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 information 

regarding 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 

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

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 662⁄3

percent of the Federal IRF PPS rate and 

331⁄3 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 and 

discharge 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 

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

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 specific 

claim 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 of 

service, 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 in 

improving 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 full 

range 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 the 

Function 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 relative 

weights) 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. 

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

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 of 

rehabilitation 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 rehabilitation 

facilities 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 ancillary 

services, 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 

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

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.—PROPOSED LIST OF CODES TO BE REMOVED FROM THE TIER LIST

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 Complications 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 of 

comorbidities 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 a 

sample 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 

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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. 

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post-PPS data, we asked RAND to 

examine possible refinements to the 

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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. The 

more 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. 

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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 


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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.—PROPOSED OPTIMAL

WEIGHTS, AVERAGED ACROSS REHABILITATION IMPAIRMENT CATEGORIES (RICS): MOTOR ITEMS

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 

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TABLE 5.—PROPOSED OPTIMAL

WEIGHTS, AVERAGED ACROSS REHABILITATION IMPAIRMENT CATEGORIES (RICS): MOTOR ITEMS—

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 payment 

groups 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.

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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 


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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 2002 

data (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
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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 the 

RPL (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 on 

reasonable 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, and 

LTCHs 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 

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

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. 

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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.) 

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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, 


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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 

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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 annual 

measure 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 

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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. 

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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 


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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.—PROPOSED FY 2002-BASED RPL MARKET BASKET AND FY 1997-BASED EXCLUDED HOSPITAL WITH CAPITAL

MARKET BASKET PERCENT CHANGES, 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 current 

definition of labor-related, the laborrelated share is the sum of the relative 

importance of wages and salaries, fringe 

benefits, 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 to 

determine 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 proposed 

FY 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.—PROPOSED TOTAL LABOR-RELATED SHARE

Cost category 

Proposed FY 2002-

based RPL market 

basket relative importance (percent) 

FY 2006 

FY 1997 excluded 

hospital with capital 

market 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’ costs 

that 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 

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

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 reference 

urban 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 rest 

of 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 IRF 

labor 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 

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

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 describe 

below) 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 Metropolitan 

Divisions 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 Metropolitan 

Divisions 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-Passaic 

and Jersey City) into the New YorkWayne-White Plains, NY-NJ Division, 

under the proposed CBSA-based labor 

market area designations. In San 

Francisco, 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. 

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

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 or 

urban 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 index 

and 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 discussed 

above 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 policy 

because 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 the 

excluded 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 are 

designated 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 or 

urban 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 are 

proposing to fully adopt the CBSAbased designations without a hold 

harmless policy. We believe that it is 

not appropriate or necessary to propose 

a 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-based 

designations 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 the 

IPPS 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 

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

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 wage 

indices 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 conversion 

factor 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 

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

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 the 

IRF (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 

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

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 facilities 

according 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 Medicare Days Total 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 

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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 FY 

2006) indicate that the overall cost-tocharge ratios in IRFs have been falling 

since the IRF PPS was implemented. We 

are still analyzing possible reasons for 

this 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 

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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 

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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 to 

account 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, and 

IRFs 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 

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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, an 

IRF 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.


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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).


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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 of 

elements 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 

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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. 

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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 for 

IRFs 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 hospitals 

located 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. 

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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 update 

the 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 in 

payments 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.

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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. 


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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.—PROPOSED IMPACT OF

THE PROPOSED FY 2006 CBSABASED AREA WAGE INDEX

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 

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

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 present 

the 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 present 

the 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 present 

the effects of the proposed budgetneutral update to the adjustment to the 

Federal prospective payment rates for 

IRFs 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 Medicare Days Total Days

+

Because we are proposing to make 

this proposed update to the LIP 

adjustment in a budget neutral manner, 

payments would be redistributed among 

providers, 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 


EP25MY05.035</MATH>
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.—ACCOUNTING STATEMENT: 

CLASSIFICATION OF ESTIMATED EXPENDITURES, FROM FY 2005 TO FY 

2006 (IN 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, 

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

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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A

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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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.

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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.

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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 

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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.

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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.

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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.

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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.

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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.

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

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—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 MARKET AREA DESIGNATIONS FOR URBAN AREAS FOR THE PURPOSES OF

COMPARING WAGE INDEX VALUES WITH TABLE 2A—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 

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

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—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 MARKET AREA DESIGNATIONS FOR RURAL AREAS FOR THE

PURPOSES OF COMPARING WAGE

INDEX VALUES WITH 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 MARKET AREA DESIGNATIONS FOR RURAL AREAS FOR THE

PURPOSES OF COMPARING WAGE

INDEX VALUES WITH 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 MARKET AREA DESIGNATIONS FOR RURAL AREAS FOR THE

PURPOSES OF COMPARING WAGE

INDEX VALUES WITH 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 

1All counties within the State are classified 

urban. 

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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.

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

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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

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

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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.

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

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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

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

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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.

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

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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.

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30297

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30299

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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.

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30301

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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.

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30303

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 ́ıza Municipio, PR.

Manat ́ı Municipio, PR.

Maunabo Municipio, PR.

Morovis Municipio, PR.

Naguabo Municipio, PR.

Naranjito Municipio, PR.

Orocovis Municipio, PR.

Quebradillas Municipio, PR.

R ́ıo Grande Municipio, PR.

San Juan Municipio, PR.

San Lorenzo Municipio, PR.

Toa Alta Municipio, PR.

Toa Baja Municipio, PR.

Trujillo Alto Municipio, PR.

Vega Alta Municipio, PR.

Vega Baja Municipio, PR.

Yabucoa Municipio, PR.

42020 ....... San Luis Obispo-Paso Robles, CA ....................................................................................................................................... 1.1118

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

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30305

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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.

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30307

TABLE 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2A.—PROPOSED INPATIENT REHABILITAION FACILITY WAGE INDEX FOR URBAN AREAS BASED ON PROPOSED CBSA 

LABOR MARKET AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 1, 2005—Continued

CBSA 

code 

Urban area

(Constituent counties) 

Full wage

Index 

49740 ....... Yuma, AZ ............................................................................................................................................................................... 0.8871

Yuma County, AZ.

TABLE 2B.—PROPOSED INPATIENT REHABILITATION FACILITY WAGE INDEX

(BASED ON PROPOSED CBSA 

LABOR MARKET AREAS) FOR RURAL

AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2B.—PROPOSED INPATIENT REHABILITATION FACILITY WAGE INDEX

(BASED ON PROPOSED CBSA 

LABOR MARKET AREAS) FOR RURAL

AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 2B.—PROPOSED INPATIENT REHABILITATION FACILITY WAGE INDEX

(BASED ON PROPOSED CBSA 

LABOR MARKET AREAS) FOR RURAL

AREAS FOR DISCHARGES OCCURRING ON OR AFTER OCTOBER 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 

1All counties within the State are classified 

urban. 2 Massachusetts and Puerto Rico have 

areas designated as rural, however, no shortterm, acute care hospitals are located in the 

area(s) for FY 2006 under CBSA-based designations. Therefore, we are proposing to use 

FY 2001 MSA based hospital wage data. 

