITAL ................................................................................................... ............ 36170 44 34100 36T212 ..... LAKEWOOD REGIONAL MEDICAL CENTER ............................................................................. 05200 16 80 17460 05T581 ..... LANCASTER COMMUNITY HOSPITAL ....................................................................................... 0 5200 4480 31084 05T204 ..... LANCASTER GENERAL HOSP .............................................................................................. ..... 39440 4480 31084 39T100 ..... LANCASTER REGIONAL MEDICAL CENTER ............................................................................ 39440 40 00 29540 39T061 ..... LANDER VALLEY MEDICAL CENTER ........................................................................................ 53060 4000 29540 53T010 ..... LANE FROST HEALTH AND REHABILITATION CENTER ......................................................... 37110 53 53 373032 ..... LANE REHABILTATION CENTER ........................................................................................... .... 19160 37 37 19T020 ..... LAPLACE REHABILITATION HOSPITAL ..................................................................................... 19350 0760 12940 193064 ..... LAPORTE HOSPITAL AND HEALTH SERVICES ....................................................................... 15450 5560 35380 45T029 ..... LAREDO MEDICAL CENTER ............................................................................................... ........ 45953 4080 29700 45T107 ..... LAS PALMAS REHABILITATION HOSP ...................................................................................... 45480 2320 21340 05T095 ..... LAUREL GROVE HOSPITAL ............................................................................................... ........ 05000 5775 36084 10T246 ..... LAWNWOOD REGIONAL MEDICAL CENT ................................................................................. 10550 2710 38940 07T007 ..... LAWRENCE & MEMORIAL HOSPITAL ....................................................................................... 0 7050 5523 35980 17T137 ..... LAWRENCE MEMORIAL HOSPITAL .......................................................................................... . 17220 4150 29940 46T010 ..... LDS HOSPITAL ........................................................................................................ ..................... 46170 7160 41620 32T065 ..... LEA REGIONAL MEDICAL CENTER ......................................................................................... .. 32120 32 32 49T012 ..... LEE REGIONAL MEDICAL CENTER ......................................................................................... .. 49520 49 49 10T084 ..... LEESBURG REGIONAL MEDICAL CENTER .............................................................................. 10340 5 960 36740 193086 ..... LEESVILLE REHABILITATION HOSPITAL LLC .......................................................................... 19570 19 19 38T017 ..... LEGACY GOOD SAMARITAN HOSP & MED CTR ..................................................................... 38250 6440 38 900 34T027 ..... LENOIR MEMORIAL HOSPITAL REHAB UNIT ........................................................................... 34530 3 4 34 05T060 ..... LEON S. PETERS REHABILITATION ....................................................................................... ... 05090 2840 23420 36T086 ..... LEVINE REHABILITATION CENTER ........................................................................................ ... 36110 2000 44220 49T048 ..... LEWIS GALE MEDICAL CENTER ........................................................................................... .... 49838 6800 40220 15T006 ..... LIBERTY REHABILITATION INSTITUTE .................................................................................... . 31230 15 33140 31T118 ..... LIMA MEMORIAL HEALTH SYSTEM ......................................................................................... . 36010 3640 35644 36T009 ..... LINCOLN PARK HOSPITAL ............................................................................................... .......... 14141 4320 30620 14T207 ..... LITTLE COMPANY OF MARY

— SAN PEDRO HOSPITAL REHAB ............................................ 05200 1600 16974 05T078 ..... LIVINGSTON REGIONAL HOSPITAL ........................................................................................ .. 44660 4480 31084 44T187 ..... LODI MEMORIAL HOSPITAL .............................................................................................. ......... 05490 44 44 05T336 ..... LOGAN REGIONAL MEDICAL CENTER ..................................................................................... 51 220 8120 44700 51T048 ..... LOMA LINDA UNIVERSITY MEDICAL CENTER ......................................................................... 05460 51 51 05T327 ..... LONG BEACH MEDICAL CENTER ........................................................................................... ... 33400 6780 40140 33T225 ..... LONG BEACH MEMORIAL MEDICAL CENTER ......................................................................... 05200 5380 35004 05T485 ..... LONG ISLAND COLLEGE HOSPITAL ........................................................................................ . 33331 4480 31084 33T152 ..... LONGVIEW REGIONAL PHYSICAL REHABILITATION .............................................................. 45570 5600 3564 4 45T702 ..... LOS ROBLES HOSPITAL & MEDICAL CENTER ........................................................................ 05660 442 0 30980 05T549 ..... LOUIS A. WEISS MEMORIAL HOSPITAL ................................................................................... 1 4141 8735 37100 14T082 ..... LOUISIANA REHABILIATAION HOSPITAL OF MORGAN CITY L ............................................. 19500 1600 16974 193084 ..... LOURDES ............................................................................................................. ........................ 18720 19 19 18T102 ..... LOURDES MEDICAL CENTER .............................................................................................. ...... 50100 18 18 50R337 .... LOURDES MEDICAL CENTER ............................................................................................... ..... 50100 6740 28420 50T023 ..... LOYOLA UNIVERSITY MEDICAL CENTER ................................................................................ 1414 1 6740 28420


### 30317 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

14T276 ..... LULING REHABILITATION HOSPITAL ...................................................................................... .. 19440 1600 16974 193060 ..... LUTHERAN HOSPITAL ACUTE REHAB UNIT ............................................................................ 36170 5 560 35380 36T087 ..... LUTHERAN MEDICAL CENTER ............................................................................................. ..... 33331 1680 17460 33T306 ..... MADISON COUNTY HOSPITAL INPATIENT REHAB ................................................................. 36500 5600 356 44 45T032 ..... MADONNA REHABILITATION HOSPITAL .................................................................................. 285 40 4420 45 36T189 ..... MAGEE REHABILITATION HOSPITAL ....................................................................................... . 39620 1840 18140 283025 ..... MAGNOLIA REGIONAL HEALTH CENTER ................................................................................ 25010 4360 30700 393038 ..... MAINLAND MEDICAL HOSPITAL ........................................................................................... ..... 45550 6160 37964 25T009 ..... MARIA PARHAM HEALTHCARE ASSOCIATION, INC. .............................................................. 34900 25 25 45T530 ..... MARIANJOY REHABILITATION HOSPITAL ................................................................................ 142 50 2920 26420 34T132 ..... MARIETTA MEMORIAL HOSPITAL .......................................................................................... ... 36850 34 34 143027 ..... MARLETTE COMMUNITY HOSP CTR FOR REHAB .................................................................. 23750 1600 1697 4 36T147 ..... MARLTON REHABILITATION HOSPITAL ................................................................................... 31 150 6020 37620 23T082 ..... MARQUETTE GENERAL HOSPITAL .......................................................................................... . 23510 23 23 313032 ..... MARY BLACK CENTER FOR REHAB ......................................................................................... 42410 6160 15804 23T054 ..... MARY FREE BED HOSPITAL & REHABILITATION CENTER ................................................... 23400 23 23 42T083 ..... MARY GREELEY MEDICAL CENTER ......................................................................................... 16840 3160 43900 233026 ..... MARYVIEW CENTER FOR PHYSICAL REHABILITATION ........................................................ 49711 3000 24340 16T030 ..... MASSILLON COMMUNITY HOSPITAL ........................................................................................ 36770 16 11180 49T017 ..... MATAGORDA GENERAL HOSPITAL .......................................................................................... 45790 5720 47260 36T100 ..... MAYO CLINIC HOSPITAL ................................................................................................ ............ 03060 1320 15940 45T465 ..... MCALESTER REGIONAL HEALTH CENTER ............................................................................. 37600 45 45 ............. MCKAY-DEE HOSPITAL .............................................................................................. ................ 46280 6200 38060 37T034 ..... MCKEE MEDICAL CENTER ................................................................................................ ......... 06340 37 37 46T004 ..... MCKENNA REHAB INSTITUTE ............................................................................................. ...... 45320 7160 36260 06T030 ..... MCLAREN REGIONAL MEDICAL CENTER ................................................................................ 23240 2670 22660 45T059 ..... MCO REHAB HOSPITAL .................................................................................................. ............ 36490 7240 41700 23T141 ..... MEADOWBROOK REHAB HOSPITAL ........................................................................................ 17 450 2640 22420 36T048 ..... MEADOWBROOK REHAB HOSPITAL OF WEST GAB .............................................................. 10120 8400 45780 04T088 ..... MEADOWBROOK REHABILITAION HOSPITAL ......................................................................... 45610 04 04 17T180 ..... MEADVILLE MEDICAL CENTER ............................................................................................ ..... 39260 3760 28140 103036 ..... MECOSTA COUNTY GENERAL HOSPITAL ............................................................................... 23530 5 000 33124 453052 ..... MED CTR OF LA AT NEW ORLEANS ........................................................................................ 19350 3360 26420 39T113 ..... MEDCENTER ONE, INC. ................................................................................................. ............ 35070 39 39 23T093 ..... MEDCENTRAL HEALTH SYSTEM ............................................................................................ .. 36710 23 23 19T005 ..... MEDICAL CENTER AT TERRELL ........................................................................................... .... 45730 5560 35380 35T015 ..... MEDICAL CENTER OF ARLINGTON ......................................................................................... . 45910 1010 13900 36T118 ..... MEDICAL CENTER OF PLANO ............................................................................................. ...... 45310 4800 31900 45T683 ..... MEDICAL CENTER OF SOUTH ARKANSAS .............................................................................. 04690 1 920 19124 45T675 ..... MEDICAL CITY DALLAS HOSPITAL ........................................................................................ ... 45390 2800 23104 45T651 ..... MEDICAL CNTR OF DELAWARE ............................................................................................ .... 08010 1920 19124 45T647 ..... MEDINA HOSPITAL ..................................................................................................... ................. 33550 1920 19124 08T001 ..... MEMORIAL HEALTH UNIVERSITY MEDICAL CENTER ............................................................ 11220 9160 48864 33T053 ..... MEMORIAL HEALTHCARE CENTER .......................................................................................... 23770 6840 40380 11T036 ..... MEMORIAL HERMAN BAPTIST HOSP ORANGE ...................................................................... 45840 7520 42 340 23T121 ..... MEMORIAL HERMANN FT. BEND INPATIENT REHABILITATION ........................................... 45610 23 23 45T005 ..... MEMORIAL HERMANN NORTHWEST HOSPITAL ..................................................................... 45610 0840 131 40 45T848 ..... MEMORIAL HOSPITAL ................................................................................................... ............. 10050 3360 26420 45T184 ..... MEMORIAL HOSPITAL