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

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 ..................................................................................... 24230 24 24 

42T070 ..... ACUTE REHAB UNIT AT TUOMEY HEALTHCARE SYSTEM ................................................... 42420 8140 44940 

14T182 ..... ADVOCATE ILLINOIS MASONIC MEDICAL CENTER ................................................................ 14141 1600 16974 

14T223 ..... ADVOCATE LUTHERAN GENERAL HOSPITAL ......................................................................... 14141 1600 16974 

19T202 ..... AHS SUMMIT HOSPITAL LLC ..................................................................................................... 19160 0760 12940 

05T320 ..... ALAMEDA COUNTY MEDICAL CENTER .................................................................................... 05000 5775 36084 

02T017 ..... ALASKA REGIONAL HOSPITAL .................................................................................................. 02020 0380 11260 

33T013 ..... ALBANY MEDICAL CENTER HOSP ............................................................................................ 33000 0160 10580 

14T258 ..... ALEXIAN BROTHERS MEDICAL CENTER ................................................................................. 14141 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 7560 42540 

05T305 ..... ALTA BATES MEDICAL CENTER ............................................................................................... 05000 5775 36084 

39T073 ..... ALTOONA HOSPITAL .................................................................................................................. 39120 0280 11020 

39T121 ..... ALTOONA REGIONAL HEALTH SYSTEM .................................................................................. 39120 0280 11020 

35T019 ..... ALTRU REHABILITATION CENTER ............................................................................................ 35170 2985 24220 

05T583 ..... ALVARADO HOSPITAL MEDICAL CENTER INC. ...................................................................... 05470 7320 41740 

33T010 ..... AMSTERDAM MEMORIAL HOSPITAL ........................................................................................ 33380 0160 33 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30309

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—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 38300 

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 .................................................................................... 52040 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 43 

45T280 ..... BACHARACH INSTITUTE FOR REHABILITATION ..................................................................... 31000 1920 19124 

313030 ..... BALL MEMORIAL HOSPITAL-REHAB ......................................................................................... 15170 0560 12100 

15T089 ..... BAPTIST HEALTH REHABILITATION INSTITUTE ...................................................................... 04590 5280 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 4520 31140 

45T346 ..... BAPTIST MEMORIAL HOSPITAL NORTH MISSISSIPPI ............................................................ 25350 0840 13140 

25T034 ..... BAPTIST MEMORIAL MED CENTER, NO LITTLE ROCK .......................................................... 04590 25 25 

04T036 ..... BAPTIST REGIONAL MEDICAL CENTER ................................................................................... 18990 4400 30780 

18T080 ..... BAPTIST REHAB CENTER .......................................................................................................... 44180 18 18 

44T133 ..... BAPTIST REHABILITATION GERMANTOWN ............................................................................. 44780 5360 34980 

44T147 ..... BARBERTON CITIZENS HOSPITAL ............................................................................................ 36780 4920 32820 

36T019 ..... BARTLETT REGIONAL HOSPITAL ............................................................................................. 02110 0080 10420 

02T008 ..... BASTROP REHABILITATION HOSPITAL .................................................................................... 19330 02 02 

193058 ..... BATON ROUGE GENERAL MEDICAL CENTER ........................................................................ 19160 19 19 

19T065 ..... BAXTER REGIONAL MEDICAL CENTER ................................................................................... 04020 0760 12940 

04T027 ..... BAY MEDICAL CENTER FOR REHABILITATION ....................................................................... 23080 04 04 

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 1920 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 13820 

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 28020 

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 ...................................................................................... 45180 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.—INPATIENT REHABILITATION FACILITIES WITH CORRESPONDING STATE AND COUNTY LOCATION; CURRENT

LABOR MARKET AREA DESIGNATION; AND PROPOSED NEW CBSA-BASED LABOR MARKET AREA DESIGNATION—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 8560 46140 

14T127 ..... BRONSON VICKSBURG HOSPITAL ........................................................................................... 23380 1040 14060 

23T190 ..... BROOKS REHABILITATION HOSPITAL ..................................................................................... 10150 3720 28020 

103039 ..... BROOKWOOD MEDICAL CENTER ............................................................................................. 01360 3600 27260 

01T139 ..... BROTMAN MEDICAL CENTER ................................................................................................... 05200 1000 13820 

05T144 ..... BROWNSVILLE GENERAL HOSPITAL ....................................................................................... 39330 4480 31084 

39T166 ..... BROWNWOOD REGIONAL MEDICAL CENTER ........................................................................ 45220 6280 38300 

45T587 ..... BRUNSWICK HOSPITAL .............................................................................................................. 33700 45 45 

33T314 ..... BRYANLGH MEDICAL CENTER WEST ...................................................................................... 28540 5380 35004 

28T003 ..... BRYANT T. ALDRIDGE REHABILITATION CENTER ................................................................. 34630 4360 30700 

34T147 ..... BRYN MAWR REHABILITATION HOSPITAL .............................................................................. 39210 6895 40580 

393025 ..... BSA HEALTH SYSTEM ................................................................................................................ 45860 6160 37964 

45T231 ..... BUFFALO MERCY REHABILITATION UNIT ............................................................................... 33240 0320 11100 

33T279 ..... BURBANK REHABILITATION CENTER ...................................................................................... 22170 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 ....................................................................................... 26240 5600 35644 

19T190 ..... CANONSBURG GENERAL HOSPITAL ....................................................................................... 39750 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 ................................................................................ 39270 1400 16580 

39T058 ..... CARLSBAD MEDICAL CENTER .................................................................................................. 32070 3240 25420 

32T063 ..... CAROLINAS HOSPITAL SYSTEM ............................................................................................... 42200 32 32 

42T091 ..... CARONDELET ST JOSEPHS HOSPITAL ................................................................................... 03090 2655 22500 

03T011 ..... CARONDELET ST MARYS HOSPITAL ....................................................................................... 03090 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 ..................................................................................... 34170 4480 31084 

34T143 ..... CATHOLIC MEDICAL CENTER ................................................................................................... 30050 3290 25860 

30T034 ..... CATSKILL REGIONAL MEDICAL CENTER ................................................................................. 33710 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 ..................................................................................... 17040 04 04 

17T033 ..... CENTRAL MAINE REHABILITATION CENTER .......................................................................... 20000 17 17 

20T024 ..... CENTRAL MONTGOMERY MEDICAL CENTER ......................................................................... 39560 4243 30340 

39T012 ..... CENTURA HEALTH-ST. ANTHONY CENTRAL HOSPITAL ....................................................... 06150 6160 37964 

06T015 ..... CGRMC ACUTE REHABILITATION UNIT ................................................................................... 03100 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 5560 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 1560 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 7040 41180 

45T573 ..... CHRISTUS SPOHN HOSPITAL SHORELINE ............................................................................. 45830 45 45 

19T041 ..... CHRISTUS ST MICHAEL REHAB HOSPITAL ............................................................................. 45170 7680 43340 

45T046 ..... CHRISTUS ST. FRANCES CABRINI HOSPITAL ........................................................................ 19390 1880 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 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30311

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—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 .................................................................................. 33630 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 ..................................................................................... 11090 1680 17460 

34T131 ..... COLLEGE STATION MEDICAL CENTER .................................................................................... 45190 34 34 

11T164 ..... COLLETON MEDICAL CENTER .................................................................................................. 42140 4680 31420 

45T299 ..... COLORADO PLAINS MEDICAL CTR .......................................................................................... 06430 1260 17780 

42T030 ..... COLORADO RIVER MEDICAL CENTER ..................................................................................... 05460 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 15 18020 

37T056 ..... COMMUNITY HEALTH PARTNERS OF OH-WEST .................................................................... 36480 4200 30020 

33T159 ..... COMMUNITY HOSPITAL LOS GATOS ....................................................................................... 05530 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 .................................................................................. 23100 5080 33340 

23T078 ..... COMMUNITY REHABILITATION HOSPITAL OF COUSHATTA ................................................. 19400 0870 35660 

193080 ..... CONEY ISLAND HOSPITAL ......................................................................................................... 33331 19 19 

33T196 ..... CORNERSTONE REHABILITATION HOSPITAL ......................................................................... 45650 5600 35644 

453085 ..... CORONA REGINAL MEDICAL CENTER ..................................................................................... 05430 4880 32580 

05T329 ..... CORPUS CHRISTI WARM SPGS REHAB HOSP ....................................................................... 45830 6780 40140 

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 7360 41884 

39T110 ..... CRICHTON REHABILITATION CENTER ..................................................................................... 39160 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 41180 

193088 ..... CROWLEY REHAB HOSP, LLC ................................................................................................... 19000 3880 19 

39T180 ..... CROZER CHESTER MEDICAL CENTER .................................................................................... 39290 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 ................................................................................ 49241 1950 19260 

19T003 ..... DAUTERIVE HOSPITAL ............................................................................................................... 19220 19 19 

15T061 ..... DAVIESS COMMUNITY HOSPITAL ............................................................................................. 15130 15 15 

46T041 ..... DAVIS HOSPITAL AND MEDICAL CENTER ............................................................................... 46050 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 0520 12060 

03T093 ..... DEL E. WEBB MEMORIAL HOSPITAL ........................................................................................ 03060 6200 38060 

45T646 ..... DEL SOL MEDICAL CENTER ...................................................................................................... 45480 2320 21340 

39T081 ..... DELAWARE COUNTY MEMORIAL HOSPITAL ........................................................................... 39290 6160 37964 

25T082 ..... DELTA REGIONAL MEDICAL CENTER ...................................................................................... 25750 25 25 

45T634 ..... DENTON REGIONAL MEDICAL CENTER .................................................................................. 45410 1920 19124 

06T011 ..... DENVER HEALTH MEDICAL CENTER ....................................................................................... 06150 2080 19740 

49T011 ..... DEPAUL CENTER FOR PHYSICAL REHABILITATION .............................................................. 49641 5720 47260 

26T176 ..... DES PERES HOSPITAL ............................................................................................................... 26940 7040 41180 

05T243 ..... DESERT REGIONAL MEDICAL CENTER ................................................................................... 05430 6780 40140 

45T147 ..... DETAR HOSPITAL ....................................................................................................................... 45948 8750 47020 

19T115 ..... DOCTORS HOSPITAL .................................................................................................................. 11840 7680 43340 

11T177 ..... DOCTORS HOSPITAL OF OPELOUSAS .................................................................................... 19480 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.—INPATIENT REHABILITATION FACILITIES WITH CORRESPONDING STATE AND COUNTY LOCATION; CURRENT

LABOR MARKET AREA DESIGNATION; AND PROPOSED NEW CBSA-BASED LABOR MARKET AREA DESIGNATION—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 1320 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 ................................................................................. 19250 5560 35380 

453072 ..... EAST TEXAS MED CTR REHAB HOSP ..................................................................................... 45892 8640 46340 

01T011 ..... EASTERN HEALTH REHAB CENTER, MCE .............................................................................. 01360 1000 13820 

20T033 ..... EASTERN MAINE MEDICAL CENTER ........................................................................................ 20090 0733 12620 

39T162 ..... EASTON HOSPITAL ..................................................................................................................... 39590 0240 10900 

333029 ..... EDDY COHOES REHABILITATION CTR .................................................................................... 33000 0160 10580 

45T119 ..... EDINBURG REGIONAL MEDICAL ............................................................................................... 45650 4880 32580 

36T241 ..... EDWIN SHAW REHABILITATION HOSPITAL ............................................................................. 36780 0080 10420 

14T208 ..... EHS CHRIST HOSPITAL & MEDICAL CENTER ......................................................................... 14141 1600 16974 

03T080 ..... EL DORADO HOSPITAL .............................................................................................................. 03090 8520 46060 

15T018 ..... ELKHART GENERAL HEALTHCARE SYSTEMS ........................................................................ 15190 2330 21140 

39T289 ..... ELKINS PARK HOSPITAL ............................................................................................................ 39560 6160 37964 

33T128 ..... ELMHURST HOSPITAL CENTER ................................................................................................ 33590 5600 35644 

11T010 ..... EMORY HOSPITAL CTR FOR REHAB ....................................................................................... 11370 0520 12060 

05T158 ..... ENCINO-TARZANA REGIONAL MEDICAL CENTER .................................................................. 05200 4480 31084 

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 ................................................................................... 39720 39 39 

14T010 ..... EVANSTON NORTHWESTERN HEALTHCARE ......................................................................... 14141 1600 16974 

50T124 ..... EVERGREEN HEALTHCARE ....................................................................................................... 50160 7600 42644 

36T072 ..... FAIRFIELD MEDICAL CENTER ................................................................................................... 36230 1840 18140 

223029 ..... FAIRLAWN REHABILITATION HOSPITAL .................................................................................. 22170 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 36 41780 

34T115 ..... FIRSTHEALTH MOORE REGIONAL HOSPITAL ........................................................................ 34620 34 34

47T003 ..... FLETCHER ALLEN HEALTH CARE ............................................................................................ 47030 1303 15540 

10T068 ..... FLORIDA HOSPITAL ORMOND DIVISION ................................................................................. 10630 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 3285 25620 

36T132 ..... FORT REHABILITATION CENTER .............................................................................................. 36080 3200 17140 

10T223 ..... FORT WALTON BEACH MEDICAL CENT .................................................................................. 10450 2750 23020 

453041 ..... FORT WORTH REHABILITATION HOSPITAL ............................................................................ 45910 2800 23104 

26T137 ..... FR .................................................................................................................................................. 26480 3710 27900 

52T004 ..... FRANCISCAN SKEMP MEDICAL CENTER REHAB ................................................................... 52310 3870 29100 

18T040 ..... FRAZIER REHAB INSTITUTE ...................................................................................................... 18550 4520 31140 

17T074 ..... FRED C BRAMLAGE INPATIENT REHABILITATION UNIT ....................................................... 17300 17 17 

52T177 ..... FROEDTERT MEMORIAL LUTHERAN HOSPITAL ..................................................................... 52390 5080 33340 

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 ................................................................................... 18070 1640 17140 

33T058 ..... GE ................................................................................................................................................. 33530 6840 40380 

393047 ..... GEISINGER HEALTHSOUTH REHABILITATION HOSPITAL ..................................................... 39580 39 39 

39T270 ..... GEISINGER WYOMING VALLEY MEDICAL CENTER ............................................................... 39480 7560 42540

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30313

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—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 ..................................................................................... 37550 37 46140 

45T191 ..... GEORGETOWN HEALTHCARE SYSTEM .................................................................................. 45970 0640 12420 

11T087 ..... GLANCY ........................................................................................................................................ 11530 0520 12060 

05T239 ..... GLENDALE ADVENTIST MEDICAL CENTER ............................................................................. 05200 4480 31084 

05T058 ..... GLENDALE MEMORIAL HOSPITAL ............................................................................................ 05200 4480 31084 

33T191 ..... GLENS FALLS HOSPITAL ........................................................................................................... 33750 2975 24020 

19T160 ..... GLENWOOD REHABILITATION CENTER .................................................................................. 19360 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 38060 

39T031 ..... GOOD SAMARITAN-STINE ACUTE REHAB ............................................................................... 39650 39 39 

45T037 ..... GOOD SHEPHERD MEDICAL CENTER ..................................................................................... 45570 4420 30980 

393035 ..... GOOD SHEPHERD REHABILITATION HOSPITAL ..................................................................... 39470 0240 10900 

393050 ..... GOOD SHEPHERD REHABILITATION HOSPITAL ..................................................................... 39590 0240 10900 

24T064 ..... GRAND ITASCA CLINIC & HOSPITAL ........................................................................................ 24300 24 24 

36T133 ..... GRANDVIEW MEDICAL CENTER ............................................................................................... 36580 2000 19380 

36T017 ..... GRANT/RIVERSIDE METHODIST HOSPITALS .......................................................................... 36250 1840 18140 

23T030 ..... GRATIOT COMMUNITY HOSPITAL ............................................................................................ 23280 23 23 

16T057 ..... GREAT RIVER MEDICAL CENTER ............................................................................................. 16280 16 16 