— SOUTH BEND ..................................................................................... 15700 3360 26420 10T038 ..... MEMORIAL HOSPITAL AT GULFPORT ...................................................................................... 2 5230 2680 22744 15T058 ..... MEMORIAL HOSPITAL OF RI ............................................................................................. ........ 41030 7800 43780 25T019 ..... MEMORIAL MED CENTER OF EAST TE .................................................................................... 45 020 0920 25060 41T001 ..... MEMORIAL MEDICAL CENTER ............................................................................................. ..... 14920 6483 39300 45T211 ..... MEMORIAL MEDICAL CENTER

— REHABILITATION INSTITUTE ............................................. 19350 45 45 14T148 ..... MEMORIAL REHABILITATION HOSPITAL .................................................................................. 45 794 7880 44100 19T135 ..... MENA MEDICAL CENTER ................................................................................................. .......... 04560 5560 35380 45T133 ..... MENORAH MEDICAL CENTER .............................................................................................. ..... 17450 5800 33260 04T015 ..... MERCY FITZGERALD HOSPITAL ........................................................................................... .... 39290 04 04 17T182 ..... MERCY FRANCISCAN HOSPITAL MT. AIRY ............................................................................. 36310 3760 28140 39T156 ..... MERCY FRANCISCAN HOSPITAL WESTERN HILLS ................................................................ 36310 6160 3796 4 36T234 ..... MERCY GENERAL HEALTH PARTNERS ................................................................................... 2360 0 1640 17140 36T113 ..... MERCY GENERAL HOSPITAL .............................................................................................. ...... 05440 1640 17140 23T004 ..... MERCY HEALTH CENTER ................................................................................................. ......... 17800 3000 34740 05T017 ..... MERCY HEALTH CENTER, INC ............................................................................................ ...... 37540 6920 40900 17T142 ..... MERCY HEALTH SYSTEM CORP ............................................................................................ ... 52520 17 17 37T013 ..... MERCY HEALTH SYSTEM OF KANSAS .................................................................................... 170 50 5880 36420 52T066 ..... MERCY HOSPITAL ...................................................................................................... ................. 10120 3620 27500


### 30318 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

17T058 ..... MERCY HOSPITAL ...................................................................................................... ................. 14141 17 17 10T061 ..... MERCY HOSPITAL OF PITTSBURGH ........................................................................................ 39010 5000 33124 14T158 ..... MERCY HOSPITAL PORT HURON ........................................................................................... .. 23730 1600 16974 39T028 ..... MERCY HOSPITAL REHABILITATION UNIT .............................................................................. 3459 0 6280 38300 23T031 ..... MERCY MEDICAL ....................................................................................................... ................. 01010 2160 47644 34T098 ..... MERCY MEDICAL CENTER ................................................................................................ ........ 33400 1520 16740 013027 ..... MERCY MEDICAL CENTER ................................................................................................ ........ 36770 5160 01 33T259 ..... MERCY MEDICAL CENTER ................................................................................................ ........ 52690 5380 35004 36T070 ..... MERCY MEDICAL CENTER-DES MOINES ................................................................................ 16760 1320 15940 52T048 ..... MERCY MEDICAL CENTER-DUBUQUE ..................................................................................... 163 00 0460 36780 16T083 ..... MERCY MEDICAL CENTER-SIOUX CITY ................................................................................... 16 960 2120 19780 16T069 ..... MERCY MEDICAL CENTER-NORTH IOWA ................................................................................ 16160 2200 20220 16T153 ..... MERCY MEMORIAL HEALTH CENTER ...................................................................................... 37 090 7720 43580 16T064 ..... MERCY PROVIDENCE HOSPITAL ........................................................................................... ... 39010 16 16 37T047 ..... MERIDIA EUCLID HOSPITAL ............................................................................................. ......... 36170 37 37 39T136 ..... MERITCARE HEALTH SYSTEM ............................................................................................. ..... 35080 6280 38300 36T082 ..... MERITER HOSPITAL INC. ............................................................................................... ............ 52120 1680 17460 35T011 ..... MERWICK REHAB HOSPITAL .............................................................................................. ....... 31260 2520 22020 52T089 ..... MESA GENERAL HOSPITAL ............................................................................................... ........ 03060 4720 31540 31T010 ..... MESA LUTHERAN HOSPITAL REHAB ....................................................................................... 0 3060 8480 45940 03T017 ..... MESQUITE COMMUNITY HOSPITAL ......................................................................................... 45390 6200 38060 03T018 ..... METHODIST HOSPITAL .................................................................................................. ............ 19350 6200 38060 45T688 ..... METHODIST HOSPITAL .................................................................................................. ............ 19350 1920 19124 19T124 ..... METHODIST HOSPITAL .................................................................................................. ............ 24260 5560 35380 19T200 ..... METHODIST HOSPITAL OF SOUTHERN CA ............................................................................. 05200 5 560 35380 24T053 ..... METHODIST HOSPITAL REHABILITATION CENTER ................................................................ 18500 5120 334 60 05T238 ..... METHODIST HOSPITAL, THE ............................................................................................. ........ 45610 4480 31084 18T056 ..... METHODIST MEDICAL CENTER ............................................................................................ .... 45390 2440 21780 45T358 ..... METHODIST MEDICAL CENTER OF ILLINOIS .......................................................................... 14800 3 360 26420 45T051 ..... METHODIST NORTHLAKE ................................................................................................. ......... 15440 1920 19124 14T209 ..... METHODIST SPECIALTY/TRANSPLANT .................................................................................... 45 130 6120 37900 15T002 ..... METROHEALTH MEDICAL CENTER .......................................................................................... 36170 2960 23844 45T631 ..... METROPOLITAN HOSPITAL ............................................................................................... ........ 33420 7240 41700 36T059 ..... METROPOLITAN HOSPITAL AND METRO HEALTH CORPORATION ..................................... 23400 1680 17460 33T199 ..... METROPOLITAN METHODIST HOSP ........................................................................................ 4 5130 5600 35644 23T236 ..... MI LAND E. KNAPP REHABILITATION CENTER ....................................................................... 24260 30 00 24340 45T388 ..... MIAMI VALLEY HOSPITAL ............................................................................................... ........... 36580 7240 41700 24T004 ..... MICHAEL REESE HOSPITAL .............................................................................................. ........ 14141 5120 33460 36T051 ..... MID AMERICA REHABILITATION HOSPITAL ............................................................................. 1745 0 2000 19380 14T075 ..... MID JEFFERSON HOSPITAL .............................................................................................. ........ 45700 1600 16974 173026 ..... MIDDLETOWN REGIONAL HOSPITAL ....................................................................................... 3 6080 3760 28140 45T514 ..... MILLER DWAN MEDICAL CENTER .......................................................................................... .. 24680 0840 13140 36T076 ..... MILLS HEALTH CENTER ................................................................................................. ............ 05510 3200 17140 24T019 ..... MILTON S HERSHEY MEDICAL CENTER .................................................................................. 392 80 2240 20260 05T007 ..... MINDEN MEDICAL CENTER REHAB ......................................................................................... . 19590 7360 41884 39T256 ..... MISSION HOSPITAL .................................................................................................... ................ 05400 3240 25420 19T144 ..... MISSION HOSPITAL .................................................................................................... ................ 45650 7680 19 05T567 ..... MISSISSIPPI METHODIST REHABILITATION CENTER ............................................................ 25240 5945 4204 4 45T176 ..... MISSISSIPPI METHODIST REHABILITATION CENTER ............................................................ 25240 4880 3258 0 253025 ..... MISSOURI BAPTIST MEDICAL CENTER ................................................................................... 26 940 3560 27140 25T152 ..... MISSOURI DELTA MEDICAL CENTER ....................................................................................... 26982 3560 27140 26T108 ..... MOBILE INFIRMARY .................................................................................................... ................ 01480 7040 41180 26T113 ..... MODESTO REHABILITATION HOSPITAL ................................................................................... 05 600 26 26 01T113 ..... MONONGAHELA VALLEY HOSPITAL ........................................................................................ 3 9750 5160 33660 053036 ..... MONTEFIORE MEDICAL CENTER ........................................................................................... .. 33020 5170 33700 39T147 ..... MORGAN HOSPITAL & MEDICAL CTR ...................................................................................... 1 5540 6280 38300 33T059 ..... MORTON PLANT NORTH BAY HOSPITAL ................................................................................ 10500 5600 35644 15T038 ..... MOSES CONE HEALTH SYSTEM ............................................................................................ ... 34400 3480 26900 34T091 ..... MOSS REHAB .......................................................................................................... .................... 39620 3120 24660 39T142 ..... MOUNT CARMEL REGIONAL MEDICAL CENTER .................................................................... 17180 6160 379 64 17T006 ..... MOUNT SINAI MEDICAL CENTER .......................................................................................... .... 10120 17 17 10T034 ..... MOUNTAINVIEW REGIONAL MEDICAL CENTER ..................................................................... 32060 5000 33 124 32T085 ..... MT CARMEL INPATIENT REHAB UNIT ...................................................................................... 36250 4100 29740 36T035 ..... MT SINAI HOSPITAL ................................................................................................... ................. 33420 1840 18140 33T024 ..... MUNSON MEDICAL CENTER ............................................................................................... ...... 23270 5600 35644 23T097 ..... MUSKOGEE REGIONAL REHABILITATION CENTER ............................................................... 37500 23 23 37T025 ..... NACOGDOCHES COUNTY HOSPITAL DISTRICT ..................................................................... 45810 37 37