09T008 ..... GREATER SOUTHEAST COMMUNITY HOSPITAL .................................................................... 09000 8840 47894 

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 29100 

39T185 ..... GUNDERSON REHABILITATION CENTER ................................................................................ 39480 7560 42540 

513028 ..... H/S REHAB HOSPITAL OF HUNTINGTON ................................................................................. 51050 3400 26580 

23T066 ..... HACKLEY HOSPITAL ................................................................................................................... 23600 3000 34740 

36T137 ..... HANNA HOUSE INPATIENT REHAB CENTER .......................................................................... 36170 1680 17460 

50T064 ..... HARBORVIEW MEDICAL CENTER ............................................................................................. 50160 7600 42644 

33T240 ..... HARLEM HOSPITAL/COLUMBIA UNIVERSITY .......................................................................... 33420 5600 35644 

45T289 ..... HARRIS COUNTY HOSPITAL DISTRICT .................................................................................... 45610 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 ................................................................................... 03070 4120 03 

17T013 ..... HAYS MEDICAL CENTER ............................................................................................................ 17250 17 17 

18T029 ..... HAZARD ARH REGIONAL MEDICAL CENTER .......................................................................... 18960 18 18 

013028 ..... HEALTH SOUTH REHAB HOSPITAL OF MONTGOMERY ........................................................ 01500 5240 33860 

23T275 ..... HEALTHSOURCE SAGINAW ....................................................................................................... 23720 6960 40980 

053031 ..... HEALTHSOUTH BAKERSFIELD REHAB HOSPITAL ................................................................. 05140 0680 12540 

223027 ..... HEALTHSOUTH BRAINTREE REHAB HOSPITAL ..................................................................... 22130 1123 14484 

443030 ..... HEALTHSOUTH CANE CREEK REHAB HOSPITAL .................................................................. 44910 44 44 

113027 ..... HEALTHSOUTH CENTRAL GA REHAB HOSPITAL ................................................................... 11090 4680 31420 

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 38060 

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 ................................................................................... 42170 1440 16700 

453047 ..... HEALTHSOUTH PLANO REHABILITATION HOSP .................................................................... 45310 1920 19124 

043032 ..... HEALTHSOUTH REHAB HOSP IN PART WITH RE ................................................................... 04710 2580 22220 

453044 ..... HEALTHSOUTH REHAB HOSP OF AUSTIN .............................................................................. 45940 0640 12420 

183028 ..... HEALTHSOUTH REHAB HOSP OF CENTRAL KY ..................................................................... 18460 18 21060 

30314 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 

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—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 22500 

013029 ..... HEALTHSOUTH REHAB HOSP OF NORTH ALA ....................................................................... 01440 3440 26620 

103042 ..... HEALTHSOUTH REHAB HOSP OF SPRING HILL ..................................................................... 10260 8280 45300 

223030 ..... HEALTHSOUTH REHAB HOSP OF WESTERN MA ................................................................... 22070 8003 44140 

033029 ..... HEALTHSOUTH REHAB HOSPITAL ........................................................................................... 03090 8520 46060 

103031 ..... HEALTHSOUTH REHAB HOSPITAL ........................................................................................... 10570 7510 42260 

103038 ..... HEALTHSOUTH REHAB HOSPITAL OF MIAMI ......................................................................... 10120 5000 33124 

453059 ..... HEALTHSOUTH REHAB HOSPITAL OF NORTH HOUSTON .................................................... 45801 3360 26420 

393026 ..... HEALTHSOUTH REHAB HOSPITAL OF READING ................................................................... 39110 6680 39740 

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 46060 

393031 ..... HEALTHSOUTH REHAB OF MECHANICSBURG-ACUTE REHAB ............................................ 39270 3240 25420 

393046 ..... HEALTHSOUTH REHABILITATION HOSPITAL OF ERIE .......................................................... 39320 2360 21500 

423028 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 42450 1520 16740 

443029 ..... HEALTHSOUTH REHABILITATION CENTER OF MEMPHIS ..................................................... 44780 4920 32820 

153027 ..... HEALTHSOUTH REHABILITATION HOSP OF KOK ................................................................... 15330 3850 29020 

393037 ..... HEALTHSOUTH REHABILITATION HOSP YORK ...................................................................... 39800 9280 49620 

013030 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 01340 2180 20020 

043028 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 04650 2720 22900 

103037 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 10510 8280 45300 

153029 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 15830 8320 45460 

303027 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 30060 1123 31700

323027 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 32000 0200 10740 

403025 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 40640 7440 41980 

443027 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 44810 3660 28700 

453029 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 45610 3360 26420 

453048 ..... HEALTHSOUTH REHABILITATION HOSPITAL .......................................................................... 45700 0840 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 23460 

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 .................................................................................... 19350 5560 35380 

45T758 ..... HEALTHSOUTH SPECIALTY HOSPTIAL, INC. .......................................................................... 45390 1920 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 42044 

033032 ..... HEALTHSOUTH VALLEY OF THE SUN ...................................................................................... 03060 6200 38060 

513027 ..... HEALTHSOUTH WESTERN HILLS REGIONAL REHAB HOSPITAL ......................................... 51530 6020 37620 

193074 ..... HEALTHWEST REHABILITATION HOSPITAL ............................................................................ 19250 5560 35380 

26T006 ..... HEARTLAND REGIONAL MEDICAL CENTER ............................................................................ 26100 7000 41140 

333027 ..... HELEN HAYES HOSPITAL .......................................................................................................... 33620 5600 35644 

04T085 ..... HELENA REGIONAL REHABILITATION CENTER ...................................................................... 04530 04 04

45T229 ..... HENDRICK CENTER FOR REHABILITATION ............................................................................ 45911 0040 10180 

49T118 ..... HENRICO DOCTORS HOSPITAL PARHA .................................................................................. 49430 6760 40060 

23T204 ..... HENRY FORD BI-COUNTY HOSPITAL ....................................................................................... 23490 2160 47644 

23T146 ..... HENRY FORD WYANDOTTE HOSPITAL ................................................................................... 23810 2160 19804 

05T624 ..... HENRY MAYO NEWHALL MEMORIAL HOSPITAL .................................................................... 05200 4480 31084 

34T107 ..... HERITAGE HOSPITAL ................................................................................................................. 34320 6895 40580 

45T068 ..... HERMANN HOSPITAL ................................................................................................................. 45610 3360 26420 

23T120 ..... HERRICK MEMORIAL HOSPITAL ............................................................................................... 23450 0440 23 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30315

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—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 ................................................................................. 45780 8800 47380 

37T001 ..... HILLCREST KAISER REHABILITATION CENTER ...................................................................... 37710 8560 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 .................................................................................. 39620 6160 37964 

04T076 ..... HOT SPRING COUNTY MEDICAL CENTER .............................................................................. 04290 04 04 

153039 ..... HOWARD REGIONAL HEALTH SYSTEM-WEST CAMPUS ....................................................... 15330 3850 29020 

52T091 ..... HOWARD YOUNG MEDICAL CENTER ....................................................................................... 52420 52 52 

11T200 ..... HUGHSTON ORTHOPEDIC HOSPITAL ...................................................................................... 11780 1800 17980 

05T438 ..... HUNTINGTON MEMORIAL HOSPITAL ....................................................................................... 05200 4480 31084 

23T132 ..... HURLEY MEDICAL CENTER ....................................................................................................... 23240 2640 22420 

17T020 ..... HUTCHINSON HOSPITAL CORP. ............................................................................................... 17770 17 17 

133025 ..... IDAHO ELKS REHABILITATION HOSPITAL ............................................................................... 13000 1080 14260 

13T018 ..... IDAHO REGIONAL MEDICAL CENTER ...................................................................................... 13090 13 26820 

28T081 ..... IMMANUEL REHABILITATION CENTER ..................................................................................... 28270 5920 36540 

26T095 ..... INDEPENDENCE REGIONAL HEALTH CENTER ....................................................................... 26470 3760 28140 

14T191 ..... INGALLS MEMORIAL HOSPITAL ................................................................................................ 14141 1600 16974 

23T167 ..... INGHAM REGIONAL MEDICAL CENTER ................................................................................... 23320 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 3360 26420 

37T106 ..... INTEGRIS SOUTHWEST MEDICAL CENTER ............................................................................ 37540 5880 36420 

323029 ..... INTERFACE INC DBA LIFECOURSE REHAB SERVICES ......................................................... 32220 32 22140 

16T082 ..... IOWA METHODIST MEDICAL CENTER ..................................................................................... 16760 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 ................................................................................... 33590 5000 33124 

33T127 ..... JAMESON HOSPITAL .................................................................................................................. 39450 5600 35644 

39T016 ..... JANE PHILLIPS MEMORIAL MEDICAL CENTER ....................................................................... 37730 39 39 

37T018 ..... JEANES HOSPITAL ...................................................................................................................... 39620 37 37 

39T080 ..... JEANNETTE HOSPITAL ............................................................................................................... 39770 6160 37964 

39T010 ..... JEFFERSON REGIONAL MEDICAL CENTER ............................................................................ 04340 6280 38300 

04T071 ..... JEFFERSON REGIONAL MEDICAL CENTER ............................................................................ 39010 6240 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 ................................................................................. 39680 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 27740 

04T002 ..... JOHNSTON R. BOWMAN HEALTH CTR. ................................................................................... 14141 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 ............................................................................... 27140 8720 46700 

27T051 ..... KANSAS REHABILITATION HOSPITAL, INC .............................................................................. 17880 27 27 

173025 ..... KANSAS UNIVERSITY REHAB .................................................................................................... 17986 8440 45820 

17T040 ..... KAPLAN REHABILITATION HOSPITAL ....................................................................................... 19560 3760 28140 

193057 ..... KAWEAH DELTA REHABILITATION HOSPITAL ........................................................................ 05640 19 19 

05T057 ..... KENMORE MERCY HOSPITAL ................................................................................................... 33240 8780 47300 

33T102 ..... KENT COUNTY MEMORIAL HOSPITAL ..................................................................................... 41010 1280 15380 

30316 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 

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—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 35084 

213029 ..... KETTERING MEDICAL CENTER ................................................................................................. 36580 8840 13644 

36T079 ..... KINGMAN REGIONAL MEDICAL CENTER ................................................................................. 03070 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 3400 26580 

33T201 ..... KINGWOOD MEDICAL CENTER ................................................................................................. 45610 5600 35644 

45T775 ..... KOOTENAI MEDICAL CENTER ................................................................................................... 13270 3360 26420 

13T049 ..... LA PALMA INTERCOMMUNITY HOSPITAL ................................................................................ 05400 13 17660 

05T580 ..... LABETTE COUNTY MEDICAL CENTER ..................................................................................... 17490 5945 42044 

17T120 ..... LAC/RANCHO LOS AMIGOS NATIONAL MED CTR .................................................................. 05400 17 17 

05T717 ..... LAFAYETTE GENERAL MEDICAL CENTER .............................................................................. 19270 5945 42044 

19T002 ..... LAGRANGE COMMUNITY HOSPITAL ........................................................................................ 15430 3880 29180 

15T096 ..... LAKE CHARLES MEMORIAL HOSPITAL .................................................................................... 19090 15 15 

19T060 ..... LAKE CUMBERLAND REGIONAL HOSP .................................................................................... 18972 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 1680 17460 

05T581 ..... LANCASTER COMMUNITY HOSPITAL ....................................................................................... 05200 4480 31084 

05T204 ..... LANCASTER GENERAL HOSP ................................................................................................... 39440 4480 31084 

39T100 ..... LANCASTER REGIONAL MEDICAL CENTER ............................................................................ 39440 4000 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 ....................................................................................... 07050 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 5960 36740 

193086 ..... LEESVILLE REHABILITATION HOSPITAL LLC .......................................................................... 19570 19 19 

38T017 ..... LEGACY GOOD SAMARITAN HOSP & MED CTR ..................................................................... 38250 6440 38900 

34T027 ..... LENOIR MEMORIAL HOSPITAL REHAB UNIT ........................................................................... 34530 34 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 ..................................................................................... 51220 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 35644 

45T702 ..... LOS ROBLES HOSPITAL & MEDICAL CENTER ........................................................................ 05660 4420 30980 

05T549 ..... LOUIS A. WEISS MEMORIAL HOSPITAL ................................................................................... 14141 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 ................................................................................ 14141 6740 28420 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30317

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—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 5560 35380 

36T087 ..... LUTHERAN MEDICAL CENTER .................................................................................................. 33331 1680 17460 

33T306 ..... MADISON COUNTY HOSPITAL INPATIENT REHAB ................................................................. 36500 5600 35644 

45T032 ..... MADONNA REHABILITATION HOSPITAL .................................................................................. 28540 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 ................................................................................ 14250 2920 26420 

34T132 ..... MARIETTA MEMORIAL HOSPITAL ............................................................................................. 36850 34 34 

143027 ..... MARLETTE COMMUNITY HOSP CTR FOR REHAB .................................................................. 23750 1600 16974 

36T147 ..... MARLTON REHABILITATION HOSPITAL ................................................................................... 31150 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 ........................................................................................ 17450 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 5000 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 1920 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 42340 

23T121 ..... MEMORIAL HERMANN FT. BEND INPATIENT REHABILITATION ........................................... 45610 23 23 

45T005 ..... MEMORIAL HERMANN NORTHWEST HOSPITAL ..................................................................... 45610 0840 13140 

45T848 ..... MEMORIAL HOSPITAL ................................................................................................................ 10050 3360 26420 

45T184 ..... MEMORIAL HOSPITAL—SOUTH BEND ..................................................................................... 15700 3360 26420 

10T038 ..... MEMORIAL HOSPITAL AT GULFPORT ...................................................................................... 25230 2680 22744 

15T058 ..... MEMORIAL HOSPITAL OF RI ..................................................................................................... 41030 7800 43780 

25T019 ..... MEMORIAL MED CENTER OF EAST TE .................................................................................... 45020 0920 25060 

41T001 ..... MEMORIAL MEDICAL CENTER .................................................................................................. 14920 6483 39300 

45T211 ..... MEMORIAL MEDICAL CENTER—REHABILITATION INSTITUTE ............................................. 19350 45 45 

14T148 ..... MEMORIAL REHABILITATION HOSPITAL .................................................................................. 45794 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 37964 

36T234 ..... MERCY GENERAL HEALTH PARTNERS ................................................................................... 23600 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 .................................................................................... 17050 5880 36420 

52T066 ..... MERCY HOSPITAL ....................................................................................................................... 10120 3620 27500 

30318 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 

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—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 .............................................................................. 34590 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 ..................................................................................... 16300 0460 36780 

16T083 ..... MERCY MEDICAL CENTER-SIOUX CITY ................................................................................... 16960 2120 19780 

16T069 ..... MERCY MEDICAL CENTER-NORTH IOWA ................................................................................ 16160 2200 20220 

16T153 ..... MERCY MEMORIAL HEALTH CENTER ...................................................................................... 37090 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 ....................................................................................... 03060 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 5560 35380 

24T053 ..... METHODIST HOSPITAL REHABILITATION CENTER ................................................................ 18500 5120 33460 

05T238 ..... METHODIST HOSPITAL, THE ..................................................................................................... 45610 4480 31084 

18T056 ..... METHODIST MEDICAL CENTER ................................................................................................ 45390 2440 21780 

45T358 ..... METHODIST MEDICAL CENTER OF ILLINOIS .......................................................................... 14800 3360 26420 