### 30319 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

45T508 ..... NAPLES COMMUNITY HOSPITAL, INC. ..................................................................................... 10100 45 45 10T018 ..... NASHVILLE REHABILITATION HOSPITAL ................................................................................. 44 180 5345 34940 44T026 ..... NASSAU UNIVERSITY MEDICAL CENTER ................................................................................ 3340 0 5360 34980 33T027 ..... NATCHEZ REGIONAL MEDICAL CENTER ................................................................................. 2500 0 5380 35004 25T084 ..... NATIONAL PARK ....................................................................................................... ................... 04250 25 25 04T078 ..... NATIONAL REHABILITATION HOSPITAL ................................................................................... 0 9000 04 26300 093025 ..... NAVARRO REGIONAL HOSPITAL ........................................................................................... ... 45820 8840 47894 45T447 ..... NAZARETH HOSPITAL ................................................................................................... ............. 39620 45 45 39T204 ..... NEBRASKA METHODIST HEALTH SYSTEM ............................................................................. 28270 61 60 37964 28T040 ..... NEW ENGLAND REHAB HOSPITAL OF PORTLAND ................................................................ 20020 5920 36540 203025 ..... NEW ENGLAND REHABILITAION HOSPITAL-WOBURN .......................................................... 22090 6403 38860 223026 ..... NEW HANOVER REGIONAL MEDICAL CENTER ...................................................................... 34640 1123 15 764 34T141 ..... NEW MEXICO REHABILITATION CENTER ................................................................................ 3202 0 9200 48900 323026 ..... NEW ORLEANS EAST REHABILITATION .................................................................................. 193 50 32 32 193089 ..... NEW YORK METHODIST HOSPITAL ......................................................................................... 33331 5560 35380 33T236 ..... NEW YORK PRESBYTERIAN HOSPITAL ................................................................................... 334 20 5600 35644 33T101 ..... NEWMAN REGIONAL HEALTH .............................................................................................. ..... 17550 5600 35644 17T001 ..... NEWPORT HOSPITAL .................................................................................................... ............. 41020 17 17 41T006 ..... NEWTON MEDICAL CENTER ............................................................................................... ...... 17390 6483 39300 17T103 ..... NEWTON MEMORIAL HOSPITAL ............................................................................................ ... 31360 9040 48620 31T028 ..... NEXT STEP ACUTE REHABILITATION CENTER ...................................................................... 39190 5640 35084 39T194 ..... NIX HEALTH CARE SYSTEM .............................................................................................. ........ 45130 0240 10900 45T130 ..... NOBLE HOSPITAL REHAB UNIT ........................................................................................... ..... 22070 7240 41700 10T063 ..... NORMAN REGIONAL HOSPITAL ............................................................................................ .... 37130 8280 45300 22T065 ..... NORTH AUSTIN MEDICAL CENTER ......................................................................................... . 45940 8003 44140 37T008 ..... NORTH BROWARD MEDICAL CENTER ..................................................................................... 100 50 5880 36420 45T809 ..... NORTH CAROLINA BAPTIST HOSPITALS ................................................................................. 343 30 0640 12420 10T086 ..... NORTH CENTRAL MEDICAL CENTER ....................................................................................... 4 5310 2680 22744 34T047 ..... NORTH COLORADO MEDICAL CENTER ................................................................................... 0661 0 3120 49180 45T403 ..... NORTH COUNTRY REGIONAL HOSPITAL ................................................................................ 24030 1920 19124 06T001 ..... NORTH DALLAS REHABILITATION HOSPITAL ......................................................................... 45620 30 60 24540 24T100 ..... NORTH DALLAS REHABILITATION HOSPITAL ......................................................................... 45390 24 24 453032 ..... NORTH FULTON REGIONAL HOSPITAL ................................................................................... 114 70 1920 19124 11T198 ..... NORTH HILLS HOSPITAL ................................................................................................ ............ 45910 0520 12060 45T087 ..... NORTH KANSAS CITY HOSPITAL .......................................................................................... .... 26230 2800 23104 26T096 ..... NORTH MEMORIAL HEALTH CENTER ...................................................................................... 24 260 3760 28140 24T001 ..... NORTH MISS. MEDICAL CENTER .......................................................................................... .... 25400 5120 33460 25T004 ..... NORTH MONROE MEDICAL CENTER ....................................................................................... 19 360 25 25 19T197 ..... NORTH OAKLAND MEDICAL CENTERS .................................................................................... 236 20 5200 33740 23T013 ..... NORTH OAKS REHAB HOSP INC ........................................................................................... ... 19520 2160 47644 193044 ..... NORTH SHORE REGIONAL MEDICAL CENTER ....................................................................... 19510 19 19 19T204 ..... NORTH SHORE UNIVERSITY HOSPITAL @ GLEN COVE ....................................................... 33400 5560 35380 33T181 ..... NORTH SUBURBAN MEDICAL CENTER ................................................................................... 0600 0 5380 35004 06T065 ..... NORTHEAST GEORGIA MEDICAL CENTER ............................................................................. 11550 20 80 19740 11T029 ..... NORTHEAST METHODIST HOSPITAL ....................................................................................... 4 5130 11 23580 45T733 ..... NORTHEAST OKLAHOMA REHABILITATION ASSOCIATES, LP ............................................. 37710 7240 41700 373029 ..... NORTHEAST REGIONAL MEDICAL CENTER ........................................................................... 26000 856 0 46140 26T022 ..... NORTHEAST REHABILITATION HOSPITAL ............................................................................... 3007 0 26 26 303026 ..... NORTHERN CALIFORNIA REHABILITATION HOSPITAL .......................................................... 05550 1123 40484 05T699 ..... NORTHERN ILLINOIS MEDICAL CENTER ................................................................................. 146 40 6690 39820 14T116 ..... NORTHERN MICHIGAN HOSPITAL .......................................................................................... .. 23230 1600 16974 23T105 ..... NORTHERN NEVADA MEDICAL CENTER ................................................................................. 29150 23 23 29T032 ..... NORTHLAKE MEDICAL CENTER ............................................................................................ ... 11370 6720 39900 11T033 ..... NORTHPORT MEDICAL CENTER ............................................................................................ ... 01620 0520 12060 01T145 ..... NORTHRIDGE HOSPITAL MEDICAL CENTER .......................................................................... 05200 860 0 46220 05T116 ..... NORTHWEST HEALTH SYSTEM ............................................................................................. ... 04710 4480 31084 04T022 ..... NORTHWEST HOSPITAL .................................................................................................. .......... 50160 2580 22220 50T001 ..... NORTHWEST MISSISSIPPI REGIONAL MED CTR ................................................................... 25130 7600 42 644 25T042 ..... NORTHWEST REGIONAL HOSPITAL ......................................................................................... 45830 25 25 45T131 ..... NORWALK HOSPITAL ASSOCIATION ........................................................................................ 07000 1880 18580 07T034 ..... OAK FOREST HOSPITAL ................................................................................................. ........... 14141 5483 14860 14T301 ..... OAKLAND REGIONAL HOSPITAL ........................................................................................... .... 23620 1600 16974 233028 ..... OAKWOOD HERITAGE HOSPITAL ........................................................................................... .. 23810 2160 47644 23T270 ..... OCHSNER REHABILITATION CENTER ...................................................................................... 1 9250 2160 19804 19T036 ..... OGDEN REGIONAL MEDICAL CENTER .................................................................................... 462 80 5560 35380 46T005 ..... OHIO STATE UNIVERSITY HOSPITAL ...................................................................................... . 36250 7160 36260 36T085 ..... OHIO VALLEY GENERAL HOSPITAL ARU ................................................................................ 3901 0 1840 18140


### 30320 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

39T157 ..... OM .................................................................................................................. ............................... 18290 6280 38300 18T038 ..... OPELOUSAS GENERAL HOSPITAL .......................................................................................... . 19480 5990 36980 19T017 ..... ORANGE REGIONAL MEDICAL CENTER .................................................................................. 3354 0 3880 19 33T001 ..... ORANGE REGIONAL MEDICAL CENTER .................................................................................. 3354 0 5660 39100 33T126 ..... OREGON REHABILITATION CENTER ........................................................................................ 38190 5660 39100 38T033 ..... ORLANDO REGIONAL HEALTHCARE-CMR .............................................................................. 10470 24 00 21660 10T006 ..... OSTEOPATHIC MEDICAL CENTER OF TEXAS ........................................................................ 45910 5960 36740 45T121 ..... OU MEDICAL CENTER ................................................................................................... ............. 37540 2800 23104 37T093 ..... OUR LADY OF LOURDES MEDICAL CENTER .......................................................................... 31160 588 0 36420 31T029 ..... OUR LADY OF LOURDES REG MED CENTER ......................................................................... 19270 6160 15804 19T102 ..... OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER ...................................................... 19160 3880 29180 19T064 ..... OVERLAKE HOSPITAL MEDICAL CENTER ............................................................................... 50160 0760 12940 50T051 ..... PALESTINE REGIONAL REHAB HOSPITAL .............................................................................. 45000 7600 42644 45T113 ..... PALMYRA MEDICAL CENTER .............................................................................................. ...... 11390 45 45 11T163 ..... PALOMAR MEDICAL CENTER .............................................................................................. ...... 05470 0120 10500 05T115 ..... PAMPA REGIONAL MEDICAL CENTER ..................................................................................... 45 563 7320 41740 45T099 ..... PARADISE VALLEY HOSPITAL ............................................................................................ ....... 05470 45 45 05T024 ..... PARIS REGIONAL MEDICAL CENTER ....................................................................................... 45750 7320 41740 45T196 ..... PARK PLACE MEDICAL CENTER ........................................................................................... .... 45700 45 45 45T518 ..... PARK PLAZA HOSPITAL ................................................................................................. ............ 45610 0840 13140 45T659 ..... PARKLAND HEALTH AND HOSPITAL SYSTEM ........................................................................ 45390 3360 26420 45T015 ..... PARKRIDGE MEDICAL CENTER ............................................................................................ .... 44320 1920 19124 44T156 ..... PARKVIEW HOSPITAL ................................................................................................... .............. 15010 1560 16860 15T021 ..... PARKVIEW MEDICAL CENTER ............................................................................................. ..... 06500 2760 23060 06T020 ..... PARKVIEW REGIONAL HOSPITAL .......................................................................................... ... 45758 6560 39380 45T400 ..... PARKWAY REGIONAL MEDICAL CENTER ................................................................................ 10120 45 45 10T114 ..... PARMA COMMUNITY GENERAL HOSPITAL ............................................................................. 36170 50 00 33124 36T041 ..... PATRICIA NEAL REHABILITATION CENTER ............................................................................. 4446 0 1680 17460 44T125 ..... PENINSULA HOSPITAL CENTER ........................................................................................... .... 33590 3840 28940 33T002 ..... PENNYSLVANIA HOSPITAL, ACUTE REHABILITATION UNIT ................................................. 39620 5600 35644 39T226 ..... PENROSE HOSPITAL/ELEANOR-CAPRON ............................................................................... 06200 6 160 37964 06T031 ..... PETERSON REHABILITATION HOSPITAL AND GERIATIC CEN ............................................. 51340 1720 17820 513025 ..... PHELPS COUNTY REGIONAL MED CENTER ........................................................................... 26800 900 0 48540 26T017 ..... PHELPS MEMORIAL HOSPITAL ............................................................................................ ..... 33800 26 26 33T261 ..... PHOEBE PUTNEY ....................................................................................................... ................. 11390 5600 35644 11T007 ..... PHOENIX BAPTIST HOSPITAL ............................................................................................ ....... 03060 0120 10500 03T030 ..... PHYSICAL REHABILITAITON UNIT AT OTTUMWA REGIONAL H ........................................... 16890 6200 38060 16T089 ..... PIEDMONT HOSPITAL ................................................................................................... .............. 11470 16 16 11T083 ..... PIKEVILLE METHODIST REHABILITATION HOSPITAL ............................................................ 18970 0520 1206 0 18T044 ..... PINECREST REHABILITATION HOSPITAL ................................................................................ 104 90 18 18 103030 ..... PINNACLE REHAB ...................................................................................................... ................. 37540 8960 48424 373025 ..... PINNACLEHEALTH HOSPITALS ............................................................................................ ..... 39280 5880 36420 39T067 ..... PITT COUNTY MEMORIAL HOSPITAL ....................................................................................... 34730 3240 25420 34T040 ..... PLAZA MEDICAL CENTER ................................................................................................ .......... 45910 3150 24780 45T672 ..... POPLAR BLUFF REGIONAL MEDICAL CENTER ...................................................................... 26110 2800 2 3104 26T119 ..... PORTER ADVENTIST HOSPITAL ........................................................................................... .... 06150 26 26 06T064 ..... PORTNEUF MEDICAL CENTER ............................................................................................. ..... 13020 2080 19740 13T028 ..... POTTSTOWN MEMORIAL MEDICAL CENTER .......................................................................... 39560 6340 38540 39T123 ..... POTTSVILLE HOSPITAL-WARNE CLINIC .................................................................................. 39 650 6160 37964 39T030 ..... POUDRE VALLEY HEALTH CARE INC ...................................................................................... 0 6340 39 39 06T010 ..... PREMIER REHABILITATION HOSPITAL .................................................................................... 1 9360 2670 22660 14T007 ..... PRESBYTERIAN HOSPITAL OF DALLAS ................................................................................... 45 390 1600 16974 193082 ..... PRESBYTERIAN INTERCOMMUNITY HOSPITAL ...................................................................... 05200 5200 3 3740 45T462 ..... PROVENA COVENANT MEDICAL CENTER REHAB ................................................................. 14090 1920 19124 05T169 ..... PROVENA SAINT JOSEPH HOSPITAL ....................................................................................... 14530 4480 31084 14T113 ..... PROVENA ST. JOSEPH MEDICAL CENTER ............................................................................. 14989 1 400 16580 14T217 ..... PROVIDENCE ALASKA MEDICAL CENTER .............................................................................. 02020 1 600 16974 02T001 ..... PROVIDENCE CENTRALIA HOSPITAL ...................................................................................... 5 0200 0380 11260 50T019 ..... PROVIDENCE EVERETT MEDICAL CENTER ............................................................................ 50300 50 50 50T014 ..... PROVIDENCE HOLY CROSS MEDICAL CENTER ..................................................................... 05200 7600 42 644 05T278 ..... PROVIDENCE HOSPITAL ................................................................................................. ........... 23620 4480 31084 23T019 ..... PROVIDENCE MEDFORD MEDICAL CENTER .......................................................................... 38140 2160 47644 38T075 ..... PROVIDENCE PORTLAND MEDICAL CENTER ......................................................................... 38250 4890 32780 38T061 ..... PROVIDENCE SAINT JOSEPH MEDICAL CENTER .................................................................. 05200 6440 389 00 05T235 ..... PROVIDENCE ST. PETER HOSPITAL ....................................................................................... . 50330 4480 31084 50T024 ..... QUEEN OF ANGELS-HOLLYWOOD PRESBYTERIAN MEDICAL C ......................................... 05200 5910 36500 05T063 ..... QUEEN OF THE VALLEY HOSPITAL ........................................................................................ . 05380 4480 31084