45T051 ..... METHODIST NORTHLAKE .......................................................................................................... 15440 1920 19124 

14T209 ..... METHODIST SPECIALTY/TRANSPLANT .................................................................................... 45130 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 ........................................................................................ 45130 5600 35644 

23T236 ..... MI LAND E. KNAPP REHABILITATION CENTER ....................................................................... 24260 3000 24340 

45T388 ..... MIAMI VALLEY HOSPITAL .......................................................................................................... 36580 7240 41700 

24T004 ..... MICHAEL REESE HOSPITAL ...................................................................................................... 14141 5120 33460 

36T051 ..... MID AMERICA REHABILITATION HOSPITAL ............................................................................. 17450 2000 19380 

14T075 ..... MID JEFFERSON HOSPITAL ...................................................................................................... 45700 1600 16974 

173026 ..... MIDDLETOWN REGIONAL HOSPITAL ....................................................................................... 36080 3760 28140 

45T514 ..... MILLER DWAN MEDICAL CENTER ............................................................................................ 24680 0840 13140 

36T076 ..... MILLS HEALTH CENTER ............................................................................................................. 05510 3200 17140 

24T019 ..... MILTON S HERSHEY MEDICAL CENTER .................................................................................. 39280 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 42044 

45T176 ..... MISSISSIPPI METHODIST REHABILITATION CENTER ............................................................ 25240 4880 32580 

253025 ..... MISSOURI BAPTIST MEDICAL CENTER ................................................................................... 26940 3560 27140 

25T152 ..... MISSOURI DELTA MEDICAL CENTER ....................................................................................... 26982 3560 27140 

26T108 ..... MOBILE INFIRMARY .................................................................................................................... 01480 7040 41180 

26T113 ..... MODESTO REHABILITATION HOSPITAL ................................................................................... 05600 26 26 

01T113 ..... MONONGAHELA VALLEY HOSPITAL ........................................................................................ 39750 5160 33660 

053036 ..... MONTEFIORE MEDICAL CENTER ............................................................................................. 33020 5170 33700 

39T147 ..... MORGAN HOSPITAL & MEDICAL CTR ...................................................................................... 15540 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 37964 

17T006 ..... MOUNT SINAI MEDICAL CENTER .............................................................................................. 10120 17 17 

10T034 ..... MOUNTAINVIEW REGIONAL MEDICAL CENTER ..................................................................... 32060 5000 33124 

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 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30319

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—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 ................................................................................. 44180 5345 34940 

44T026 ..... NASSAU UNIVERSITY MEDICAL CENTER ................................................................................ 33400 5360 34980 

33T027 ..... NATCHEZ REGIONAL MEDICAL CENTER ................................................................................. 25000 5380 35004 

25T084 ..... NATIONAL PARK .......................................................................................................................... 04250 25 25 

04T078 ..... NATIONAL REHABILITATION HOSPITAL ................................................................................... 09000 04 26300 

093025 ..... NAVARRO REGIONAL HOSPITAL .............................................................................................. 45820 8840 47894 

45T447 ..... NAZARETH HOSPITAL ................................................................................................................ 39620 45 45 

39T204 ..... NEBRASKA METHODIST HEALTH SYSTEM ............................................................................. 28270 6160 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 15764 

34T141 ..... NEW MEXICO REHABILITATION CENTER ................................................................................ 32020 9200 48900 

323026 ..... NEW ORLEANS EAST REHABILITATION .................................................................................. 19350 32 32 

193089 ..... NEW YORK METHODIST HOSPITAL ......................................................................................... 33331 5560 35380 

33T236 ..... NEW YORK PRESBYTERIAN HOSPITAL ................................................................................... 33420 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 ..................................................................................... 10050 5880 36420 

45T809 ..... NORTH CAROLINA BAPTIST HOSPITALS ................................................................................. 34330 0640 12420 

10T086 ..... NORTH CENTRAL MEDICAL CENTER ....................................................................................... 45310 2680 22744 

34T047 ..... NORTH COLORADO MEDICAL CENTER ................................................................................... 06610 3120 49180 

45T403 ..... NORTH COUNTRY REGIONAL HOSPITAL ................................................................................ 24030 1920 19124 

06T001 ..... NORTH DALLAS REHABILITATION HOSPITAL ......................................................................... 45620 3060 24540 

24T100 ..... NORTH DALLAS REHABILITATION HOSPITAL ......................................................................... 45390 24 24 

453032 ..... NORTH FULTON REGIONAL HOSPITAL ................................................................................... 11470 1920 19124 

11T198 ..... NORTH HILLS HOSPITAL ............................................................................................................ 45910 0520 12060 

45T087 ..... NORTH KANSAS CITY HOSPITAL .............................................................................................. 26230 2800 23104 

26T096 ..... NORTH MEMORIAL HEALTH CENTER ...................................................................................... 24260 3760 28140 

24T001 ..... NORTH MISS. MEDICAL CENTER .............................................................................................. 25400 5120 33460 

25T004 ..... NORTH MONROE MEDICAL CENTER ....................................................................................... 19360 25 25 

19T197 ..... NORTH OAKLAND MEDICAL CENTERS .................................................................................... 23620 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 ................................................................................... 06000 5380 35004 

06T065 ..... NORTHEAST GEORGIA MEDICAL CENTER ............................................................................. 11550 2080 19740 

11T029 ..... NORTHEAST METHODIST HOSPITAL ....................................................................................... 45130 11 23580 

45T733 ..... NORTHEAST OKLAHOMA REHABILITATION ASSOCIATES, LP ............................................. 37710 7240 41700 

373029 ..... NORTHEAST REGIONAL MEDICAL CENTER ........................................................................... 26000 8560 46140 

26T022 ..... NORTHEAST REHABILITATION HOSPITAL ............................................................................... 30070 26 26 

303026 ..... NORTHERN CALIFORNIA REHABILITATION HOSPITAL .......................................................... 05550 1123 40484 

05T699 ..... NORTHERN ILLINOIS MEDICAL CENTER ................................................................................. 14640 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 8600 46220 

05T116 ..... NORTHWEST HEALTH SYSTEM ................................................................................................ 04710 4480 31084 

04T022 ..... NORTHWEST HOSPITAL ............................................................................................................ 50160 2580 22220 

50T001 ..... NORTHWEST MISSISSIPPI REGIONAL MED CTR ................................................................... 25130 7600 42644 

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 ...................................................................................... 19250 2160 19804 

19T036 ..... OGDEN REGIONAL MEDICAL CENTER .................................................................................... 46280 5560 35380 

46T005 ..... OHIO STATE UNIVERSITY HOSPITAL ....................................................................................... 36250 7160 36260 

36T085 ..... OHIO VALLEY GENERAL HOSPITAL ARU ................................................................................ 39010 1840 18140 

30320 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 

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—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 .................................................................................. 33540 3880 19 

33T001 ..... ORANGE REGIONAL MEDICAL CENTER .................................................................................. 33540 5660 39100 

33T126 ..... OREGON REHABILITATION CENTER ........................................................................................ 38190 5660 39100 

38T033 ..... ORLANDO REGIONAL HEALTHCARE-CMR .............................................................................. 10470 2400 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 5880 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 ..................................................................................... 45563 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 5000 33124 

36T041 ..... PATRICIA NEAL REHABILITATION CENTER ............................................................................. 44460 1680 17460 

44T125 ..... PENINSULA HOSPITAL CENTER ............................................................................................... 33590 3840 28940 

33T002 ..... PENNYSLVANIA HOSPITAL, ACUTE REHABILITATION UNIT ................................................. 39620 5600 35644 

39T226 ..... PENROSE HOSPITAL/ELEANOR-CAPRON ............................................................................... 06200 6160 37964 

06T031 ..... PETERSON REHABILITATION HOSPITAL AND GERIATIC CEN ............................................. 51340 1720 17820 

513025 ..... PHELPS COUNTY REGIONAL MED CENTER ........................................................................... 26800 9000 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 12060 

18T044 ..... PINECREST REHABILITATION HOSPITAL ................................................................................ 10490 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 23104 

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 .................................................................................. 39650 6160 37964 

39T030 ..... POUDRE VALLEY HEALTH CARE INC ...................................................................................... 06340 39 39 

06T010 ..... PREMIER REHABILITATION HOSPITAL .................................................................................... 19360 2670 22660 

14T007 ..... PRESBYTERIAN HOSPITAL OF DALLAS ................................................................................... 45390 1600 16974 

193082 ..... PRESBYTERIAN INTERCOMMUNITY HOSPITAL ...................................................................... 05200 5200 33740 

45T462 ..... PROVENA COVENANT MEDICAL CENTER REHAB ................................................................. 14090 1920 19124

05T169 ..... PROVENA SAINT JOSEPH HOSPITAL ....................................................................................... 14530 4480 31084 

14T113 ..... PROVENA ST. JOSEPH MEDICAL CENTER ............................................................................. 14989 1400 16580 

14T217 ..... PROVIDENCE ALASKA MEDICAL CENTER .............................................................................. 02020 1600 16974 

02T001 ..... PROVIDENCE CENTRALIA HOSPITAL ...................................................................................... 50200 0380 11260 

50T019 ..... PROVIDENCE EVERETT MEDICAL CENTER ............................................................................ 50300 50 50 

50T014 ..... PROVIDENCE HOLY CROSS MEDICAL CENTER ..................................................................... 05200 7600 42644 

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 38900 

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 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30321

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—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 ..................................................................................... 11460 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 ..................................................................................... 42280 49 49 

42T036 ..... REGIONAL REHABILITATION HOSPITAL .................................................................................. 01500 42 42 

013033 ..... REGIONS HOSPITAL REHAB INSTITUTE .................................................................................. 24610 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 6483 39300 

223032 ..... REHAB HOSPITAL OF BATON ROUGE ..................................................................................... 19160 0743 12700 

193028 ..... REHAB INSTITUTE AT SANTA BARBARA,THE ......................................................................... 05520 0760 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 4480 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 ................................................................................ 15480 3283 25540 

153028 ..... REHABILITATION HOSPITAL OF INDIANA AT ST VINCENT ................................................... 15480 3480 26900 

153038 ..... REHABILITATION HOSPITAL OF MEMPHIS .............................................................................. 44780 3480 26900 

44T152 ..... REHABILITATION HOSPITAL OF NEW MEXICO ....................................................................... 32000 4920 32820 

323028 ..... REHABILITATION HOSPITAL OF SOUTH JERSEY ................................................................... 31190 0200 10740 

313036 ..... REHABILITATION HOSPITAL OF THE PACIFIC ........................................................................ 12020 8760 47220 

123025 ..... REHABILITATION HOSPITAL OF TINTON FALLS ..................................................................... 31290 3320 26180 

313035 ..... REHABILITATION INSTITUTE AT MORRISTOWN MEMORIAL ................................................ 31300 5190 20764 

31T015 ..... REHABILITATION INSTITUTE OF CHICAGO ............................................................................. 14141 5640 35084 

143026 ..... REHABILITATION INSTITUTE OF MCALLEN ............................................................................. 45650 1600 16974 

45T811 ..... REHABILITATION INSTITUTE OF MICHIGAN ............................................................................ 23810 4880 32580 

233027 ..... REHABILITATION INSTITUTE OF ST LOUIS, THE .................................................................... 26940 2160 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 1920 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 .................................................................................... 34790 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 ................................................................................. 47100 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.—INPATIENT REHABILITATION FACILITIES WITH CORRESPONDING STATE AND COUNTY LOCATION; CURRENT

LABOR MARKET AREA DESIGNATION; AND PROPOSED NEW CBSA-BASED LABOR MARKET AREA DESIGNATION—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 12940 

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 .................................................................................... 05480 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 ................................................................................... 14141 3760 28140 

14T180 ..... SAINT MARYS REGIONAL MEDICAL CENTER ......................................................................... 29150 1600 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 ..................................................................................... 45610 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 41940 

06T008 ..... SANTA CLARA VALLEY MEDICAL CENTER ............................................................................. 05530 06 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 ..................................................................................... 14141 19 19 

143025 ..... SCOTT & WHITE .......................................................................................................................... 45120 1600 16974 

45T054 ..... SCOTTSDALE HEALTHCARE INPATIENT REHAB .................................................................... 03060 3810 28660 

03T038 ..... SCRIPPS MEMORIAL HOSPITAL ENCINITAS ........................................................................... 05470 6200 38060 

05T503 ..... SENTARA NORFOLK GENERAL HOSPITAL .............................................................................. 49641 7320 41740 

49T007 ..... SEWICKLEY VALLEY HOSPITAL ................................................................................................ 39010 5720 47260 

39T037 ..... SHANDS REHAB HOSPITAL ....................................................................................................... 10000 6280 38300 

10T113 ..... SHANNON WEST TEXAS MEMORIAL HOSPITAL ..................................................................... 45930 2900 23540 

45T571 ..... SHARON REGIONAL HEALTH SYSTEM .................................................................................... 39530 7200 41660 

39T211 ..... SHARP MEMORIAL REHABILITATION CENTER ....................................................................... 05470 7610 49660 

05T100 ..... SHELTERING ARMS REHABILITATION HOSPITAL .................................................................. 49430 7320 41740 

493025 ..... SHORE REHABILITATION INSTITUTE ....................................................................................... 31310 6760 40060 

313033 ..... SHREVEPORT REHABILITATION HOSPITAL ............................................................................ 19080 5190 20764 

193083 ..... SID PETERSON MEMORIAL HOSPITAL .................................................................................... 45734 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 1600 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 43620 

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 ....................................................................................... 11700 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 17460 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30323

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—Continued

Provider 

number Provider name 

SSA 

State and 

county 

code 

FY 06 

MSA 

code 

FY 06 

CBSA 

code 

45T165 ..... SOUTHCOAST HOSPITALS GROUP, INC. ................................................................................ 22150 45 41700 

22T074 ..... SOUTHEAST MISSOURI HOSPITAL ........................................................................................... 26150 1123 14484 

26T110 ..... SOUTHEASTERN REGIONAL REHABILITATION CENTER ...................................................... 34250 26 26 

34T028 ..... SOUTHERN HILLS REGIONAL REHAB ...................................................................................... 51270 2560 22180 

513026 ..... SOUTHERN INDIANA REHABILITATION HOSPITAL ................................................................. 15210 51 51 

153037 ..... SOUTHERN KENTUCKY REHABILITATION HOSPITAL ............................................................ 18986 4520 31140 

183029 ..... SOUTHERN OHIO MEDICAL CENTER ....................................................................................... 36740 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 ....................................................................................... 37540 6440 38900 

37T097 ..... SOUTHWESTERN REHABILITATION HOSPITAL ...................................................................... 23120 5880 36420 

233025 ..... SPAIN REHABILITATION CENTER ............................................................................................. 01360 3720 12980 

01T033 ..... SPALDING REHABILITATION HOSPITAL ................................................................................... 06150 1000 13820 

063027 ..... SPRING BRANCH MEDICAL CENTER ....................................................................................... 45610 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 .................................................................................... 23810 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 ..................................................................................... 23490 2160 47644 

37T114 ..... ST. JOHNS REGIONAL MEDICAL CENTER ............................................................................... 26480 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 05 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 .................................................................................. 26470 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 ................................................................................. 50310 3760 28140 

193087 ..... ST. MARGARET MERCY HLTHCARE CTRS .............................................................................. 15440 3880 29180 

503025 ..... ST. MARY MEDICAL CENTER .................................................................................................... 05200 7840 44060 