### 30321 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

05T009 ..... QUEENS HOSPITAL CENTER .............................................................................................. ...... 33590 8720 34900 33T231 ..... RANCHO REHABILITATION ............................................................................................... ......... 29010 5600 35644 29T007 ..... RAPID CITY REGIONAL HOSPITAL ........................................................................................ ... 43510 4120 29820 43T077 ..... REBSAMEN MEDICAL CENTER ............................................................................................. .... 04590 6660 39660 04T074 ..... REDMOND REHABILITATION CENTER ..................................................................................... 11 460 4400 30780 11T168 ..... REGIONAL MEDICAL CENTER ............................................................................................. ...... 18530 11 40660 18T093 ..... REGIONAL REHAB CENTER AT HUGH CHATHAM .................................................................. 34850 18 18 34T097 ..... REGIONAL REHAB CENTER OF NORTON COMMUNITY HOSPITAL ..................................... 49661 34 34 49T001 ..... REGIONAL REHABILITATION CENTER ..................................................................................... 4 2280 49 49 42T036 ..... REGIONAL REHABILITATION HOSPITAL .................................................................................. 01 500 42 42 013033 ..... REGIONS HOSPITAL REHAB INSTITUTE .................................................................................. 24 610 5240 33860 24T106 ..... REHAB CARE CENTER AT INDIANA REGIONAL MEDICAL CTR ............................................ 39390 5120 33460 39T173 ..... REHAB CENTER OF MARION .............................................................................................. ...... 36520 39 39 36T011 ..... REHAB HOSP OF R I ................................................................................................... ................ 41030 36 36 413025 ..... REHAB HOSP OF THE CAPE AND ISLANDS ............................................................................ 22000 6 483 39300 223032 ..... REHAB HOSPITAL OF BATON ROUGE ..................................................................................... 19 160 0743 12700 193028 ..... REHAB INSTITUTE AT SANTA BARBARA,THE ......................................................................... 05520 07 60 12940 053028 ..... REHAB INSTITUTE AT TCMC ............................................................................................. ........ 44180 7480 42060 44T135 ..... REHAB MEDICINE ST. MARY ’ S ATHENS .................................................................................. 11260 5360 34980 11T006 ..... REHAB UNIT OF PACIFIC ALLIANCE MEDICAL CENTER ....................................................... 05200 0500 12020 05T018 ..... REHABCARE CENTER AT HOSPITAL DR. PILA ....................................................................... 40560 448 0 31084 40T003 ..... REHABILITATION CENTER AT LAFAYETTE HOME HOSPITAL .............................................. 15780 6360 38660 15T109 ..... REHABILITATION CENTER OF NORTHERN ARIZONA ............................................................ 03020 3920 29140 03T023 ..... REHABILITATION HOSPITAL ............................................................................................. ......... 15010 2620 22380 153030 ..... REHABILITATION HOSPITAL OF CONNECTICUT,THE ............................................................ 07010 2760 23060 073025 ..... REHABILITATION HOSPITAL OF INDIANA ................................................................................ 15 480 3283 25540 153028 ..... REHABILITATION HOSPITAL OF INDIANA AT ST VINCENT ................................................... 15480 3480 26900 153038 ..... REHABILITATION HOSPITAL OF MEMPHIS .............................................................................. 4478 0 3480 26900 44T152 ..... REHABILITATION HOSPITAL OF NEW MEXICO ....................................................................... 32000 492 0 32820 323028 ..... REHABILITATION HOSPITAL OF SOUTH JERSEY ................................................................... 31190 0200 1 0740 313036 ..... REHABILITATION HOSPITAL OF THE PACIFIC ........................................................................ 12020 8 760 47220 123025 ..... REHABILITATION HOSPITAL OF TINTON FALLS ..................................................................... 31290 332 0 26180 313035 ..... REHABILITATION INSTITUTE AT MORRISTOWN MEMORIAL ................................................ 31300 5190 20764 31T015 ..... REHABILITATION INSTITUTE OF CHICAGO ............................................................................. 1414 1 5640 35084 143026 ..... REHABILITATION INSTITUTE OF MCALLEN ............................................................................. 4565 0 1600 16974 45T811 ..... REHABILITATION INSTITUTE OF MICHIGAN ............................................................................ 2381 0 4880 32580 233027 ..... REHABILITATION INSTITUTE OF ST LOUIS, THE .................................................................... 26940 21 60 19804 263028 ..... REHABILITATION PATIENT CARE UNIT .................................................................................... 06200 7040 41180 06T022 ..... REID HOSP-ACUTE REHAB UNIT .......................................................................................... .... 15880 1720 17820 15T048 ..... RENO REHAB ASSOCIATES, LIMITED PARTNERSHIP ........................................................... 29150 15 15 293027 ..... RESEARCH MEDICAL CENTER ............................................................................................. .... 26070 6720 39900 26T027 ..... RESURRECTION MEDICAL CENTER ......................................................................................... 14141 26 26 14T117 ..... RHD MEMORIAL MEDICAL CENTER ......................................................................................... 45390 1600 16974 45T379 ..... RICHLAND PARISH REHABILITATION HOSPITA ...................................................................... 19410 192 0 19124 193075 ..... RILEY MEMORIAL HOSPITAL ............................................................................................. ........ 25370 19 19 25T081 ..... RIO VISTA REHAB HOSPITAL ............................................................................................ ........ 45480 25 25 453033 ..... RIVER PARK HOSPITAL ................................................................................................. ............. 44880 2320 21340 44T151 ..... RIVER REGION HEALTH SYSTEM .......................................................................................... ... 25740 44 44 25T031 ..... RIVER WEST MEDICAL CENTER ........................................................................................... .... 19230 25 25 19T131 ..... RIVERSIDE MEDICAL CENTER ............................................................................................ ...... 14540 19 12940 14T186 ..... RIVERSIDE REHAB INSTITUTE ........................................................................................... ....... 49622 3740 28100 493027 ..... RIVERVIEW HOSPITAL .................................................................................................. ............. 15280 5720 47260 15T059 ..... RIVERVIEW MEDICAL CENTER ............................................................................................ ..... 31290 3480 26900 31T034 ..... ROCHESTER GENERAL HOSPITAL .......................................................................................... . 33370 5190 20764 33T125 ..... ROGER C. PEACE ...................................................................................................... ................. 42220 6840 40380 42T078 ..... ROGERS CITY REHABILITATION HOSPITAL ............................................................................ 23700 3160 24860 233029 ..... ROME MEMORIAL HOSPITAL .............................................................................................. ...... 33510 23 23 33T215 ..... ROPER REHABILITATION HOSPITAL ....................................................................................... . 42090 8680 46540 42T087 ..... ROWAN REGIONAL MEDICAL CENTER .................................................................................... 347 90 1440 16700 34T015 ..... ROXBOROUGH .......................................................................................................... .................. 39620 1520 34 39T304 ..... RUSH OAK PARK HOSPITAL .............................................................................................. ........ 14141 6160 37964 14T063 ..... RUSH-COPLEY MEDICAL CENTER .......................................................................................... . 14530 1600 16974 14T029 ..... RUSK INSTITUTE ...................................................................................................... ................... 33420 1600 16974 33T214 ..... RUSK REHABILITATION CENTER LLC ...................................................................................... 26090 5600 35644 263027 ..... RUTLAND REGIONAL MEDICAL CENTER ................................................................................. 4710 0 1740 17860 47T005 ..... SACRED HEART HOSPITAL ............................................................................................... ........ 52170 47 47 52T013 ..... SACRED HEART REHAB INST ............................................................................................. ...... 52390 2290 20740


### 30322 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

523025 ..... SADDLEBACK MEMORIAL MEDICAL CENTER ......................................................................... 05400 5080 33340 05T603 ..... SAGE REHAB INSTITUTE ................................................................................................ ........... 19160 5945 42044 193078 ..... SAINT ALPHONSUS REGIONAL MEDICAL CENTER ................................................................ 13000 0760 1294 0 13T007 ..... SAINT ANTHONY ’ S HEALTH CENTER ....................................................................................... 14680 1080 14260 14T052 ..... SAINT FRANCIS HOSPITAL .............................................................................................. .......... 31230 7040 41180 313037 ..... SAINT FRANCIS HOSPITAL .............................................................................................. .......... 33230 3640 35644 33T067 ..... SAINT FRANCIS HOSPITAL .............................................................................................. .......... 44780 2281 39100 44T183 ..... SAINT FRANCIS MEDICAL CENTER ........................................................................................ .. 14800 4920 32820 14T067 ..... SAINT FRANCIS MEMORIAL HOSPITAL .................................................................................... 0 5480 6120 37900 05T152 ..... SAINT JOHNS MERCY MEDICAL CENTER ............................................................................... 26940 7360 41884 26T020 ..... SAINT JOSEPH HEALTH CENTER .......................................................................................... ... 26470 7040 41180 26T085 ..... SAINT JOSEPH HOSPITAL ............................................................................................... .......... 14141 3760 28140 14T224 ..... SAINT JOSEPH REGIONAL MEDICAL CENTER ....................................................................... 15700 1600 16974 15T012 ..... SAINT LUKE ’ S SOUTH HOSPITAL ............................................................................................. 17450 7800 43780 17T185 ..... SAINT MARY OF NAZARETH HOSPITAL ................................................................................... 14 141 3760 28140 14T180 ..... SAINT MARYS REGIONAL MEDICAL CENTER ......................................................................... 29150 160 0 16974 29T009 ..... SAINT VINCENT CATHOLIC MEDICAL CENTERS OF NEW YORK ......................................... 33420 6720 39900 33T290 ..... SAINT VINCENT HEALTH CENTER ......................................................................................... ... 39320 5600 35644 39T009 ..... SALEM HOSPITAL REGIONAL REHABILITATION CENTER ..................................................... 38230 2360 21500 38T051 ..... SALINA REGIONAL HEALTH CENTER ....................................................................................... 17840 7080 41420 17T012 ..... SALINE MEMORIAL HOSPITAL ............................................................................................ ...... 04620 17 17 04T084 ..... SALT LAKE REGIONAL MEDICAL CENTER .............................................................................. 46170 4400 30780 46T003 ..... SAM KARAS ACUTE REHAB AT NATIVIDAD MEDICAL CENTER ........................................... 05370 7160 41620 05T248 ..... SAMARITAN MEDICAL CENTER ............................................................................................ .... 33330 7120 41500 33T157 ..... SAN ANGELO COMMUNITY MEDICAL CENTER ...................................................................... 45930 33 33 45T340 ..... SAN ANTONIO WARM SRPINGS REHABILITATION HOSPITAL .............................................. 45130 7200 41660 453035 ..... SAN CLEMENTE HOSPITAL ............................................................................................... ........ 05400 7240 41700 05T585 ..... SAN JACINTO METHODIST HOSPITAL ..................................................................................... 4 5610 5945 42044 45T424 ..... SAN JOAQUIN GENERAL HOSPITAL ........................................................................................ . 05490 3360 26420 05T167 ..... SAN JOAQUIN VALLEY REHABILITATION HOSP ..................................................................... 05090 8120 44700 053032 ..... SAN JOSE MEDICAL CENTER ............................................................................................. ...... 05530 2840 23420 05T215 ..... SAN LUIS VALLEY REGIONAL MEDICAL CENTER .................................................................. 06010 7400 41 940 06T008 ..... SANTA CLARA VALLEY MEDICAL CENTER ............................................................................. 05530 0 6 06 05T038 ..... SANTA ROSA MEMORIAL HOSPITAL ........................................................................................ 05590 7400 41940 05T174 ..... SARASOTA MEMORIAL HOSPITAL .......................................................................................... .. 10570 7500 42220 10T087 ..... SATILLA REGIONAL REHABILITATION INSTITUTE .................................................................. 11940 7510 42260 11T003 ..... SAVOY MEDICAL CENTER ................................................................................................ ......... 19190 11 11 19T025 ..... SCHWAB REHABILITATION HOSPITAL ..................................................................................... 1 4141 19 19 143025 ..... SCOTT & WHITE ....................................................................................................... ................... 45120 1600 16974 45T054 ..... SCOTTSDALE HEALTHCARE INPATIENT REHAB .................................................................... 03060 3810 28 660 03T038 ..... SCRIPPS MEMORIAL HOSPITAL ENCINITAS ........................................................................... 05470 6 200 38060 05T503 ..... SENTARA NORFOLK GENERAL HOSPITAL .............................................................................. 49641 7 320 41740 49T007 ..... SEWICKLEY VALLEY HOSPITAL ........................................................................................... ..... 39010 5720 47260 39T037 ..... SHANDS REHAB HOSPITAL ............................................................................................... ........ 10000 6280 38300 10T113 ..... SHANNON WEST TEXAS MEMORIAL HOSPITAL ..................................................................... 45930 2900 23 540 45T571 ..... SHARON REGIONAL HEALTH SYSTEM .................................................................................... 395 30 7200 41660 39T211 ..... SHARP MEMORIAL REHABILITATION CENTER ....................................................................... 05470 7610 49660 05T100 ..... SHELTERING ARMS REHABILITATION HOSPITAL .................................................................. 49430 7320 41 740 493025 ..... SHORE REHABILITATION INSTITUTE ...................................................................................... . 31310 6760 40060 313033 ..... SHREVEPORT REHABILITATION HOSPITAL ............................................................................ 19080 5 190 20764 193083 ..... SID PETERSON MEMORIAL HOSPITAL .................................................................................... 45 734 7680 43340 45T007 ..... SIERRA VISTA REGIONAL MEDICAL CENTER ......................................................................... 05500 45 45 05T506 ..... SILVER CROSS HOSPITAL ............................................................................................... .......... 14989 7460 42020 14T213 ..... SIMI VALLEY HOSPITAL & HEALTH CARE SVC ....................................................................... 05660 16 00 16974 05T236 ..... SINAI-GRACE HOSPITAL ................................................................................................ ............ 23810 8735 37100 23T024 ..... SINGING RIVER HOSPITAL .............................................................................................. .......... 25290 2160 19804 25T040 ..... SIOUX VALLEY HOSPITAL ............................................................................................... ........... 43490 0920 37700 43T027 ..... SISKIN HOSPITAL FOR PHYSICAL REHABILITATION ............................................................. 44320 7760 436 20 443025 ..... SISTER KENNY REHAB INSTITUTE

—ABBOTT NORTHWESTERN ......................................... 24260 1560 16860 24T057 ..... SISTER KENNY REHAB INSTITUTE

— UNITED HOSPITAL ....................................................... 24610 5120 33460 24T038 ..... SKYLINE REHABILITATION CENTER ....................................................................................... .. 44180 5120 33460 44T006 ..... SLIDELL MEMORIAL HOSPITAL ........................................................................................... ...... 19510 5360 34980 19T040 ..... SOUTH FULTON ........................................................................................................ .................. 11470 5560 35380 11T219 ..... SOUTH GEORGIA MEDICAL CENTER ....................................................................................... 1 1700 0520 12060 11T122 ..... SOUTH MIAMI HOSPITAL PHYSICAL MEDICINE & REHAB .................................................... 10120 11 46660 10T154 ..... SOUTH POINTE HOSPITAL ............................................................................................... ......... 36170 5000 33124 36T144 ..... SOUTH TEXAS REGIONAL SPECIALTY HOSPITAL ................................................................. 45060 1680 174 60