15T004 ..... ST. MARY MEDICAL CENTER .................................................................................................... 50350 2960 23844 

05T191 ..... ST. MARY-CORWIN MEDICAL CENTER .................................................................................... 06500 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 42140 

30324 Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 

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—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 48864 

14T172 ..... ST. JOHNS REGIONAL HEALTH CENTER ................................................................................ 26380 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 0860 13380 

50T108 ..... ST. JOSEPHS HOSPITAL ............................................................................................................ 03060 8200 45104 

23T156 ..... ST. JOSEPH’S HOSPITAL ........................................................................................................... 33070 0440 11460 

03T024 ..... ST. JOSEPH’S HOSPITAL ........................................................................................................... 52700 6200 38060 

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 4120 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 4120 29820 

36T020 ..... SUMNER REGIONAL MEDICAL CENTER .................................................................................. 44820 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 ................................................................................... 33331 4120 29820 

33T350 ..... SUTTER AUBURN FAITH HOSPITAL ......................................................................................... 05410 5600 35644 

05T498 ..... SWEDISH COVENANT HOSPITAL .............................................................................................. 14141 6920 40900 

14T114 ..... SWEDISH GENERAL REHABILITATION ..................................................................................... 06020 1600 16974 

06T034 ..... SWEDISH MEDICAL CENTER ..................................................................................................... 50160 2080 19740 

50T025 ..... TAH INPATIENT REHAB UNIT .................................................................................................... 39260 7600 42644 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30325

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—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 .................................................................................... 10280 44 44 

10T128 ..... TARRANT COUNTY REHABILITATION HOSPITAL ................................................................... 45910 8280 45300 

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 ...................................................................................... 20010 20 20 

36T163 ..... THE CHRIST HOSPITAL REHAB UNIT ....................................................................................... 36310 1640 17140 

09T001 ..... THE GEORGE WASHINGTON UNIVERSITY ARU ..................................................................... 09000 8840 47894 

39T066 ..... THE GOOD SAMARITAN HOSPITAL .......................................................................................... 39460 3240 30140 

33T004 ..... THE KINGSTON HOSPITAL REHABILITATION CENTER .......................................................... 33740 33 28740 

25T099 ..... THE LEFLORE REHABILITATION CENTER ............................................................................... 25410 25 25 

33T056 ..... THE PARKSIDE ACUTE REHABILITATION CENTER ................................................................ 33331 5600 35644 

33T049 ..... THE PAUL ROSENTHAL REHABILITATION CENTER AT NDH ................................................ 33230 2281 39100 

39T044 ..... THE READING HOSPITAL AND MEDICAL CENTER ................................................................. 39110 6680 39740 

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 ................................................................................... 11220 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 20 20 

42T067 ..... THE REHABILITATION UNIT AT BEAUFORT MEMORIAL HOSPI ............................................ 42060 42 42 

36T211 ..... THE TRINITY REHABILITATION CENTER ................................................................................. 36420 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 3350 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 ...................................................................................... 37710 5560 35380 

37T078 ..... TWELVE OAKS MEDICAL CENTER ........................................................................................... 45610 8560 46140 

45T378 ..... TWIN RIVERS REGIONAL MEDICAL CENTER .......................................................................... 26340 3360 26420 

26T015 ..... U W HOSPITAL & CLINIC ............................................................................................................ 52120 26 26 

52T098 ..... UAB MEDICAL WEST REHABILITATION UNIT .......................................................................... 01360 4720 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 1580 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 .................................................................................... 39010 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 .................................................................................. 06150 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.—INPATIENT REHABILITATION FACILITIES WITH CORRESPONDING STATE AND COUNTY LOCATION; CURRENT

LABOR MARKET AREA DESIGNATION; AND PROPOSED NEW CBSA-BASED LABOR MARKET AREA DESIGNATION—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 .................................................................................. 25240 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 39340 

493029 ..... VALLEY BAPTIST HEALTH SYSTEM REHAB UNIT .................................................................. 45240 1540 16820 

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 40420 

443028 ..... VCUHS .......................................................................................................................................... 49791 5360 34980 

49T032 ..... VERMILION REHABILITATION HOSPITAL ................................................................................. 19480 6760 40060 

193047 ..... VIA CHRISTI REHABILITATION CENTER .................................................................................. 17860 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 .................................................................................. 24680 7600 42644 

24T084 ..... VISTA HEALTH ST. THERESE REHAB UNIT ............................................................................. 14570 2240 20260 

14T033 ..... WACCAMAW REHABILITATION CENTER .................................................................................. 42210 1600 29404 

42T098 ..... WADSWORTH RITTMAN HOSPITAL .......................................................................................... 36530 42 42 

36T195 ..... WAKEMED REHAB ...................................................................................................................... 34910 1680 17460 

34T069 ..... WALTER O. BOSWELL MEMORIAL HOSPITAL ......................................................................... 03060 6640 39580 

03T061 ..... WALTON REHABILITATION HOSPITAL ..................................................................................... 11840 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 ................................................................................... 45650 50 48300 

453091 ..... WESLEY REHABILITATION HOSPITAL ...................................................................................... 17860 4880 32580 

173027 ..... WESLEY WOODS GERIATRIC HOSPITAL ................................................................................. 11370 9040 48620 

11T203 ..... WEST ALLIS MEMORIAL HOSPITAL .......................................................................................... 52390 0520 12060 

52T139 ..... WEST FLORIDA REHAB INSTITUTE .......................................................................................... 10160 5080 33340 

10T231 ..... WEST HOUSTON MEDICAL CENTER ........................................................................................ 45610 6080 37860 

45T644 ..... WEST JEFFERSON MEDICAL CENTER .................................................................................... 19250 3360 26420 

19T039 ..... WEST TENNESSEE REHABILITATION CENTER ...................................................................... 44560 5560 35380 

44T002 ..... WEST VIRGINIA REHAB HOSP .................................................................................................. 51190 3580 27180 

513029 ..... WESTCHESTER MEDICAL CENTER .......................................................................................... 33800 1480 16620 

33T234 ..... WESTERN PENNSYLVANIA HOSPITAL ..................................................................................... 39010 5600 35644 

39T090 ..... WESTERN PLAINS MEDICAL COMPLEX ................................................................................... 17280 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 ..................................................................................... 34330 3480 26900 

34T014 ..... WHITE COUNTY MEDICAL CENTER ......................................................................................... 04720 3120 49180 

04T100 ..... WHITE MEMORIAL MEDICAL CENTER ..................................................................................... 05200 04 04 

05T103 ..... WHITE RIVER MEDICAL CENTER .............................................................................................. 04310 4480 31084 

04T119 ..... WHITTIER REHABILITATION HOSPITAL ................................................................................... 22040 04 04 

223028 ..... WHITTIER REHABILTATION HOSPITAL .................................................................................... 22170 1123 21604 

223033 ..... WICHITA VALLEY REHABILITATION HOSPITAL ....................................................................... 45960 1123 49340 

Federal Register / Vol. 70, No. 100 / Wednesday, May 25, 2005 / Proposed Rules 30327

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—Continued

Provider 

number Provider name 

SSA 

State and 

county 

code 

FY 06 

MSA 

code 

FY 06 

CBSA 

code 

453088 ..... WILLAMETTE VALLEY MEDICAL CENTER ................................................................................ 38350 9080 48660 

38T071 ..... WILLIAM BEAUMONT HOSPITAL ............................................................................................... 23620 6440 38900 

23T130 ..... WILLIAM N. WISHARD MEMORIAL HOSPITAL ......................................................................... 15480 2160 47644 

39T045 ..... WILLIAMSPORT HOSPITAL REHAB ........................................................................................... 39510 9140 48700 

19T111 ..... WILLIS-KNIGHTON MEDICAL CENTER ..................................................................................... 19080 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 45 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