### 30323 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

45T165 ..... SOUTHCOAST HOSPITALS GROUP, INC. ................................................................................ 2215 0 45 41700 22T074 ..... SOUTHEAST MISSOURI HOSPITAL ......................................................................................... .. 26150 1123 14484 26T110 ..... SOUTHEASTERN REGIONAL REHABILITATION CENTER ...................................................... 34250 26 26 34T028 ..... SOUTHERN HILLS REGIONAL REHAB ...................................................................................... 5 1270 2560 22180 513026 ..... SOUTHERN INDIANA REHABILITATION HOSPITAL ................................................................. 15210 51 51 153037 ..... SOUTHERN KENTUCKY REHABILITATION HOSPITAL ............................................................ 18986 4520 31140 183029 ..... SOUTHERN OHIO MEDICAL CENTER ....................................................................................... 3 6740 18 14540 36T008 ..... SOUTHERN TENNESSEE MEDICAL CENTER .......................................................................... 44250 36 36 44T058 ..... SOUTHSIDE HOSPITAL .................................................................................................. ............. 33700 44 44 33T043 ..... SOUTHWEST GENERAL HOSPITAL .......................................................................................... 45130 5380 35004 45T697 ..... SOUTHWEST MEDICAL CENTER ............................................................................................ .. 19270 7240 41700 19T205 ..... SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER .................................................... 25560 3880 29180 25T097 ..... SOUTHWEST WASHINGTON MEDICAL CENTER .................................................................... 50050 25 25 50T050 ..... SOUTHWESTERN MEDICAL CENTER ....................................................................................... 37 540 6440 38900 37T097 ..... SOUTHWESTERN REHABILITATION HOSPITAL ...................................................................... 23120 5880 3 6420 233025 ..... SPAIN REHABILITATION CENTER ......................................................................................... .... 01360 3720 12980 01T033 ..... SPALDING REHABILITATION HOSPITAL ................................................................................... 0 6150 1000 13820 063027 ..... SPRING BRANCH MEDICAL CENTER ....................................................................................... 4 5610 2080 19740 45T630 ..... SSM DEPAUL HEALTH CENTER ............................................................................................ .... 26940 3360 26420 26T104 ..... SSM REHABILITATION INSTITUTE ........................................................................................ .... 26940 7040 41180 263025 ..... SSM ST. JOSEPH KIRKWOOD ............................................................................................. ...... 26940 7040 41180 26T081 ..... ST. FRANCIS MEDICAL CTR ............................................................................................. ......... 19360 7040 41180 04T007 ..... ST. AGNES MEDICAL CENTER ............................................................................................ ...... 39620 4400 30780 19T125 ..... ST. ALEXIUS MEDICAL CENTER .......................................................................................... ..... 35070 5200 33740 39T022 ..... ST. ANTHONYS MEDICAL CENTER ......................................................................................... .. 26940 6160 37964 35T002 ..... ST. ANTHONY ’ S REHABILITATION HOSPITAL ......................................................................... 10050 1010 13900 26T077 ..... ST. CATHERINE ’ S REHABILITATION HOSPITAL ...................................................................... 10120 7040 41180 103027 ..... ST. DAVIDS REHABILITATION CENTER .................................................................................... 45940 2680 22744 103026 ..... ST. EDWARD MERCY MEDICAL CENTER ................................................................................ 04650 5000 33124 453038 ..... ST. ELIZABETH HEALTH CENTER ......................................................................................... .... 36510 0640 12420 04T062 ..... ST. FRANCIS MEDICAL CENTER .......................................................................................... ..... 26260 2720 22900 36T064 ..... ST. JOHN DETROIT RIVERVIEW HOSP .................................................................................... 2 3810 9320 49660 26T183 ..... ST. JOHN MACOMB HOSPITAL ............................................................................................ ...... 23490 26 26 23T119 ..... ST. JOHN MEDICAL CENTER, INC. ....................................................................................... .... 37710 2160 19804 23T195 ..... ST. JOHN NORTH SHORES HOSPITAL ..................................................................................... 2 3490 2160 47644 37T114 ..... ST. JOHNS REGIONAL MEDICAL CENTER ............................................................................... 2648 0 8560 46140 23T257 ..... ST. JOHN ’ S REGIONAL MEDICAL CENTER .............................................................................. 05660 2160 47644 26T001 ..... ST. JOHN ’ S REHABILITATION HOSPITAL ................................................................................. 19250 3710 27900 05T082 ..... ST. JOSEPH HEALTH SERVICES OF RI .................................................................................... 41030 8735 37100 193061 ..... ST. JOSEPH HOSPITAL ................................................................................................. ............. 05110 5560 35380 41T005 ..... ST. JOSEPH HOSPITAL ................................................................................................. ............. 30050 6483 39300 05T006 ..... ST. JOSEPH HOSPITAL & HEALTH CENTER ........................................................................... 15330 0 5 05 30T011 ..... ST. JOSEPH REGIONAL REHAB ........................................................................................... ..... 45190 1123 31700 15T010 ..... ST. JOSEPHS HOSPITAL ................................................................................................ ............ 52390 3850 29020 45T011 ..... ST. JOSEPH ’ S MERCY HEALTH CENTER ................................................................................. 04250 1260 17780 52T136 ..... ST. LAWRENCE REHABILITATION CENTER ............................................................................. 31260 5080 33340 04T026 ..... ST. LUKES EPISCOPAL HOSPTIAL ........................................................................................ ... 45610 04 26300 313027 ..... ST. LUKES HOSPITAL OF KANSAS CITY .................................................................................. 2 6470 8480 45940 45T193 ..... ST. LUKES NORTHLAND HOSPITAL ........................................................................................ . 26230 3360 26420 26T138 ..... ST. LUKE ’ S REHABILITATION HOSPITAL OF LAFAYETTE ..................................................... 19270 3760 28140 26T062 ..... ST. LUKES REHABILITATION INSTITUTE ................................................................................. 5 0310 3760 28140 193087 ..... ST. MARGARET MERCY HLTHCARE CTRS .............................................................................. 15440 3 880 29180 503025 ..... ST. MARY MEDICAL CENTER ............................................................................................. ....... 05200 7840 44060 15T004 ..... ST. MARY MEDICAL CENTER ............................................................................................. ....... 50350 2960 23844 05T191 ..... ST. MARY-CORWIN MEDICAL CENTER .................................................................................... 06 500 4480 31084 50T002 ..... ST. MARYS HOSPITAL .................................................................................................. .............. 24540 50 50 06T012 ..... ST. MARY ’ S HOSPITAL BLUE SPRINGS ................................................................................... 26470 6560 39380 24T010 ..... ST. MARYS MEDICAL CENTER ............................................................................................ ...... 15810 6820 40340 26T193 ..... ST. MARYS MEDICAL CENTER ............................................................................................ ...... 44460 3760 28140 15T100 ..... ST. MARY ’ S MEDICAL CENTER ................................................................................................. 05480 2440 21780 44T120 ..... ST. MARY ’ S WEST PALM BEACH .............................................................................................. 10120 3840 28940 05T457 ..... ST. NICHOLAS HOSPITAL ............................................................................................... ........... 52580 7360 41884 10T288 ..... ST. PAUL HOSPITAL ................................................................................................... ................ 45390 5000 33124 52T044 ..... ST. VINCENT HEALTHCARE .............................................................................................. ......... 27550 7620 43100 45T044 ..... ST. VINCENT HOSPITAL ................................................................................................ ............. 32240 1920 19124 27T049 ..... ST. VINCENT HOSPITAL ................................................................................................ ............. 52040 0880 13740 32T002 ..... ST. VINCENT REHAB HOSP IN PART HLTHSOUT ................................................................... 04590 7490 4 2140


### 30324 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

52T075 ..... ST. AGNES HOSPITAL .................................................................................................. .............. 52190 3080 24580 043031 ..... ST. ALEXIUS HOSPITAL ................................................................................................ .............. 26940 4400 30780 52T088 ..... ST. ANTHONY HOSPITAL REHAB CENTER .............................................................................. 37540 52 22540 26T210 ..... ST. ANTHONY MEDICAL CENTER .......................................................................................... ... 15440 7040 41180 37T037 ..... ST. ANTHONY MEMORIAL HEALTH CENTERS ........................................................................ 15450 5880 36420 15T126 ..... ST. CHARLES HOSPITAL AND REHABILITATION CENTER .................................................... 33700 2960 23844 15T015 ..... ST. CHARLES MERCY HOSPITAL .......................................................................................... .... 36490 15 33140 33T246 ..... ST. CLAIR HOSPITAL .................................................................................................. ................ 39010 5380 35004 36T081 ..... ST. CLAIRE MC ....................................................................................................... ..................... 18975 8400 45780 39T228 ..... ST. CLOUD HOSPITAL .................................................................................................. .............. 24720 6280 38300 18T018 ..... ST. ELIZABETH HOSPITAL .............................................................................................. ........... 52430 18 18 24T036 ..... ST. ELIZABETH HOSPITAL REHAB ........................................................................................ .... 14900 6980 41060 52T009 ..... ST. FRANCIS HOSPITAL REHAB .......................................................................................... ..... 08010 0460 11540 14T187 ..... ST. JAMES HOSPITAL AND HEALTH CENTERS ...................................................................... 14141 7040 41180 08T003 ..... ST. JOHN NORTHEAST COMMUNITY HOSPITAL .................................................................... 23810 9160 48 864 14T172 ..... ST. JOHNS REGIONAL HEALTH CENTER ................................................................................ 2638 0 1600 16974 23T065 ..... ST. JOSEPH HOSPITAL ................................................................................................. ............. 50360 2160 19804 26T065 ..... ST. JOSEPH MEDICAL CENTER ........................................................................................... ..... 50260 7920 44180 50T030 ..... ST. JOSEPH MERCY HOSPITAL-ANN ARBOR ......................................................................... 23800 086 0 13380 50T108 ..... ST. JOSEPHS HOSPITAL ................................................................................................ ............ 03060 8200 45104 23T156 ..... ST. JOSEPH ’ S HOSPITAL ........................................................................................................... 33070 0440 1 1460 03T024 ..... ST. JOSEPH ’ S HOSPITAL ........................................................................................................... 52700 6200 3 8060 33T108 ..... ST. JOSEPH ’ S MERCY OF MACOMB ........................................................................................ 23490 2335 21300 52T037 ..... ST. JOSEPH ’ S WAYNE HOSPITAL ............................................................................................. 31320 52 52 23T047 ..... ST. JUDE MEDICAL CENTER ............................................................................................. ........ 05400 2160 47644 31T116 ..... ST. LUKE ’ S .............................................................................................................................. ..... 24680 0875 35644 05T168 ..... ST. LUKE ’ S/ROOSEVELT HOSPITAL CENTER ......................................................................... 33420 5945 42044 24T047 ..... ST. LUKES ACUTE REHAB ............................................................................................... .......... 03060 2240 20260 33T046 ..... ST. LUKES HOSPITAL .................................................................................................. ............... 16560 5600 35644 03T037 ..... ST. LUKE ’ S HOSPITAL ................................................................................................................ 26940 6200 38060 16T045 ..... ST. LUKE ’ S HOSPITAL ................................................................................................................ 36490 1360 16300 26T179 ..... ST. LUKE ’ S REHAB UNIT AT ST. LUKE ’ S SOUTH SHORE ...................................................... 52580 7040 41180 36T090 ..... ST. MARY MEDICAL CENTER ............................................................................................. ....... 39140 8400 45780 52T138 ..... ST. MARY MEDICAL CENTER INC ......................................................................................... .... 15440 7620 43100 39T258 ..... ST. MARYS HOSPITAL AND MEDICAL CENTER ...................................................................... 06380 6160 37964 15T034 ..... ST. MARY ’ S REGIONAL MEDICAL CENTER ............................................................................. 04570 2960 23844 06T023 ..... ST. MARY ’ S REGIONAL MEDICAL CENTER ............................................................................. 37230 2995 24300 04T041 ..... ST. PETERS HOSPITAL ................................................................................................. ............. 33000 04 04 37T026 ..... ST. RITA ’ S MEDICAL CENTER ................................................................................................... 36010 2340 37 33T057 ..... ST. ROSE DOMINICAN HOSPITAL ......................................................................................... .... 29010 0160 10580 36T066 ..... ST. TAMMANY PARISH HOSPITAL ......................................................................................... ... 19510 4320 30620 29T012 ..... ST. VINCENT INFIRMARY MEDICAL CENTER .......................................................................... 04590 4 120 29820 19T045 ..... ST. VINCENT ’ S MEDICAL CENTER ............................................................................................ 07000 5560 35380 07T028 ..... ST. FRANCIS HEALTH CENTER ........................................................................................... ...... 17880 5483 14860 17T016 ..... ST. JOSEPH HOSPITAL REHAB UNIT ...................................................................................... . 15010 8440 45820 15T047 ..... STAMFORD HOSPITAL ................................................................................................... ............ 07070 2760 23060 073026 ..... STANFORD HOSPITAL & CLINICS ......................................................................................... .... 05530 07 07 05T441 ..... STANLY MEMORIAL HOSPITAL ............................................................................................ ..... 34830 7400 41940 34T119 ..... STARKE MEMORIAL HOSPITAL ............................................................................................ ..... 15740 1520 34 15T102 ..... STATEN ISLAND HOSPITAL .............................................................................................. ......... 33610 15 15 33T160 ..... STERLINGTON REHAB HOSPITAL .......................................................................................... .. 19360 5600 35644 193069 ..... STILLWATER MEDICAL CENTER ........................................................................................... .... 37590 5200 33740 37T049 ..... STRONG MEMORIAL HOSPITAL ............................................................................................ .... 33370 37 37 33T285 ..... SUMMA HEALTH SYSTEM ................................................................................................. ......... 36780 6840 40380 29T041 ..... SUMMERLIN HOSPITAL MEDICAL CENTER ............................................................................. 29010 4 120 29820 36T020 ..... SUMNER REGIONAL MEDICAL CENTER .................................................................................. 4482 0 0080 10420 44T003 ..... SUMTER REGIONAL HOSPITAL ............................................................................................ ..... 11870 5360 34980 11T044 ..... SUN COAST HOSPITAL .................................................................................................. ............ 10510 11 11 10T015 ..... SUN HEALTH ROBERT H BALLARD REHAB HOSPITAL ......................................................... 05460 8280 45300 053037 ..... SUNNYVIEW HOSPITAL AND REHABILITATION CENTER ...................................................... 33650 6780 40140 333025 ..... SUNRISE HOSPITAL & MEDICAL CEN ...................................................................................... 29010 0160 10580 29T003 ..... SUNY DOWNSTATE MEDICAL CENTER ................................................................................... 3333 1 4120 29820 33T350 ..... SUTTER AUBURN FAITH HOSPITAL ........................................................................................ . 05410 5600 35644 05T498 ..... SWEDISH COVENANT HOSPITAL ........................................................................................... ... 14141 6920 40900 14T114 ..... SWEDISH GENERAL REHABILITATION ..................................................................................... 0 6020 1600 16974 06T034 ..... SWEDISH MEDICAL CENTER .............................................................................................. ....... 50160 2080 19740 50T025 ..... TAH INPATIENT REHAB UNIT ............................................................................................ ........ 39260 7600 42644


### 30325 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

39T122 ..... TAKOMA ADVENTIST HOSPITAL ........................................................................................... .... 44290 39 39 44T050 ..... TAMPA GENERAL REHABILATION CTR .................................................................................... 10 280 44 44 10T128 ..... TARRANT COUNTY REHABILITATION HOSPITAL ................................................................... 45910 8280 45 300 453042 ..... TEMPLE UNIVERSITY HOSPITAL .......................................................................................... .... 39620 2800 23104 39T027 ..... TERREBONNE GENERAL MEDICAL CENTER .......................................................................... 19540 6160 37964 19T008 ..... TEXOMA MEDICAL CENTER ............................................................................................... ....... 45564 3350 26380 28T061 ..... THE ACUTE REHAB UNIT AT REGIONAL WEST MEDICAL CENT ......................................... 28780 28 28 20T018 ..... THE AROOSTOOK MEDICAL CENTER ...................................................................................... 20 010 20 20 36T163 ..... THE CHRIST HOSPITAL REHAB UNIT ...................................................................................... . 36310 1640 17140 09T001 ..... THE GEORGE WASHINGTON UNIVERSITY ARU ..................................................................... 09000 8840 47 894 39T066 ..... THE GOOD SAMARITAN HOSPITAL ......................................................................................... . 39460 3240 30140 33T004 ..... THE KINGSTON HOSPITAL REHABILITATION CENTER .......................................................... 33740 33 28740 25T099 ..... THE LEFLORE REHABILITATION CENTER ............................................................................... 2541 0 25 25 33T056 ..... THE PARKSIDE ACUTE REHABILITATION CENTER ................................................................ 33331 5600 356 44 33T049 ..... THE PAUL ROSENTHAL REHABILITATION CENTER AT NDH ................................................ 33230 2281 39100 39T044 ..... THE READING HOSPITAL AND MEDICAL CENTER ................................................................. 39110 6680 397 40 42T068 ..... THE REGIONAL MEDICAL CENTER REHABCENTRE .............................................................. 42370 42 42 15T051 ..... THE REHAB CENTER AT BLOOMINGTON HOSPITAL ............................................................. 15520 1020 14020 11T024 ..... THE REHAB CENTER AT CANDLER ......................................................................................... . 11220 7520 42340 44T059 ..... THE REHAB CENTER AT COOKEVILLE RMC ........................................................................... 44700 44 44 16T146 ..... THE REHAB CENTER AT ST. LUKE ’ S ....................................................................................... 16960 7720 43580 11T043 ..... THE REHAB CENTER AT ST. JOSEPHS ................................................................................... 11 220 7520 42340 15T008 ..... THE REHABILITATION CENTER AT ST. CATHERINE HOSPITA ............................................. 15440 2960 23844 10T012 ..... THE REHABILITATION HOSPITAL ......................................................................................... ..... 10350 2700 15980 20T039 ..... THE REHABILITATION INSTITUTE AT MGMC .......................................................................... 20050 2 0 20 42T067 ..... THE REHABILITATION UNIT AT BEAUFORT MEMORIAL HOSPI ............................................ 42060 42 42 36T211 ..... THE TRINITY REHABILITATION CENTER ................................................................................. 36 420 8080 48260 39T042 ..... THE WASHINGTON HOSPITAL ACUTE REHABILITATION UNIT ............................................. 39750 6280 38300 52T045 ..... THEDA CLARK MEDICAL CENTER .......................................................................................... .. 52690 0460 36780 19T004 ..... THIBODAUX REGIONAL MEDICAL CENTER ............................................................................. 19280 3 350 26380 39T174 ..... THOMAS JEFFERSON UNIVERSITY HOSPITAL ....................................................................... 39620 6160 37964 343025 ..... THOMS REHABILITATION HOSP ........................................................................................... .... 34100 0480 11700 23T015 ..... THREE RIVERS REHABILITATION PAVILION ........................................................................... 23740 23 23 11T095 ..... TIFT REGIONAL MEDICAL CENTER ........................................................................................ .. 11900 11 11 45T080 ..... TITUS REGIONAL MEDICAL CENTER ....................................................................................... 45531 45 45 45T324 ..... TOMBALL REGIONAL HOSPITAL ........................................................................................... .... 45610 7640 43300 45T670 ..... TOURO REHABILITATION CENTER ......................................................................................... .. 19350 3360 26420 193034 ..... TRI-CITY MEDICAL CENTER ............................................................................................. ......... 05470 5560 35380 05T128 ..... TRI PARISH REHABILITATION HOSPITAL LLC ......................................................................... 19050 7320 41740 193050 ..... TRINITY MEDICAL CENTER .............................................................................................. ......... 14890 19 19 14T280 ..... TRINITY REHABCARE CENTER ............................................................................................ ..... 35500 1960 19340 35T006 ..... TULANE INPATIENT REHAB CENTER ....................................................................................... 19350 35 35 19T176 ..... TULSA REGIONAL MEDICAL CENTER ...................................................................................... 3 7710 5560 35380 37T078 ..... TWELVE OAKS MEDICAL CENTER .......................................................................................... . 45610 8560 46140 45T378 ..... TWIN RIVERS REGIONAL MEDICAL CENTER .......................................................................... 26340 33 60 26420 26T015 ..... U W HOSPITAL & CLINIC ............................................................................................... ............. 52120 26 26 52T098 ..... UAB MEDICAL WEST REHABILITATION UNIT .......................................................................... 01360 4 720 31540 01T114 ..... UC DAVIS MEDICAL CENTER ............................................................................................. ....... 05440 1000 13820 05T599 ..... UCLA MED CTR-RRU .................................................................................................... .............. 05200 6920 40900 05T262 ..... UHS HOSPITALS ....................................................................................................... ................... 33030 4480 31084 33T394 ..... UNC HOSPITALS ....................................................................................................... .................. 34670 0960 13780 34T061 ..... UNION HOSPITAL ...................................................................................................... .................. 15830 6640 20500 15T023 ..... UNIONTOWN HOSPITAL .................................................................................................. ........... 39330 8320 45460 39T041 ..... UNITED MEDICAL CENTER ARU ........................................................................................... .... 53100 6280 38300 53T014 ..... UNITED MEDICAL REHABILITATION HOSPITAL ...................................................................... 19350 158 0 16940 193079 ..... UNITY HEALTH CENTER ................................................................................................. ........... 37620 5560 35380 37T149 ..... UNITY HEALTH SYSTEM ................................................................................................. ........... 33370 5880 37 33T226 ..... UNIV OF CA IRVINE MED CTR ........................................................................................... ........ 05400 6840 40380 05T348 ..... UNIV OF PITTSBURGH MED CTR-MUH .................................................................................... 39 010 5945 42044 39T164 ..... UNIVERSITY COMMUNITY HOSPITAL ....................................................................................... 10280 6280 38300 10T173 ..... UNIVERSITY HEALTH SYSTEM ............................................................................................ ...... 45130 8280 45300 45T213 ..... UNIVERSITY HOSPITAL ................................................................................................. ............. 33520 7240 41700 33T241 ..... UNIVERSITY MEDICAL CENTER ........................................................................................... ..... 44940 8160 45060 44T193 ..... UNIVERSITY MEDICAL CENTER ........................................................................................... ..... 45770 5360 34980 45T686 ..... UNIVERSITY OF COLORADO HOSPITAL .................................................................................. 061 50 4600 31180 06T024 ..... UNIVERSITY OF ILLINOIS MEDICAL CENTER AT CHICAGO .................................................. 14141 2080 19740 14T150 ..... UNIVERSITY OF MICHIGAN HOSPITAL ..................................................................................... 23800 1600 16974


### 30326 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

23T046 ..... UNIVERSITY OF UTAH HOSPITAL ......................................................................................... .... 46170 0440 11460 46T009 ..... UNIVERSITY OF WASHINGTON MED CTR ............................................................................... 50160 7160 41620 50T008 ..... UNIVERSITY REHABILITATION CENTER .................................................................................. 25 240 7600 42644 25T001 ..... UPMC HORIZON ........................................................................................................ .................. 39530 3560 27140 39T178 ..... UPMC LEE REGIONAL REHAB UNIT ........................................................................................ . 39160 7610 49660 39T011 ..... UPMC MCKEESPORT ..................................................................................................... ............. 39010 3680 27780 39T002 ..... UPMC NORTHWEST ...................................................................................................... .............. 39730 6280 38300 39T091 ..... UPMC PASSAVANT-REHABILITATION CENTER ...................................................................... 39010 39 39 39T107 ..... UPMC REHABILITATION HOSPITAL ........................................................................................ .. 39010 6280 38300 393042 ..... UPMC SOUTHSIDE ...................................................................................................... ................ 39010 6280 38300 39T131 ..... UPMC ST MARGARET .................................................................................................... ............. 39010 6280 38300 39T102 ..... UPPER VALLEY MEDICAL CENTER ......................................................................................... . 36560 6280 38300 36T174 ..... UTAH VALLEY REGIONAL MEDICAL CENTER-REHABILITATION .......................................... 46240 2000 19380 46T001 ..... UVA-HEALTHSOUTH REHABILITATION HOSPITAL ................................................................. 49191 6520 393 40 493029 ..... VALLEY BAPTIST HEALTH SYSTEM REHAB UNIT .................................................................. 45240 1540 16 820 45T033 ..... VALLEY HOSPITAL MEDICAL CENTER REHABILITAION UNIT ............................................... 29010 1240 15180 29T021 ..... VALLEY MEMORIAL HOSPITAL ............................................................................................ ...... 05000 4120 29820 05T283 ..... VALLEY PRESBYTERIAN HOSPITAL ........................................................................................ . 05200 5775 36084 05T126 ..... VALLEY VIEW HOSPITAL ................................................................................................ ............ 06070 4480 31084 06T075 ..... VALLEY VIEW REGIONAL HOSPITAL ....................................................................................... . 37610 06 06 37T020 ..... VAN MATRE HEALTHSOUTH REHABILITATION HOSPITAL .................................................... 14991 37 37 143028 ..... VANDERBILT STALLWORTH REHAB HOSPITAL ...................................................................... 44180 6880 4 0420 443028 ..... VCUHS ............................................................................................................... ........................... 49791 5360 34980 49T032 ..... VERMILION REHABILITATION HOSPITAL ................................................................................. 19 480 6760 40060 193047 ..... VIA CHRISTI REHABILITATION CENTER .................................................................................. 1 7860 3880 19 173028 ..... VICTORIA WARM SPRINGS REHAB HOSPITAL ....................................................................... 45948 9040 48620 453083 ..... VICTORY MEMORIAL HOSPITAL ........................................................................................... .... 33331 8750 47020 33T242 ..... VIRGINIA BAPTIST HOSPITAL ........................................................................................... ......... 49551 5600 35644 49T021 ..... VIRGINIA MASON MEDICAL CENTER ....................................................................................... 50160 4640 31340 50T005 ..... VIRGINIA REGIONAL MEDICAL CENTER .................................................................................. 24 680 7600 42644 24T084 ..... VISTA HEALTH ST. THERESE REHAB UNIT ............................................................................. 1457 0 2240 20260 14T033 ..... WACCAMAW REHABILITATION CENTER .................................................................................. 4221 0 1600 29404 42T098 ..... WADSWORTH RITTMAN HOSPITAL .......................................................................................... 36530 42 42 36T195 ..... WAKEMED REHAB ....................................................................................................... ............... 34910 1680 17460 34T069 ..... WALTER O. BOSWELL MEMORIAL HOSPITAL ......................................................................... 03060 664 0 39580 03T061 ..... WALTON REHABILITATION HOSPITAL ..................................................................................... 1 1840 6200 38060 113026 ..... WARMINSTER HOSPITAL ................................................................................................. .......... 39140 0600 12260 39T286 ..... WASHOE MEDICAL CENTER REHABILITATION HOSPITAL .................................................... 29120 6160 37964 29T049 ..... WASHOE VILLAGE REHAB ................................................................................................ ......... 29150 29 16180 293030 ..... WAUKESHA MEMORIAL HOSPITAL .......................................................................................... . 52660 6720 39900 52T008 ..... WAUSAU HOSPITAL ..................................................................................................... ............... 52360 5080 33340 52T030 ..... WELDON CENTER FOR REHABILITATION ............................................................................... 22070 8940 48140 22T066 ..... WELLSTAR COBB HOSPITAL .............................................................................................. ....... 11290 8003 44140 11T143 ..... WELLSTAR KENNESTONE INPATIENT REHAB ........................................................................ 11290 0520 12060 11T035 ..... WENATCHEE VALLEY HOSPITAL REHABILITATION CENTER ............................................... 50030 0520 12060 50T148 ..... WESLACO REHABILITATION HOSPITAL ................................................................................... 45 650 50 48300 453091 ..... WESLEY REHABILITATION HOSPITAL ...................................................................................... 17860 4880 32580 173027 ..... WESLEY WOODS GERIATRIC HOSPITAL ................................................................................. 1137 0 9040 48620 11T203 ..... WEST ALLIS MEMORIAL HOSPITAL ........................................................................................ .. 52390 0520 12060 52T139 ..... WEST FLORIDA REHAB INSTITUTE ........................................................................................ .. 10160 5080 33340 10T231 ..... WEST HOUSTON MEDICAL CENTER ........................................................................................ 4 5610 6080 37860 45T644 ..... WEST JEFFERSON MEDICAL CENTER .................................................................................... 192 50 3360 26420 19T039 ..... WEST TENNESSEE REHABILITATION CENTER ...................................................................... 44560 5560 3 5380 44T002 ..... WEST VIRGINIA REHAB HOSP ............................................................................................ ...... 51190 3580 27180 513029 ..... WESTCHESTER MEDICAL CENTER .......................................................................................... 33800 1480 16620 33T234 ..... WESTERN PENNSYLVANIA HOSPITAL ..................................................................................... 39 010 5600 35644 39T090 ..... WESTERN PLAINS MEDICAL COMPLEX ................................................................................... 172 80 6280 38300 17T175 ..... WESTLAKE HOSPITAL ................................................................................................... ............. 14141 17 17 14T240 ..... WESTMORELAND REGIONAL HOSPITAL ................................................................................. 39770 1600 16974 39T145 ..... WESTVIEW HOSPITAL ................................................................................................... ............. 15480 6280 38300 15T129 ..... WHITAKER REHABILITATION CENTER ..................................................................................... 3 4330 3480 26900 34T014 ..... WHITE COUNTY MEDICAL CENTER ......................................................................................... 04720 3120 49180 04T100 ..... WHITE MEMORIAL MEDICAL CENTER ..................................................................................... 05 200 04 04 05T103 ..... WHITE RIVER MEDICAL CENTER .......................................................................................... .... 04310 4480 31084 04T119 ..... WHITTIER REHABILITATION HOSPITAL ................................................................................... 2 2040 04 04 223028 ..... WHITTIER REHABILTATION HOSPITAL .................................................................................... 2 2170 1123 21604 223033 ..... WICHITA VALLEY REHABILITATION HOSPITAL ....................................................................... 45960 11 23 49340


### 30327 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules

TABLE 

### 3.

— I NPATIENT 

### R EHABILITATION 

### F ACILITIES 

### W ITH 

### C ORRESPONDING 

### S TATE AND 

### C OUNTY 

### L OCATION 

### ; C URRENT 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION 

### ; AND 

### P ROPOSED 

### N EW 

### CBSA-B ASED 

### LABOR 

### M ARKET 

### A REA 

### D ESIGNATION



### —Continued

Provider number Provider name SSA State and

county code FY 06 MSA code FY 06 CBSA code

453088 ..... WILLAMETTE VALLEY MEDICAL CENTER ................................................................................ 3835 0 9080 48660 38T071 ..... WILLIAM BEAUMONT HOSPITAL ........................................................................................... .... 23620 6440 38900 23T130 ..... WILLIAM N. WISHARD MEMORIAL HOSPITAL ......................................................................... 15480 21 60 47644 39T045 ..... WILLIAMSPORT HOSPITAL REHAB ......................................................................................... .. 39510 9140 48700 19T111 ..... WILLIS-KNIGHTON MEDICAL CENTER ..................................................................................... 1 9080 7680 43340 45T469 ..... WILSON N. JONES MEDICAL CENTER-MAIN CAMPUS .......................................................... 45564 7640 43300 45T393 ..... WILSON N. JONES MEDICAL CENTER-NORTH CAMPUS ....................................................... 45564 7640 43300 49T005 ..... WINCHESTER REHABILITATION CTR ....................................................................................... 49962 49 49020 15T014 ..... WINONA MEMORIAL HOSPITAL ............................................................................................ .... 15480 3480 26900 10T052 ..... WINTER HAVEN HOSPITAL ............................................................................................... ......... 10520 3980 29460 33T239 ..... WOMANS CHRISTIAN ASSOCIATION ........................................................................................ 33060 3610 33 33T396 ..... WOODHULL MEDICAL CENTER ............................................................................................. .... 33331 5600 35644 45T484 ..... WOODLAND HEIGHTS MEDICAL CENTER ............................................................................... 45020 4 5 45 53T012 ..... WYOMING MEDICAL CENTER .............................................................................................. ..... 53120 1350 16220 50T012 ..... YAKIMA REGIONAL ..................................................................................................... ................ 50380 9260 49420 07T022 ..... YALE-NEW HAVEN HOSPITAL ............................................................................................. ...... 07040 5483 35300 033034 ..... YUMA REHABILITATION HOSPITAL ........................................................................................ .. 03130 9360 49740 45T766 ..... ZALE LIPSHY UNIVERSITY HOSPITAL ..................................................................................... . 45390 1920 19124

[FR Doc. 05

– 10264 Filed 5

– 19

– 05; 4:00 pm]

**BILLING CODE 4120**

**– 01** 

**– P**